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Sjuksköterskors upplevelser av att arbeta utifrån vårdprogrammet ERAS : inom gastrointestinal kirurgi / Nurses' experiences of working according to the care plan ERAS : in gastrointestinal surgeryJansson Grönwald, Bastian, Lundmark, Nathalie January 2013 (has links)
Bakgrund Enhanced Recovery After Surgery, ERAS, är ett relativt nytt vårdprogram för perioperativ vård som framför allt används inom kolorektalkirurgin. Detta vårdprogram är beroende av ett multidisciplinärt samarbete där olika yrkeskategorier samverkar, och är på väg att spridas och implementeras i flera andra verksamhetsområden inom kirurgin. Programmet består av pre-, intra- och postoperativa omvårdnadsåtgärder och medicinska interventioner som syftar att minska kroppens stressvar, påskynda återhämtningen och reducera antalet komplikationer hos patienten. En stor del av ansvaret för att ERAS följs och implementeras är allmänsjuksköterskans uppgift, framför allt den preoperativa vården och inom den postoperativa omvårdnaden på avdelningen. Syfte Syftet var att undersöka sjuksköterskors upplevelser av att arbeta utifrån vårdprogrammet ERAS på gastrointestinala kirurgavdelningar.MetodFör studien har kvalitativ metod använts. Sju semistrukturerade intervjuer genomfördes med sjuksköterskor på tre olika kliniker i stockholmsområdet. Intervjuerna spelades in och transkriberades för att sedan bearbetas med hjälp av kvalitativ innehållsanalys. Resultat Sjuksköterskorna beskrev sina upplevelser av att arbeta utifrån ERAS som övervägande positiva. Upplevelsen var ett mycket strukturerat, patientsäkert arbetssätt och det var svårt att missa saker som skulle göras eftersom de hade mallar att gå efter. Skillnaden mellan att arbeta med patienter inom ERAS och andra patienter var inte heller speciellt stor, varken beträffande tidsåtgång eller arbetsbelastning. De påpekade också att de flesta arbetade utifrån ERAS även med de patienter som inte var inskrivna i programmet. Sjuksköterskorna upplevde att teamarbetet var en mycket viktig del och att det var centralt att samarbetet fungerade och att de oftast fick allt stöd de behövde. Sin egen roll såg de som oerhört central i teamet då de kände att det var de som såg till att arbetet flöt på, att de hade en ledande roll och att det var de som såg patienten mest. Sjuksköterskorna belyste att patientinformation var en viktig förutsättning för att arbetet med ERAS skulle fungera då en välinformerad patient utifrån deras erfarenheter kunde delta mer i sin egen vård, var lättare att motivera och kände sig tryggare. De ansåg att det svåraste i arbetet var att motivera patienten till att äta, dricka och röra på sig men att det var tryggt att veta att allt de gjorde hade en vetenskaplig grund. Slutsats Sjuksköterskorna upplevde att ERAS är ett välfungerande arbetssätt som ger trygghet och struktur för både patient och sjuksköterska. De ansåg att programmet med vissa modifieringar skulle kunna införas till att omfatta andra patientgrupper.
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Nanoscale electronic and thermal transport properties in III-V/RE-V nanostructuresPark, Keun Woo 18 February 2014 (has links)
The incorporation of rare earth-V (RE-V) semimetallic nanoparticles embedded in III-V compound semiconductors is of great interest for applications in solid-state devices including multijunction tandem solar cells, thermoelectric devices, and fast photoconductors for terahertz radiation sources and receivers. With regard to those nanoparticle roles in device applications and material itself, electrical and thermal properties of embedded RE-V nanoparticles, including nanoscale morphology, electronic structure, and electrical and thermal conductivity of such nanoparticles are essential to be understood to engineer their properties to optimize their influence on device performance. To understand embedded RE-V semimetallic nanostructures in III-V compound semiconductors, nanoscale characterization tools are essential for analysis their properties incorporated in compound semiconductors. In this dissertation, we used atomic force microscopy (AFM) with other secondary detection tools to investigate nanoscale material properties of semimetallic RE-V and GaAs heterostructures, grown by molecular beam epitaxy. We used scanning capacitance microscopy and conductive AFM techniques to understand electronic and electrical properties of ErAs/GaAs heterostructures. For the electrical properties, this thesis investigates details of statistical analysis of scanning capacitance and local conductivity images contrast to provide insights into (i) nanoparticle structure at length scales smaller than the nominal spatial resolution of the scanned probe measurement, and (ii) both lateral and vertical nanoparticle morphology at nanometer to atomic length scales, and their influence on electrical conductivity. To understand thermal properties of ErAs nanoparticles, in-plane and cross-sectional plane of ErAs/GaAs superlattice structure were investigated with a scanning probe microscopy technique implemented with 3[omega] method for thermal measurement. By performing detailed numerical modeling of thermal transport between thermal probe tip and employed samples, and estimation of additional phonon scattering induced by ErAs nanoparticles, we could understand influences of ErAs nanoparticles on the host GaAs thermal conductivity. Investigation of ErAs semimetallic nanostructure embedded in GaAs matrix with scanned probe microscopy provided detailed understanding of their electronic, electrical and thermal properties. In addition, this dissertation also demonstrates that an atomic force microscope with secondary detection techniques is promising apparatus to understand and investigate intrinsic properties of nanostructure materials, nanoscale charge transports, when the system is combined with detailed modeling and simulations. / text
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Evaluating the Effects of Alvimopan, Liposomal Bupivacaine and Intravenous Acetaminophen in Colorectal Surgery PatientsWeinstein, Sara January 2017 (has links)
Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes.
Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg).
Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.
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Evaluating the Effects of Alvimopan, Liposomal Bupivacaine and Intravenous Acetaminophen in Colorectal Surgery PatientsJanuary 2017 (has links)
Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes.
Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg).
Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.
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Patientens upplevelse av delaktighet vid operation utifrån ERAS : En litteraturbaserad studie / The patient’s experience of participation in surgery based on ERAS : A literature-based studyFogelberg, Emma, Roos, Emma January 2023 (has links)
Bakgrund: Kolorektalcancer är den tredje vanligaste cancerdiagnosen i världen. En av behandlingsmetoderna är operation, där det kan ske via ett evidensbaserat vårdprogram, kallad ERAS. Programmet har som syfte att påskynda återhämtningsprocessen och därmed en kortare vistelse på sjukhus. Syfte: Syftet med studien var att beskriva patienters upplevelse av delaktighet vid operation via ett evidensbaserat vårdprogram. Metod: En kvalitativ litteraturstudie baserat på tio kvalitativa artiklar som analyserades via Fribergs femstegsmodell. Resultat: Resultatet visade på att vissa patienter inte upplever sig delaktiga vid sin operationsresa, medan vissa patienter upplevde att information delgivningen var tillräcklig. Detta visar på hur viktigt det är att individanpassa vården. Detta för att ge patienter bästa möjliga förutsättningar för att ge en sådan bra vård som möjligt. Konklusion: Att opereras utifrån ERAS ger bra operationsresultat. En del av patienterna som ingår i ERAS programmet upplever dock minskad delaktighet på grund av att informationen inte var personcentrerad. Studien bidrar till att uppmärksamma behovet av personcentrerad vård och patientundervisning. En brist på detta kan leda till minskad tillit till sjuksköterskan. Brist på individanpassad information kan bidra till ökad stress hos patienten, vilket kan leda till längre återhämtningstid som belastar vården. / Background: Colorectal cancer is the third most common cancer diagnosis in the world. One of the treatment methods is surgery, which can be done via ERAS. The aim of the program is to speed up the recovery process and thus a shorter stay in hospital. Aim: The aim of the study was to describe patients' experience of participation in surgery via ERAS. Method: A qualitative literature study based on ten qualitative articles that were analyzed via Friberg's five-step model. Findings: The results showed that some patients did not feel involved in their surgical journey, while some patients felt that the information provision was sufficient. This shows how important it is to tailor care to the individual. This is to give patients the best possible conditions to provide such good care as possible. Conclusion: Surgery based on ERAS gives good results. Some of the patients who are part of the ERAS program experience reduced participation because the information was not person-centered. As a lack of this can lead to reduced trust in the nurse. A lack of individually tailored information can contribute to increased stress in the patient, which can lead to longer recovery times than burden care.
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Recommending an ERAS Guideline for Patients Undergoing Total Joint ArthroplastyKnapke, Kahl January 2024 (has links)
No description available.
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Patienters upplevelse av Enhanced Recovery After Surgery (ERAS) vid kolorektalkirurgi : En litteraturöversiktElgh, Märta, Hansen, Maria January 2019 (has links)
Bakgrund: Enhanced Recovery After Surgery (ERAS) är ett vårdprogram skapat för att förbättra återhämtning och minska kroppens stresspåslag efter kirurgi. Det första ERAS- programmet utvecklades år 2012 för kolorektalkirurgi. Kolorektalcancer drabbar ca 6 400 personer/år i Sverige, och ca 2 600 personer dör årligen. Detta gör det till en av de vanligaste cancerformerna, och den behandlas med kirurgi. Fler och fler sjukhus vårdar patienter, med denna typ av cancer, enligt vårdprogrammet ERAS. Det har visat sig att det har gett patienter en kortare vårdtid, färre komplikationer och i och med detta blir kostnaderna inte lika höga. Syfte: Syftet är att beskriva patienters upplevelse av att vårdas enligt ERAS vid kolorektalkirurgi. Metod: En litteraturöversikt baserat på 10 empiriska studier. Databaserna PubMed och CINAHL användes vid datainsamlingen. Virginia Hendersons omvårdnadsteori utgjorde litteraturöversiktens teoretiska referensram. Resultat: Fem teman identifierades som beskrev patienternas upplevelse av ERAS vid kolorektalkirurgi. Dessa teman var: information, vårdpersonalens bemötande, delaktighet i sin egen vård, nutrition och vårdmiljö. Resultatet visar att mer information behövs och att både informationen och vården måste vara individanpassad. Slutsats: Patienterna upplever inte att ERAS individanpassar informationen vilket gör den svårförstådd och ger en känsla av att inte ha kontroll. Programmet skulle behöva göra individanpassningar för att passa alla typer av patienter och för att kunna ge patienterna möjlighet till att vara delaktiga i sin vård. Genom att vårdpersonal får en ökad förståelse för patienternas upplevelser kan vårdprogrammet förbättras.
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Enhanced Recovery After HysterectomyWijk, Lena January 2017 (has links)
Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques. Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance. Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.
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Evidence-Based Practice Guidelines: Anesthesia for Total Knee and Hip ArthroplastyKleinfelder, Amanda January 2024 (has links)
No description available.
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Electronic reverse auctions: emerging from the shadows?Tassabehji, Rana January 2014 (has links)
No / This chapter examines the role of business-to-business electronic reverse auctions (eRAs), one tool in the armoury of e-purchasing used by businesses including retailers. It tracks the development of this particular technology through the hype cycle and presents some propositions to maximise the use of eRAs as an effective e-purchasing tool. It also explains the damaging effect of the early negative perceptions and underlines the difficulty in overcoming them.
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