No

There is a growing interest in the impact of waiting for surgery, a common experience for many Canadians. Pain and psychological symptoms prior to surgical management are frequently problems for women with gynaecological conditions, however minimal research was found to investigate pain and psychological symptoms in these women prior to surgery. Also pain is recognized to increase healthcare utilization, but this has not been previously examined in this population. The objectives of this research project were to examine levels of pain, psychological factors associated with pain and frequency of healthcare utilization due to pain in a population of women waiting for gynaecological surgery, predominantly undergoing hysterectomies. Four hundred and twenty nine women in a tertiary care centre in southeastern Ontario were included in the study. Anxiety was measured using the State Trait Anxiety Inventory (STAI), depression with the Centre for Epidemiologic Studies Depression Scale (CES-D), somatization using the Seven Symptom Screening Test (SSST) and catastrophizing was measured using an abbreviated coping strategies questionnaire (CSQ). Pain was assessed using the Brief Pain Inventory (BPI). Women also reported on their healthcare utilization for pain over the past 12 months. The length of wait was obtained from hospital waiting data. Results showed a moderate to severe pain intensity score occurred in 30.5% of women and a moderate to severe interference score in 31.5%. Being younger, married, employed and with high trait anxiety were factors associated with higher rates of healthcare utilization. High levels of depression, somatization and catastrophizing were associated with higher pain intensity and interference scores. This study supports the need for preoperative assessment of physical and psychological symptoms in women waiting for gynaecological surgery. Improving patients’ health prior to surgery will potentially reduce their healthcare demands on a financially constrained healthcare service. / Thesis (Master, Nursing) -- Queen's University, 2009-09-25 12:31:28.298

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009). Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness. / On the day of the public defence the status of article IV was: Submitted.