Thesis (M.H.A.)--University of Michigan, 1974.

Bakgrund Inom hälso- och sjukvården eftersträvar verksamheterna att öka effektivitet och produktion. Studier visar att en av de verksamheter med störst möjlighet att öka sjukhusets produktion är operationsavdelningen. Utmaningen för operationsavdelningarna är att utföra fler ingrepp med befintliga resurser utan att personalen upplever ökad arbetsbelastning och stress. Med detta ändamål har de på det valda sjukhuset utarbetat en arbetsmodell. Syftet med denna studie är att undersöka operationssjuksköterskors erfarenheter av optimerad arbetsmodell i förhållande till vanlig elektiv arbetsmodell. Metod En kvalitativ studie genomfördes, ett bekvämlighetsurval användes och 18 operationssjuksköterskor från ett medelstort sjukhus i Mellansverige deltog i studien. Semistrukturerade intervjuer utfördes med hjälp av en intervjuguide, en kvalitativ manifest innehållsanalys utfördes. Resultatet Tre kategorier och sju subkategorier kom fram. Operationssjuksköterskorna ansåg att den optimerade arbetsmodellen gav många fördelar och få nackdelar för personalen, patienterna och verksamheten. Den ökade bemanningen samt standardiseringen av ingrepp, patienter, arbetsuppgifter, operationssalar och material var de faktorer som ledde till fördelarna i den optimerade arbetsmodellen. Hälften av operationssjuksköterskorna föredrog inte den ena arbetsmodellen framför den andra, antalet operationssjuksköterskor som hade en preferens var jämt fördelat mellan arbetsmodellerna. Slutsats En majoritet av operationssjuksköterskorna ansåg att den optimerade arbetsmodellen ledde till mindre stress och ökad patientsäkerhet samtidigt som ett fåtal upplevde ökad stress och sämre patientsäkerhet. / Background Healthcare organizations strive to increase their efficiency. Studies show that the operating room is one of the departments with the greatest possibility to increase a hospital's efficiency. Their challenge is to perform more surgeries using the existing resources without increasing personnel workload or causing stress. In order to achieve this a new work model has been established by the selected hospital. The aim of this study was to investigate the operation room nurses' experiences of this new work model in relation to a conventional work model. Method A qualitative study was performed, a convenience sample was used and 18 operation room nurses from a hospital in central Sweden took part in a survey. Semi-structured interviews were conducted with an interview guide, a manifest qualitative content analysis was performed. Results Three categories and seven subcategories emerged. The operating room nurses believed that the new work model lead to many advantages and few disadvantages for the staff, patients and the department as a whole. The operating room nurses believed that the increase in staffing combined with a standardization of operation procedures, patients, tasks, operation rooms and material were the main reasons to the advantages with the new work model. Half of the operating room nurses did not prefer one work model over the other, the amount of operating room nurses that did was equal between the two work models. Conclusion A majority of the operation room nurses believed that the new work model lead to a decline in stress and to higher patient safety, but a minority experienced more stress and lower patient safety.

The diploma thesis is focused on the design of air-conditioning systems for two operating theatres and their auxiliary facilities. An introduction to ventilation of clean rooms and other indoor environments with special requirements on environmental conditions and air cleanliness is given at the beginning of the thesis. The thesis contains calculations and proposed design solution of the air-conditioning systems. The calculations include determination of the air flow rates of air supplied into the ventilated spaces, heating and cooling loads of the operation theatres, the psychometric calculations for summer and winter operational conditions and sizing of equipment, piping and ductworks. The design part also includes air distribution elements, pipeline and ductwork routing and packaged air-handling units. The complete drawing documentation is also included in the thesis.

Orientador: Silvana Andréa Molina Lima / Resumo: Objetivo: Mensurar o tempo dos processos relacionados à rotina cirúrgica de um hospital de ensino. Método: Trata-se de um estudo quantitativo, retrospectivo e transversal. Foram analisadas 3.468 cirurgias realizadas no período de outubro de 2018 a setembro de 2019 em um hospital público do estado de São Paulo. Resultados: Os tempos mensurados, em minutos, foram: 11,72 (± 7,29) de remoção; 17,53 (± 20,31) de espera no Centro Cirúrgico; 30,59 (± 16,71) de remoção na Unidade de Terapia Intensiva (UTI); 213,31 (± 117,41) de sala cirúrgica; 15,36 (± 7,46) de limpeza; e 60,33 (± 31,12) de Turnover time. O atraso ocorreu em 16% das cirurgias avaliadas. Conclusão: O estudo permitiu a mensuração do tempo relacionado aos processos cirúrgicos e não cirúrgicos bem como a ocorrência de atrasos cirúrgicos. Portanto, o produto elaborado foi um plano de ações para otimizar o processo de trabalho na Unidade de Centro-Cirúrgico. / Abstract: Objective: Measure the execution time of the procedures related to the surgical routine of a medical school hospital. Method: This is a quantitative, retrospective and cross-sectional study. A total of 3,468 surgeries performed from October 2018 to September 2019 at a public hospital in São Paulo state were analyzed. Results: The periods of time measured in minutes were: 11.72 (± 7.29) removal; 17.53 (± 20.31) waiting at the Surgery Center; 30.59 (± 16.71) removal in the Intensive Care Unit (ICU); 213.31 (± 117.41) in the operating room; 15.36 (± 7.46) cleaning up; and 60.33 (± 31.12) turnover time. Delay occurred in 16% of the evaluated surgeries. Conclusion: This study measured the execution time regarding surgical and non-surgical procedures, as well as verified the occurrence of surgical delays. Therefore, the product developed was an action plan to optimize the work process at the Surgery Center. / Mestre

Bakgrund: Operationsteamet består av ett komplext samspel mellan olika professioner som tillsammans ska arbeta kring patienten vid kirurgiska ingrepp. Kirurgisk säkerhetschecklista [KSC] är ett redskap som ska bistå med hjälp för samarbetet och kommunikationen inom operationsteamet. Det finns en stor mängd forskning som bevisar hur KSC förbättrar mortalitet, morbiditet och patientsäkerheten, trots detta har operationsteamet bristande följsamhet gentemot KSC. Syfte: Syftet med denna litteraturöversikt var att beskriva operationsteamets uppfattningar av att använda KSC. Metod: Litteraturöversikten baserades på 14 vetenskapliga artiklar av kvalitativ, kvantitativ och mixad ansats. Artiklarna kvalitetsgranskades, analyserades, sönderdelades, tematiserades och sammanfogades till denna översikts resultat. Resultat: KSC kunde bidra till förbättrat teamarbete, kommunikation, och arbetsmiljö på operationssalen, samtidigt uppmärksammades olika hinder med samarbetet kring KSC. Personliga attityder, ställningstaganden och övertygelser hos de olika professionerna var faktorer som påverkade teamarbetet. Hur operationsteamet var lett påverkade även samarbetet kring KSC. Upplevelsen av tidsbrist och svårigheter med timing försvårade genomgången av KSC. Slutsats: Det är essentiellt att förstå den komplicerade arbetsmiljön på operationssalarna och hur KSC kan underlätta arbetet i operationssalen men även vilka faktorer som försvårar för operationsteamet att arbeta säkert. För att bilda en djupare uppfattning om operationsteamets komplexitet och arbete med KSC krävs vidare forskning. Resultatet av denna litteraturöversikt skulle kunna bistå med hjälp för klinikerna i sitt arbete kring säkerheten och samarbetet på operationssalarna. / Background: The surgical team consists of a complex interaction between different professionals who work together around the patient during surgical procedures. Surgical Safety Checklist [SSC] is a tool that should assist the interaction and communication within the surgical team. There is a great deal of research that proves how SSC improves mortality, morbidity and patient safety. The surgical team has despite that a lack of compliance with SSC. Aim: The aim of this litterateur review was to describe the surgical team’s perceptions of using the SSC. Method: The literature review was based on 14 scientific articles of qualitative, quantitative and mixed approaches. The articles were quality checked, analysed, broken down, thematized and merged into the result of this overview. Result: SSC was able to contribute to improved teamwork, communication, and work environment in the operating room, while at the same time various obstacles were highlighted with the collaboration around SSC. Personal attitudes, standpoints and beliefs within the various professions were factors that influenced teamwork. How the surgical team was led also affected the collaboration around SSC. The experience of lack of time and difficulties with timing made the performance of SSC more difficult. Conclusion: It is essential to understand the complicated work environment in the operating rooms and how SSC can facilitate the work in the operating room, also what factors hinder the operating team to work safely. In order to form a deeper understanding of the complexity of the operation team and their work with SSC, further research is needed. The result of this literature review could be of assistance to clinics in their work to improve safety and collaboration in the operating rooms.

Bakgrund: På en operationsavdelning används en betydande mängd medicintekniskutrustning. Anestesisjuksköterskor, operationssjuksköterskor och undersköterskoransvarar för att förbereda, iordningställa och hantera maskiner, utrustning och detmaterial som behövs under en operation eller undersökning. För att kunna utföraarbetet behövs kunskap och samarbete. Den medicintekniska utrustningen byts ut,uppdateras eller ersätts för att förbättra och/eller effektivisera i det område den äravsedd att användas. Motiv: Mängden medicinteknisk utrustning ökar och den uppdateras eller byts utmot mer avancerad utrustning. Det kräver att operationspersonalen ständigtuppdaterar sina kunskaper. Ofta förväntas personalen att ta till sig ny utrustningunder pågående operationsprogram mellan operationer. Syfte: Att beskriva operationspersonalens erfarenheter av att arbeta medmedicinteknisk utrustning. Metod: För att undersöka personalens erfarenheter av att arbeta medmedicinteknisk utrustning valdes en kvalitativ metod med semistruktureradeintervjuer. Nio intervjuer analyserades med innehållsanalys. Resultat: Presenteras i två kategorier med underliggande subkategorier: Positivaerfarenheter av medicinteknisk utrustning. Med subkategorierna; Denmedicintekniska utrustningen fyller ett syfte, Den medicintekniska utrustningenfrämjar patientsäkerheten och Kunskap och erfarenhet påverkar arbetet medmedicinteknisk utrustning positivt. Negativa erfarenheter av medicintekniskutrustning. Med subkategorierna; Den medicintekniska utrustningen innebärtidskrävande arbete, Den medicintekniska utrustningens påverkan på arbetsmiljön,Bristande utbildning om medicinteknisk utrustning och Den medicintekniskautrustningens påverkan på patientsäkerheten. Det mest framträdande resultatet varatt samtliga deltagare uttryckte att det läggs för lite tid och resurser till utbildning. Konklusion: Om utbildning prioriteras skulle det kunna minska stress, irritation,förkorta operationstider, ge mer tid till patienterna och förbättra patientsäkerheten. / Background: In the surgical ward a substantial amount of medical equipmentis used. The anesthetic nurses, operating theatre nurses and the assistant nursesare all responsible for setting up and preparing the appropriate machines, equipment and material as well as knowing how to use them. In orderto accomplish this both teamwork and knowledge is needed. In order to enhanceand or increase efficiency medical equipment is updated or replaced. Motive: The amount of medical equipment increases in a steady state, isupdated or replaced with more advanced equipment thus the staff in theoperating ward constantly needs to keep updating their knowledge. Staff areexpected to learn how to handle new equipment in between operations andduring ongoing operating schedule. Aim: The focus of this study was to describe the staff¨s experiences of workingwith medical equipment. Methods: A qualitative method with semi structured interviews was used. Nineinterviews were analyzed with a content analysis. Result: Two main categories with subcategories. Positive experiences ofworking with medical equipment. Subcategories: The medical equipmenthas a purpose, Medical equipment enhances patient safety and Knowledge andexperience affects work with medical equipment in a positive way. Category:Negative experiences of working with medical equipment.Subcategories: Working with medical equipment is time consuming, Themedical equipment’s impact on the working environment, Lack of education ofthe medical equipment and Medical equipment affect´s patient safety. The mostprominent result was that all the informants experienced lack of opportunities toachieve correct education of the medical equipment. Conclusion: Prioritization of education and training could reduce stress,irritation, shorten operating time, create more time to take care of patients andenhance patient safety.

Orientador: Reinaldo Wilson Vieira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T17:55:04Z (GMT). No. of bitstreams: 1 Aranha_GuiomarTerezinhaCarvalho_D.pdf: 1075475 bytes, checksum: f4e2df58563be1cdd8864a1a094d7ff1 (MD5) Previous issue date: 2009 / Resumo: Introdução: A organização do trabalho científico através da lógica e experimentos, a estrutura do estabelecimento de pesquisa individual ou aos diferentes aspectos da vida da comunidade científica foram o eixo de mudanças na relação ciência e tecnologia. A Universidade, dentro deste contexto, se constitui em uma fonte de criação permanente, sistematização e difusão do conhecimento científico e tecnológico. A estatística como instrumento da qualidade se constitui em apoio às ações que visem à otimização dos recursos disponíveis e melhoria da prestação de serviços com qualidade. Objetivo: O estudo proposto, junto à especialidade de Cirurgia Cardíaca/Hospital de Clínicas/Unicamp tem como objetivo identificar um método estatístico que expresse o tempo da presença do doente na sala de operação e construir uma "matriz de relação" de otimização deste tempo, o tempo exato e real da operação. Método: O método de análise de sobrevivência aplicada utilizando o estimador não paramétrico de Kaplan-Meier, permite calcular as curvas de sobrevivência para os tempos em estudo, e com o resultado obtido criar uma "matriz de relação" da otimização do tempo da presença do doente na sala de operação por meio de dez hipóteses que auxiliam na escolha da nova operação, e melhor ocupação da sala. Este estudo tem como parâmetro de referência para o tempo de limpeza da sala de operação, o que a literatura estabelece em aproximadamente 30 minutos, além do tempo de cada tipo de procedimento cirúrgico. A amostra aleatória simples para estimar a curva de sobrevivência constitui-se de 71 pacientes, das operações eletivas de adultos da Cirurgia Cardíaca/Hospital de Clínicas/UNICAMP, durante o ano de 2008. Resultados: Nos resultados encontrados observou-se que os tempos que sobram das operações em média estão em um intervalo de 140 minutos a 200 minutos e excedem de 5 minutos a 90 minutos, para realização de novas operações. No geral, realizou-se em média diariamente uma operação dentro de 520 minutos, para um tempo disponível de 720 minutos. No ano de 2008 foram suspensas 39% das operações, sendo que 81% dos motivos foram "fatores hospitalares extrapacientes" e 19% "relativos ao paciente". Em suma com os resultados obtidos pela metodologia de análise de sobrevivência, metodologia tradicional, e metodologia de gestão da qualidade, é possível cruzar informações e construir passo a passo o conhecimento científico e tecnológico. Conclusão: (1) O tempo do doente na sala de operação é um tempo que tem nele incluso, o tempo de aprendizado pelo aluno, em um hospital escola, universitário. (2) Com o tempo máximo disponível de 720 minutos não é possível realizar outra operação, a não ser utilizando da "matriz de relação", sendo que o tempo máximo disponível varia entre 660 minutos e 690 minutos, considerando-se intervalo de limpeza da sala. (3) Ao otimizar o tempo do doente na sala de operação, através da "matriz de relação", mais doentes serão beneficiados, acarretando uma diminuição da fila de espera para novas operações, garantindo uma eficiente relação custo benefício. (4) A "matriz de relação" fornece dados que permitem visualizar, opinar e decidir qual é a melhor operação a ser realizada e se há tempo disponível para tal / Abstract: Introduction: The science and technology evolution were made by the scientific literature and the scientific methodological theory. The Academy with this background is the continuing source of sistematization and difusion of scientific acknowledge. Statistics as a tool for a quality control might support actions that may promote the available resources optimization and improvements on services with higher quality. Objective: The present study, carried out with the Cardiac Surgery Discipline at Hospital de Clínicas/Unicamp had the aim to identify the best statistical method for patient time at operation room by fitting and bulding up a model for predicted operation room time, and observed operation room time measurements. Method: The method of survival analysis performed using the nonparametric estimator of Kaplan-Meier allows to calculate the survival curves for time to study. Using this analysis was possible to build up a "relationship matrix" for operation room time optimization, predicted operation room time, and observed operation time by choosing ten different hypotheses which assisted for the next operation type to be performed increasing the operation room time availability. The "relationship matrix" took into account as parameters: time period for operation room disinfection that the consulted literature reports to be around 30 minutes; and surgery procedure type performed. This study included 71 patients underwent open-heart surgeries by Discipline of Cardiac Surgery at Hospital de Clinicas/Unicamp randomly sampled during 2008. Results: The remaining mean operation time after the first surgery in the day ranged from 140 to 200 minutes and the exceeding mean operation time after first surgery in the day ranged from 5 to 90 minutes. The average surgeries performed every day were one procedure spending 520 minutes within 720 minutes available for every day. In 2008, 39% of the procedures were postponed, such that 81% of those due to "hospital related" reasons and 19% to "patient related" reasons. In summary, the results showed above using Kaplan-Meier statistical method, traditional methodology, and managing of quality methodology it was possible to build up a scientific acknowledge. Conclusion: (1) The patient time at the operation room inclued a students learning time a school hospital. (2) With the maximum available time (i.e.720 minutes) it is not possible to perform another operation, nonetheless employing the "relationship matrix", with a maximum available time between 660 and 690 minutes, taking into account were inclued in this interval the disinfection room time. (3) By optimizing the patient time at operation room, more patients will be benefit shorting the wating list time for operations and increasing the cost/benefit ratio. (4) The "relationship matrix" gave data that provided valuable information for choosing next operation type based on remained time / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

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No. of bitstreams: 1 elianeraimundadeoliveiratostes.pdf: 2469357 bytes, checksum: cf6f8e5d454803037ab31ac571dbdf24 (MD5) Previous issue date: 2016-12-09 / Este estudo tem por objeto de investigação a aplicabilidade do protocolo de cirurgia segura por profissionais que atuam em centro cirúrgico. Objetivo geral Analisar a atuação da equipe interprofissional de cirurgia na aplicabilidade do protocolo de cirurgia segura de um centro cirúrgico. Os objetivos específicos foram: descrever a completude dos profissionais da equipe interprofissional da equipe interprofissional à aplicação do protocolo de cirurgia segura; conhecer as ações dos profissionais quanto ao gerenciamento de evento adverso no centro cirúrgico, tendo por base o protocolo de Cirurgia Segura da Organização Mundial da Saúde, e analisar a importância da aplicação do checklist de cirurgia segura sob a óptica dos profissionais. Para a fundamentação teórica, utilizaram-se estudos sobre gestão de riscos, segurança do paciente, checklist de cirurgia segura e histórico e definição do centro cirúrgico. A metodologia é de natureza descritiva com abordagem qualitativa. O cenário foi um hospital geral público situado em uma cidade da Zona da Mata mineira. A pesquisa foi realizada em dois momentos: o primeiro foi uma busca nos prontuários de pacientes que foram submetidos a procedimentos cirúrgicos no período de outubro de 2013 a dezembro de 2015 para levantamento da adesão do preenchimento do protocolo de cirurgia segura e o segundo foi realizado através de um questionário semiestruturado, no período de março a maio de 2016, com 40 profissionais que exercem suas atividades laborais no centro cirúrgico. Os dados encontrados foram elencados em quatro categorias temáticas: adesão dos profissionais que compõem a equipe de cirurgia à aplicação do protocolo de cirurgia segura foi possível estratificar o número de cirurgias realizadas trimestralmente, onde foram realizados 6.647 procedimentos cirúrgicos no período analisado e 5.912 impressos de protocolos de cirurgia segura foram preenchidos corretamente, o que equivale à média, nesse período analisado, de 90,2% de preenchimento correto do protocolo de cirurgia segura durante cada procedimento cirúrgico, entendimento do profissional sobre o evento adverso no centro cirúrgico percebe-se que havia o conhecimento sobre o termo evento adverso, porque os posicionamentos estavam em comum acordo com os princípios e diretrizes definidos pela organização mundial de saúde, porém em algumas respostas de alguns profissionais da categoria de medicina e técnico de enfermagem, escreveram mais exemplificando o conceito de evento adverso do que propriamente conceituou este termo. Risco, fato indesejável, prejuízo, falhas ou erro, impactos e danos para o paciente foram termos mencionados pelos participantes, mostrando esse conhecimento parcial acerca do conceito de evento adverso, ações tomadas para o gerenciamento de evento adverso no entendimento dos participantes, percebe-se que as ações tomadas em relação ao gerenciamento do evento adverso nesse cenário seriam como barreiras preventivas por meio da aplicação do checklist de cirurgia segura que inclui a diminuição da morbimortalidade de pacientes cirúrgicos. Além disso, dá às equipes cirúrgicas e aos administradores hospitalares orientações sobre a função de cada um e qual é o padrão de uma cirurgia segura, bem como oferece um instrumento de avaliação uniforme do serviço de vigilância. e a percepção dos profissionais quanto à aplicabilidade do checklist de cirurgia segura, onde nesta última categoria foi avaliado cada etapa do protocolo de cirurgia segura quanto ao grau de importância instituído no questionário foi de extremamente importante a sem importância e também nessa categoria foi apresentado algumas dificuldades elencadas pelos participantes, obtiveram-se respostas de: falta de participação da equipe, lista de verificação muito longa, falta de tempo para o preenchimento dos dados a serem checados, falta de treinamento para implementação do checklist. Observou-se que as dificuldades apontadas circulavam entre enfermeiros, médicos e técnicos de enfermagem. Também se verificou que, entre os profissionais citados, as respostas indicavam não terem dificuldades, no entanto houve respondente (técnico de enfermagem) que mencionou o termo “preguiça” no preenchimento relacionado à parte da medicina. Considerou-se que é necessário investir em educação permanente, sobretudo para sanar as dificuldades no preenchimento do checklist. / This study aims to investigate the applicability of the safe surgery protocol by professionals working in the operating theater. General objective To analyze the performance of the interprofessional team of surgery in the applicability of the protocol of safe surgery of a surgical Center. The stated objectives were: describing the a completeness of professionals of the surgical staff to implement the safe surgery protocol; having knowledge of the actions of the professionals regarding the management of adverse events in the operation theater based on the safe surgery protocol of the World Health Organization, and analyzing the importance of the implementation of the surgical safety checklist from the professionals’ perspective. For a theoretical foundation, it has been used studies on risk management, patient safety, surgical safety and record checklist and the definition of operating theater. The methodology has a descriptive nature with a qualitative approach. The scenario was a general public hospital situated in a town in Zona da Mata mineira. The research was conducted in two stages: the first was a search for the medical records of patients who underwent surgical procedures from October 2013 to December 2015 for the analysis of the safe surgery filling-in protocol and the second was performed through a semi structured questionnaire, from March to May 2016, with 40 professionals who exercise their labor activities in the operating theater. The data we have found were listed in four thematic categories: if the professionals who belong to the surgical staff implemented the safe surgery protocol it was possible to stratify the number of surgeries performed quarterly, where 6,647 surgical procedures were performed in the analyzed period and 5,912 printed safe surgical protocols were filled in correctly, which is equivalent to the average of 90.2% correct filling of the Protocol during each surgical procedure, if they understand the adverse event in the OT, it was perceived that there was knowledge about the term adverse event, because the positions were in agreement with the principles and guidelines defined by the world health organization, but in some answers of some professionals of the category of medicine and nursing technician, they wrote more Exemplifying the concept of adverse event of what properly denominated this term. Risk, undesirable fact, injury, failures or error, impacts and damages to the patient were terms mentioned by the participants, showing this partial knowledge about the concept of adverse event, if they take actions to manage adverse event It is perceived that the actions taken in relation to the management of the adverse event in this scenario would be as preventive barriers through the application of the safe surgery checklist that includes the reduction of the morbimortality of surgical patients. In addition, it gives surgical teams and hospital administrators guidance on the role of each and what is the standard of safe surgery, as well as provides a uniform assessment tool for the surveillance service, and if they had the perception of the applicability of the surgical safety checklist Where in the last category was evaluated each step of the protocol of safe surgery as to the degree of importance instituted in the questionnaire was extremely important the unimportant and also in this category was presented some difficulties listed by the participants, were obtained answers of: lack of participation of the Team, very long checklist, lack of time to fill in the data to be checked, lack of training to implement the checklist. It was observed that the mentioned difficulties circulated among nurses, doctors and nursing technicians. It was also verified that, among the professionals cited, the answers indicated that they did not have difficulties, however there was a respondent (nursing technician) who mentioned the term "laziness" in the filling related to the medicine part. It is considered that it is necessary to invest in permanent education, especially to deal with the difficulties when filling the checklist.

Abstract The purpose of the present study was to implement a unique low-field open magnetic resonance scanner for perioperative imaging in neurosurgery. A paradigm was created for joint intraoperative/interventional MRI, including premises, surgical practice and an operational model. The feasibility of the paradigm was tested in clinical work. The joint use of the facilities between the Departments of Neurosurgery and Diagnostic Radiology was found to enhance the economic rationale and provide for perioperative imaging. It was also found to be organizationally viable in the long run. Intraoperative MRI was implemented and studied in connection with neuronavigation and other intraoperative instruments, tools and imaging modalities. The unique shut down possibility of the magnet enabled staged operating-imaging practice, use of non-MRI-compatible instruments and devices, multimodal imaging with navigation, and avoidance of safety risks associated with operating in magnetic fringe fields. Two dynamic contrast enhanced MR imaging sequences, which used undersampled projection reconstruction, were implemented in the low-field scanner. The applicability of these imaging sequences to follow contrast enhancement of meningiomas was studied in laboratory experiments and in two patient cases. The laboratory experiments showed a nearly linear response in signal intensity to the concentration of gadopentetate dimeglumine in purified water up to 1.25 mM. The patient cases showed results consistent with an earlier study performed at high-field strength. The potential of low-field MRI study including dynamic contrast enhanced imaging to predict surgical and histopathologic characteristics of meningiomas was studied in a series of 21 patients. Dynamic contrast enhanced imaging could be used to evaluate microvessel densities of meningiomas. Surgical bleeding, blood loss during operation, progesterone receptor expression and collagen content were statistically best correlated to the relative intensity of meningioma on FLAIR images. Tissue hardness correlated best with relative intensity on T2-weighted images.

Background Because of extreme population and a lack of resources the risk of beeing harmed while admitted to a hospital in Bangladesh is big. Mistakes made at operating theatres can result in devastating consequences, but by evaluating the patient safety that risk can be minimized. Right now Bangladesh is in the middle of an industrialisation that is contributing to the growing need for an expanding health care. The country is regularly suffering from cyclones, tsunamis and monsoon rains and there is an urgent demand for safe health care. Method The aim of this thesis was to study the physical structure, organisation and practice at operating theatres in Bangladesh. At three private and two public hospitals 14 operating rooms in total were visited and the basic equipment was examined. Managers, physicians, nurses and technicians were interviewed at all hospitals, 41 people in total participated in the study. Results The temperature control was not up to standard, bigger storages were needed and none of the public hospitals had enough washing equipment for proper scrubbing. Only one hospital could monitor the patient’s body temperature during surgery and proper resuscitation equipment was missing in half of the operating rooms. The autoclave process could not keep up with the surgeries and delays were not unusual. The cleaning staff had no training in patient safety and the staff found that the nurse’s education was not enough. The reporting of mistakes rarely reached the management and a written report was unusual. Discussion Most of the staff did not know what calibration meant and there were only biomedical departments at two of the hospitals. Even though training was re- quested by the staff the management did not plan for any changes. This shows that it is the organisation, not the human errors, that is the source to the unstable situation of health care. The lacking of the reporting system is an- other reason for the slow development. Staff with technical knowledge must be available at the hospitals in order to help prevent risks and all hospitals should establish a biomedical department. Patients had to lie on the floor, due to the shortness of space. This is not good for patient safety, but the alternative would be that they would end up with no help at all. The outcome of patient safety should always result in better health for the people. The personal had this view of thinking and they showed great engagement to their work. Key words: Patient safety, Bangladesh, operating theatres, operating rooms / Bakgrund På grund av extrem befolkningsmängd och brist på resurser är risken för att bli skadad av sjukvården i Bangladesh stor. Misstag inom kirurgin ger förödande konsekvenser, men genom att utreda patientsäkerheten kan risken minimeras avsevärt. Bangladesh befinner sig just nu i en industrialisering som bidrar till det ökande behovet av vård. Flodvågor, översvämningar och stormar drabbar landet regelbundet och efterfrågan på säker sjukvård är akut. Metod Patientsäkerheten analyserades genom att undersöka den fysiska miljön, organi- sationen och den praktiska utövningen i operationssalar. På tre privata och två statliga sjukhus i Bangladesh besöktes sammanlagt 14 operationsrum, där den grundläggande utrustningen utvärderades. Avdelningschefer, läkare, sköterskor och tekniker intervjuades på samtliga sjukhus, totalt är 41 anställda med i stu- dien. Resultat Temperaturkontrollen var bristfällig, bättre förvaringsmöjligheter efterfrågades och ingen av de statliga sjukhusen hade tillräcklig utrustning för att tvätta händerna rätt. Endast ett sjuhus kunde övervaka patientens kroppstemperatur och återupplivningsutrustning saknades på hälften. Sterilisering av instrument kunde inte ske i samma tempo som operationerna och förseningar var vanligt. Städpersonalen hade ingen träning i patientsäkerhet och det fanns ett missnöje över sköterskornas utbildning. Rapportering av misstag gick sällan till sjukhus- ledningen och skriftlig rapportering var sällsynt. Diskussion De flesta av de tillfrågade visste inte vad innebörden av kalibrering var och endast två av sjukhusen hade en medicinteknisk avdelning. Trots att vidareut- bildning efterfrågades av personalen hade ledningen inga planer på förändringar. Detta visar på att det är organisationen, inte de anställdas misstag, som är källan till den osäkra sjukvården. Den otillräckliga rapporteringen är också en anled- ning till varför utvecklingen hämmas. Tekniskt kunniga personer måste finnas tillgängliga på sjukhusen för att förebygga risker och varje sjukhus bör organi- sera en medicinteknisk avdelning. På grund av platsbrist låg många patienter på golvet. Detta är självklart inte bra för patientsäkerheten, men alternativet skulle vara att de inte fick någon hjälp alls. Synen på patientsäkerhet måste alltid inkludera att hälsan i sin helhet förbättras, den insikten hade personalen på sjukhusen och de visade stort engagemang. Key words: Patientsäkerhet, Bangladesh, operationsavdelningar, operations- salar