published_or_final_version / Medicine / Master / Doctor of Medicine

Thesis (M.D.)--University of Hong Kong, 2004. / Also available in print.

Orientador: Lino Lemonica / Resumo: Com o rápido avanço que foi observado nos últimos anos nas técnicas cirúrgicas e anestésicas, os procedimentos se tornaram cada vez mais invasivos. Como houve progressivo envelhecimento da população, o período mais delicado de recuperação, ou seja, o pós-operatório, passou a receber maior atenção. O surgimento de novas técnicas de analgesia, como a Analgesia Controlada pelo Paciente (PCA), vem preencher as necessidades da comunidade médica, cada vez mais atenta à qualidade dos serviços prestados. O Hospital de Clínicas da Faculdade de Medicina da UNESP, Botucatu, atento a essa nova realidade constituiu o Serviço de Dor Aguda (SEDA) para que esta lacuna fosse também preenchida em nosso meio. No intuito de identificar a atuação do SEDA, realizou-se levantamento, de fevereiro de 1995 a dezembro de 1997, com a pesquisa das evoluções de 679 pacientes seguidos pelo SEDA e que fizeram uso do método PCA de analgesia. Observou-se que os resultados obtidos pelo Serviço estavam acima da média relatada pela literatura internacional, com excelentes níveis de analgesia atingidos, baixa ocorrência de efeitos colaterais, e nenhuma complicação fatal no período do estudo. / Abstract: In the past years a fast developing has been observed in the surgery and anesthetic technique, with more invasive procedures being performed. As the general population has becoming older, the critical recovery period, it means the post surgery period, became focus of attention. The developing of new analgesia techniques, such as Patient Controlled Analgesia (PCA), has the intention of fulfill the needs of the medical community, day by day more aware about the quality of the services. The Hospital of the Sao Paulo State Medical School, Botucatu, aware of this new reality had decided to form the Acute Pain Management Service (SEDA). With the goal of identify the way the SEDA acts this research was realized in period between February, 1995, to December, 1997. Data of 679 patients who used the PCA device were evaluated. The results in this study were as good as the international literature shows, with high quality analgesia, low side effects and no fatal complications on the period observed. / Mestre

Abstracts: The purpose of the study was to compare the efficacy and cost between intravenous patient-controlled analgesia (PCA) with intramuscular (IM) analgesics for women in the first two days after surgery. The study included 200 patients who were assigned to receive PCA or intramuscular injections opioid during a period of 2 days after surgery. The PCA group included 124 patients and IM group had 76 patients. The data were collected using a structured questionnaires, patient chart review and hospital charge data. The several findings were observed in this study. 1. The pain level in the PCA group was significantly lower than in the IM group (P< 0.01). The PCA group had significantly greater satisfaction with pain control than those in IM group (p< 0.01). The influence of activity by pain in the IM group had significantly greater than those in PCA group (p< 0.05). 2. The incidence of skin itching in PCA group was significantly higher than in the IM group ¡]P< 0.01¡^.3. Cost per patient was higher for PCA group¡]NT$ 420.9¡Ó22.6¡^than IM group¡]NT$228.4¡Ó60.1¡^. In conclusion, PCA produced better pain relief, get better patient¡¦s satisfaction than conventional on-demand IM opioid injections but it was more expensive.

Bakgrund: Patientkontrollerad smärtlindring och patientkontrollerad sedering (PCA/PCS) är kliniskt sett säkra metoder för att leverera smärtlindring eller sedering till patienter utan direkt åtgärd från sjuksköterskor. Metoderna anses av sjuksköterskor vara metoder som stärker patienters autonomi, men riskerar att distansera sjuksköterskor från patienter. För att skapa ett bredare perspektiv på metoderna undersöks i detta arbete patienters upplevelser av PCA/PCS. Syfte; Syftet är att beskriva patienters upplevelse i samband med användning av patientkontrollerad smärtlindring och sedering (PCA/PCS). Metod: Integrativ litteraturöversikt baserad på 19 artiklar. Resultat: Två teman med tre respektive två subteman framkom från analysen. Det första temat var Möjligheter med PCA/PCS beskrivet av subteman Att ha färre biverkningar, Att ha ökad autonomi och Att vara bekväm med administreringsmetoden av läkemedel. Det andra temat var Utmaningar med PCA/PCS, beskrivet av subteman Att inte få individuella behov bemötta och Att känna minskad trygghet. Slutsats: Patienters upplevelser av PCA/PCS har varit generellt positiva, med goda möjligheter att öka tillfredställelsen med den vård som erbjuds. Resultatet visar att metoderna är användbara för att stärka patienters upplevelse av autonomi. Vidare påvisas att utmaningar som metoderna innebär kan motverkas av välinformerade patienter. / Background: Patient-controlled analgesia and patient-controlled sedation (PCA/PCS) are clinically safe methods for sedation and pain management for patients without direct intervention from nurses. The methods are viewed by nurses to be a way to strengthen patients' autonomy but poses a risk of distancing patients from nurses. To broaden the perspective on these methods, this paper studies patients' experiences of PCA/PCS. Aim: The aim of this paper is to describe the patients’ experience in relation with the use of patient-controlled analgesia and sedation (PCA/PCS). Method: Integrative review based on 19 articles. Result: Two themes emerged from the analysis. The first theme was Possibilities of PCA/PCS, described by the three subthemes To have fewer side effects, To have strengthened autonomy and To be comfortable the method of drug administration. The second theme was Challenges of PCS/PCS described by the two subthemes To not have individual needs met and To feel unsafe. Conclusion: Patients' experiences of PCA/PCS have been generally positive, with strong possibilities of increasing patients satisfaction with provided care. The result shows that the methods are useful for strengthening patients' autonomy. Additionally, eventual challenges that may occur while using these methods may be alleviated with well-informed patients.

Background: The psychiatric care has changed from an institutionalized care towards a more patient-centered care, were ideas such as autonomy and patient participation are raised. The model of Patient-controlled admission has been developed in line with the development. With a focus on a shift of power in the relations between caregiver and patient, with a patient taking more responsibility. Aim: The aim of this study is to describe the central components of the care-model of patient-controlled admission through the experiences of patients and caregivers in psychiatry. Method: A scoping study based on the review of seven scientific articles and three empirical qualitative student essays (master-level). Result: Our research of the data was synthesized into three main themes: Responsibility, Trust and Empowerment. Each theme had three subthemes. These themes show how the acquired and lost responsibility affects the patient and health professionals and the importance of a safe and trusting ward. Most importantly for the patient was that control and knowledge about one’s health raises confidence and resulted in empowering. Conclusion: By turning the traditional paradigm around of the caregiver deciding admission in favor of the patient this strengthens autonomy and feelings of empowerment. The availability of a safe space is positive. / Bakgrund: Den psykiatriska vården har ändrats genom åren från ett varaktigt omhändertagande mot en mer personcentrerad vård där tankar kring autonomi och patientdelaktighet lyfts. I linje med utvecklingen så har modellen Självvald inläggning utformats där en maktförskjutning sker i vårdrelationen då patienterna tar mer ansvar i sin vård. Syfte: Syftet med denna studie är att beskriva de centrala komponenterna i vårdformen Självvald inläggning genom patienter och vårdpersonalens upplevelser inom den psykiatriska vården. Metod: En scoping study där sju stycken vetenskapliga artiklar och tre empiriska examensarbeten med kvalitativ ansats på D-nivå har granskats Resultat: Datan sammanställdes i tre teman: Ansvar, Tillit och Egenmakt. Respektive tema hade tre stycken subteman. Dessa teman visar vikten av en trygg och förtroendeingivande avdelning och hur det givna och förlorade ansvaret påverkar patienten och vårdpersonal. Mest återkommande var att kontroll och kunskap kring sin egen hälsa ökade patientens självförtroende och skapade egenmakt. Slutsats: Genom att vända på det traditionella dörrväktar-perspektivet så stärks patientens autonomi, känsla av egenmakt och trygghet i tillgången till ett andrum.

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T20:28:37Z : No. of bitstreams: 1 barros_gam_me_botfm.pdf: 228323 bytes, checksum: 6466d10f0d4eb9a3ff79e8f785fea941 (MD5) / Com o rápido avanço que foi observado nos últimos anos nas técnicas cirúrgicas e anestésicas, os procedimentos se tornaram cada vez mais invasivos. Como houve progressivo envelhecimento da população, o período mais delicado de recuperação, ou seja, o pós-operatório, passou a receber maior atenção. O surgimento de novas técnicas de analgesia, como a Analgesia Controlada pelo Paciente (PCA), vem preencher as necessidades da comunidade médica, cada vez mais atenta à qualidade dos serviços prestados. O Hospital de Clínicas da Faculdade de Medicina da UNESP, Botucatu, atento a essa nova realidade constituiu o Serviço de Dor Aguda (SEDA) para que esta lacuna fosse também preenchida em nosso meio. No intuito de identificar a atuação do SEDA, realizou-se levantamento, de fevereiro de 1995 a dezembro de 1997, com a pesquisa das evoluções de 679 pacientes seguidos pelo SEDA e que fizeram uso do método PCA de analgesia. Observou-se que os resultados obtidos pelo Serviço estavam acima da média relatada pela literatura internacional, com excelentes níveis de analgesia atingidos, baixa ocorrência de efeitos colaterais, e nenhuma complicação fatal no período do estudo. / In the past years a fast developing has been observed in the surgery and anesthetic technique, with more invasive procedures being performed. As the general population has becoming older, the critical recovery period, it means the post surgery period, became focus of attention. The developing of new analgesia techniques, such as Patient Controlled Analgesia (PCA), has the intention of fulfill the needs of the medical community, day by day more aware about the quality of the services. The Hospital of the Sao Paulo State Medical School, Botucatu, aware of this new reality had decided to form the Acute Pain Management Service (SEDA). With the goal of identify the way the SEDA acts this research was realized in period between February, 1995, to December, 1997. Data of 679 patients who used the PCA device were evaluated. The results in this study were as good as the international literature shows, with high quality analgesia, low side effects and no fatal complications on the period observed.

Bakgrund/syfte: Smärtlindring via PCA-pump är en effektiv och säker metod vid postoperativ vård. Den syftar till att ge patienten större möjlighet att påverka sin smärtlindring. Tidigare studier påvisar att många patienter upplever sin kunskap om PCA- pumpen som otillräcklig. Denna studie syftar till att undersöka vilken grad av självskattad kunskap patienter upplever sig ha om PCA-pumpen vid smärtlindring med hjälp av PCA vid postoperativ vård. Dessutom undersöks om utförlig information, både muntlig och skriftlig, leder till ökad kunskap beträffande PCA-pumpen samt om patientinformation om PCA- pumpen minskar patientens självskattade smärta vid smärtlindring med hjälp av PCA-pump postoperativt. Metod: En deskriptiv konsekutiv enkätinsamling genomfördes på fem kirurgavdelningar vid ett sjukhus i mellersta delen av Sverige. 26 patienter deltog i studien. Resultat: Denna studie påvisade ett positivt samband mellan patientinformation och smärtlindring (r = 0,74, p = 0,0005). Det framkom även ett positivt samband mellan att få utförlig information om PCA-pumpen, muntlig och skriftlig, och ökad kunskap om PCA- pumpen hos patienten (r = 0,61, p = 0,0009). Självskattad kunskap om PCA pumpen och dess funktioner var i genomsnitt 6,3/10. Studien påvisade även att kombinerad smärtlindring med PCA-pump och EDA postoperativt leder i genomsnitt till ett VAS-värde som var 1,57 lägre efter administrering, i jämförelse med de som endast hade smärtlindring via PCA-pump, resultatet var dock inte signifikant (p = 0,1). Slutsats: Patientinformation kan spela en stor roll kring smärtlindringen hos patienter med PCA-pump. Utveckling av kvalitetsdokument för hur patientinformationen skall utföras kliniskt kan leda till en ökad smärtlindring hos patienter som vårdas postoperativt med PCA- pump. Mera forskning och större undersökningsgrupper behövs för att styrka generaliserbarheten och validiteten. / Background: Pain relief through PCA pump is an effective and safe method for the treatment of postoperative pain. It aims to provide the patient with greater ability to influence their pain. Previous studies shows that many patients experience their knowledge of the PCA pump as inadequate. This study aims to examine the degree of self-assessed knowledge patients feel that they have on the PCA pump during pain treatment through PCA in postoperative care. The study also aims to examine if detailed information, both verbal and written, will lead to increased knowledge regarding the PCA pump and whether extended information about PCA pumps reduces the patients self-rated pain during pain relief through PCA pump postoperatively. Method: A descriptive consecutive survey data collection was conducted on five surgical wards in the middle part of Sweden. 26 patients participated in this survey. Results: This study showed a positive correlation between patients and pain relief (r = 0,74, p = 0,0005). It was also a positive correlation between getting detailed information, both verbal and written, and increased knowledge for the patient (r = 0,61, p = 0,0009). Self-perceived knowledge of the PCA pump and its functions were an average of 6.3/10. The study also showed that combined pain treatment using the PCA-pump and EDA postoperatively leads to an avarage VAS-value that was 1,57 lower after administration, in comparison with those who only had pain treatment through the PCA-pump, the result was not significant (p = 0,1). Conclusion: Patient information can play a big role on pain relief in patients with PCA pump. Development of quality document for how patient information is to be performed clinically may lead to increased pain relief in patients treated postoperatively with PCA pump. More research and larger study groups are needed to demonstrate the generalizability and validity.

The aim of this research was to compare the pain experience of cardiac surgical patients who attended the Acute Pain Service (APS) education program with cardiac surgical patients who did not attend the APS. The participants of both groups, pain levels, consumption of total analgesia, anxiety levels, satisfaction with pain management, ratios of self-administered bolus doses and failed attempts on Patient Controlled Analgesia (PCA) device and their length of hospital stay were compared. The findings indicated no statistical significant differences between the two groups being investigated in relation to pain levels, total analgesia consumed, anxiety levels, satisfaction with pain management, total demands and delivery attempts on the PCA and their length of hospital stay. The clinical mplications are significant. The preoperative pain management education program provided by APS clinical nurses for cardiac surgical patients does not have the positive outcomes expected.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.