Bakgrund: Barn behöver ibland uppsöka sjukvård för att genomgå vårdprocedurer av olika slag. Barns reaktioner på oro och rädsla styrs av ålder, förståelse, fantasi och verklighetsuppfattning. Barn behöver därför förberedas inför obehagliga ingrepp som ska hända till exempel: smärtsamma undersökningar, venpunktion eller injektioner. Dessa undersökningar kan skapa oro och rädsla hos barn. Syfte: Syftet med studien var att beskriva olika icke farmakologiska avledande metoder och dess effekter vid procedursmärta hos barn. Samt att beskriva undersökningsgrupperna i de inkluderade artiklarna. Metod: En deskriptiv design användes för att besvara litteraturstudiens syfte och frågeställningar. Studien baserades på tretton vetenskapliga artiklar. De vetenskapliga artiklarna söktes i databaserna Cinahl och PubMed. Artiklarna var publicerade mellan åren 2006-2016. Huvudresultat: Studien påvisar att icke farmakologiska avledande metoder som till exempel: blåsa såpbubblor, titta i ett kalejdoskop, lyssna på musik eller använda ”Buzzy” har haft lindrande effekt på barns rädsla, oro och smärta. Effekterna har skattats med hjälp av olika skalor genom sjuksköterskors, forskare och föräldrars observationer. Barnen har själva fått skattat effekterna av de icke farmakologiska avledande metoderna. Slutsats: I resultatet i föreliggande studie har författarna kommit fram till att icke farmakologiska avledande metoder kan lindra barnens rädsla, oro eller smärta vid olika omvårdnadshandlingar. Författarna har även kommit fram till slutsatsen att de avledande metoderna som undersökts kan användas i det vardagliga arbetet inom barnsjukvården. / Background: Children sometimes need to seek medical help in order to undergo treatment procedures of various kinds. Children's reaction to anxiety and fear are governed by age, understanding, imagination and perception of reality. Children therefore need to be prepared for unpleasant procedures that they will undergo, such as: painful examinations, venipuncture or injections. These procedures can create anxiety and fear in children. Purpose: The purpose of this study was to describe the various non - pharmacological istraction methods and its effects on procedural pain in children. And to describe the study groups in the included articles. Method: A descriptive design was used to answer the literature studies experimental purpose and questioning. The study was based on thirteen scientific articles. The papers were searched in databases Cinahl and PubMed. The articles were published between the years 2006-2016. Result: The study demonstrates that non - pharmacological distraction methods for example: playing with soap bubbles, looking through a kaleidoscope, listen to music and use a “Buzzy” have had a soothing effect on children’s fear, anxiety and pain. The effects have been estimated using different scales by nurses, researchers and parents' observations. The children themselves have been estimating the effects of the non - pharmacological distraction methods. Conclusion: In the results of the present study, the authors concluded that non-pharmacological distraction methods can ease children's fear, anxiety or pain at different nursing actions. The authors have also come to the conclusion that the distraction methods investigated can be used in everyday work in pediatric care.

Bakgrund: Alzheimers sjukdom (AD) är den vanligaste formen av demenssjukdomar och antalet människor som insjuknar i AD förväntas öka kraftigt med tiden. Dessutom kännetecknas personer med AD ofta av beteendemässiga och psykiska symtom (BPSD) som kan innefatta agitation, depression, vanföreställningar, oro, ångest, hallucinationer, sömnrubbningar, rastlöshet och apati. Dessa symtom kan orsaka lidande hos patienten och är svåra att hantera för både vårdgivaren och anhöriga, samt försvårar omvårdnadsarbetet. Syftet var att beskriva icke-farmakologiska metoder och effekter av dessa metoder vid omvårdnad av personer med Alzheimers sjukdom som har beteendemässiga och psykiska symtom. Metod: En litteraturöversikt bestående av 16 utvalda kvantitativa forskningsartiklar har genomförts. Artiklarna publicerades mellan år 2006-2016. Resultat. De studerade icke-farmakologiska metoderna var musikterapi, vissa typer av massage, reminiscence-terapi, vårdhundterapi och ljusterapi. Resultaten visade att icke-farmakologiska metoder kan ha en varierande effekt på BPSD. Litteraturöversikten visade att musikintervention var mest effektiv för att minska agitationsbeteende. Individualiserad musik i samband med speciella minnen minskade stress, fobier hos personer med svår demens. Intervention av handmassage, aromaterapi, taktil massage och terapeutisk beröring minskade aggression och agitationsbeteende. Vissa studier visade dock att fotmassageintervention och vårdhundterapi kunde öka verbal aggressivitet hos personer med demens, medan en annan studie visade att djurassisterade aktiviteter kunde minska nedstämdhet medan glädje och generell uppmärksamhet ökade. Effekten av ljusbehandling var förbättrad sömn, minskad depression, agitation och ätstörningar. Slutsats. Icke-farmakologiska metoder kan minska beteendemässiga och psykiska symtom hos personer med Alzheimers sjukdom, dock med varierande effekt. De varierande resultaten kan tolkas som att icke-farmakologiska metoder bör individanpassas och att det behövs vidare forskning inom området. / Background: Alzheimer's disease (AD) is the most common of dementia and the number of people diagnosed with AD is expected to rise significantly over time. In addition, people diagnosed with AD often exhibit the Behavioural and Psychological Symptoms of Dementia (BPSD), which include agitation, depression, delusions, agitation, anxiety, hallucinations, sleep disturbances, anxiety and apathy. These symptoms can cause suffer to the patient and is difficult to manage for both the caregiver and family members, as well as hampers nursing. Aim: the aim was to describe non-pharmacological methods and effects of these methods when caring for people with Alzheimer's disease who have behavioural and psychological symptoms. Method: a literature review consisting of 16 selected quantitative research articles has been performed. The selected articles ware published between years 2006- 2016. Results: The studied non-pharmacological methods were: music therapy, certain types of massage, reminiscence therapy, dog therapy and light therapy. The results showed that non-pharmacological methods can have a varying effect on BPSD. The literature review showed that music intervention was most effective in reducing agitated behaviour. Individualized music in conjunction with special memories reduced stress, phobias for persons with severe dementia. The hand massage, aroma therapy, tactile massage and therapeutic touch decreased aggression and agitated behaviour. Some studies showed that foot massage intervention and dog therapy could increase the verbal aggression for people with dementia, while another study showed that animal-assisted activities could reduce depression and increase joy and general attention. The effect of light therapy was an improved sleep, decreased depression, agitation, and eating disorders. Conclusions: non-pharmacological nursing interventions can reduce behavioural and psychological symptoms for people with Alzheimer's disease, however, with varying effect. The varying results can be interpreted as following: nonpharmacological nursing interventions should be adapted in each individual case and that there is a need for further research in this area.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: For several decades childbirth educators and midwives have focused on the alleviation or reduction of pain and suffering during the childbirth experience (Brown, Douglas & Flood 2001:1). Nursing professionals who care for labouring women require current, evidence-based knowledge regarding pain management options, including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238). Objectives: This study examined the effects of non-pharmacological pain relief strategies for pain management during labour. Search methods: The researcher conducted a search between February and May 2010 on PubMed, CINAHL and CENTRAL for randomised controlled trials published from inception to 2010. The Medical Search Headings (MeSH) included non-pharmacological, alternative, pain management, labour, pregnant, complementary, randomised, randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water birth, acupuncture, aromatherapy. Selection criteria: The studies included reported on pregnant women, primigravida or multigravida, term (37 weeks and more), spontaneous labour (first or second stage) without any complications in previous or current pregnancies. The researcher searched for randomised controlled trials with an intervention and a control group. Due to financial restrictions the researcher assessed studies that were published in English only. Interventions were childbirth education, continuous support, relaxation, breathing techniques, movement and positioning, music, manual healing, aromatherapy, hydrotherapy, hypnosis and acupuncture. Data collection and analysis: Meta-analysis was performed using Relative Risks and 95% Confidence Interval for dichotomous outcomes and Weighted mean differences and 95% Confidence Interval for continuous outcomes. Review Manager (RevMan), a statistical software was used. Where meta-analyses were impossible results were presented in narrative form. The outcome measures were a decreased need for pharmacological pain relief, maternal satisfaction with the overall childbirth experience, length of labour (normal or shorter progress), incidence of postnatal depression, incidence of postpartum haemorrhage, an Apgar score of more than seven at five minutes, resuscitation of the neonate and admission to the neonatal intensive care unit. Results: Thirteen (13) eligible RCT’s were included in the systematic review. Four trials involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials involved childbirth education (n=6398), one trial involved continuous support (n=2844), one trial involved aromatherapy (n=513), one trial involved maternal positioning (n=2547), one trial involved music, massage and relaxation (n=90) and one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the hypnosis group required less pharmacological pain relief 15/29 compared to women in the control group 20/36. Women in the intervention group also experienced greater satisfaction with the childbirth experience 15/29 (52%) compared to women in the control group 8/36 (23%). The trials of acupuncture showed a decreased need for pharmacological pain management in Skilnand (2002) (n=208) for epidural 11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as Pethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group. In the Borup trial (2009) it was reported that acupuncture during labour reduced the need for pharmacological pain management for the intervention group 185/314 (58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome. The secondary outcome of length of labour (minutes) in the Skilnand trial is significantly in favour of the acupuncture group with a mean value of 212 (SD, 155), compared to the control group with a mean value of 283 (SD, 225) with a p-value of 0.01. Conclusions: Acupuncture may relieve labour pain and also shorten the duration of labour, and women experience greater satisfaction with the childbirth experience. Hypnosis may decrease the need for pharmacological pain relief requirements, and may also increase an overall maternal satisfaction with the childbirth experience. There is insufficient evidence about the benefits of childbirth education, continuous support, aromatherapy, music, massage, movement and positioning, breathing and relaxation. / AFRIKAANSE OPSOMMING: Agtergrond: Vir talle dekades het die verloskundiges en vroedvroue gefokus op die verligting of vermindering van pyn en lyding gedurende die ervaring van kindergeboorte (Brown, Douglas & Flood 2001:1). Professionele verpleegkundiges wat omsien na vrouens wat kraam het die huidige, bewyslewerende kennis aangaande pynbestuuropsies nodig, insluitende die wyse van optrede, voordele, risiko en effektiwiteit (Florence & Palmer 2003:238). Doelstellings: Hierdie studie het die effekte van nie-farmakologiese pynverligtingstrategieë vir die beheer van pyn gedurende die kraamproses nagevors. Ondersoekmetodes: Die navorser het gedurende Februarie en Mei 2010 ’n ondersoek gedoen na PubMed, CINAHL en CENTRAL vir ewekansigbeheerde proewe gepubliseer vanaf die aanvang tot 2010. Die Mediese Ondersoekhoofde het farmakologiese, alternatiewe, pynbeheer, kraam, swangerskap, komplementêre, ewekansigheid, toevalligheid, verloskunde, natuurlike geboorte, ontspanning, asemhaling, posisionering, hipnose, watergeboorte, akupunktuur en aromaterapie ingesluit. Seleksie kriteria: Die studies het navorsing oor swanger vroue, primigravida of multigravida, tydperk (37 weke en meer), spontane kraam (eerste of tweede stadium) sonder enige komplikasies in vorige of huidige swangerskappe ingesluit. Die navorser het ewekansigbeheerde toetsing met ’n intervensie en ’n kontrole groep ondersoek. As gevolg van finansiële beperkings het die navorser studies wat alleenlik in Engels gepubliseer is, geassesseer. Intervensies soos die opvoeding oor kindergeboorte, deurlopende ondersteuning, ontspanning, asemhalingstegnieke, beweging en posisionering, musiek, handegenesing, aromaterapie, hidroterapie en akupunktuur is bestudeer. Data-insameling en analise: Meta-analise is uitgevoer deur gebruik te maak van Relatiewe Risiko’s en 95% Betroubaarheidsinterval vir tweeledige uitkomste en Gewigdraende gemiddelde afwykings en 95% Betroubaarheidsinterval vir deurlopende resultate. Review Manager (RevMan), ’n statistiese sagteware is gebruik. Waar dit ontmoontlik was om meta-analise uit te voer, was resultate gepresenteer in narratiewe vorm. Die uitkomste meting is ’n afname in die behoefte vir farmakologiese pynverligting, moederskapbevrediging met die algehele geboorteskenkervaring, die duur van die bevalling (normale of korter vordering), gevalle van postnatale depressie, voorkoms van postpartum bloeding , ’n Apgartelling van meer as sewe teen vyf minute, resussitasie van die neonaat en toelating tot die neonatale intensiewe sorgeenheid. Resultate: Dertien (13) geskikte ewekansigbeheerde proewe is ingesluit in die sistematiese oorsig. Vier proewe het hidroterapie (n=585), twee proewe akupunktuur (n=480), twee proewe die opvoeding van kindergeboorte (n=6398), een proef deurlopende ondersteuning (n=2844), een proef aromaterapie (n=513), een proef moederlike posisionering (n=2547), een proef musiek, massering en ontspanning (n=90) en een proef het hipnose (n=82). Die proef vir hipnose het ‘n afname in die behoefte vir farmakologiese pynbeheer met 15/29 vroue in die hipnose groep en 20/36 vroue in die kontrole groep getoon. Vroue in die hipnose groep het ook groter bevrediging gevind met die ervaring van die geboorteskenking met 15/29 (29%) in vergelyking met 8/36 (23%) in die kontrole groep. Die proewe vir akupunktuur het ’n afname in die behoefte vir farmakologiese pynbeheer Skilnand (2002) (n=208), met ‘n gemiddelde waarde van 11/106 (10%) vir epiduraal en 15/106 (14%) vir Pethidien in die intervensie groep en ‘n gemiddelde waarde van 27/106 (26.5%) vir epidural en 36/102 (35%) in die kontrole groep. Borup (2009) (n=384) toon ook ‘n afname in die behoefte van farmakologiese pynbeheer met ‘n waarde van 185/314 (58.9%) in vergelyking met die kontrole groep 124/149 (83.2%). Die sekondêre uitkomste van die duur van die kraamproses (minute) in Skilnand (2002), is noemenswaardig ten gunste van die akupunktuurgroep met ’n gemiddelde waarde van 212 (SA, 155) in die intervensie groep en ’n gemiddelde waarde van 283 (SA, 225) in die kontrole groep met ’n p-waarde van 0.01. Gevolgtrekkings: Akupunktuur mag kraampyn verlig en ook die duur van die kraamproses verkort, vandaar dat vrouens groter bevrediging mag ervaar met die ervaring van geboorteskenk. Hipnose mag die begeerte na farmakologiese pynverligting verminder en sodoende vroue groter ervaring met geboorteskenk mag ervaar. Daar is onvoldoende bewys aangaande die voordele van die opvoeding van kindergeboorte, deurlopende ondersteuning, aromaterapie, musiek, massering, beweging en posisionering, asemhaling en ontspanning.

Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: In traditional medicine, there is a long-standing culture of combining herbal drugs to increase the therapeutic efficacy. The improved medical action is thought to be due to synergistic interactions between different plant bioactive components. The aim of this study was to test the pharmacological interactions in a medicinal plant combination which consisted of Agathosma crenulata, Dodonaea viscosa and Eucalyptus globulus. The rationale for the analysis of this particular mixture is that it had noteworthy antibacterial activity and exhibited the highest activity out of seven medicinal plant mixtures previously investigated. Using chromatographic analysis, the phytochemistry of the plants was also assessed. The chloroform: methanol (1:1; v/v) extracts or hydo-distilled essential oils (A. crenulata and E. globulus) were screened individually and in combinations (double and triple plant combination) for activity against five respiratory pathogens using a microdilution assay. The antimicrobial interactions in combinations were assessed with the fractional inhibitory concentration (FIC) and the isobolograms. The organic extracts generally showed the highest antimicrobial activity with E. globulus having the highest activity with MIC values below 1 mg ml-1 representing noteworthy activity. The overall activity of the aqueous extracts was poor. The essential oil activity of E. globulus was mostly noteworthy (0.5 to 2 mg ml-1) while A. crenulata essential oil displayed moderate activity (1 to 4 mg ml-1). The ΣFIC values for double combinations (1:1) of A. crenulata with D. viscosa, A. crenulata with E. globulus and D. viscosa with E. globulus were calculated from the minimum inhibitory concentration (MIC) data and the interactions were classified as synergistic, additive, indifferent and antagonistic. The highest synergistic interactions observed were for a 1:1 combination of A. crenulata with E. globulus against K. pneumoniae, S. aureus and B. subtilis with ΣFIC values of 0.07. There was only one incident of antagonism noted in the study for D. viscosa with E. globulus (1:1) against C. neoformans with ΣFIC value of 4.25. The double combinations against selective pathogens (K. pneumoniae, S. aureus and E. coli) were further analysed for interactions using isobolograms. Mostly, the antimicrobial interactions as presented by the isobolograms were congruent with FIC results which further validated the occurrence of relevant antimicrobial interactions in those combinations. The ΣFIC values for triple combinations (1:1:1) revealed mostly synergistic interactions. When the triple combinations were analysed further against certain pathogens based on the predictions of the Design of Experiments software program (MODDE 9.1®), the MIC values remained the same despite the different combinations that were tested Thin layer chromatography (TLC) was used for a quick chemical fingerprinting of the plant extracts. This was followed by a bio-autographic assay. The chemical profiles of the organic extracts and essential oils from two of the study aromatic plants (A. crenulata and E. globulus) were further analysed with liquid chromatography mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS) respectively. For combined plant extracts, a multivariate data analysis using principal component analysis (PCA) and hierarchical clustering analysis (HCA) was used to determine the relationship of the chemical make-up of combinations with that of individual plant extracts. According to the TLC analysis, E. globulus extracts had more compounds than the other two plants in the study. For the bio-autographic assay, E. globulus and combinations that included this plant showed greater inhibition zones than A. crenulata and D. viscosa. For the LC-MS analysis, PCA and HCA showed a close relationship between A. crenulata with D. viscosa, D. viscosa with E. globulus and the triple combination. Twenty one components were identified in the essential oil of A. crenulata representing 88.83% of the total oil composition. The oil was dominated by oxygen-containing monoterpenes (46.25%). In the essential oil of E. globulus, twenty six compounds were identified making up to 95.62% of the oil composition. Oxygen-containing monoterpenes (32.98%) also dominated the E. globulus essential oil. There was no great variation in essential oil metabolites of the individual plants and their combination as shown by both PCA and HCA. The enhanced in vitro antimicrobial activity and pharmacological interactions (synergy and additivity) in some of the combinations (double and triple) that were tested in this study adds scientific support to the use of medicinal plant combinations in Western Cape traditional medicine. The metabolic profiles of plants in combination might be unique due to interaction of the different plant bioactive molecules and thus result into defined antimicrobial activity. / AFRIKAANSE OPSOMMING: In tradisionele geneeskunde is dit ’n lank bestaande kultuur om kruiemiddels te kombineer om die terapeutiese werking daarvan te verhoog. Dié verbeterde mediese werking word toegeskryf aan die oënskynlik sinergistiese interaksies tussen verskillende bioaktiewe plantkomponente. Die doel van hierdie studie was om die farmakologiese interaksies in medisinale plantkombinasies van Agathosma crenulata, Dodonaea viscosa en Eucalyptus globulus te bestudeer. Daar is op die ontleding van hierdie spesifieke mengsel besluit omdat dit oor beduidende antibakteriese waarde beskik en omdat dit uit sewe medisinale plantmengsels wat voorheen bestudeer is, as die doeltreffendste een aangewys is. Die fitochemie van die plante is ook met behulp van chromatografiese ontleding beoordeel. Deur middel van ’n mikroverdunningstoets is die chloroform:metanol- (1:1; v/v-)ekstrakte of hidrogedistilleerde vlugtige olies (A. crenulata en E. globulus) individueel sowel as in kombinasie (dubbele en drievoudige plantkombinasies) nagegaan vir hul werking met betrekking tot vyf respiratoriese patogene. Die gekombineerde antimikrobiese interaksies is met behulp van fraksioneel stremmende konsentrasie (FIC) en isobologramme ondersoek. Die organiese ekstrakte het oor die algemeen die meeste antimikrobiese aktiwiteit by E. globulus getoon, met MIC-waardes onder 1 mg ml-1 wat as noemenswaardige aktiwiteit beskou is. Die algehele aktiwiteit van die waterekstrakte was swak. Die vlugtige-olieaktiwiteit van E. globulus was merendeels noemenswaardig (0,5 tot 2 mg ml-1), terwyl die vlugtige olie van A. crenulata matige aktiwiteit getoon het (1 tot 4 mg ml-1). Die ΣFIC-waardes vir dubbelkombinasies (1:1) van A. crenulata en D. viscosa, A. crenulata en E. globulus, en D. viscosa en E. globulus is uit die minimum stremmende konsentrasie (MIC) bereken en die interaksies is as sinergisties, additief, neutraal en antagonisties geklassifiseer. Die sterkste sinergistiese interaksies is by ’n 1:1-kombinasie van A. crenulata en E. globulus met betrekking tot K. pneumoniae, S. aureus en B. subtilis opgemerk, met ΣFIC-waardes van 0,07. Die studie het slegs een geval van antagonisme opgelewer, naamlik by D. viscosa en E. globulus (1:1) met betrekking tot C. neoformans, wat ’n ΣFIC-waarde van 4,25 geregistreer het. Die werking van die dubbelkombinasies met betrekking tot gekose patogene (K. pneumoniae, S. aureus en E. coli) is voorts met behulp van isobologramme vir interaksies nagegaan. Die antimikrobiese interaksies wat uit die isobologramme geblyk het, was meestal in pas met FIC-resultate, wat die bestaan van tersaaklike antimikrobiese interaksies in daardie kombinasies verder bevestig het. Die ΣFIC-waardes vir die drievoudige kombinasies (1:1:1) het meestal sinergistiese interaksies aan die lig gebring. Toe die drievoudige kombinasies verder op grond van die voorspellings van die sagteware Design of Experiments (MODDE 9.1®) met betrekking tot sekere patogene ontleed is, het die MIC-waardes onveranderd gebly, ondanks verskillende toetskombinasies. Dunlaagchromatografie (TLC) is vir ’n vinnige chemiese ontleding van die plantekstrakte gebruik en is gevolg deur ’n bio-outografiese toets. Die chemiese profiele van die organiese ekstrakte en vlugtige olies van twee van die aromatiese plante in die studie (A. crenulata en E. globulus) is verder met vloeistofchromatografie-massaspektrometrie (LC-MS) en gaschromatografie-massaspektrometrie (GC-MS) onderskeidelik ontleed. Vir gekombineerde plantekstrakte is veelveranderlike-ontleding in die vorm van hoofkomponentontleding (PCA) en hiërargiese groepsontleding (HCA) gebruik om die verhouding van die chemiese samestelling van kombinasies in vergelyking met dié van individuele plantekstrakte te bepaal. Volgens die TLC-ontleding beskik E. globulus-ekstrakte oor meer verbindings as die ander twee plante in die studie. Vir die bio-outografiese toets het E. globulus en kombinasies daarmee groter stremmingsones as A. crenulata en D. viscosa getoon. In die LC-MS-ontleding het PCA en HCA op ’n hegte verhouding tussen A. crenulata en D. viscosa, D. viscosa en E. globulus, en die drievoudige kombinasie daarvan gedui. Een-en-twintig komponente is in die vlugtige olie van A. crenulata gevind, wat 88,83% van die algehele oliesamestelling uitmaak. Die olie is deur suurstofhoudende monoterpene (46,25%) oorheers. Die vlugtige olie van E. globulus het 26 verbindings opgelewer, wat 95,62% van die oliesamestelling uitmaak. Suurstofhoudende monoterpene (32,98%) het ook die vlugtige olie van E. globulus oorheers. Nóg PCA nóg HCA het op enige beduidende variasie in die metaboliete van die vlugtige olies van die individuele plante en hul kombinasies gedui. Die verhoogde in vitro- antimikrobiese aktiwiteit en farmakologiese interaksies (sinergie en additiwiteit) in van die kombinasies (dubbel én drievoudig) wat in hierdie studie getoets is, bied wetenskaplike stawing vir die gebruik van medisinale plantkombinasies in Wes-Kaapse tradisionele geneeskunde. Die metaboliese profiele van plantkombinasies kan verander weens die interaksie van die verskillende bioaktiewe plantmolekules, en kan baie bepaalde antimikrobiese aktiwiteit tot gevolg hê.

Bakgrund: Postoperativ smärta är vanligt förkommande och påverkar patientens välbefinnande. Sjuksköterskor har en central roll i smärtbehandling, det finns flertalet icke-farmakologiska metoder som kan användas för postoperativ smärtlindring. Syfte: Syftet med litteraturöversikten var att identifiera icke-farmakologiska metoder som en grundutbildad sjuksköterska kan utföra eller erbjuda som komplement vid en postoperativ smärtbehandling hos vuxna, samt utvärdera dess effekt. Metod: En litteraturöversikt. Resultat: Fyra icke-farmakologiska metoder uppmärksammades: musikterapi, avslappningsövningar, beröringsmetoder och patientutbildning. Musikterapi i 30 minuter hade en signifikant smärtlindrande effekt. Beröringsmetoder och avslappningsövningar resulterade i en succesivt ökad smärtlindrande effekt. Patientutbildning gav en smärtlindrande effekt upp till 48 timmar efter operation. Slutsats: Icke-farmakologiska metoder kan användas som komplement till en farmakologisk behandling för att lindra postoperativ smärta. / Background: Postoperative pain is common and affects the patients’ wellbeing. Nurses have a central role in pain management, there are many non-pharmacological methods that can be used as postoperative pain relief. Aim: The aim of this literature review was to identify non-pharmacological methods that the basic trained nurse can perform or provide as a complement to a postoperative pain relief for adults and to evaluate their effect. Method: A literature review Results: Four non-pharmacological methods were observed: music therapy, relaxation exercises, touching methods and patient education. Music therapy for 30 minutes showed a significant pain relieving effect. Massage therapies and relaxation exercises gave a gradually increased pain relieving effect. Patient education gave a pain relief up to 48 hours after surgery. Conclusion: Non- pharmacological methods can be used as a complement to a pharmacological treatment as to relieve postoperative pain.

Cognitive behavioural therapy for insomnia (CBT-i) is the most effective treatment for insomnia. Studies show that auricular acupuncture (AA) may alleviate insomnia symptoms. The overall aim of the thesis was to compare treatment effects of auricular acupuncture (AA) with cognitive behavioural therapy for insomnia (CBT-i) on symptoms of insomnia, anxiety, depression, hypnotic drugs consumption and quality of life from short- and long-term perspectives. Paper I had a qualitative approach with a descriptive design. 16 participants received group-treatment with AA during their protracted withdrawal phase and were interviewed about their experiences. They participants experienced a reduction in protracted withdrawal symptoms, improved subjective sleep quality, a strong sensation of peacefulness and increased wellbeing. Paper II, III and IV present results from a randomised controlled trial in where the effects of group-treatment with AA and CBT-i were compared in short- and long-term using subjective (questionnaires and sleep diary) and objective (actigraphy) measurements. The results showed that CBT-i was superior to AA in reducing insomnia symptoms in both the short and long run. Both groups experienced significant long-term reduction of depressive symptoms. Further, both groups managed to maintain a decreased intake of hypnotic drugs at the end of the treatment when compared to baseline measurement. Short-term reduction of symptoms of anxiety and depression improved only in the AA group. The results from the objective actigraph recordings showed that the AA group slept more and the CBT-i group less after the treatment and that sleep patterns in both groups reverted to pre-treatment levels after 6 months. Conclusively: AA, as administered in this study, was not as good as CBT-i in treating insomnia symptoms, and should not be used as a stand-alone treatment for insomnia. Our results also demonstrate that prolonged sleep time does not necessarily yield better sleep, and that the perception of insomnia symptoms is not inevitably affected by sleep duration. AA was as effective as CBT-i in ending hypnotic drugs consumption. Moreover, AA was more successful than CBT-i in reducing symptoms of anxiety and depression in the short run. Further studies investigating AA for anxiety and depression are motivated.

In view of the discrepancies and conflicts produced by previous studies on amphibian lymph hearts, a study was initiated to reinvestigate the pharmacological, temperature, and electrical aspects of lymph heart physiology. Bullfrogs were chosen as the experimental animal, All lymph heart responses to experimentation were physiographically recorded as myograms and electrograms. The results are in agreement with previous studies on some aspects and in conflict on others. From the results obtained, lymph heart muscle appears to possess both skeletal and cardiac muscle properties as evidenced by drug responses and reactions to temperature. The precise components of the electrogram remain unclear. It is suggested that further investigation should be made to better determine the true nature of lymph hearts.

This diploma thesis, "Alzheimer's disabilities ", deals with questions around people with Alzheimer's disabilities, which is the most common type of dementia. Alzheimer's disabilities is also very widespread in the population; and it is the 4th or 5th most common cause of death. The thesis is divided into two parts, the first part is theoretical and the second is empirical. In the theoretical part the thesis deals with the general characteristics of this disorder such as: causes, prevention, clinical manifestations, consequences, diagnostics and pharmacological approaches. The main focus of the theoretical part is in the second chapter, which deals with non-pharmacological approaches to people with Alzheimer's disabilities. In the empirical part, case studies on sufferers of Alzheimer's disabilities will be included. The empirical part focuses on substantive changes which occur in the lives of people with Alzheimer's disabilities, and whether these changes can be confirmed as being consequential of the affliction. Key words Dementia, Alzheimer's disabilities, clinical manifestation, non-pharmacological approaches.

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Due to the demographic development osteopoorosis is an increasing serious medical and economical problem today in developed industrial countries including Czech republic. Fractures of the proximal femur in the elderly are one of the manifestations of the illness. Within the context of the pharmacological prevention we must consider carefully its contribution in comparison with costs of the fracture treatment in the hospital. This graduation theses deals with evaluation of expenses on the surgical treatment of these fractures and expenses on the pharmacological prevention using Fosamax. This comparison is made in economic situation in Czech republic in the end of the first decade of 21. century