Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Postoperative pain is still the most common and anticipated problem following surgery and inadequate post-operative pain management remains problematic. There is a significant variation in post-operative pain experience of patients following identical surgical procedures and this has been related to a variety of psychological factors. Depression has been considered a predictor of post-operative pain. The overall aim of the study was to determine the relationship between depressive symptoms and subjective pain experienced in dental surgery. The Beck Depression Inventory (BDI) was administrated to a sample of 35 patients presenting with dental impaction to assess general depression severity. Participants were assigned to one of two groups using a cutoff score of 10 on the BDI. Pain was measured by a Visual analog pain scale. The results showed that participants with pre-operative depressive symptoms had a trend to experience more pain pre-operatively but less pain post-operatively than participants without depressive symptoms this difference was however not statistically significant. No significant correlations were found between the presence of depressive symptoms pre-operative and pain perception pre-operatively and post-operatively. However significant relationships were found between the absence of depressive symptoms pre-operative and pain perception pre-operatively and post-operatively. Pre-operative depressive symptoms were also found to be predictive of post-operative depressive symptoms. The study concluded that pain and depression co-occur, but the direction of causality is not clearly understood. The use of psychotherapeutic tools for identifying pre-operative predictors for intense post-operative pain will enhance the quality of pain management and therefore has a positive impact on the quality of life of the patient. / AFRIKAANSE OPSOMMING: Post-operatiewe pyn is een van die mees algemene en verwagte probleme na afloop van chirurgie en onvoldoende behandeling van die pyn bly problematies. Daar is 'n beduidende verskil in die ervaring van post-operatiewe pyn van pasiënte na identiese chirurgiese prosedures en dit hou verband met 'n verskeidenheid van sielkundige faktore. Depressie word beskou as 'n voorspeller van post-operatiewe pyn. Die hoof doel van die studie was om die verhouding tussen depressiewe simptome en subjektiewe pyn ervaring in tandheelkundige chirurgie te bepaal. Die Beck Depression Inventory (BDI) is gebruik om die erns van algemene depressie onder ‘n steekproef van 35 pasiënte wat presenteer met tand impaksie te evalueer. 'n Afsny-telling van 10 is gebruik om die deelnemers toe te wys aan een van twee groepe. Pyn was gemeet deur 'n Visuele analog pynskaal (VAS). Die resultate het getoon dat deelnemers met pre-operatiewe depressiewe simptome 'n neiging het om meer pyn pre-operatief, maar minder pyn post-operatief te ervaar as deelnemers sonder depressiewe simptome. Die verskil was egter nie statisties beduidend nie. Geen beduidende korrelasies is gevind tussen die teenwoordigheid van pre-operatiewe depressiewe simptome en die persepsie van pyn pre-operatief en post-operatief nie. Beduidende verbande is egter gevind tussen die afwesigheid van pre-operatiewe depressiewe simptome en persepsie van pyn pre-operatief en post-operatief. Pre-operatiewe depressiewe simptome het ook post-operatiewe depressiewe simptome voorspel. Die studie het bevind dat pyn en depressie saam voorkom maar die rigting van oorsaak is nie uitgewys. Die gebruik van psigoterapeutiese instrumente vir identifisering van pre-operatiewe voorspellers vir intense post-operatiewe pyn sal die gehalte van pynbehandeling verbeter en sodoende 'n positiewe impak op die kwaliteit van lewe van die pasiënt hê.

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Background: Approximately 2,8 million surgical procedures were performed in Sweden 2016. After surgery, patients experienced different degrees of postoperative pain. Under treated postoperative pain created great suffering for patients, delayed the recovery after surgery and could increase the risk of complications. Therefore, it is of importance to explore and describe patients’ experiences regarding pain in conjunction with surgery, in order to improve postoperative pain relief from a nursing perspective. Aim: To describe how patients experience postoperative pain and pain relief. Method: A literature review was conducted in which four qualitative studies and three quantitative studies were included. The studies were subjected to assurance of quality and Friberg’s three-step analysis was used. Results: Two categories and eight subcategories emerged. The two categories were (1) The time before surgery and (2) The time after surgery. The categories illustrated how patients experienced postoperative pain and pain relief before and after surgical procedures. Conclusion: Patients had previous experiences, expectations, knowledge and beliefs about postoperative pain and pain relief that affected their experiences before surgery. After the procedure, patients' difficulty in communicating, their participation, the attitudes of healthcare professionals and the degree of attendance of the nurse were important experiences related to postoperative pain and pain relief.

Thesis advisor: Barbara E. Wolfe / Postoperative cognitive dysfunction (POCD) is characterized by a decline in cognitive performance following anesthesia and surgery and is a major cause of morbidity and mortality in the postoperative period. Moreover, studies suggest that patients who develop POCD may be at higher risk for cognitive decline later in life. POCD is of critical importance in relation to independent living, need for care, personal and economic cost, and quality of life. The majority of studies to date examine risk factors, prevalence, and complications associated with POCD. There is a lack of effective intervention strategies being developed to promote improved cognitive processing in this patient population. The primary aim of this study was to examine the feasibility and acceptability of a cognitive training intervention (CTI) for postoperative cardiac surgical patient. Feasibility was examined by conducting an attrition analysis to compare percent of attrition between intervention and control groups. A chi-square was conducted to answer the research question examining the difference between groups on attrition from study. Acceptability was examined by the administration of a "feasibility and acceptability" questionnaire, which was a 15-item questionnaire specific to the intervention. Fifteen one-sample t tests were used to determine acceptability of the intervention in the treatment population. The secondary purpose of the study was to investigate the preliminary effect of the CTI on cognitive outcomes following cardiac surgery. A randomized controlled, single-blind, repeated measures design was used to test the hypothesis that following cardiac surgery, patients who receive a 6-week CTI when compared with those who receive usual care will demonstrate a significantly greater improvement in cognitive status when comparing discharge scores to scores at 6 weeks and 3 months postoperatively. Collection of data from 53 patients who underwent cardiac surgery was conducted from May 2008 to January 2010 at Catholic Medical Center in Manchester, NH. Factorial Analyses of Variance were conducted to answer the research question assessing the effectiveness of a cognitive training intervention (CTI) on cognitive outcomes following cardiac surgery. However given assumptions of ANOVA were violated and non parametric statistics including two Kruskall Wallis H tests for independent samples at each assessment period as well as two Wilcoxon's signed ranks tests for related samples for each group were conducted. The results of the chi-square were not significant, x2(1) = 0.95, p = .329, suggesting no relationship exists between withdrawn participants and group. After Bonferroni adjustment the results of the fifteen one-sample t tests on the feasibility questionnaire (Q1-Q15) for the intervention group reveal questions 2-8, 10, 14 and 15 have a larger mean compared to the neutral median value of 3.0, suggesting that participants tended toward a high level of acceptability over neutrality. Wilcoxon signed rank test on TICS scores by control group and time period (posttest vs. six week follow up and posttest vs. three month follow up) revealed a significant main effect by time period, p< .01 at both time periods. Wilcoxon signed rank test on TICS scores by experimental group and time period (posttest vs. six week follow up and posttest vs. three month follow up) revealed a significant main effect by time period, p< .01 at both time periods. Kruskall Wallis test at six week follow up and three month follow up by group (control vs. experimental) was not significant, x2 (1) = 0.01, p = .934, and x2 (1) = 0.02, p = .891 respectively suggesting no statistical difference at six week follow up by group. The Wilcoxon signed rank on TICS by group and time period (six week follow up vs. 3 month follow up) was not significant (p=.274) and the Kruskall Wallis test at three month follow up by group (control vs. experimental) was not significant, x2 (1) = 0.02, p = .891, suggesting no statistical difference at three month follow up by group. The results of this study suggest that a CTI is feasible to conduct and acceptable to patients following cardiac surgery. Results of the preliminary effect of the CTI suggest that cognitive performance improves over a six-week period following cardiac surgery independent of the CTI and there are no significant changes from the six-week to the three-month period. Preliminary findings yield further inquiry into cognitive enhancing interventions in the cardiac surgical patient. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

by Li Ho Cheung, William. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 82-88). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgements --- p.vi / Table of Contents --- p.vii / List of Tables --- p.viii / List of Appendices --- p.x / Chapter Chapter 1 : --- Introduction and Literature Review --- p.1 / Chapter Chapter 2 : --- Method --- p.31 / Chapter Chapter 3 : --- Results --- p.48 / Chapter Chapter 4 : --- Discussion --- p.60 / Reference --- p.82 / Appendices --- p.89

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Esse estudo avaliou as anastomoses colo-cÃlicas sem preparo intestinal comparando com anastomoses realizadas com preparo intestinal prÃvio. Foram utilizados 42 animais (Canis familiares) fÃmeas, pesando entre 8,4 a 16,9 Kg, clinicamente sadios, oriundos do Canil da Prefeitura Municipal de Teresina, PiauÃ. Foram distribuÃdos em 2 grupos de 21 animais: grupo I (controle) â animais submetidos ao preparo intestinal com soluÃÃo glicerinada a 12% via retal 24hs antes do procedimento e grupo II (estudo) â animais submetidos ao procedimento sem preparo intestinal prÃvio. Todos os animais de ambos os grupos foram submetidos à laparotomia com secÃÃo do cÃlon descendente e anastomose primÃria com fio de polipropileno e acompanhados no trans e pÃs-operatÃrio por um mÃdico veterinÃrio, sendo a dieta instituÃda quando ocorreu a primeira evacuaÃÃo. Esses animais foram submetidos à eutanÃsia no 21 dia de pÃs-operatÃrio apÃs anestesia venosa com cloridrato de cetamina e aplicaÃÃo de cloreto de potÃssio a 20% endovenosa; realizou-se nova laparotomia e avaliaÃÃo da anastomose colo-cÃlica. Avaliou-se a evoluÃÃo clÃnica, o grau de aderÃncias intestinais e a pressÃo de ruptura da anastomose. Utilizou-se o teste T para amostras nÃo pareadas para dados paramÃtricos e Mann-Whitney test para dados nÃo paramÃtricos. Ocorreu um (4,5%) Ãbito em cada grupo sendo o do grupo I (controle) no 7 dia pÃs-operatÃrio devido à deiscÃncia da anastomose colo-cÃlica e outro no 10 dia de pÃs-operatÃrio no grupo II(estudo) devido à infecÃÃo de sÃtio cirÃrgico incisional profunda com deiscÃncia total da parede abdominal. NÃo foi observado diferenÃa estatisticamente significante no grau de aderÃncias intestinais entre os grupos. Durante a realizaÃÃo do teste de pressÃo de ruptura ocorreu ruptura da anastomose de um animal em cada grupo e nÃo houve diferenÃa estatisticamente significante entre os grupos (p>0,05). A anastomose colo-cÃlica sem preparo intestinal apresentou a mesma seguranÃa e eficÃcia da anastomose realizada com preparo prÃvio. / Esse estudo avaliou as anastomoses colo-cÃlicas sem preparo intestinal comparando com anastomoses realizadas com preparo intestinal prÃvio. Foram utilizados 42 animais (Canis familiares) fÃmeas, pesando entre 8,4 a 16,9 Kg, clinicamente sadios, oriundos do Canil da Prefeitura Municipal de Teresina, PiauÃ. Foram distribuÃdos em 2 grupos de 21 animais: grupo I (controle) â animais submetidos ao preparo intestinal com soluÃÃo glicerinada a 12% via retal 24hs antes do procedimento e grupo II (estudo) â animais submetidos ao procedimento sem preparo intestinal prÃvio. Todos os animais de ambos os grupos foram submetidos à laparotomia com secÃÃo do cÃlon descendente e anastomose primÃria com fio de polipropileno e acompanhados no trans e pÃs-operatÃrio por um mÃdico veterinÃrio, sendo a dieta instituÃda quando ocorreu a primeira evacuaÃÃo. Esses animais foram submetidos à eutanÃsia no 21 dia de pÃs-operatÃrio apÃs anestesia venosa com cloridrato de cetamina e aplicaÃÃo de cloreto de potÃssio a 20% endovenosa; realizou-se nova laparotomia e avaliaÃÃo da anastomose colo-cÃlica. Avaliou-se a evoluÃÃo clÃnica, o grau de aderÃncias intestinais e a pressÃo de ruptura da anastomose. Utilizou-se o teste T para amostras nÃo pareadas para dados paramÃtricos e Mann-Whitney test para dados nÃo paramÃtricos. Ocorreu um (4,5%) Ãbito em cada grupo sendo o do grupo I (controle) no 7 dia pÃs-operatÃrio devido à deiscÃncia da anastomose colo-cÃlica e outro no 10 dia de pÃs-operatÃrio no grupo II(estudo) devido à infecÃÃo de sÃtio cirÃrgico incisional profunda com deiscÃncia total da parede abdominal. NÃo foi observado diferenÃa estatisticamente significante no grau de aderÃncias intestinais entre os grupos. Durante a realizaÃÃo do teste de pressÃo de ruptura ocorreu ruptura da anastomose de um animal em cada grupo e nÃo houve diferenÃa estatisticamente significante entre os grupos (p>0,05). A anastomose colo-cÃlica sem preparo intestinal apresentou a mesma seguranÃa e eficÃcia da anastomose realizada com preparo prÃvio. / The objective of this study was to evaluate the efficacy of colo-colonic anastomosis in dogs with and without preoperative bowel preparation. The experiment included 42 healthy female mongrel dogs (Canis familiaris) weighing 8.4-16.9 Kg, supplied by the municipal dog pound of Teresina, PiauÃ. The animals were distributed at random in two groups of 21 animals each: Group I (control) = submitted to bowel preparation with rectal administration of 12% glycerin solution one day before the procedure, and Group II (study) = without previous bowel preparation. All animals were submitted to laparotomy with sectioning of the descending colon and primary anastomosis using polypropylene thread under the peri and postoperative supervision of a veterinary physician. The animals were allowed access ad libitum to water and standard feed following the first evacuation. On the 21st postoperative day (POD 21), the dogs were euthanized with ketamine i.v. followed by 20% potassium chloride i.v., and a second laparotomy was performed through the same incision in order to evaluate the anstomosis. In addition, the abdominal cavity was evaluated for adhesions and the burst pressure of the anastomosis was tested. The unpaired samples were compared with Student&#700;s t test for parametric data and with the Mann-Whitney test for non-parametric data. One animal in each group (4.5%) died. The death in Group I (control) occurred on POD 7 due to anastomotic dehiscence. The death in Group II (study) occurred on POD 10 due to deep incisional infection at the surgical site and complete dehiscence of the abdominal wall. The groups did not differ significantly with regard to adhesion grade or anastomotic burst pressure (one specimen burst in each group) (p>0.05). In conclusion, the level of safety and efficacy was the same for colo-colonic anastomosis with and without previous bowel preparation. / The objective of this study was to evaluate the efficacy of colo-colonic anastomosis in dogs with and without preoperative bowel preparation. The experiment included 42 healthy female mongrel dogs (Canis familiaris) weighing 8.4-16.9 Kg, supplied by the municipal dog pound of Teresina, PiauÃ. The animals were distributed at random in two groups of 21 animals each: Group I (control) = submitted to bowel preparation with rectal administration of 12% glycerin solution one day before the procedure, and Group II (study) = without previous bowel preparation. All animals were submitted to laparotomy with sectioning of the descending colon and primary anastomosis using polypropylene thread under the peri and postoperative supervision of a veterinary physician. The animals were allowed access ad libitum to water and standard feed following the first evacuation. On the 21st postoperative day (POD 21), the dogs were euthanized with ketamine i.v. followed by 20% potassium chloride i.v., and a second laparotomy was performed through the same incision in order to evaluate the anstomosis. In addition, the abdominal cavity was evaluated for adhesions and the burst pressure of the anastomosis was tested. The unpaired samples were compared with Student&#700;s t test for parametric data and with the Mann-Whitney test for non-parametric data. One animal in each group (4.5%) died. The death in Group I (control) occurred on POD 7 due to anastomotic dehiscence. The death in Group II (study) occurred on POD 10 due to deep incisional infection at the surgical site and complete dehiscence of the abdominal wall. The groups did not differ significantly with regard to adhesion grade or anastomotic burst pressure (one specimen burst in each group) (p>0.05). In conclusion, the level of safety and efficacy was the same for colo-colonic anastomosis with and without previous bowel preparation.

Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient safety performance in relation to one hospital acquired condition: postoperative sepsis – a condition that complicates hospitalizations, increases lengths of stay, and leads to higher mortality rates. Administrative data from several sources were utilized in order to obtain comprehensive information about the patient, organizational, and market characteristics of hospitals, their EHR adoption patterns, and the occurrence of postoperative sepsis among their patients. The study sample consisted of 404 general, short-term, acute care, non-federal, and urban hospitals based in six states, which provided longitudinal data from 2005 to 2009. Hospital EHR and the EHR’s sophistication level were measured by the presence of eight clinical applications. Econometric techniques were used to test six hypotheses that were derived from macro-organizational theories and frameworks. After controlling for potential confounders, the study’s key findings suggested that hospitals had a significant increase in the probability of having EHR as the percent of other hospitals having the most sophisticated EHR (i.e., EHRS3) in the market increased. Conversely, hospitals had a significant decrease in the probability of having EHR when the percent of Medicaid patients increased within a hospital or when the hospital belonged to centralized or moderately centralized systems. Also, the study findings suggested that EHR was associated with a higher rate of postoperative sepsis. Specifically, the intermediate EHR sophistication level (i.e., EHRS2) and the most sophisticated EHR level (i.e., EHRS3) were associated with a significantly higher rate of postoperative sepsis when compared to hospitals that did not have such EHR sophistication. The study results, however, did not support the hypotheses that higher degrees of fit between hospitals’ EHR sophistication level and specific structural dimensions were associated with greater reductions in postoperative sepsis outcomes vis-à-vis hospitals that did not have these types of fit.

Postoperative Frühkomplikationen haben weitreichende Konsequenzen für die Morbidität und Mortalität des operierten Patienten. Im Klinikalltag treten bei vermehrten Komplikationen und verlängerten Intensivstations- und Krankenhausaufenthaltszeiten organisatorische Probleme in den Vordergrund. Nicht zuletzt führen vermehrte Komplikationen zu steigenden Kosten. Diese Studie hat 70 Patienten mit einem durchschnittlichen Alter von 67 Jahren betreut. Hiervon erhielten 48 Patienten ein Herzbyassoperation, 16 eine Aortenklappenoperation und 6 Patienten eine Mitralklappenoperation. 42 Patienten wurden mit Herzlungenmaschine operiert. Es erfolgten prä- und postoperative Blutentnahmen zur Untersuchung kardialer Biomarker. Hierbei stand der kardiale Biomarker heart–fatty acid binding protein (H-FABP) im Vordergrund und wurde mittels eines ELISA Verfahrens detektiert. Die Hypothese war, dass H-FABP als kardiospezifischer Biomarker mit einer frühzeitigen Freisetzungskinetik nach myokardialen Schädigungen als präoperativer Biomarker für postoperative Komplikationen, insbesondere für das Acute Kidney Injury, nach kardiochirurgischen Eingriffen dienen kann. Bisher existierten hierzu keine Daten. Dies ist die erste Studie die nachweisen konnte, dass das präoperative H-FABP als prädiktiver Faktor für das Acute Kidney Injury, den Serumkreatininkriterien der Acute Kidney Injury Network und der KDIGO entsprechend, gilt. Des Weiteren bestand ein signifikanter Zusammenhang zwischen dem präoperativen H-FABP und der postoperativen Intensivstations- und Krankenhausaufenthaltsdauer. / Significance of heart-type fatty acid binding protein as a predictive factor for post-operative complications after cardiac surgery

Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Aims to identify if the current practice of post-operative vital sign collection detects complications in the first 24 hours after the patient has returned to the general ward setting using a combination of methods within a triangulated approach to data collection.