Le but de la thèse était d’avancer les connaissances sur les procédures diagnostiques ayant pour objectif  la latéralisation des déficits de la mémoire visuelle, ainsi que d’étudier la perception dans l´épilepsie du lobe temporal (ELT). La première étude a examiné l’aptitude de quatre tests de mémoire visuo-spatiale, comme méthode d´identification des dysfonctions du lobe temporal médial droit. Des méthodes statistiques variées, illustrent la capacité limitée de ces tests à latéraliser la zone dysfonctionnelle, même lorsque les facteurs cliniques liées à l’épilepsie ainsi que d’autres facteurs cognitives étaient contrôlés. La deuxième étude est fondé sur la première, et à pour but de valider un nouveau paradigme. Ainsi, nous avons examiné des patients avec ELT en préopératoire avec le Delayed Matching to Sample (DMS-48) test et en postopératoire avec deux versions parallèles que nous avions développées et standardisées auprès des sujets contrôles sains. Nos analyses démontrent que le DMS-48 et ces versions parallèles ont pu latéraliser la zone épileptogène avant et après l´intervention chirurgicale. La troisième partie comprime une expansion de la mémoire visuelle à la perception visuelle. Une étude de cas unique suggère que la reconnaissance de l´objet et l´imagerie mentale sont soutenues par des régions corticales proches, situées en contiguïté de la voie temporo-occipitale. De plus, la perception et l´imagerie de l´espace sont rendues possibles par des mécanismes en dehors de la voie ventrale. En outre, ces résultats semblent indiquer que des dysfonctions chroniques du système visuel peuvent être réversibles avec un contrôle des crises effectif. / The aim of the present thesis was to advance the knowledge of diagnostic procedures for lateralizing visual memory deficits and to study the characteristics of perception in temporal lobe epilepsy (TLE). The first study examined the appropriateness of four routinely used learning and reproduction visuo-spatial memory tests as an identification method for right mesial temporal lobe dysfunctions. Various statistical methods illustrate the tests poor capacity to lateralize the functional deficit zone, even when epilepsy-related clinical and other cognitive factors were controlled. The second study is built upon the results of the first, aiming to validate a new test paradigm for lateralizing right hippocampal dysfunctions. Thus we assessed mesial TLE patients preoperatively with the Delayed Matching to Sample (DMS-48) task and postoperatively with two parallel versions that we had developed and standardized in healthy controls. Our analysis suggests that the DMS-48 and its parallel versions were able to lateralize the epileptic onset zone pre- and postsurgically. The third part consists of an expansion from visual memory to visual perception. A study of single case suggests that visual object recognition and visual imagery are sustained by cortical areas located in proximity to the temporo-occipital ventral pathway and that perception and imagery for space is subserved by mechanisms, which are close anatomically, and outside the ventral path. Furthermore, the results seem to indicate that nonlesional paroxysmal activity in the posterior temporal lobe can cause chronic dysfunctions of the visual system, which may be reversible with effective seizure control.

Forty to sixty percent of all children having surgery experience preoperative anxiety. Preoperative anxiety is a risk factor for negative behavioural changes postoperative. It is of importance to find strategies in the interaction with the child to reduce anxiety. The overall aim was to describe CRNA's interaction with the child in relation to anxiety during anaesthesia induction and to describe the translation process of m-YPAS into Swedish and the testing of the psychometric properties in a Swedish context. In paper I an explorative qualitative approach with CIT was used and 32 CRNAs were interviewed. Experiences described were about the organisation which included effect of information, teamwork and time. Other experiences were grouped around interrelations such as, communication, meeting both anxious and calm children and experiences of use of physical restraint. Actions taken to reduce anxiety were optimizing the situation, as acting according to the situation, it could mean altering routines, though always without jeopardizing the safety of the child, preparing ahead and using distraction. Creating interpersonal interaction such as, creating contact, participation and using collaboration with the child, parents and colleagues. In paper II m-YPAS was translated into Swedish using cross cultural back translation. The psychometric properties of m-YPAS were tested in two phases. In phase I 52 children were assessed in real time by two SRNAs and one CRNA using m-YPAS and NAS. In phase II 98 video films of children were assessed by experienced CRNAs in the same way as in phase I. The psychometric properties of m-YPAS were good. Conclusion: In the interaction between CRNAs and the child, being flexible and sensitive to the child, taking the role of the child, and acting according to the need of the child were cornerstones in reducing preoperative anxiety and avoiding use of physical restraint. The m-YPAS can be used as an educational tool to enhance the anaesthetist's ability to interpret the child's anxiety. The m-YPAS is a valid and reliable assessment instrument to examine the efficiency of interventions and compare the result of research between cultures.

Introdução: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. O objetivo deste estudo foi determinar qual o método de avaliação nutricional melhor prediz a mortalidade de 90 dias. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média(DP) 63 anos de idade (10,2) anos (intervalo = 34 a 83), submetidos a ressecções cirúrgicas, nove gastrectomias parciais e 34 (77,3%) gastrectomias totais para os tumores do estômago (Estágio II a IIIa ) foram avaliados no pré-operatório pela Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP), antropometria e métodos laboratoriais como previamente validados em outros estudos. Resultados: Vinte e nove (66%) eram desnutridos pelo método subjetivo, sendo 15 grau A, 18 grau B e 11 casos grau C. A média(DP) de espessura do músculo adutor do polegar da mão dominante (MAPD) foi de 13,2(3,8) mm e a média de albumina sérica(DP) foi de 3,9(0,5)g/dL. Os casos com ASG-PPP-B (p<0,013) e com MAPD ≤10,8mm (p=0,003) foram significativamente associados à maior mortalidade. As curvas ROC (intervalo de confiança de 95%) de ambas ASG-PPP e espessura da MAPD (0,74 e 0,78) fidedignamente predisseram mortalidade em 30 dias e 0,739 e 0,866 respectivamente em 90 dias. Conclusão: ASG-PPP e espessura da MAPD podem ser utilizados como parâmetros pré-operatórios para risco de morte. / Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. The aim of this study was to determine which nutritional assessment method better predicts 90-days mortality. Methods: Forty-four patients, 29 men and 15 women; mean(SD) age of 63(10.2) yr (range = 34 to 83), undergoing surgical resections, nine (20,5%) partial gastrectomies and 34(77,3%) total gastrectomies for stomach tumors (Stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and by laboratory sampling as previously validated in other studies. Results: Twenty-nine (66%) of them were unnourished by the subjective method as 15 grade A, 18 grade B, and 11 grade C cases. Mean(SD) of dominant hand adductor pollicis muscle thickness (DAPMT) was 13.2(3.8) mm and mean(SD) serum albumin was 3.9(0.5)g/dL. PG-SGA grade B cases (P<0.013) and DAPMT ≤10,8mm (P=0,003) were significantly associated with higher mortality. Receiver operating characteristic curves (95% confidence interval) both PG-SGA and DAPMT (0.74 and 0.78) reliably predicted in 30-day and 0.739 and 0.866 respectively in 90-day mortality. Conclusion: PG-SGA and DAPMT may be used as preoperative parameter of risk of death.

Submitted by Jordan (jordanbiblio@gmail.com) on 2017-08-29T16:50:00Z No. of bitstreams: 1 DISS_2014_Ana Laura de Almeida Dias.pdf: 1017791 bytes, checksum: 4013006bdacc910e66cd95454d5dabcd (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-08-29T16:50:22Z (GMT) No. of bitstreams: 1 DISS_2014_Ana Laura de Almeida Dias.pdf: 1017791 bytes, checksum: 4013006bdacc910e66cd95454d5dabcd (MD5) / Made available in DSpace on 2017-08-29T16:50:22Z (GMT). No. of bitstreams: 1 DISS_2014_Ana Laura de Almeida Dias.pdf: 1017791 bytes, checksum: 4013006bdacc910e66cd95454d5dabcd (MD5) Previous issue date: 2014-04-15 / Introdução: Jejum prolongado aumenta a resposta metabólica ao trauma. Este estudo multicêntrico investigou a diferença entre o tempo de jejum pré-operatório prescrito e o realizado em hospitais brasileiros. Métodos: Foram inicialmente convidados investigadores de 25 hospitais brasileiros para incluírem neste estudo, pacientes candidatos à cirurgia eletiva no período de Agosto de 2011 a Setembro de 2012. A variável de interesse principal foi a diferença entre o tempo de jejum prescrito e realizado. Outras variáveis coletadas foram sexo, idade, diagnóstico (doença maligna ou benigna), tipo de operação, escore físico ASA (Sociedade Americana de Anestesiologia), tipo de hospital (público ou privado), e o estado nutricional. Resultados: Apenas 16 dos 25 hospitais convidados enviaram dados. Os dados de 3715 pacientes (58,1% do sexo feminino) com idade média de 49 (18-94) anos de hospitais de todas as regiões do país foram analisados. A mediana (variação) do tempo de jejum pré-operatório foi de 12 (2-216) horas. Este tempo foi maior (p < 0.001) em 12 hospitais que ainda praticavam o protocolo de jejum tradicional (13[6-216] h) do que os quatro outros hospitais que já adotavam novas diretrizes de jejum (8 [2-48] h). A maioria dos pacientes (n = 2962; 79,4%) foi operada com tempo superior a 8 horas de jejum e 46% (n = 1.718) com mais 12 horas. Não houve influencia do escore físico ASA, idade, sexo, tipo de cirurgia e tipo de hospital no tempo de jejum observado (p > 0.05). Pacientes operados devido à doença benigna tiveram um tempo de jejum pré-operatório significativamente maior do que aqueles por câncer. Conclusão: O tempo de jejum pré-operatório nos hospitais brasileiros estudados é maior que o prescrito. A maioria desses hospitais ainda adota protocolos tradicionais ao invés de diretrizes modernas de jejum pré-operatório e nestes, o tempo de jejum é mais prolongado. Todos os pacientes estão em risco de permaneceram longos períodos de jejum, independente das variáveis estudadas. Pacientes submetidos a cirurgia por doença benigna tem provavelmente maior risco de jejum prolongado. / Background: Prolonged fast increases the organic response after trauma. This multicenter study investigated the difference between the prescribed and the actual preoperative fasting time in Brazilian hospitals. Methods: We initially invited researchers from 25 Brazilian hospitals to include in this study, patients candidates for elective surgery between August 2011 and September 2012. The variable of primary interest was the difference between the time of fasting prescribed and executed. Other variables collected were sex, age, surgical disease (malignancies or benign disease), operation type, ASA (American Society of Anesthesiologists) physical status score, type of hospital (public or private) and the nutritional status. Results: Only 16 of the 25 invited hospitals sent data. The data of 3,715 patients (58.1% females) with median age of 49 (18-94) years-old from hospitals in all regions of the country were analyzed. The median (range) time of preoperative fast was 12 (2-216) h. This time was greater (p < 0.001) in 12 hospitals that still using traditional fasting protocol (13 [6-216] h) than in 4 others that had already adopted new fasting guidelines (8 [2-48] h). The vast majority (n = 2,962; 79.4%) of the patients were operated on bearing greater than 8h of fast and 46% (n = 1,718) with more than 12h. There was no influence of ASA physical score, age, sex, type of surgery, and type of hospital in the observed fasting time. Patients operated on due to a benign disease had a preoperative fasting time longer than those for cancer. Conclusion: The duration of preoperative fasting in Brazilian hospitals studied is greater than the prescribed. Most of these hospitals still adopt traditional rather than modern fasting guidelines and these the fasting time is longer. All patients are remained at risk for long periods of fasting, independent of the variables studied. Patients undergoing surgery for benign disease probably have increased risk of prolonged fasting.

Bakgrund: Postoperativa sårinfektioner är en vanlig komplikation till kirurgi och orsakar lidande för patienten och extra kostnader för samhället. Preoperativ dusch är en viktig faktor som kan förhindra uppkomsten av komplikationer efter en operation. Sjuksköterskan ansvarar för att kunna anpassa informationen till patienten om den preoperativa duschen så att patienten känner sig välinformerad och trygg i situationen. Syfte: Syftet med denna studie var att undersöka hur information om genomförandet och vikten av den preoperativa duschen anpassas till patienten. Metod: Deskriptiv design med kvalitativ induktiv ansats. Semistrukurerade intervjuer genomfördes med 11 sjuksköterskor. För analys av resultatet har kvalitativ innehållsanalys inspirerad av Graneheim och Lundman (2004) använts.  Resultat: Studiens resultat visade att anpassad information om genomförandet och vikten av den preoperativa duschen var viktig för att öka patientens känsla av trygghet och delaktighet. Att använda ett gemensamt språk med ord anpassade till patienten lyftes fram som viktigt för att kunna ge anpassad information. I intervjuerna framkom även att det fanns ett behov av skriftlig information på olika språk. Sjuksköterskorna var överens om att faktorer i arbetsmiljön – såsom tidspress, hög arbetsbelastning samt dåligt samarbete mellan avdelningar - var en stor anledning till att information blev bristfällig och nedprioriterades. Slutsats: Sjuksköterskornas information om den preoperativa duschen fokuserade främst på genomförandet och lite vikt las på varför den skulle göras. Att ha tid identifierades som en viktig förutsättning för att kunna anpassa information till patienten, och på så viss öka deras känslor av delaktighet och trygghet. Informationen om den preoperativa duschen nedprioriterades ofta på grund av att andra arbetsuppgifter ansågs viktigare. För att öka sjuksköterskornas förståelse för betydelsen av den preoperativa duschen skulle operationssjuksköterskan kunna dela med sig av sin kompetens och hjälpa till med utformandet av skriftlig information. / Background: Surgical site infections are common complications of surgery and causes suffering for the patient and extra costs for the society. The preoperative shower is an important factor that can prevent the occurrence of complications caused by surgery. The Registered Nurse is responsible to inform the patient about the preoperative shower so that the patient feels well-informed and safe in the situation.  Aim: The aim of this study is to explore how information about the implementation and the importance of the preoperative shower is adapted to the patient.  Method: Descriptive design with a qualitative inductive onset. Semi-structured interviews were conducted with 11 Registered Nurses. A qualitative content analysis inspired by Graneheim and Lundman (2004) was used for the analysis.  Result: The result showed that adapted information about the implementation and importance of the preoperative shower was important for enhancing the patient’s feeling of safety and participation. To use a common language with words adapted to the patient was regarded as important for the ability to give an adapted information. The necessity of written information in different languages was also identified in the interviews. The Registered Nurses agreed that factors in the work-environment – such as insufficient time, an extensive workload and poor co-operation between wards – were strong reasons causing information to become inadequate and not prioritised. Conclusion: The Registered Nurses information about the preoperative shower focused mainly on its implementation, and little on its importance. To be given time was identified as important for the ability to adept the information to the patient, and thus enhance the patients feeling of participation and safety. Information about the preoperative shower was often given lower priority due to other, higher prioritised, duties. To enhance the Registered Nurses understanding of the meaning of the preoperative shower the theater nurse could share their knowledge and be helpful in the design of written information.

Introdução: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. O objetivo deste estudo foi determinar qual o método de avaliação nutricional melhor prediz a mortalidade de 90 dias. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média(DP) 63 anos de idade (10,2) anos (intervalo = 34 a 83), submetidos a ressecções cirúrgicas, nove gastrectomias parciais e 34 (77,3%) gastrectomias totais para os tumores do estômago (Estágio II a IIIa ) foram avaliados no pré-operatório pela Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP), antropometria e métodos laboratoriais como previamente validados em outros estudos. Resultados: Vinte e nove (66%) eram desnutridos pelo método subjetivo, sendo 15 grau A, 18 grau B e 11 casos grau C. A média(DP) de espessura do músculo adutor do polegar da mão dominante (MAPD) foi de 13,2(3,8) mm e a média de albumina sérica(DP) foi de 3,9(0,5)g/dL. Os casos com ASG-PPP-B (p<0,013) e com MAPD ≤10,8mm (p=0,003) foram significativamente associados à maior mortalidade. As curvas ROC (intervalo de confiança de 95%) de ambas ASG-PPP e espessura da MAPD (0,74 e 0,78) fidedignamente predisseram mortalidade em 30 dias e 0,739 e 0,866 respectivamente em 90 dias. Conclusão: ASG-PPP e espessura da MAPD podem ser utilizados como parâmetros pré-operatórios para risco de morte. / Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. The aim of this study was to determine which nutritional assessment method better predicts 90-days mortality. Methods: Forty-four patients, 29 men and 15 women; mean(SD) age of 63(10.2) yr (range = 34 to 83), undergoing surgical resections, nine (20,5%) partial gastrectomies and 34(77,3%) total gastrectomies for stomach tumors (Stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and by laboratory sampling as previously validated in other studies. Results: Twenty-nine (66%) of them were unnourished by the subjective method as 15 grade A, 18 grade B, and 11 grade C cases. Mean(SD) of dominant hand adductor pollicis muscle thickness (DAPMT) was 13.2(3.8) mm and mean(SD) serum albumin was 3.9(0.5)g/dL. PG-SGA grade B cases (P<0.013) and DAPMT ≤10,8mm (P=0,003) were significantly associated with higher mortality. Receiver operating characteristic curves (95% confidence interval) both PG-SGA and DAPMT (0.74 and 0.78) reliably predicted in 30-day and 0.739 and 0.866 respectively in 90-day mortality. Conclusion: PG-SGA and DAPMT may be used as preoperative parameter of risk of death.

Gällande riktlinjer för preoperativ fasta beskriver att patienter med liten risk för aspiration kan inta fast föda fram till sex timmar och klara drycker fram till två timmar före start av anestesi. Studier har visat att många patienter fastar längre, vilket kan ha negativ inverkan både fysiologiskt och på välbefinnandet som till exempel dehydrering, törst, illamående, huvudvärk och nedsatt insulinkänslighet. Syftet med studien var att kartlägga och beskriva preoperativa fastetider, dryckintag samt förekomst av törst hos patienter planerade för elektiv kirurgi. Strukturerade intervjuer genomfördes under fem dagar med 50 patienter som rekryterades konsekutivt på två preoperativa avdelningar. Resultaten visade att majoriteten av patienterna instruerats att inta klara drycker fram till två timmar före start av anestesi. Fastetider hos patienter med strikt fasta varierade mellan 7,75 till 13,25 timmar (median 10 och dryckintag mellan 0,5 till 7,5 glas (medelvärde 3,14; standardavvikelse 1,98). Fastetider hos patienter med flytande fasta varierade mellan 0,75 till 11,25 timmar (median 3,5 och dryckintag mellan 1 till 9 glas (medelvärde 4,31; standardavvikelse 1,91). Av de 50 intervjuade patienterna uppgav 44 % att de upplevde törst. Studiens resultat visade på en stor variation i fastetider och dryckintag där de äldsta patienterna tenderade att fasta länge och inta små mängder dryck preoperativt. / Existing guidelines for preoperative fasting means that patients with a minimal risk of aspiration can take solid food until six hours, and clear drinks until two hours before start of anesthesia. Studies have shown that many patients are fasting longer, which may be detrimental both physiologically and on wellbeing, for example, dehydration, thirst, nausea, headache and reduced insulin sensitivity. The purpose of this study was to map and describe fasting times, beverage intake and the incidence of thirst preoperatively in patients who were undergoing elective surgery. Structured interviews were conducted over five days with 50 patients who were enrolled consecutively in two preoperative departments. The results showed that fasting times in patients with strict fasting ranged from 7.75 to 13.25 hours (MD 10) and beverage intake between 0.5 to 7.5 glasses (3.14 SD 1,98). Fasting times in patients with float fasting ranged from 0.75 to 11.25 hours (MD 3,5) and beverage intake between 1 to 9 glasses (4,31 SD 1,91). Of the 50 interviewed patients, 44 % said they experienced thirst. The results indicated a wide variation in preoperative fasting times and beverage intake, where the oldest patients tended to have long duration of fasting and intake of small amounts of beverage preoperatively. / <p>2010 felaktigt årtal titelsida</p>

Bakgrund: Många barn upplever ett stort stresspåslag inför sövning, detta kallas preoperativ oro och drabbar mellan 40-60 % av alla barn som sövs. Preoperativ oro hos barnet kan ge upphov till känslor av anspänning, stress, nervositet och oro samt agitation vid uppvaknande. Preventiva metoder för att minska preoperativ oro kan delas in i grupper som innefattar icke-farmakologiska och farmakologiska metoder. Syfte: Syftet med studien var att beskriva olika preventiva åtgärder och deras effektivitet för att minska barns preoperativa oro i åldrarna 2-12 år. Metod: Litteraturstudie med metaanalys. Inklusionskriterierna var RCT-studier publicerade mellan 2006-01-01 och 2017-01-12, engelskspråkiga och publicerade i referee-granskade tidskrifter, tydligt beskriven intervention, mätning av preoperativ oro samt att deltagarålder skulle vara mellan 2-12 år. Databassökningarna utfördes i PubMED, Cinahl och PsycINFO. Resultat: Video- och dataspelsdistraktion, clowner, teknikbaserad preoperativ information och lekterapi är effektivt för att minska barns preoperativa oro och ängslan. Föräldranärvaro saknar effekt på barns preoperativa oro och ängslan. Midazolam är effektivt som premedicinering. En inspelning av barnets moders röst samt en icke-farmakologisk multidisciplinär approach har båda effekt på barns preoperativa oro och ängslan. Konklusion: Video- och dataspelsdistraktion, clowner, lekterapi och premedicinering var välfungerande och effektiva interventioner för att minska barns preoperativa oro.

Bakgrund: Preoperativ nutritionsbehandling har en betydande effekt på den postoperativa återhämtningen och hälsan hos patienten. Syfte: Beskriva i vilken utsträckning patienter, vilka genomgår elektiv kirurgi, får evidensbaserad omvårdnad i form av preoperativ nutritionsbehandling och vilka hinder som kan finnas för att följa riktlinjerna enligt de inkluderade sjuksköterskorna. Eventuella skillnader i genomförandet av den preoperativa nutritionsbehandlingen, beroende på om kirurgin utförs tidigt på morgonen eller inte, har också beskrivits. Metod: Deskriptiv med egenkonstruerad enkät. Enkäten innehåller fem frågor med förutbestämda svarsalternativ samt möjlighet till fri text. Fyra kirurgiska enheter sammankopplade på centraloperation på Akademiska sjukhuset i Uppsala utförde 114 elektiva operationer under datainsamlingsperioden. Av de 114 operationerna inkluderades totalt 103 enkäter. Resultat: 17,5 % av patienterna erhöll preoperativ nutritionsbehandling. Vid 8,7 % av operationerna visste inte ansvarig sjuksköterska om patienten fått behandlingen. Bland de orsaker som sjuksköterskor angav då någon av rekommendationerna inte följdes var “annan rutin på avdelning” (53,9%) mest förekommande. Nollhypotesen förkastas eftersom den preoperativa nutritionsbehandlingen genomförs oftare för patienter innan klockan 08.30 (30,7%) till skillnad från efter klockan 08.30 (4%). Slutsats: Evidensbaserade rekommendationer beträffande preoperativ nutritionsbehandling genomförs i låg utsträckning. Det förekommer också omvårdnadskillnader angående nutritionen över dygnet. Resultatet visar på bristande implementering och uppföljning av rutiner samt otillräckligt uppdaterad personal. Det är av betydelse att erinra sjuksköterskan om hennes kärnkompetenser och vad det innebär att tillgodose patienten en god vård, för att upprätthålla liv, främja hälsa och öka välbefinnande. / Background: Preoperative nutrition therapy has a significant effect on the postoperative recovery and health of the patient. Objective: To describe the extent patients, undergoing elective surgery, receive evidence-based preoperative nutrition treatment. Also to describe any possible barriers, by asking included nurses, why the guidelines were not executed. The aim was further to describe if there may be any differences in the implementation of the preoperative nutrition treatment, depending on if the surgery is planned before 8.30am or after. Method: Descriptive and the questionnaire was designed for this study. Four surgical units at Uppsala University Hospital performed 114 elective operations and a total of 103 questionnaires were valid data. Result: 17,5% of elective surgical patients received preoperative nutrition treatment. Among the reasons nurses indicated, when one of the recommendations was not executed, was the most common "other routines by department" (53.9%). In addition, the zero hypothesis is rejected because the preoperative nutritional treatment is performed more often for patients before 8:30 am (30,7%) compared to after (4%). Conclusion: Recommendations based on evidence and regarding preoperative nutrition treatment are conducted to a limited extent. There are also differences regarding the nutrition care throughout the day. The result shows lack of implementation and control of routines and insufficiently updated staff. It is important to remind the nurse of her core competencies and what it means to provide the patient with a good care in order to maintain life, promote health and increase well-being.

Introduction. Every year, millions of people are undergoing operation in Sweden. Many patients feel worry, anxiety and fear about this. Preoperative information is of great importance and the way it is communicated. Aim: To illuminate how patients who have undergone surgery experienced the communication and treatment from healthcare professionals and how it affected their wellbeing before an operation. Method: A general literature review based on 9 scientific articles with a qualitative approach. PubMed and CINAHL were the databases used in the literature search. The articles have been quality reviewed and were published between 2003-2020. Result: Patients appreciated when healthcare professionals communicated information that was tailored to their information needs and given in a way that the patient could understand, which reduced their concerns. The best method was individual for each patient. The fact that patients felt seen as individuals had a major impact on their preoperative anxiety. Negative experiences that were highlighted in the studies were when the healthcare professionals didn't have time to talk or when they ignored the patients, which created worry and unnecessary anxiety. Conclusion: Patients appreciate a person-centered treatment where the healthcare professionals looks after and meets the needs of the unique person. By providing good preoperative information with a good treatment and good communication, symptoms such as worry, anxiety and fear can be reduced, and increased well-being created.Keywords: Patient, treatment, communication, nurse, preoperative