Placa óssea é o nome designado para os implantes sintéticos utilizados como suporte – a fim de auxiliar na consolidação óssea − quando por algum motivo ocorrer fratura do sistema ósseo do corpo humano. Esta tese investiga o comportamento em fadiga de placas ósseas, do tipo DCP (Dynamic Compression Plate), utilizadas no tratamento de fraturas do fêmur, fabricadas em aço inoxidável e submetidas a condições pré-operatórias. A deformação pré-operatória é uma prática comum realizada antes da operação cirúrgica, a qual consiste no encurvamento do componente, com o objetivo de ajustar a placa à anatomia do osso, aumentando a compressão nos ossos fraturados e facilitando a consolidação óssea. O encurvamento da placa gera deformação plástica permanente no metal, sendo previsto na norma de placas ósseas da série ABNT NBR 15676 (equivalente à ASTM F 382). Contudo, na mesma série de normas, é recomendado que o ensaio de fadiga em flexão seja conduzido sem a deformação da placa, o que não condiz com a realidade de utilização do componente. Desta forma, uma investigação aprofundada sobre as tensões residuais impostas pelo encurvamento da placa, e suas consequências na vida em fadiga foram analisadas, com o intuito de verificar a influência deste procedimento na resistência do componente. Para isto, 30 placas foram avaliadas quanto aos seguintes requisitos: acabamento superficial (lupa), tensões residuais (difratômetro de raio X), flexão estático e fadiga (máquina de ensaios mecânicos servo-hidráulica), superfície de fratura (microscópio eletrônico de varredura) e aspecto microestrutural (microscópio ótico). Os resultados indicam que o dobramento controlado pode contribuir para resistência da placa, porém se o dobramento for realizado de forma descontrolada, a resistência à fadiga é reduzida, expondo o paciente a um risco de fratura do componente metálico dentro do corpo. / Bone plate is the name designated to the synthetic implants used to give support to a fractured bone of the human skeletal system. This thesis investigates the fatigue behavior of DCP (Dynamic Compression Plate) plate bone, which is used for treatment of femoral fractures, treatment of femoral fractures manufactured in stainless steel and subjected to preoperative conditions. Preoperative deformation, or contouring, is a common practice performed before surgical operation, which consists to bend the component, in order to adjust it to the bone anatomy, increasing the compression on the fractured bones and facilitating bone healing. This practice is predicted in the bone plates standard (ABNT NBR 15676/ASTM F382). However, the test method recommends that the test should be conducted without contouring, but this is not consistent with the reality of the component use. Thus, a thorough investigation of residual stresses imposed by the plate bending and their consequences on fatigue limit were analyzed, in order to check the influence of this procedure on the strength of the component. Therefore, 30 plates were evaluated against the following requirements: surface finish (stereoscopic microscope), residual stress (X-ray diffractometer), static and dynamic bend testing (Servo Hydraulic Mechanical Testing Machines), fracture surface analysis (scanning electron microscope) and microstructural aspects (optical microscope). The results indicate that controlled bending contributes to plate strength, but if uncontrolled bending is carried out, the fatigue strength is reduced, exposing the patient to a risk of breaking the component inside the body.

Trata-se de um estudo descritivo prospectivo, com abordagem quantitativa, sobre as complicações de estoma e de pele periestoma de estomizados intestinais em seguimento ambulatorial, que teve como objetivos caracterizar o perfil sociodemográfico e clínico desta clientela em um hospital universitário de ensino público; descrever a presença de fatores de risco descritos na literatura científica para esta clientela; e analisar a presença de complicações de estoma e de pele periestoma nesta clientela (CEP/EERP 383.771). Os critérios de inclusão da amostra foram pacientes maiores de 18 anos, independente da raça, classe social e sexo, com estomias intestinais e em seguimento ambulatorial no período da coleta de dados e o critério de exclusão foi paciente com instabilidade clínica. A amostra de conveniência foi composta por 56 estomizados. Utilizou-se instrumento de coleta de dados, contemplando dados sociodemográficos, clínicos e terapêuticos, assim como presença de complicações de estoma e pele periestoma e utilização de equipamentos coletores e adjuvantes. A coleta de dados ocorreu no período de setembro de 2013 a fevereiro de 2014. Foi criado um banco de dados no Excel, mediante dupla digitação, cuja análise estatística descritiva foi realizada pelo Programa SPSS, versão 17.0, com frequência absoluta, relativa e percentual. Os resultados evidenciaram distribuição equitativa em relação ao sexo, média de idade de 56,2 anos, predomínio das neoplasias colorretais 31 (55,4%), de normalidade do índice de massa corporal 47 (83,9%), presença de comorbidades 7 (12,5%), realização de quimioterapia adjuvante 15 (26,8%), cirurgias de grande porte 43 (76,8%) e demarcação pré-operatória 43 (76,8%) e 21 (37,5%) pacientes com complicações de estoma e pele periestoma. Do total de 43 (76,8%) demarcados, 14 (32,6%) apresentaram complicações, enquanto que nos 13 (23,2%) não demarcados, 7 (53,8%) tiveram complicações. Em relação aos equipamentos coletores e adjuvantes 51 (91%) utilizavam bolsa de duas peças, drenável 51 (91%), base flexível 31 (55,4%), cinto 40 (71,4%) e barreira protetora 1 (1,8%). Os fatores de risco para complicações de estoma e de pele periestoma como idade avançada, comorbidade, localização do estoma, não demarcação de estoma e não utilização de barreiras protetoras foi verificada na amostra. Conclui-se que no seguimento ambulatorial desta clientela, há necessidade de avaliação periódica e sistematizada em relação ao autocuidado, indicação dos equipamentos coletores e adjuvantes com adaptação às necessidades de cada paciente, além da identificação dos fatores de risco para prevenção destas complicações / This is a prospective descriptive study with a quantitative approach, on the complications of the stoma and peristomal skin of ostomy intestinal outpatients, we aimed to characterize the sociodemographic and clinical profile of the clientele in a university hospital in public education; describe the presence of risk factors described in the scientific literature for this clientele; and analyze the presence of complications of the stoma and peristomal skin in this clientele (CEP / EERP 383 771). The inclusion criteria for the sample were patients older than 18 years, regardless of race, social class and gender, with intestinal stomas and in outpatients in the period of data collection and the exclusion criteria were patients with clinical instability. The convenience sample consisted of 56 ostomates. Instrument was used for data collection, covering sociodemographic, clinical and therapeutic data, as well as the presence of complications of the stoma and peristomal skin and use of equipment and aids collectors. Data collection occurred from September 2013 to February 2014. A database in Excel, by double entry, whose descriptive statistical analysis was performed using SPSS, version 17.0, with absolute, relative and percentage frequency was created. The results showed equal distribution in relation to sex, average age of 56.2 years, prevalence of colorectal neoplasms 31 (55.4%), normal body mass index 47 (83.9%), presence of comorbidities 7 (12.5%) accomplishment of adjuvant chemotherapy 15 (26.8%), large surgeries 43 (76.8%) and preoperative demarcation 43 (76.8%) and 21 (37.5%) patients with complications of the stoma and peristomal skin. Of 43 (76.8%) demarcated, 14 (32.6%) had complications, whereas in 13 (23.2%) unmarked, 7 (53.8%) had complications. Regarding equipment collectors and adjuvants 51 (91%) used two-piece pouch, drainable 51 (91%), flexible base 31 (55.4%), belt 40 (71.4%) and protective barrier 1 (1, 8%). Risk factors for complications of the stoma and peristomal skin such as age, comorbidity, location of stoma, no demarcation of stoma and non-use of protective barriers was seen in the sample. It is concluded that, for the outpatients, there is need for regular and systematic review in relation to self-care, statement of collectors equipment and aids to adapt to the needs of each patient during follow-up of this clientele, in addition to the identification of risk factors for prevention of these complications

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-06T14:11:31Z No. of bitstreams: 1 lucianodemellofonseca.pdf: 1602877 bytes, checksum: bb883b5f6533f44501e8e6cbd9f346ac (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-07T12:01:09Z (GMT) No. of bitstreams: 1 lucianodemellofonseca.pdf: 1602877 bytes, checksum: bb883b5f6533f44501e8e6cbd9f346ac (MD5) / Made available in DSpace on 2016-10-07T12:01:09Z (GMT). No. of bitstreams: 1 lucianodemellofonseca.pdf: 1602877 bytes, checksum: bb883b5f6533f44501e8e6cbd9f346ac (MD5) Previous issue date: 2009-03-30 / A ansiedade pré–operatória é um evento deletério que acomete um grande número de pessoas, nos mais variados graus e seu controle antes e durante os procedimentos cirúrgicos odontológicos torna-se então de fundamental importância na prática clínica, pois trará mais conforto tanto para pacientes quanto para o Cirurgião–Dentista. Avaliou comparativamente a efetividade clínica da acupuntura sistêmica e auricular no controle da ansiedade antes de cirurgias de terceiro molares inferiores. Os pacientes foram distribuídos em três grupos: grupo sistêmico, constituído de 12 indivíduos, tratados com acupuntura sistêmica, antes do procedimento cirúrgico; grupo auricular, constituído de 13 indivíduos, tratados com acupuntura auricular, antes do procedimento cirúrgico; grupo controle, constituído de 12 indivíduos, que não receberam tratamento antes da cirurgia. A avaliação da efetividade terapêutica fundamentou- se na mensuração da ansiedade, conduzida de forma objetiva, através da aferição da pressão arterial e freqüência cardíaca, e subjetiva, por intermédio de dois tipos de escalas visuais analógicas (EVA). Os resultados obtidos nos dois grupos, quanto à avaliação objetiva, não foram estatisticamente significativos as variações da pressão arterial (p>0,05), contudo houve diferenças estatisticamente significativa nas variações da freqüência cardíaca ( p<0,05) evidenciados pela diminuição dos seus valores, quando comparados antes e depois do tratamento. Quanto a avaliação subjetiva, resultados significativos foram obtidos pelos dois grupos tratamento (p<0,05), demonstrados pela diminuição dos escores, quando comparados antes e depois do tratamento com cada modalidade de acupuntura. Podemos concluir que a acupuntura sistêmica e auricular mostraram- se importantes métodos de tratamento da ansiedade pré- operatória em cirurgias odontológicas, visto terem alcançado uma confiabilidade significativa de efetividade, que nos faz indicá-la e sugerir o seu uso com esta finalidade. / Pre-operative anxiety is a deleterious event that affects a large number of people in different degrees and their control in the dental surgery then becomes of paramount importance in clinical practice, it brings more comfort for both patients and for the surgeon to evaluate the clinical effectiveness of auricular acupuncture and systemic control of anxiety before and during surgery of the third lower molars. The patients were divided at random into three groups: systemic group consisting of 12 subjects treated with systemic acupuncture before surgery; auricular group, consisting of 13 patients treated with auricular acupuncture before surgical procedures and control group, consisting of 12 individuals who received no treatment before surgery The assessment of therapeutic effectiveness was based on measurement of anxiety conducted in two forms: objective, through the measurement of blood pressure and heart rate, and subjective, through two types of visual analog scales (VAS). The results obtained from the systemic group and from the auricular group as to the objective evaluation in blood pressure were not statistically significant (p> 0.05) though there was a significant variation in heart rate (p <0.05) evidenced by the decrease in their values when compared before and after treatment. As to the subjective evaluation significant results were obtained by the two treatment groups (P <0.05), demonstrated by the decrease in scores when compared before and after treatment with each type of acupuncture. We conclude that the systemic and auricular acupuncture proved to be important methods of treatment of preoperative anxiety in dental surgery, since they have achieved a significant degree of reliability that makes us suggest its use for this purpose.

Sammanfattning Bakgrund:  Preoperativ oro kan orsaka höga nivåer av stress hos barnet bland annat på grund av separation från föräldrarna, rädsla, inte veta vad som skall hända och att befinna sig i en okänd miljö. Upp till 50% av barn som skall opereras upplever preoperativ oro vilket kan leda till oönskade konsekvenser som högre förekomst av postoperativt delirium, postoperativ oro och ökad smärta men även ge negativa effekter under en längre tid postoperativt som mardrömmar, att vakna gråtandes, separationsångest, vredesutbrott, trots riktat mot föräldrarna och nytillkommen nattlig sängvätning. Anestesisjuksköterskan har ett ansvar i att minska preoperativ oro och därmed förbättra barnets upplevelse av situationen och förebygga negativa konsekvenser. Syfte: Syftet med studien är att belysa icke farmakologiska strategier och deras effekt i arbetet med preoperativt oroliga barn vilka skall genomgå generell anestesi. Metod: Systematisk litteraturstudie. Inklusionskriterier experiment studier rörande barn 0-18 år som skulle genomgå generell anestesi inför operation,  publicerade 120101-180213, i vetenskapliga engelskspråkiga referee-granskade tidskrifter. Databassökningar utfördes i PubMED, Cinahl och PsychINFO. Resultat: Två metoder som effektivt lindrar oro framkom i materialet. Distraktion, genom film, spel eller böcker, i samband med anestesiinduktion är en metod. Även preoperativt förberedande information i form av multi-media eller specialskrivna texter (sagoböcker och informationsbroschyrer) har visat sig ha en lindrande effekt. Utvidgad information till föräldrar, med tanke att förberedda föräldrar bättre hjälper sitt barn och minskar barnets preoperativa oro, gav inte mätbar effekt på barnens oro. / Abstract Background: Preoperative anxiety can cause high levels of stress in the child, for example due to separation from parents, fear, not knowing what to happen and being in an unknown environment. Up to 50% of children to be treated experience preoperative anxiety which may lead to unwanted consequences such as higher incidence of postoperative delirium, postoperative anxiety and increased pain but also give negative effects for a longer period of time postoperatively like nightmares, waking crying, separation anxiety, outbreaks of anger, temper tantrums and enuresis. Nurse anesthetist has a responsibility in reducing preoperative anxiety and thus improving the child's experience of the situation, preventing negative consequences. Purpose: The purpose of the study is to highlight non-pharmacological strategies and their effects in the work with preoperatively anxoius children, undergoing general anesthesia. Method: Systematic literature study. Inclusion criteria experimental studies on children 0-18 years who were to undergo general anesthesia prior to surgery, published 120101-180213, in scientific English-language referee-reviewed journals. Database searches were performed in PubMED, Cinahl and PsychINFO. Result: Two methods that relieve anxiety emerged in the material. Distraction, through movies, games or books, during the anesthesia indiction or preoperatively preparatory information in the form of multi-media or special-written texts (storybooks and information brochures). Expanded information to parents, given that prepared parents better help their children and reduce the child's preoperative anxiety, did not give a measurable effect. Conclusion: Preoperative, age-appropriate information for the child and distraction during the anesthesia induction are, respectively, effective methods to alleviate the preoperative anxiety of children.

Surgery is an experience that brings uncomfortable examinations and discomfort and can often become an incomprehensible and traumatic experience. In the case of pediatric surgery, there is a belief that children are not always in a position to understand and deal with what surgery encompasses, considering that their psychic apparatus is still being formed. These procedures are, obviously, accompanied by numerous fantasies in an attempt to defense themselves and recover emotional balance to be able to face the situation. Therefore, this was a qualitative, descriptive and exploratory study to investigate children s fantasies the day before surgery, in psychoanalytic theory. Seven children were included, of both sexes, five to twelve years old, admitted in a public hospital for surgery during 2014. Play Time and Fables Test were used as instruments. The implementation of the instruments was performed in a single moment, recorded, transcribed verbatim and the data was then passed through content analysis. The participants expressed the perception of themselves as defective and possessed feelings of fragility, helplessness and had many fears. The presence of frightening and elaborative fantasies was identified as a defense attempt and a way of making sense of surgical experience. It was concluded that the fantasies had a paradoxical role; that is, even if they constituted a regressive defense, they proved to be protective structure and helped to make sense of the surgical experience. / A cirurgia é uma experiência que traz consigo exames incômodos e mal-estares, tornando-se, muitas vezes, uma experiência incompreensível e traumatizante. No caso da cirurgia pediátrica, existe a crença de que a criança, na medida em que, por estar com o aparelho psíquico ainda em formação, nem sempre tem condições para compreender e lidar com o que a cirurgia mobiliza. Estes procedimentos, naturalmente, são acompanhados de inúmeras fantasias, como tentativa de defesa e de reestabelecimento de equilíbrio emocional para conseguir enfrentar essa situação. Para tanto, realizou-se estudo qualitativo, descritivo e exploratório que se propôs a investigar as fantasias presentes em crianças no dia anterior à cirurgia, dentro de um referencial teórico psicanalítico. Foram incluídas sete crianças, de ambos os sexos, com idade de cinco a doze anos, internadas em hospital público para realização de cirurgia durante o ano de 2014. Utilizaram-se como instrumentos A Hora do Jogo e o Teste das Fábulas, aplicados em um único momento, tendo sido gravados e transcritos na íntegra; os dados passaram por análise de conteúdo. Os participantes expressaram a percepção de si enquanto defeituosos, bem como sentimentos de fragilidade, desamparo e diversos medos. Identificou-se a presença de fantasias atemorizantes e elaborativas como tentativa de defesa e de atribuir sentido à experiência cirúrgica. Concluiuse que a fantasia manteve seu papel paradoxal, isto é, ao mesmo em que se constituiu em uma defesa regressiva, revelou-se uma estrutura protetora, auxiliando a atribuir sentido pessoal à cirurgia.

Abstract The goal of this study was to explore preoperative evaluation of patients with intracranial tumours using magnetic resonance imaging (MRI) methods: oedema-attenuated inversion recovery (EDAIR) sequence in low-field MRI, and diffusion-weighted imaging (DWI) and resting-state functional MRI (fMRI) in high-field MRI. The aim was also to increase our knowledge about the effects of brain surgery on eloquent brain cortices using new MRI techniques. The total number of patients in these studies was 50 (24 women). Enhancement of the tumour in ten patients after intravenous administration of gadolinium-based contrast agent in low-field MRI was examined with a new sequence, EDAIR, and compared with more conventionally used partial saturation spin echo sequences. EDAIR may facilitate the perception of small enhancing lesions and is valuable in low-field imaging, where T1-based contrast is inferior to high-field imaging. DWI was performed on 25 patients in order to evaluate the potential of this imaging method to assist in differential diagnosis of intracranial tumours. It was shown that apparent diffusion coefficient values of the tumour and peritumoural oedema produced by DWI were different in benign and malignant tumours. Resting-state blood oxygen level-dependent (BOLD) fMRI was performed on eight patients and ten healthy volunteers to examine if functional sensorimotor areas in the brain could be determined without any task-related activations. It was shown that intracranial tumours do not appear to hamper visualization of the sensorimotor area in resting-state BOLD fMRI when independent component analysis is performed, and this method may be used in preoperative imaging when activation studies cannot be performed. Conventional BOLD fMRI with motor and auditory stimuli was used with seven patients as the effect of brain surgery was studied. The results suggest that resection of a tumour with preoperative oedema probably decreases pressure on the brain and makes the functional cortex transiently more easily detectable in BOLD fMRI. In conclusion, the MRI imaging methods used in this study can give valuable additional information about the tumour, specifically for preoperative imaging and planning for surgery.

Cette thèse présente une approche multicompartimentée en métabolomique appliquée au diagnostic des tumeurs indéterminées de la thyroïde et à la caractérisation de l’effet du fructo-oligosaccharide sous condition de régime hyperlipidique chez la souris. L’objectif était de montrer qu’une telle approche permettrait de visualiser de façon plus globale des modulations du métabolisme induites, et par conséquent, d’améliorer la pertinence des marqueurs discriminants identifiés. Dans le cas de l'analyse nutritionnelle, l’analyse mono-compartimentée des différentes organes/segments intestinaux des souris ont permis de mettre en évidence les voies métaboliques affectées par le régime hyperlipidique mais pas d’observer un effet significatif du prébiotique FOS. Dans le cas du cancer de la thyroïde, l’étude multicompartimentée n’a pas pu être mise en place dans de bonnes conditions (problème de prélèvement d’échantillons). Cependant, l’analyse métabolomique monocompartimentée basée sur l’analyse HR-MAS des ponctions prélevées à l’aiguille fine a mené à une discrimination significative entre les lésions bénignes et malignes avec une prédictivité similaire aux tests moléculaires actuellement disponibles. En parallèle, nous avons exploré la technique HR-MAS à rotation lente dans le but de préserver l’intégrité des tissus au cours des expériences. L’utilisation de cette technique s’accompagne d’un certain nombre d’inconvénients que nous avons contournés en utilisant des séquences RMN particulières, et en mettant en place un protocole robuste de préparation d’échantillons. Enfin, nous avons évalué le filtre T1ρ et son application en métabolomique comme alternative au filtre T2. / This thesis presents a multicompartmental metabolomics approach applied to the diagnosis of indeterminate thyroid tumours and to the characterization of the effect of fructo-oligosaccharide (FOS), a prebiotic, under high fat diet condition in a mouse model. The aim of this project is to show that such approach could lead to a more global visualization of the induced metabolic modulations, and therefore, improve the identified discriminant markers relevance. Regarding the diet study, the mono-compartmental analysis of the different mouse organs/intestine segments enabled us to identify metabolic pathways affected by the high fat diet whereas the effect of FOS could only be characterized for the feces samples collected at day 28. Regarding the thyroid cancer study, the multi-compartmental approach could not have been continued due to sample handling issues. However, the classical metabolomics analysis of the fine-needle aspiration biopsies (FNAB) from patients with benign or malignant tumours led to a clear discrimination between both groups with a predictivity similar to that of commercial diagnosis tests. In the meantime, we explored the slow-spinning NMR HR-MAS technique in order to preserve the integrity of the tissues during the experiments. The use of this technique is accompanied by a number of drawbacks that we have avoided using special NMR sequences, and putting in place a robust protocol for sample preparation. Finally, we evaluated the T1ρ filter and its applications to metabolomics as an alternative to T2 filter.

Placa óssea é o nome designado para os implantes sintéticos utilizados como suporte – a fim de auxiliar na consolidação óssea − quando por algum motivo ocorrer fratura do sistema ósseo do corpo humano. Esta tese investiga o comportamento em fadiga de placas ósseas, do tipo DCP (Dynamic Compression Plate), utilizadas no tratamento de fraturas do fêmur, fabricadas em aço inoxidável e submetidas a condições pré-operatórias. A deformação pré-operatória é uma prática comum realizada antes da operação cirúrgica, a qual consiste no encurvamento do componente, com o objetivo de ajustar a placa à anatomia do osso, aumentando a compressão nos ossos fraturados e facilitando a consolidação óssea. O encurvamento da placa gera deformação plástica permanente no metal, sendo previsto na norma de placas ósseas da série ABNT NBR 15676 (equivalente à ASTM F 382). Contudo, na mesma série de normas, é recomendado que o ensaio de fadiga em flexão seja conduzido sem a deformação da placa, o que não condiz com a realidade de utilização do componente. Desta forma, uma investigação aprofundada sobre as tensões residuais impostas pelo encurvamento da placa, e suas consequências na vida em fadiga foram analisadas, com o intuito de verificar a influência deste procedimento na resistência do componente. Para isto, 30 placas foram avaliadas quanto aos seguintes requisitos: acabamento superficial (lupa), tensões residuais (difratômetro de raio X), flexão estático e fadiga (máquina de ensaios mecânicos servo-hidráulica), superfície de fratura (microscópio eletrônico de varredura) e aspecto microestrutural (microscópio ótico). Os resultados indicam que o dobramento controlado pode contribuir para resistência da placa, porém se o dobramento for realizado de forma descontrolada, a resistência à fadiga é reduzida, expondo o paciente a um risco de fratura do componente metálico dentro do corpo. / Bone plate is the name designated to the synthetic implants used to give support to a fractured bone of the human skeletal system. This thesis investigates the fatigue behavior of DCP (Dynamic Compression Plate) plate bone, which is used for treatment of femoral fractures, treatment of femoral fractures manufactured in stainless steel and subjected to preoperative conditions. Preoperative deformation, or contouring, is a common practice performed before surgical operation, which consists to bend the component, in order to adjust it to the bone anatomy, increasing the compression on the fractured bones and facilitating bone healing. This practice is predicted in the bone plates standard (ABNT NBR 15676/ASTM F382). However, the test method recommends that the test should be conducted without contouring, but this is not consistent with the reality of the component use. Thus, a thorough investigation of residual stresses imposed by the plate bending and their consequences on fatigue limit were analyzed, in order to check the influence of this procedure on the strength of the component. Therefore, 30 plates were evaluated against the following requirements: surface finish (stereoscopic microscope), residual stress (X-ray diffractometer), static and dynamic bend testing (Servo Hydraulic Mechanical Testing Machines), fracture surface analysis (scanning electron microscope) and microstructural aspects (optical microscope). The results indicate that controlled bending contributes to plate strength, but if uncontrolled bending is carried out, the fatigue strength is reduced, exposing the patient to a risk of breaking the component inside the body.

Abstrakt Bakgrund: Preoperativ fasta syftar till att minska innehållet- och sänka pH värdet i magsäcken och i sin tur reducera risken för aspiration i samband med induktion. Rekommendationerna som råder idag för preoperativ fasta är sex timmar från fast föda och två timmar från klar vätska.  Trots dessa rekommendationer har patienter tendens till att överskrida tiden för fasta från föda respektive vätska vilket kan leda till fysiologiska konsekvenser och postoperativa obehag. Anledningen till detta har bland annat beskrivits bero på bristande information från sjukhus och vårdpersonal. Syfte: Syftet med denna studie var att undersöka patienters följsamhet till preoperativ fasta. Metod: Designen som användes var en kvantitativ ansats med en icke-experimentell retrospektiv design. Urvalet bestod av ett bekvämlighetsurval och sammanlagt deltog 186 personer från arton regioner i Sverige. Deltagarna besvarade en egenkonstruerad webbaserad enkät som var distribuerad via sociala medier och e-post. Elva frågor analyserades i programmet SPSS version 26 och tre öppna frågor analyserades med en kvantitativ innehållsanalys. Resultat: Resultatet visade att deltagarna i snitt fastade från fast föda i tretton timmar respektive vätska i sex timmar och fyrtiotvå minuter. Majoriteten av deltagarna erhöll information om preoperativ fasta från ett informationsblad från sjukhuset eller från vårdpersonal och de flesta av deltagarna upplevde informationen som tydlig eller mycket tydlig. En vanlig känsla hos deltagarna som upplevdes inför operation var oro. Den främsta orsaken och konsekvensen till varför man ska fasta inför operation beskrev deltagarna bero på aspiration eller kräkning. De främsta riskerna med lång fasta beskrevs av deltagarna vara fysiologiska konsekvenser men en del av deltagarna mindes inte eller visste inte några risker förenat med en lång fasta. Slutsats: Deltagarna i detta examensarbete upplevde att informationen de erhållit om fasta var tydlig eller mycket tydlig, dock visade resultatet att deltagarnas medeltid för fasta överskred nuvarande rekommendationer. Detta indikerar att informationen som patienter erhåller för preoperativ fasta behöver förbättras.       Nyckelord: Följsamhet, Preoperativ, Fasta, Information, Kunskap, Anestesi Keywords: Adherence, Preoperative, Fast, Information, Knowledge, Anesthesia

Bakgrund: Artros är en av de ledande orsakerna till funktionshinder hos äldre vuxna. Träning är en grundsten i vanlig artrosbehandling, men vid uteblivna resultat kan protesoperation vara nödvändig. Träning inför höftprotesoperation kan minska dekonditionering och ge gynnsamma postoperativa utfall, men träningsupplägg och dos har inte undersökts tillräckligt noggrant för att säkerställa bäst effekt. Syfte: Att genom en systematisk litteraturstudie kartlägga hur preoperativ träning genomförts inför höftprotesoperation och dess påverkan på postoperative smärta och funktion. Metod: Sökningar genomfördes i databaserna CINAHL, PubMed, Cochrane och Web of Science för att identifiera relevanta artiklar. Grovsållning av artikelnamn och abstrakt utfördes individuellt av författarna i programmet “Rayyan”. Potentiellt relevanta artiklar lästes i fulltext innan dess relevans bedömdes. Därefter skedde granskningar av metodologisk kvalitet och forskningsetiken av inkluderade studier. Resultat: Tio RCT-studier inkluderades. Preoperativa interventioner bestod av styrketräning, konditionsträning, flexibilitetsträning, postural kontroll eller funktionell träning. Interventionerna och doseringen var olika tydligt beskrivna och utförda och med varierande effekt på både smärta och funktion. På grund av studiernas metodologiska brister användes endast fyra studier som underlag för slutsatser kring träningsupplägg och dos. Slutsats: Få studier har säkerställt tydlighet i träningsprogrammen, att träningen bygger på evidensbaserad rekommendation, progression och följsamhet. Frekvens och volym verkar till viss del kompensera för utebliven intensitet / Background: Osteoarthritis is one of the leading causes of disability among older adults. Exercise is a cornerstone in regular osteoarthritis treatment, but sometimes a joint replacement may be necessary. Training prior to hip replacement surgery can reduce patient deconditioning and produce positive postoperative results, but the type of training and dosage hasn’t been researched regarding best possible effects. Purpose: Through a systematic literature study survey the types of preoperative training used for hip replacement surgery and present results for postoperative pain and function. Method: Searches were conducted in the databases CINAHL, PubMed, Cochrane and Web of Science to identify relevant articles. Titles and abstracts were screened individually by the authors in the program “Rayyan”. Potentially relevant articles were read in full text. A review and examination regarding methodological quality and ethics of the included articles was conducted. Results: Ten RCT-studies were included. Preoperative interventions consisted of strength training, endurance training, flexibility training, postural control or functional training. Descriptions of interventions and dosage were at varying levels of detail. The effects on pain and function also varied. Due to insufficient methodological quality only four studies were used for conclusions regarding training intervention and dose. Conclusion: Few studies have clearly defined exercise programs, and lack evidence-based recommendations, progressive overload and compliance. Frequency and volume seem to partially compensate for lack of exercise intensity.