This dissertation uses population-based administrative healthcare data to evaluate the outcomes, processes-of-care and practice variation associated with preoperative medical consultation in Ontario, Canada. First, a multicentre cross-sectional study was conducted to develop a novel algorithm for identifying preoperative medical consultations using administrative data. The optimal claims-based algorithm was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 120 days before the index surgery. This algorithm had a sensitivity of 90% (95% confidence interval [CI], 86 to 93) and specificity of 92% (95% CI, 88 to 95). Second, we conducted a population-based cohort study to evaluate the association of preoperative medical consultation with outcomes and processes-of-care. After adjustment for measured confounders using propensity-score methods, consultation was associated with increased preoperative testing, preoperative pharmacological interventions, 30-day mortality [relative risk (RR) 1.16; 95% CI, 1.07 to 1.25], 1-year mortality (RR 1.08; 95% CI, 1.04 to 1.12), and mean hospital stay (difference 0.67 days; 95% CI, 0.59 to 0.76). These findings were stable across subgroups, as well as sensitivity analyses that tested for unmeasured confounding. Third, temporal trends and practice variation in consultation were evaluated within the population-based cohort. The proportion of patients undergoing consultation remained relatively stable over the study period, at approximately 39%. Although patient-level and surgery-level factors did predict consultation use, they explained only 6.8% of variation in consultation rates. By comparison, inter-hospital differences in rates were substantial (range, 1.9% to 86.8%), were not explained by surgical volume or teaching status, and persisted after adjustment for patient-level and surgery-level factors. Overall, this dissertation highlights the need for research to identify interventions for safely decreasing perioperative risk, define mechanisms by which consultation influences outcomes, examine factors that influence practice variation in medical consultation, and identify patients who benefit most from preoperative medical consultation.

Syfte: Att undersöka hur musik som omvårdnadsåtgärd påverkar patienten fysiskt och psykiskt pre-, peri- och postoperativt. Metod: Deskriptiv litteraturstudie. 12 artiklar inkluderades som granskades, analyserades och sammanställdes. Sökningarna utfördes i databaserna PubMed och Cinahl. Huvudresultat: Resultatet visade att musik i samband med operation påverkar patienten både fysiskt och psykiskt på flera olika sätt. Musik lindrar framförallt oro och minskar smärtupplevelsen. Viss påverkan kunde ses på vitala parametrar såsom minskning av puls, blodtryck och andningsfrekvens. Stressreaktionen i kroppen påverkas också till viss del genom att kortisolnivån minskar av musiklyssnande. Musik kan också reducera depression i samband med operation. Slutsats: Musik påverkar faktorerna oro, smärta, stress, vitala parametrar och depression positivt hos patienter pre-, peri- och postoperativt. Musik som omvårdnadsåtgärd i samband med operation kan vara ett bra komplement för sjuksköterskan att använda sig av i omvårdnadsarbetet för att lindra patientens lidande. / Aim: To examine how music as a nursing intervention affects the patient physically and mentally pre-, peri-and postoperatively. Method: Descriptive study. 12 articles were included that were examined, analyzed and summarized. The searches were conducted in PubMed and Cinahl. Results: The results showed that music associated with surgery affects patients both physically and psychologically in various ways. Music soothes especially anxiety and reduces pain. Some effects could be seen on vital parameters such as reduction of heart rate, blood pressure and respiratory rate. The stress response in the body is also affected to some extent by cortisol level decreases when listening to music. Music can also reduce depression associated with surgery. Conclusion: Music have a positive effect on the factors of anxiety, pain, stress, vital parameters and depression in patients pre-, peri-and postoperatively. Music as a nursing intervention associated with surgery can be a good addition for the nurse to use in the nursing process to relieve the patient's suffering.

Bakgrund: Hjärtoperationer förekommer över hela världen. Förutom den genetiska faktorn så ökar antalet insjuknanden delvis på grund av välfärdssamhället. Studier har visat att personer med hjärtsjukdom upplever ökad oro vid vardagliga aktiviteter. På grund av oron är informationen som ges till patienter mycket viktig. Syfte: Belysa patienters upplevelser av information inför planerad hjärtoperation. Metod: Allmän litteraturstudie, 10 artiklar användes. Resultat: Under analysen framkom fyra kategorier; emotionell påverkan, behov av information, mottaglighet och hanterbarhet samt delaktighet. Studier visade att information minskade oron och ökade tillfredsställelsen. Patienter som hade fått rutinmässig information efterfrågade ytterligare. Andra studier visade att informationsnivån inte hade någon effekt på oron inför operation och det fanns studier som visade att information ökade oron. När informationen gavs spelade stor roll för hur patienterna upplevde den preoperativa tiden. Patienter uttryckte även en önskan om att få ytterligare information för att kunna uppleva delaktighet i sin vård. Diskussion: Tre kategorier arbetades fram; positiv påverkan, informationskrav och negativ påverkan. Informationen var viktig och ledde till en bättre utgång. Patienternas krav på information har ändrats genom åren och är större nu. För lite information ledde till känslor som oro, rädsla och ovisshet. Slutsats: Information påverkar patienters upplevelser inför operation, både positivt och negativt. / Background: Cardiac surgery is carried out worldwide. The genetic factor and today’s welfare society has resulted in an increase in the number of episodes. Studies have shown that people with heart disease experience increased anxiety in everyday activities. The information given to patients therefore becomes highly important. Purpose: Highlight the patients' experiences of information prior to planned cardiac surgery. Method: Literature review. Results: Four categories was revealed: emotional impact, need of information, responsiveness and manageability and participation. Studies showed that information decreased anxiety and increased the level of satisfaction. Additional information was requested by patients who had received routine information. Other studies showed that the level of information had no effect on the patient’s anxiety and in other cases increased the anxiety. The timing of when the information was given had a large impact on how patients experienced the preoperative period. Discussion: Three categories were developed; positive impact, information requirements and negative impact. The information was important and led to a better outcome. Patients' information requirements are bigger today than in the past. A lack of information led to feelings of anxiety, fear and uncertainty. Conclusion: Information has both positive and negative impact on the patients’ experiences prior to surgery.

The problem addressed in this study was whether Preoperative Holding Areas minimized the preoperative anxiety of patients having a cholecystectomy. The study used a pre-experimental, descriptive design to determine the level of anxiety reported.The sample was a convenience sample consisting of forty preoperative, adult patients having a cholecystectomy. Twenty of the patients went to a Preoperative Holding Area for sedation and preparation, and twenty remained in their rooms. The instruments utilized were the A-State and A-Trait forms of Spielberger's State-Trait Anxiety Inventory.The hypothesis was accepted at the .05 level of significance. It was noted that the patients remaining on the floor had higher levels of Trait Anxiety.Ball State UniversityMuncie, IN 47306

This dissertation uses population-based administrative healthcare data to evaluate the outcomes, processes-of-care and practice variation associated with preoperative medical consultation in Ontario, Canada. First, a multicentre cross-sectional study was conducted to develop a novel algorithm for identifying preoperative medical consultations using administrative data. The optimal claims-based algorithm was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 120 days before the index surgery. This algorithm had a sensitivity of 90% (95% confidence interval [CI], 86 to 93) and specificity of 92% (95% CI, 88 to 95). Second, we conducted a population-based cohort study to evaluate the association of preoperative medical consultation with outcomes and processes-of-care. After adjustment for measured confounders using propensity-score methods, consultation was associated with increased preoperative testing, preoperative pharmacological interventions, 30-day mortality [relative risk (RR) 1.16; 95% CI, 1.07 to 1.25], 1-year mortality (RR 1.08; 95% CI, 1.04 to 1.12), and mean hospital stay (difference 0.67 days; 95% CI, 0.59 to 0.76). These findings were stable across subgroups, as well as sensitivity analyses that tested for unmeasured confounding. Third, temporal trends and practice variation in consultation were evaluated within the population-based cohort. The proportion of patients undergoing consultation remained relatively stable over the study period, at approximately 39%. Although patient-level and surgery-level factors did predict consultation use, they explained only 6.8% of variation in consultation rates. By comparison, inter-hospital differences in rates were substantial (range, 1.9% to 86.8%), were not explained by surgical volume or teaching status, and persisted after adjustment for patient-level and surgery-level factors. Overall, this dissertation highlights the need for research to identify interventions for safely decreasing perioperative risk, define mechanisms by which consultation influences outcomes, examine factors that influence practice variation in medical consultation, and identify patients who benefit most from preoperative medical consultation.

Syftet med studien var att beskriva förekomst och typ av patienters eventuella oro inför anestesi. Litteraturöversikten har baserats på vetenskapliga artiklar av både kvantitativ och kvalitativ art. Trettioen artiklar granskades och 21 av dessa valdes ut till resultatet.De flesta studier som behandlade oro inför anestesi var av kvantitativ art. Oro i form av olika slags olustkänslor definierades av flera författare utförligt och på flera sätt. Resultatet påvisade att oro var ett vanligt förekommande fenomen och kunde objektivt mätas med hjälp av självskattningsskalor, där de vanligast förekommande är Visuel Analog Skala (VAS) och State Trait Anxiety Inventory (STAI). Dagkirurgin har ökat och tiden att träffa patienten för mental förberedelse har minskat, vilket var till nackdel för både patient och personal. Vi har genom den här studien och kliniska erfarenheter uppmärksammat riskfaktorer för oro, till exempel kvinnor och yngre patienter. En studie påvisade även att patienter med sen placering på operationslistan hade en signifikant högre nivå av oro. För att ge känslomässigt stöd till patienter som har behov av ökad uppmärksamhet, krävs en bred insats som omfattar bemötande, information, patientutbildning och kommunikation. Trots all kunskap som finns presenterad i resultatet av studierna förstår vi det som att den psykologiska omvårdnaden är otillräcklig och måste prioriteras.

Syftet med denna litteraturstudie var att undersöka vilka emotionella omvårdnadsbehov patienterna hade innan operation och hur sjuksköterskan på bästa sätt kunde lindra dem. Metoden var en litteraturstudie baserad på vetenskapliga artiklar med dels en kvalitativ ansats (n= 5) och dels en kvantitativ (n= 10). Artikelsökningarna gjordes via sökmotorn ELIN och databaserna CINAHL och PubMED. Artiklarna var etiskt godkända samt publicerade mellan 2000-2010 och skrivna på engelska. De granskades med hjälp av granskningsmallar. Resultaten i studien visade att de emotionella behov som fanns var att lindra rädsla och känslan av övergivenhet. Resultaten visade att sjuksköterskan, kunde lindra dessa emotionella behov genom information, ett gott bemötande, att låta patienterna lyssna på musik, se på film eller video samt ge essentiella oljor.

To supply the health care service has to possess plenty of professional medical knowledge. However, consumers cannot learn sufficient information from the health care market. As a result of unequal position in obtaining information, it is easy to create intenseness between doctors and patients. Patients need to know more about anesthesia and illness to relieve their anxiety. Based on the patient-centered idea to enhance medical service quality, this research expects to discuss the influence of the involvement of the education about preoperative anesthesia on hospitals¡¦ service quality through establishing appropriate anesthesia teaching videotapes. Then, the research tries to connect patients¡¦ satisfaction and their intend to return with the quality of hospitals¡¦ service. The research method is experimental, and the objects of this research are surgical inpatients from one medical center including 219 people in the test group who accepted introduction to preoperative anesthesia and 125 people in the comparative group who were taken care as usual. Some tools such as demography characteristic recording list, disease characteristic recording list, modified PZB (SERVQUAL) scale, satisfaction questionnaire from THIS¡]Taiwan Healthcare Indicator Series¡^and SPSS10.0 software were used to develop descriptive statistic analysis, item analysis, factor analysis, and one-way ANVOA and regression analysis. The results of this research appear as followed: 1. The recognition of hospitals¡¦ service quality has a positive influence on patients¡¦ satisfaction. 2. Patients¡¦ satisfaction has a positive influence on their intend to return. 3. The recognition of hospitals¡¦ service quality has a positive influence on patients¡¦ intend to return. 4. Patients¡¦ satisfaction produces an intermediary effect on the relationship between the recognition of hospitals¡¦ service quality and patients¡¦ intend to return. 5. The education about preoperative anesthesia produces no interference with the relationship between the recognition of hospitals¡¦ service quality and patients¡¦ satisfaction. 6. The education about preoperative anesthesia produces partial interference with the relationship between patients¡¦ satisfaction and their intend to return.

No description available.

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.