<p> Meta-analysis is a statistical method to summarize the overall evidence of effects on intervention by systematically combining outcomes from available studies in the literature which are homogeneous in research methodology and research interest. The objective of this project is to evaluate the treatment effects of preoperative aspirin on bleeding and other cardiovascular outcomes from 11 randomized control trials (RCT) and 19 observational (non-RCT) studies. Both Bayesian meta-analysis and classical (frequentist) meta-analysis were applied to continuous and binary outcomes, and the results were compared.</p> <p> The robustness of the Bayesian approach is assessed by examining the performances of different likelihood functions and priors. We also discuss strategies on dealing with zero-event studies for binary outcomes, and the implementation of multiple imputation (MI) technique to missing data for continuous outcomes.</p> <p> Most results of primary analysis agree between the Bayesian and classical approaches. We suggest that the final conclusion of a meta-analysis should be based on the comparison of the results from both Bayesian and classical approaches.</p> / Thesis / Master of Science (MSc)

Aging and age-related frailty are important public health problems. There is a need to develop rehabilitation interventions to reduce the prevalence and disabling effects of frailty. This thesis reports the rationale and design of two studies and findings of three studies aimed to optimize health outcomes of frail older adults and their caregivers. The second chapter describes the protocol of the first network meta-analysis to determine the comparative effect of interventions targeting the prevention or treatment of frailty. In the third chapter, the results of frailty network meta-analysis were presented and 89 RCTs were included. The review shows that physical activity and medication management are the most effective frailty interventions. The fourth chapter describes a protocol of pilot randomized controlled trial (RCT) to examine a preoperative multi-modal frailty intervention in pre-frail/frail older adults undergoing elective joint replacements. The fifth chapter describes the results of a subgroup analysis of a RCT examining the effect of complex primary care intervention to support caregivers of frail older adults. There were no differences between caregivers of frail older adults and non-caregivers in quality of life, social support, hospitalization, and emergency department visits. The sixth chapter examines the construct validity and discriminative properties of the fracture rating scale (FRS) (a tool designed for fracture risk assessment in long term care (LTC)). The FRS is a valid tool for identifying LTC residents at different risk levels for hip fracture in three Canadian provinces. The work presented in this thesis is proposing and examining the comparative effect of frailty interventions, a preoperative frailty intervention/ model, a primary care intervention to identify and support caregivers, and a predictive tool to optimize care planning of LTC residents. These findings will support the rehabilitation and care program for older adults and their caregivers and improve their health outcomes. / Thesis / Doctor of Philosophy (PhD) / There is a need to develop rehabilitation interventions to reduce the prevalence and disabling effects of frailty. This thesis reports the rationale and design of two studies and findings of three studies aimed to improve health outcomes of frail older adults and their caregivers. The second and third chapters of this thesis describe the protocol and results of a review aims to identify the effect of interventions targeting frailty, the review found that physical activity and medication management are the most effective frailty interventions. The fourth chapter describes a study examining the possibility of comparing a complex intervention to usual care in frail older adults undergoing joint replacements. The fifth chapter showed that a primary care intervention did not improve the caregivers’ health outcome. The sixth chapter presents the fracture rating scale, a valid tool for identifying Long-term care residents at risk of hip fracture in three Canadian provinces. These findings aim to improve the care for older adults and their caregivers.

The Preop medical expert system (Langton et. al, 1990) was originally developed using the expert system tool, Nexpert Object, on a VAX computer. Nexpert Object creates an expert system specification which is executed by an interpreter within Nexpert Object. The original implementation, however, has several limitations, including: 1. lack of physical portability 2. requires Nexpert Object to run 3. crude user interface. In order to overcome the first limitation, Preop is implemented on a PC DOS portable computer. This project is addresses the other two limitations. Creating a compiled version of Preop eliminates the need for the Nexpert Object interpreter, and implementing it as a Microsoft Windows application provides a better user interface. / Thesis / Master of Science (MSc)

Bakgrund Oro och ångest är vanligt förekommande inför operation. Patienters upplevelse är individuell där preoperativ oro och ångest kan grunda sig i olika faktorer. Preoperativ oro och ångest kan leda till konsekvenser för hela det perioperativa vårdförloppet. Preoperativt förbereds patienter med nödvändiga förberedelser utifrån operationens art samt patienters individuella behov. Sjuksköterskor har i den preoperativa fasen en central roll i att bemöta och uppmärksamma patienters oro och ångest för att tillämpa adekvata omvårdnadsåtgärder. Syfte Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder för att lindra patienters preoperativa oro och ångest. Metod Examensarbetet har genomförts som en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska litteraturöversikter. Databaserna CINAHL och PubMed har använts för urval av artiklar. Artiklarna kvalitetsgranskades utifrån Nilssons granskningsmall. Analysen utfördes utifrån Fribergs analysmodell. Resultatet grundar sig på 17 vetenskapliga artiklar publicerade mellan år 2014–2024. Resultat Huvudkategorierna sjuksköterskors åtgärder och terapier identifierades i resultatet. Resultatet delades upp i följande underkategorier; patientutbildning, samtal med patient, avslappning, massage, musik samt aromaterapi. Slutsats Resultatet visar att det finns olika typer av icke-farmakologiska omvårdnadsåtgärder som kan lindra preoperativ oro och ångest. Genom att uppmärksamma och tillämpa relevanta omvårdnadsåtgärder kan patienters oro och ångest i den preoperativa fasen lindras. / Background Anxiety is common before surgery. The patient’s experience is individual and various factors can be the basis for preoperative anxiety. Preoperative anxiety can lead to consequences for the entire perioperative care process. Preoperatively, the patient is prepared with necessary preparations, which are determined based on type of surgery and the patient’s individual needs. In the preoperative phase, nurses have a central role in meeting and paying attention to the patient’s individual needs in order to relieve anxiety with the help of nursing interventions. Aim The aim was to describe nurses’ nursing interventions to relieve patients preoperative anxiety. Method The thesis has been carried out as a structured literature review with elements of the methodology used in systematic literature review. The databases CINAHL and PubMed were used for selection of articles. The articles were quality reviewed based on Nilsson’s review template. The analysis was conducted based on Friberg’s analysis model. The result is based on 17 scientific articles published between the years 2014–2024. Results The main categories nurses nursing interventions and therapies were identified with the subcategories of patient education, conversation with patient, relaxation, massage, music and aromatherapy. Conclusions The results shows that there are different types of non-pharmacological nursing interventions that can relieve preoperative anxiety. By paying attention and implementing relevant nursing interventions, the patient’s preoperative anxiety can be relieved.

Bakgrund: Information är en viktig del i anestesisjuksköterskans möte med patienten. Information som verktyg, syftar till en bättre omvårdnad och patientsäkerhet. Vid en sövning kontrolleras patienters luftväg och andning varvid halsont och heshet kan upplevas postoperativt. Postoperativt halsont och heshet är vanligt och drabbar flertalet patienter. Att ge preoperativ information om luftvägshantering samt eventuella postoperativa halsbesvär kan därför vara av betydelse för patienters välbefinnande. Syfte: Att undersöka patienters upplevelser av preoperativ information gällande luftvägshantering samt postoperativa halsbesvär. Metod: Kvalitativ intervjustudie. 8 semistrukturerade intervjuer genomfördes på patienter som opererats i generell anestesi. Resultat: Intervjuerna resulterade i tre olika kategorier med respektive underkategorier. Känslor inför operation; i en stressad situation kände patienterna förtroende och tillit samt att lugn och trygghet ingavs. Vikten av att avväga informationsmängd; vissa upplevde för mycket information, andra för lite och det är viktigt med individanpassad information efter vad respektive patient vill veta. Informationssätt; hur, när och var information ges, påverkar patienterna, kontinuerlig och kortfattad information med möjlighet att få ställa frågor upplevs positivt. Slutsats: Patienter är olika och reagerar olika på informationsmängd samt informationssätt. Det är därför viktigt att anpassa informationsmängden och ge individanpassad information format efter patienten. Att få ingående information om luftvägsförfarande upplevs av vissa som obehagligt. Information om postoperativa halsbesvär lugnar. / Background: Information is an important part of the nurse anesthetist’s encounterwith the patient. Information as a tool, aims for a better care and safety for the patient. During an anesthesia, the patients airway and breathing is controlled, wherein sore throat and hoarsness can occur post operative. Post operative sore throat and hoarsness are common and affect many patients. Giving preoperative information regarding airway management and probable postoperative sore throat inconvenience, can be of importance of the patients well-being. Objectives: To analyze patients experiences of preoperative information regarding airway management and postoperative throat inconvenience. Methods: Qualitative interviews study. 8 semi structured interviews, were conducted on patients who had been operated in general anesthesia. Results: The interviews resulted in three different categories with respectively sub categories. Feelings before surgery; in a stressful situation the patients felt confidence and trust, and also that calm and safety were submitted. The importance of estimating amount of information; some experienced too much information, others too little and that it is important with personalized information, fitted for what each and other patient wants to know. Means of information; where, when and how the information is given, affects the patients. Continious and concised information, with opportunity to ask questions, is experienced as positive. Conclusions: Patients are different and reacts different on the amount of information and means of information. It is therefor important to adjust the amount of information and to give personalized information suited for each and other patient. Given thorough information about airway management is experienced by some patients as unpleasant. Given information about postoperative throat inconvenience soothes.Keywords preoperative information; airway management; postoperative throatinconvenience; feelings; amount of information; means of information.

Introduktion: Anestesi på barn ställer anestesisjuksköterskan inför en komplex situation. Barn är oroliga inför det okända som ska hända. För att minska oron behöver anestesisjuksköterskan reducera deras nivå av oro. Föräldrarna tryggar barnen och tillsammans med dem ska anestesisjuksköterskan delge barnen trygghet. Syfte: Beskriva anestesisjuksköterskors erfarenheter i att bemöta och lindra oro hos barn som ska genomgå anestesi. Metod: En kvalitativ intervjustudie, innehåll analyserades utifrån kvalitativ innehållsanalys. Sammanlagt intervjuades 8 anestesisjuksköterskor med varierande ålder och yrkeserfarenhet. Resultat: Anestesisjuksköterskornas erfarenheter visade att skapa trygghet, ha ett avledande tillvägagångsätt och att utgå ifrån den egna professionen var viktigt för att bemöta och lindra oro. Att samarbeta med föräldrarna, skapa en relation till barnet och ha bra preoperativa förberedelser tycktes skapa trygghet hos både barnet och föräldern. De använde sig av avledande strategier för att flytta den negativa oron till något positivt. Den erfarenhet som anestesisjuksköterskorna hade gav dem en trygg grund i de situationer som inte var fullt så optimala. Då det inte fanns några färdiga mallar i hur de ska bemöta och lindra oro hos barn ansåg de flesta att ”fingertoppskänslan” har stor betydelse. Det viktiga var att hela tiden anpassa sig till barnet och ta den tid som behövdes. Slutsats: Studien belyste anestesisjuksköterskans erfarenhet av att bemöta och lindra oro hos barn. I resultatet framkom att anestesisjuksköterskan upplevde svårighet att bemöta oroliga barn samt att det var en svår situation de ställdes inför. Emellanåt kunde samarbetet med oroliga föräldrar vara svårt, dock kunde samarbetet förbättras om anestesisjuksköterskan och föräldern hade samma målbild. Det ställdes höga krav på kompetens och ödmjukhet samtidigt som anestesisjuksköterskan hade en viktig roll i att skapa trygghet hos barnen. / Introduction To prepare a child for anesthesia put the nurses in a complex situation. The child is worried about the unknow that is going to happen and therefore the nurse needs to reduce the child’s level of anxiety and worry. The parents are supposed to comfort the child and together with the nurse they should help the child to manage the difficult situation. Aim: Describe the anesthesia nurses experience in addressing and reducing anxiety in children who are about to undergo anesthesia. Method:A qualitative interview study of 8 nurses with different age and work experience where included and interviewed. Result: Based on the experience of the nurses it showed that the most important thing where to create comfort, use distractions and the ability to use their previous professional experience. To be able to cooperate with the parents, create a relationship with the child as well as excellent preoperative preparation seemed to create comfort in both the child and the parents. The nurses used distracting strategies to transfer the negative anxiety to something more positive.  Since there are no written guidelines of how to comfort children about to undergo anesthesia the nurses had to use and incorporate their previous experience as an anesthesia nurse. The nurses mentioned that it is crucial to be able to sense and evaluate the situation and then act based on the conclusion. The most important thing was to adapt and conform to the need of the child and not rush the process. Conclusion: The study highlighted the experience of the nurse’s preoperative care. The result showed that the nurses experienced difficulty to care for worried children as well as the complex situation they were presented with. Sometimes worried parents made the situation more complex for the anesthesia nurse since they were not able to cooperate and work together. However, the corporation could be improved if the anesthesia nurse and the parent had the same goal and a joint way of handling the situation. The anesthesia nurse were required to have high professional competence, advanced humility as well the ability to make sure that the child  is comfortable and relaxed.

Bakgrund: Inför ett kirurgiskt ingrepp erhålls information kring pre/intra/post – operativa rutiner. Det är inte helt klarlagt hur patienter uppfattar och kan ta till sig denna information. Syfte: Att beskriva patienters erfarenheter av preoperativ information inför kolo-rektal cancer kirurgi. Design: Kvalitativ deskriptiv studie med semi-strukturerade intervjuer. Kontext: Intervjuerna genomfördes på en vårdavdelning tillhörande ett universitetssjukhus i Sverige. Deltagare: 14 deltagare tillfrågades att delta i studien varav sju accepterade att delta. Metod: Intervjuerna spelades in på band och transkriberades ordagrant, insamlad data analyserades efter latent innehåll utefter Graneheim och Lundmans modell för innehållsanalys. Resultat: Huvudtema: Personcentrerad omvårdnad, och fyra teman: 1. Betydelsen av individuellt anpassad information. 2. Tydliga besked och bra bemötande främjar trygghet. 3. Stöd av närstående är betydelsefullt. 4. Väntan på svar främjar ovisshet. Deltagarna var sammantaget nöjda med erhållen preoperativ information. Några av deltagarna hade dock svårigheter att minnas all information som givits. Att leva i ovisshet kring fortsatt prognos samt framtiden gav känslor av otrygghet och oro. Betydelsen av närstående och anhöriga var stor, dels för att uppfatta informationen korrekt, för att minnas den samt för emotionellt stöd. Behov av ytterligare information gällde biverkningar av läkemedel, kostråd efter kirurgi, provsvar, peroperativa förlopp samt information kring livet efter sjukhusvistelsen. Slutsats: : Att utgå från en personcentrerad vård, där patientens egna berättelse är i fokus, kan bidra till att ge en mer individbaserad preoperativ information, och på så sätt stärka patientens egna resurser under vårdtiden. / Background: Information regarding the pre/intra/post – operative routines is given prior to surgical interventions. It is not entirely clarified how patients perceive this information. Objective: To explore patients´ experiences regarding preoperative information before undergoing colo-rectal cancer surgery. Design: Qualitative descriptive study with semi-structured interviews. Setting: Interviews were conducted in a hospital ward on a university hospital in Sweden. Participants: 14 participants were asked to participate and seven accepted to participate in the study. Method: Interviews were tape recordered and collected data were transcribed verbatim and analyzed for latent content using Graneheim and Lundman´s outline for content analysis. Results: Main theme: Person-centered nursing care. Four themes were identified: 1. The meaning of individual-based information. 2. Explicit notifications and warm receptions promote feelings of safety. 3. Support from next of kin are meaningfull. 4. Waiting for answers promotes feelings of uncertainty. All of the participants were satisfied with acquired preoperative information. However, a few of the participants had difficulties remembering all of the information given. Feelings of uncertainty about the prognosis and the future were present and were experienced as to somewhat burdensome. The importance of relatives and next of kin were very important in regard of understanding and memorizing given information, but also for emotional support. The need for further desired information included pharmacological side effects, dietary advice following surgery, test results, perioperative complications and information regarding life after discharge. Conclusions: Providing person-centered care based on the narrative from the patient can help healthcare professionals to provide more accurate and individual based preoperative information.

Introdução: As infecções do sítio cirúrgico (ISC) são um dos principais eventos adversos evitáveis no perioperatório, ocasionando danos econômicos, físicos e emocionais aos pacientes acometidos. Nesse contexto, o uso de antissépticos no pré-operatório reduz a contagem microbiana da pele, podendo contribuir para a prevenção da ISC. Evidências internacionais apontam que as toalhas impregnadas com gluconato de clorexidina (CHG) 2% destacam-se por sua praticidade e efeito residual superior. No Brasil, no entanto, não existem estudos relacionados à utilização do produto para a redução da contagem microbiana de pele no pré-operatório. Objetivo: Comparar o uso das toalhas impregnadas com CHG 2% ao banho pré-operatório tradicional com CHG 2% convencional/líquida na prevenção da ocorrência da ISC entre pacientes submetidos a cirurgias eletivas potencialmente contaminadas. Método: Trata-se de um estudo piloto de ensaio clínico randomizado controlado, composto por pacientes submetidos a cirurgias eletivas potencialmente contaminadas, distribuídos aleatoriamente em grupo intervenção (n=23), constituído pelos que utilizaram as toalhas impregnadas com CHG 2% no pré-operatório, e grupo controle (n=22), composto pelos submetidos ao banho pré-operatório com CHG 2% convencional/líquida. Ambos utilizaram os produtos na noite anterior e na manhã da cirurgia e receberam orientações verbais e por escrito. Resultados: Os pacientes não apresentaram diferenças em relação às características clínicas e cirúrgicas. Não foram observadas diferenças estatísticas significativas entre os grupos intervenção e controle quanto à redução na ocorrência de ISC (p=1,000). Conclusão: Não houve diferença entre os grupos intervenção e controle quanto à ocorrência de ISC. / Introduction: Surgical site infections (SSI) are described as evitable perioperative adverse effect, affected patients suffer economic, physical, and emotional harm. Preoperative antiseptics use reduces skin microbial counts and prevention SSI. International evidences suggest that 2% chlorhexidine gluconate (CHG) impregnated cloth bathing are practical and presents a superior residual effect. However, in Brazil no studies related to the use of this product for the reduction of skin microbial count in perioperative were conducted. Objective: To compare the use of 2% chlorhexidine gluconate impregnated cloth bathing to the traditional preoperative 2% CHG standard/liquid bathing to prevent SSI incidence in patients submitted to clean-contaminated electives surgeries. Method: Pilot randomized clinical trial conducted with patients submitted to potentially contaminated electives surgeries. They were randomly distributed in intervention group (n=23) that used the 2% CHG impregnated cloth bathing in the preoperative, and control group (n=22) that was submitted to the standard/ liquid preoperative 2% CHG. Both groups used the products in the previous night and morning of the surgery, and received verbal and written orientation. Results: The patients did not present differences related to clinical and surgical features. No statistical differences between intervention and control groups were observed concerning the reduction of SSI (p=1,000). Conclusion: There were no differences between intervention and control groups concerning ISC reduction.

No description available.

Bakgrund: Att använda rätt preoperativ information till rätt patient är av yttersta vikt för att patienten ska känna delaktighet i sin egen vård. Vid operation av barn är det dessutom viktigt att informationen nås ut och förstås av både barnet och dess föräldrar. Syfte: Syfte med denna studie var att undersöka hur föräldrar till de barn som opereras under narkos tycker att den preoperativa informationen i form av ett bildstöd fungerar och om det är skillnad mellan yngre och äldre barn. Metod: Studien hade en kvantitativ ansats där en enkät delades ut till föräldrar vars barn opererats under narkos. Data samlades in under sex veckor. Urvalet var alla föräldrar (en per barn) till barn i ålder 1-10år. De familjer som var i behov av tolk exkluderades från studien. Enkätsvaren har analyserats i statistikprogrammet SPSS och redovisas både som tabeller och text. Den öppna frågan har analyserats genom innehållanalys. Resultat: Föräldrarna ansåg att deras barn förstått och blivit hjälpta av bildstödet. Även de själva ansåg att de haft nytta av det. Det skapade trygghet och delaktighet. De äldre barnen förstod informationen bättre än de yngre barnen. Slutsats: Att använda sig av ett bildstöd, som både skickas hem och som sedan används under operationsdagen skapar trygghet och delaktighet hos föräldrar och barn. / Background: Using the right preoperative information for the right patient is of the utmost importance for the patient to feel involved in their own care. In the operation of children, it is also important that the information is reached and understood by both the child and its parents. Purpose: The purpose of this study was to investigate how parents of the children who are operated under anesthesia find that the preoperative information in the form of an picture sheet works and if there is a difference between younger and older children. Method: The study has a quantitative approach where a questionnaire was distributed to parents whose children have undergone anesthesia for a period of six weeks. The selection was all parents (one per child) to children aged 1-10 years. The families in need of an interpreter were excluded from the study. The questionnaires responses have been analyzed in the statistics program SPSS and are reported both as tables and text. The open question has been analyzed through content analysis. Result: The parents felt that their children understood and were helped by the picture sheet. Even they themselves felt that they had benefited from it. It created security and participation. The older children understood the information better than the younger children. Conclusion: Using a picture sheet, which where sent both home and then used during the day, creates security and participation among parents and children.