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Alla patienter som genomgår någon typ av operation där man penetrerar huden har en ökad risk att drabbas av en postoperativ sårinfektion.Syftet var att utforska de preoperativa åtgärderna huddesinfektion och hårborttagning relaterat till uppkomsten av postoperativa sårinfektioner.Metoden var en systematisk litteratur studie där nio artiklar användes som underlag.Resultatet visade att klorhexidin reducerar bakterierna på huden, men ingen signifikant minskning av antalet postoperativa sårinfektioner kunde påvisas. Av hårborttagningsmetoderna rakhyvel, rakapparat och hårborttagningskräm ger rakhyvel upphov till fler små sår. / All patients going through any type of surgery where the skin will be penetrated have an increased risk to be afflicted to a postoperative wound infection. The aim of this study was to explore the preoperative preventions skin disinfections and hair removal related to development of postoperative wound infection. This literature review was based on nine articles. The results showed that chlorhexidine do reduce the incidence of bacteria on the skin but no significant reduction of postoperative wound infections was proved. Between the hair removal methods shaving with razor, electric clipper and depilatory the razor cause more cuts on the skin.

För att förebygga komplikationer vid kirurgiska ingrepp är den preoperativa fasen viktig. Sjuksköterskans roll innebär bland annat att försöka skapa trygghet samt ge adekvat information till patienten. Syftet med studien var att undersöka följsamheten gällande preoperativa riktlinjer och allmänna omvårdnadsåtgärder. Vid datainsamlingen utfördes totalt nio observationer på sju sjuksköterskor i deras arbetsmiljö. Studien utgör en kvalitets¬säkring och sammanställdes med stöd av innehållsanalys. Resultatet visade att tiden var en påverkande faktor, mer tid och resurser hade kunnat öka följsamheten ytterligare. Trots det speglar resultatet en god följsamhet gällande de praktiska preoperativa riktlinjerna, men det saknades fullgod kommunikation för att se till patientens inre behov. Slutsatserna visar på att det behövs fortlöpande utbildning gällande patientundervisning. Det är av stor vikt att lyssna på patienten, inte endast vad hon eller han säger, utan vad hon eller han egentligen förmedlar, med bland annat sitt kroppsspråk. / The preoperative phase is important to prevent complications during surgical procedures. The nursing role is to create safety and to give adequate information to the patient. The aim of the study was to examine the compliance regarding the preoperative guidelines and general caregiving procedures. During the data collection, nine observations were made on seven nurses in their working environment. The study can be applied as a quality assurance and was analysed by content analysis. The result shows that time was an influencing factor, and more time and resources would make it easier to increase the compliance. The result also shows that the compliance was good regarding practical preoperative guidelines. However complete communication skills were missing, to see the inner needs of the patient. The conclusion shows that there is a continuing need to develop the nurses skill regarding patient education. It is important to listen to the patient, not only to what is being said, but to what he or she really means, including body language.

INTRODUCTION: Patients with primary hyperparathyroidism generally have a single parathyroid adenoma that causes excessive excretion of parathyroid hormone. For about 2% to 15% of these patients, a double adenoma is present that involves one lesion on each side of the neck. CASE PRESENTATION: We describe a case of double parathyroid adenoma causing asymptomatic hypercalcemia. A presurgical technetium99m (Tc99m) sestamibi scan suggested an ipsilateral double adenoma in the left thyroid lobe. An intraoperative parathyroid hormone assay confirmed its successful removal. DISCUSSION: Although double adenomas are not yet widely acknowledged, presurgical imaging and nuclear scans can help to localize multiple lesions, and intraoperative parathyroid hormone assays can confirm the diagnosis and cure.

Preoperativ ångest är en vanlig upplevelse hos patienter som ska genomgå kirurgiska ingrepp och kan orsaka patienten lidande och negativa konsekvenser på individ- och samhällsnivå. Anestesisjuksköterskan ska erbjuda en personcentrerad vård av hög kvalitet grundad i livsvärldsperspektivet och ge en stödjande individualiserad perioperativ omvårdnad till patienter som upplever de här känslorna, för att kunna lindra lidande och främja hälsa samt välbefinnande. Farmakologiska behandlingar kan medföra oönskade bieffekter, därför är det relevant att undersöka effektiviteten av icke farmakologiska omvårdnadsåtgärder för att lindra patienters preoperativa ångest. Metoden som har tillämpats är en systematisk litteraturöversikt med en narrativ dataanalys av 24 kvantitativa studier. Resultatet tyder på att icke farmakologiska strategier som musik, Virtual Reality (VR), aromaterapi, akupunktur och akupressur kan lindra patienters preoperativa ångest och vara värdefulla tilläggande verktyg i den perioperativa omvårdnaden, även om fler studier om olika typer av kirurgiska ingrepp med både kvinnor och män behövs för att stärka fynden. Slutsatserna indikerar att genomförandet av studier i nordiska länder kan bidra till ökad kunskap och förtroende för de här alternativen hos vårdpersonal. Användandet av de här omvårdnadsåtgärderna kan leda till en minskning av farmakologiska behandlingar för att hantera preoperativ ångest, vilket främjar god hälsa och välbefinnande samt gynnar hållbar utveckling. / Preoperative anxiety is a common experience among patients undergoing surgical procedures and can cause patient suffering and negative consequences at both individual and societal levels. The nurse anaesthetist must provide high quality person-centered care grounded in the lifeworld perspective and offer supportive, individualized perioperative nursing care to patients experiencing these feelings, aiming to alleviate suffering, promote health and enhance well-being. Pharmacological treatments may entail undesirable side effects, hence, it is relevant to examine the effectiveness of non-pharmacological nursing interventions in alleviating patients' preoperative anxiety. The method that has been applied is a systematic literature review with a narrative data analysis of 24 quantitative studies. The findings suggest that non-pharmacological strategies such as music, Virtual Reality (VR), aromatherapy, acupuncture, and acupressure can alleviate patients' preoperative anxiety and serve as valuable adjunctive tools in perioperative care, although further studies involving various types of surgical procedures with both genders are needed to substantiate the findings. The conclusions indicate that conducting studies in Nordic countries can contribute to increased knowledge and confidence in these alternatives among healthcare professionals. Implementing these nursing interventions may lead to a reduction in pharmacological treatments for managing preoperative anxiety, thereby promoting good health and well-being and fostering sustainable development.

El presente trabajo es una revisión crítica que tiene por finalidad Conocer medidas preventivas que se utilizan para controlar las infecciones del sitio quirúrgico (ISQ) durante el preoperatorio. La ISQ es la infección más común en los centros hospitalarios; esto ocasiona un mayor tiempo de permanencia en el hospital, aumenta el costo del tratamiento y la posibilidad de complicaciones que afectan gravemente la salud del paciente e incluso le ocasionen la muerte. El método utilizado fue la EBE, se realizó el esquema PIS para plantear la pregunta clínica: ¿Qué medidas preventivas se utilizan para el control de la ISQ durante el preoperatorio?. La búsqueda de investigaciones se realizó mediante los sistemas de datos como Scielo, PubMed, Biblioteca Virtual de Salud (BVS), Google académico. Se logró obtener el total de 10 investigaciones, y al aplicar la Guía de validez y utilidad aparente de Gálvez Toro se redujo a 2. Al final se seleccionó una GPC y se utilizó el instrumento AGREE II para evaluar la calidad de ésta, tiene un nivel de evidencia alta y un grado de recomendación fuerte. La respuesta a la pregunta menciona que las medidas más utilizadas para controlar la ISQ son: profilaxis antibiótica, el lavado de manos quirúrgico, la irrigación de las heridas, no remover el pelo en el sitio quirúrgico y tener en cuenta comorbilidades de los pacientes. / The present work is a critical review whose purpose is to know preventive measures that are used to control infections of the surgical site during the preoperative period. Surgical wound infection is the most common nosocomial infection in postoperative patients; This causes them to stay longer in the hospital, increases the cost of treatment and the possibility of complications that seriously affect their health and even death. The method used was EBE, the PIS scheme was performed to ask the clinical question: What preventive measures are used to control surgical site infection during the preoperative period? The research search was carried out through data systems such as Scielo, PubMed, Virtual Health Library (VHL), and academic Google. A total of 10 articles were obtained, and after applying Gálvez Toro's Apparent Validity and Utility Guide, it was reduced to 2. In the end, a CPG was selected and the AGREE II instrument was used to assess its quality. It has a high level of evidence and a strong degree of recommendation. The answer to the question mentions that the most used measures to control surgical site infection are: antibiotic prophylaxis, surgical handwashing, wound irrigation, not removing hair in the surgical site, and taking into account comorbidities of the patients. patients.

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

A quantitative descriptive study was conducted to establish professional nurses’ and patients’ knowledge and understanding of laparoscopic surgery and to determine whether nurses are sufficiently knowledgeable to disseminate adequate information about laparoscopic surgery to patients. Two state hospitals based in KwaZulu-Natal where laparoscopic surgery is done were selected and the respondents were selected through convenience sampling. Data were collected by administering questionnaires to theatre nurses (n=39), ward nurses (n=87) and patients (n=42) scheduled for laparoscopic surgery. The SPSS version 15 for Windows was used to compute the results. The findings revealed that the professional nurses were not sufficiently knowledgeable about laparoscopic surgery to give adequate information to patients and the patients themselves were not fully informed about all aspects of laparoscopic surgery including the possibility of conversion to open surgery, complications and advantages and after care. There is therefore a dire need for improvement of patient education to assist patients gaining optimal recovery / Health Studies / M.A. (Health Studies)

Les tumeurs stromales gastrointestinales (GIST) sont les néoplasies mésenchymateuses les plus complexes du système gastrointestinal. Le traitement curatif standard de cette pathologie est la chirurgie avec l'obtention de marges microscopiques négatives. Les résultats impressionnants obtenus sur la prolongation de la survie avec l'administration d'imatinib (IM) chez les patients atteints de maladie métastatique et non-réséquable ont suggéré aux cliniciens que ce même médicament pourrait aussi collaborer à l'obtention de marges négatives plus aisément lors de cancer avancé. Jusqu'à présent, aucune étude prospective n'a caractérisée l'effet d'une thérapie néoadjuvante prolongée à l'IM sur la qualité de la résection chirurgicale subséquente. L'objectif de ce projet de maîtrise était d'évaluer l'efficacité de l'imatinib utilisé avant la chirurgie (néoadjuvant) jusqu'à l'obtention d'une réponse maximale, en vue d'augmenter le taux de résection microscopique complète (R0) dans le traitement chirurgical des GIST à haut risque de résection microscopique incomplète (R1) ou impossible (R2). Pour ce faire, une étude prospective multicentrique de phase II a été réalisée. Le traitement néoadjuvant à l'IM a été instauré chez des patients porteurs d'une GIST localement avancée ou métastatique. Au total, quatorze patients ont reçu une dose de 400-600 mg/d d'IM pour une durée de 6-12 mois avant la chirurgie. Quatorze patients ont été inclus dans l'étude. Onze ont eu une chirurgie à visée curative, un patient a démontré une maladie non-réséquable suite à une laparotomie exploratrice et deux patients ont refusé la chirurgie. Après un suivi moyen de 48 mois, tous les patients opérés étaient vivants et sept sans évidence de récidive. L'utilisation prolongée (12 mois) d'IM dans un contexte néoadjuvant est faisable, sécuritaire, efficace et comporte peu de toxicité. De plus, cette approche est associée à des hauts taux de résection complète (R0), tout en permettant une chirurgie moins extensive. Des études de phase III actuellement en cours sont nécessaires afin de confirmer nos résultats. / Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the GI tract. The current standard of care for GIST is surgical complete resection with negative margins. The agent response rate as well as survival advantages obtained with imatinib mesylate in patients with metastatic and/or non-resectable GIST has lead clinicians to evaluate this therapy as neoadjuvant treatment in patients with locally advanced or metastatic but potentially resectable GIST. This study was designed to evaluate the efficacy of neoadjuvant use of imatinib mesylate until maximal clinical response in potentially resectable GIST patients (locally advanced or metastatic), in order to provide preliminary data regarding the efficacy of this approach in the surgical treatment of GIST at high-risk of incomplete microscopic (R1) or macroscopic (R2) margins. A prospective multicenter phase II trial was designed. Fourteen consecutive patients diagnosed with advanced GIST received imatinib at dose of 400 mg/d to 600 mg/d, given from 6 to 12 months prior to surgery. Amoung the 14 patients included, 11 underwent surgery and had a complete microscopic resection (R0). After a median follow-up of 48 months, all operated patients were alive and 7 without evidence of recurrence. The prolonged use (12 months) of neoadjuvant imatinib is feasible, safe, eficient ans associated with low toxicity. Furthermore, it is associated with a high rate of microscopic resection (R0) and a less extensive surgical approach. Phase III study with higher cohorts are necessary to confirm our primary results.

Dans les élevages laitiers d’aujourd’hui, les déplacements de la caillette sont parmi les conditions chirurgicales les plus souvent rencontrées. Le pronostic pour ces pathologies est cependant très différent que l’on soit en présence d’une dilatation de la caillette à droite (DCD) ou d’un volvulus de la caillette (VC). En pratique, la distinction en période préopératoire entre ces deux conditions est difficile. Afin de limiter les pertes économiques associées aux DCD/VC, l’identification et la réforme précoce des animaux ayant le plus grand risque d’avoir une mauvaise évolution postopératoire deviennent des enjeux de premier plan. Les objectifs de cette étude étaient de déterminer la valeur pronostique de la L-lactatémie (LAC) mesurée à la ferme en préopératoire à l’aide d’un appareil portatif chez des vaches souffrant de DCD ou VC et de suggérer des seuils de LAC cliniquement significatifs. Nos résultats indiquent que la LAC est un bon indicateur pronostique lors de DCD/VC. Une LAC ≤ 2 mmol/L est un bon indicateur de succès chirurgical et s’avère très utile pour appuyer la décision d’opérer l’animal (sensibilité, spécificité, valeurs prédictives positive et négative de respectivement 76.2, 82.7, 53.3 et 93.1%). Par ailleurs, il n’y a aucun avantage économique à effectuer une chirurgie chez des vaches commerciales souffrant de DCD/VC qui ont une LAC ≥ 6 mmol/L (sensibilité, spécificité, valeurs prédictives positive et négative de respectivement 28.6, 97.5, 75 et 84%). Par conséquent, ces animaux devraient, dans la plupart des cas, être réformés en raison de la probabilité élevée qu’ils aient une mauvaise évolution postopératoire. / Abomasal displacement is among the most commonly encountered surgical disorder in modern dairy herds. Prognosis, however, varies widely among type of abomasal displacement, and preoperative diagnostic may be difficult to assess. To control the economic loss associated with abomasal disorders, especially right displaced abomasum (RDA) and abomasal volvulus (AV), early identification and culling of animals at higher risk of developing a surgical failure (SF) would be of interest. The objectives of this study were to determine the prognostic value of preoperative L-lactate concentration (LAC) measured on farm with a portable clinical analyzer for cows with RDA or AV, and to suggest LAC clinical relevant decision thresholds. Our results showed that LAC was correlated with the prognosis of RDA/AV. A LAC ≤ 2 mmol/L seemed to be good indicator of surgical success and would be useful to support a surgical decision (sensitivity, specificity, positive and negative predictive values of 76.2, 82.7, 53.3 and 93.1%; respectively). On the other hand, there is no economic advantage to perform a surgery on commercial cows with RDA/AV that have LAC ≥ 6 mmol/L and these animals should potentially be culled according to their high probability of SF (sensitivity, specificity, positive and negative predictive values of 28.6, 97.5, 75 and 84%; respectively).