Bakgrund: Det är vanligt att patienter känner oro för att genomgå en operation. Bristfällig information kan skapa oro och känslan av att inte vara förberedd. Standardiserade metoden för att ge preoperativ information visar sig ha brister. Existerande forskning kring multimedia visar positiva effekter gällande patienters kunskap/förståelse, oro och förberedelse men det finns ingen överblick över befintliga studier utförda på området. Syftet med denna studie är att studera hur preoperativ information i form av multimedia kan påverka patienters grad av kunskap/förståelse, förberedelse och oro i den perioperativa perioden. Metod: Systematisk litteraturstudie med kvantitativ ansats. Datainsamlingen utfördes i databaserna Pubmed och Cinahl. Urvalsprocessen utgick från modellen PICO. Kvalitetsgranskning utfördes, 16 artiklar inkluderades, varav 14 RCT-studier. Analysen bestod av att syntetisera och summera data. Resultat: Mer än hälften av deltagarna (53%) i interventionsgruppen skattade ingen signifikant skillnad gällande oro jämfört med kontrollgruppen. Majoriteten av deltagarna i interventionsgruppen (87%) hade signifikant mer kunskap/förståelse jämfört kontrollgruppen. Gällande förberedelse kände 57% av deltagarna i interventionsgruppen sig signifikant mer förberedda jämfört med kontrollgruppen. Konklusion: Multimedia är ett effektivare verktyg för att öka patienters kunskap/förståelse och förberedelse jämfört med standardiserad vård. Multimedia är dock inte mer effektivt än standardiserad metod för att minska patienters oro. Författarna föreslår att individuellt anpassad preoperativ information kombinerat med multimedia kan tillämpas för patienter som ska genom en operation för att minska lidandet. Det finns behov av fortsatt forskning inom området. / Background: Patients undergoing surgery often experience feeling of anxiety. Lack of information is a common cause of anxiety and also provokes a feeling of not being prepared. The way patients are informed preoperatively today has clear flaws. There are studies showing benefits regarding patients’ level of knowledge/understanding, anxiety and preparedness before surgery when multimedia is used preoperatively. Reviews on the subject are lacking. Aim: To study how preoperative information given through multimedia can impact the level of knowledge/understanding, anxiety and feeling of preparedness among patients undergoing surgery. Methods: Quantitative review article. The databases Pubmed and Cinahl were used. The PICO-model was used for article selection. 16 articles were included, 14 of them were RCTs. The analysis consisted of synthesizing and summarizing the findings. Results: More than half (53%) of the patients in the intervention group did not score any significant change in level of anxiety compared to control. The majority (87%) of the patients in the intervention group had significantly better knowledge/understanding compared to control. Regarding feeling of preparedness, 57% of the patients in the intervention group feel significantly more prepared compared to control. Conclusions: Multimedia as a tool is more effective in providing patients undergoing surgery with knowledge/understanding and preparedness compared to standard care. Multimedia is not better at reducing anxiety compared to standard care. The authors suggest that tailored preoperative information combined with multimedia should be used for patients undergoing surgery. Further research is needed within the field.

Abstract Cardiovascular diseases are the leading cause of death worldwide, and coronary artery disease accounts for the majority of them. The treatment of choice for complex coronary artery disease is coronary artery bypass grafting. However, as surgery in general, cardiac surgery is associated with an increased risk of perioperative bleeding and utilization of blood products. The present study aimed to investigate the impact of preoperative anemia, perioperative bleeding and retained blood syndrome as well as blood transfusion on the outcomes after isolated coronary surgery. The severity of perioperative bleeding was assessed mainly using the E-CABG and UDPB stratification criteria. Our analyses showed that severe bleeding is associated with a significantly increased risk of stroke. Furthermore, severe bleeding increased the risk of several adverse events even in low-risk patients. Retained blood syndrome was observed to be a common complication after coronary surgery and was associated with an increased risk of postoperative complications. Preoperative anemia seems to have no significant impact on patient early and late survival. Instead, the frequent exposure to blood products may be the determinant of poorer survival observed among anemic patients. Perioperative blood loss and exposure to allogeneic blood has been shown to increase adverse events. Therefore, prevention of bleeding and measures to optimize patient blood management could improve patient outcomes after cardiac surgery. / Tiivistelmä Sydän ja verisuonitaudit ovat maailmanlaajuisesti yleisin kuoleman aiheuttaja, joista sepelvaltimotaudilla on suurin vaikutus. Sepelvaltimoiden ohitusleikkaus on käypä hoito vakavassa sepelvaltimotaudissa. Kuten kirurgiassa yleisestikin, erityisesti sydänkirurgia on yhdistetty suurentuneeseen verenevuodon ja verituotteiden saannin riskiin. Tutkimukseni tavoitteena oli selvittää preoperatiivisen anemian, perioperatiivisen verenvuodon, verituotteiden annon, sekä leikkausalueelle jääneen veren itsenäisiä vaikutuksia potilaiden lopputulemiin sepelvaltimoiden ohitusleikkauksen jälkeen. Verituotteiden ja perioperatiivisen verenvuodon määrää arvioitiin pääsääntöisesti käyttäen E-CABG ja UDPB verenvuotoluokituksia. Tuloksenamme oli, että vakava verenvuoto lisää merkitsevästi aivoinfarktin riskiä. Lisäksi vakava perioperatiivinen verenvuoto on yhteydessä useisiin komplikaatioihin myös matalan leikkausriskin potilailla. Leikkausalueelle jääneen veren huomattiin olevan yleinen ongelma sepelvaltimoiden ohitusleikkauksen jälkeen, minkä lisäksi se lisäsi riskiä useille haitta-tapahtumille. Preoperatiivisella anemialla ei ollut tilastollisesti merkitsevää vaikutusta potilaiden lyhyen ja pitkän aikavälin ennusteisiin. Sen sijaan, aneemisille potilaille annetut verensiirrot saattaisivat aiheuttaa näillä potilailla huomatun alentuneen elinajan ennusteen. Perioperatiivisen verenvuodon ja altistumisen verituotteille on osoitettu lisäävän haittatapahtumia. Siispä verenvuodon vähentäminen ja verituotteiden säästäminen voisi parantaa potilaiden ennustetta sydänkirurgiassa.

L’Ostéotomie Tibiale de Valgisation (OTV) par ouverture médiale est un traitement conservatif efficace dans le traitement de la gonarthrose médiale chez le patient jeune et actif présentant un défaut d’alignement du membre inférieur. Ce défaut entraine un déséquilibre dans la répartition des charges transitant dans le genou et est un facteur de risque la gonarthrose. L’objectif est de corriger l’alignement en corrigeant une déformation osseuse du tibia proximal. Une coupe osseuse médiolatérale incomplète partant du bord médial de la métaphyse tibiale et orientée vers l’articulation tibio-fibulaire permet de créer une ouverture sur le bord médial par rotation autour de la charnière latérale, épaisseur d’os non-coupée sur le bord latéral. L’importance de l’ouverture dépend de la déformation osseuse et du stade d’arthrose. La réussite de l’OTV par ouverture médiale est conditionnée par une correction précise, un montage d’ostéosynthèse stable et une charnière latérale préservée pendant l’ouverture. L’objectif de cette thèse était de proposer une méthodologie de planification préopératoire à associer à une instrumentation patient-spécifique réalisée en impression 3D. Cette instrumentation devait permettre d’appliquer la correction souhaitée dans les plans frontal et sagittal mais aussi de préserver la charnière latérale pendant la chirurgie. Nos résultats ont montré, grâce aux études in-vitro et in-vivo réalisées au cours de la thèse, que le guide de coupe patient-spécifique développé permet de reproduire avec précision la planification préopératoire en apportant de la sécurité au geste opératoire tant au niveau de la précision que de la préservation de la charnière latérale. / Medial Opening Wedge High Tibial Osteotomy (MOWHTO) is an efficient conservative surgical treatment for young and active patients with moderate medial gonarthrosis and varus lower limb malalignment. Varus malalignment unbalances load distribution in the knee, which is a gonarthrosis risk factor. MOWHTO aims to correct the lower limb alignment by correcting the proximal tibia bony deformity. Incomplete mediolateral cut is performed in the proximal tibia from the medial side of the tibial metaphysis towards the tibiofibular joint, and then opened by rotation around the lateral hinge which is the remaining uncut bone thickness on the lateral side. Amount of the opening depends on the importance of the proximal tibial deformity and on the medial gonarthrosis stage. MOWHTO success remains on precise correction, stable osteosynthesis system and lateral hinge preservation during the opening. Objective of this thesis was to propose a preoperative planning methodology to be associated with 3D printed patientspecific instrumentation. This instrumentation was intended to apply the correction chosen by the surgeon in the frontal and sagittal planes, but also to preserve the lateral hinge during the surgery. Our in-vitro and in-vivo results have shown that the developed patient-specific cutting guide make it possible to accurately reproduce the preoperative planning with security to the surgical gesture by bringing accuracy and lateral hinge preservation.

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)

No description available.

La préadaptation vise à optimiser la santé d’un individu entre le diagnostic de cancer et la chirurgie. L’approche multimodale, qui cible deux composantes ou plus comme l’activité physique, la nutrition et le soutien psychosocial, est recommandée. Ce type d’intervention est généralement proposé en clinique et en suivi individuel, ce qui peut limiter l’accessibilité et les bénéfices tirés d’une pratique d’activité physique en groupe. Pour mieux répondre aux besoins des individus ayant reçu un diagnostic de cancer, nous avons développé et testé un programme de télé-préadaptation multimodale en groupe en évaluant l’implantabilité (acceptabilité, fidélité, faisabilité) et les effets préliminaires (capacité physique, santé mentale, soutien social, activité physique). Les participants (n=25) étaient évalués virtuellement par un kinésiologue et complétaient un questionnaire au départ (T1), pré-chirurgie (T2) et 12 semaines post-chirurgie (T3). Trois séances en groupe de 90 minutes par semaine, avec une composante exercice et éducative, étaient supervisées virtuellement par un kinésiologue. Des analyses descriptives et statistiques (test-T pairé et Wilcoxon) ont été réalisées. L’évaluation de l’implantabilité suggère un niveau élevé d’acceptabilité (satisfaction, utilité, sécurité, intentions futures en activité physique et recommandation à un proche (88%-100%)); de fidélité (dispensé comme prévu, mais quelques adaptations effectuées); et de faisabilité (rétention (98%), adhérence (70%)). La principale barrière est le faible taux de référencement de patients éligibles (31%). Les effets préliminaires suggèrent une amélioration au 2-minute Step Test (+18,86 pas), au 30-second Sit-to-Stand (+1,10 répétition) et pour le volume hebdomadaire d'activité physique modérée (+104,80 minutes) entre T1 et T2, ainsi qu’une diminution du niveau de stress (-0,53) et de la qualité de vie (-8,68) entre T1 et T3. L’évaluation de la mise à l’échelle et de la viabilité de ce programme est envisageable pour réduire les barrières à l’activité physique et les inégalités d’accès aux soins en contexte de cancer. / Prehabilitation aims to optimize an individual's health between cancer diagnosis and surgery. A multimodal approach, which targets two or more components such as physical activity, nutrition and psychosocial support, is recommended. This type of intervention is usually offered in-clinic and with one-on-one follow-ups, which may limit the accessibility and benefits of a group-based physical activity program. To better meet the needs of individuals diagnosed with cancer, we developed and tested a virtual multimodal group prehabilitation program assessing the implementability (acceptability, fidelity, feasibility) and preliminary effects (physical capacity, mental health, social support, physical activity). Participants (n=25) were assessed virtually by a kinesiologist and completed a questionnaire at baseline (T1), pre-surgery (T2) and 12 weeks post-surgery (T3). Three 90-minute group sessions per week were virtually supervised by a kinesiologist and comprised an exercise and educational component. Descriptive and statistical analyses (paired t-test and Wilcoxon) were performed. The evaluation of implementability suggests a high level of acceptability (satisfaction, usefulness, safety, future physical activity intentions and recommendation to a relative (88%-100%)); fidelity (delivered as planned, but some adaptations were made); and feasibility (retention (98%), adherence (70%)). The main barrier is the low rate of eligible referrals (31%). Preliminary effects suggest an improvement in the 2-minute Step Test (+18.86 steps), the 30-second Sit-to-Stand (+1.10 repetitions), and the moderate physical activity weekly volume (+104.80 minutes) between T1 and T2, as well as a decrease in stress level (-0.53) and quality of life (-8.68) between T1 and T3. Scalability and viability can be assessed and show promise to reduce barriers to physical activity and inequities in access to care in the cancer setting.

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common severe surgical complication after pancreatic surgery. Current risk stratification systems mostly rely on intraoperatively assessed factors like manually determined gland texture or blood loss. We developed a preoperatively available image-based risk score predicting CR-POPF as a complication of pancreatic head resection. Frequency of CR-POPF and occurrence of salvage completion pancreatectomy during the hospital stay were associated with an intraoperative surgical (sFRS) and image-based preoperative CT-based (rFRS) fistula risk score, both considering pancreatic gland texture, pancreatic duct diameter and pathology, in 195 patients undergoing pancreatic head resection. Based on its association with fistula-related outcome, radiologically estimated pancreatic remnant volume was included in a preoperative (preFRS) score for POPF risk stratification. Intraoperatively assessed pancreatic duct diameter (p < 0.001), gland texture (p < 0.001) and high-risk pathology (p < 0.001) as well as radiographically determined pancreatic duct diameter (p < 0.001), gland texture (p < 0.001), high-risk pathology (p = 0.001), and estimated pancreatic remnant volume (p < 0.001) correlated with the risk of CR-POPF development. PreFRS predicted the risk of CR-POPF development (AUC = 0.83) and correlated with the risk of rescue completion pancreatectomy. In summary, preFRS facilitates preoperative POPF risk stratification in patients undergoing pancreatic head resection, enabling individualized therapeutic approaches and optimized perioperative management.

There are few data on the associations between anaemia, allogeneic blood transfusion (ABT), patient blood management, and outcome after arthroplasty in the UK. National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management. Internationally, blood management programmes show encouraging results. METHODS: We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors. We used these data to modify previously published algorithms for UK practice and audited its introduction prospectively. The retrospective audit group served as a control. RESULTS: Preoperative haemoglobin (Hb) concentration predicted ABT (odds ratio 0.25 per 1 g dl(-1), P<0.001). It also predicted the length of stay (LOS, effect size -0.7 days per 1 g dl(-1), P=0.004) independently of ABT, including in non-anaemic patients. Patient blood management implementation was associated with lower ABT rates for hip (23-7%, P<0.001) and knee (7-0%, P=0.001) arthroplasty. LOS for total hip replacement and total knee replacement decreased from 6 (5-8) days to 5 (3-7) and 4 (3-6) days, respectively, after algorithm implementation (P<0.001). The all-cause re-admission rate within 90 days decreased from 13.5% (97/717) before to 8.2% (23/281) after algorithm implementation (P=0.02). CONCLUSIONS: We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice. A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge.

<p>Увод: Објективна процена оперативног ризика кардиохируршких болесника и процена потребне постоперативне ангажованости медицинских сестара у јединици интензивног лечења могу допринети брзом увиду у тежину здравственог стања болесника , осигурању оптималног броја сестара, омогућавању квалитетне здравствене неге болесника, олакшању организације рада , аргументованом уговарању потреба за сестринским кадром. Најчешће коришћени физиолошки скорови, за процену обима ангажованости медицинских сестара су: Nine Equivalent of Nursing Use Manpower Score (NEMS)и Nursing Activities Score (NAS). Током 2010. године, за процену ризика у кардиохирургији, креиран је модел European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Циљеви истрађивања: 1.Испитати повезаност EuroSCORE II, и активности медицинских сестара у јединици интензивног лечења. 2.Утврдити утицај релевантних фактора ризика из EuroSCORE II, на активности медицинских сестара у јединици интензивног лечења. 3.Испитати повезаност EuroSCORE II, и специфичних интервенција медицинских сестара јединице интензивног лечења. Методе:У студију je била укључена консекутивна серија од 809 болесника, оперисаних на Клиници за кардиоваскуларну хирургију Института за кардиоваскуларне болести, у периоду од 01.02. 2014-30.11.2014. године. Подаци о вредностима EuroSCORE II и релевантним факторима ризика преузети су болничког информационог система.Подаци о сестринским активностима у јединици интензивног лечења, након кардиохируршке интервенције, регистровани у одговарајућим листама. Испитивање повезаности нивоа оперативног ризика и активност медицинских сетра вршено је помоћу линеарне корелације. Утицај појединих фактора из модела EuroSCORE II на активност медицинских сестара испитиван је мултиваријантном линеарном регресијом. Зависност специфичних интервенција медицинских сестара од нивоа EuroSCORE II и других параметара оцењивана је помоћу бинарне логистичке регресије. Квалитет предиктивног модела, одређиван је помоћу ROC кривих, укључујући одређивање оптималног пресека, сензитивности и специфичности. Резултати: EuroSCORE II је у позитивној корелацији са укупним NEMS (r=0,207;p&lt;0,0005) и NAS (r=0,242;p&lt;0,005). Ослабљена функција бубрега, ослабљена систолна функција леве коморе и плућна хипертензија, повезани су са повећаним активностима медицинских сестара (p&lt;0,0005). EuroSCORE II и укупна ангажованост медицинских сестра били су у корелацији (r=0,098; p=0,005 за NEMS, односно r=0,100; p=0,004 за NAS). Mултиваријантна бинарна логистичка регресија показује да на повећани NAS утичу комбинована кардиохиршка процедура (p=0,005), претходне операције (p=0,009), oслабљена функција бубрега (p&lt;0,0005), NYHA класа (p=0,007) и плућна хипертензија (p &lt; 0,0005). Модел има добру моћ дискриминације односно, добар је маркер за разликовање болесника код којих се, после операције на срцу, очекује повећан укупан NAS (area=0,702, p&lt;0,0005). Прeсечна тачка (cut-off) је 23, сензитивност 0,624 а специфичност 0,688. Закључак: Постоји позитивна корелација између нивоа EuroSCORE II и укупне активности медицинских сестара у јединици интензивног лечења. Ослабљена функција бубрега, ослабљена систолна функција леве коморе и плућна хипертензија, повезани су са повећаним активностима медицинских сестара израженим помоћу NEMS и NAS. EuroSCORE II и збир специфичних интервенција, односно укупна ангажованост медицинских сестара и EuroSCORE II били су у корелацији. Могуће је направити Модел за предикцију вероватноће повећаног укупног ангажовања медицинских сестара у јединици интензивног лечења кардиохируршких болесника.</p> / <p>Uvod: Objektivna procena operativnog rizika kardiohirurških bolesnika i procena potrebne postoperativne angažovanosti medicinskih sestara u jedinici intenzivnog lečenja mogu doprineti brzom uvidu u težinu zdravstvenog stanja bolesnika , osiguranju optimalnog broja sestara, omogućavanju kvalitetne zdravstvene nege bolesnika, olakšanju organizacije rada , argumentovanom ugovaranju potreba za sestrinskim kadrom. Najčešće korišćeni fiziološki skorovi, za procenu obima angažovanosti medicinskih sestara su: Nine Equivalent of Nursing Use Manpower Score (NEMS)i Nursing Activities Score (NAS). Tokom 2010. godine, za procenu rizika u kardiohirurgiji, kreiran je model European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Ciljevi istrađivanja: 1.Ispitati povezanost EuroSCORE II, i aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. 2.Utvrditi uticaj relevantnih faktora rizika iz EuroSCORE II, na aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. 3.Ispitati povezanost EuroSCORE II, i specifičnih intervencija medicinskih sestara jedinice intenzivnog lečenja. Metode:U studiju je bila uključena konsekutivna serija od 809 bolesnika, operisanih na Klinici za kardiovaskularnu hirurgiju Instituta za kardiovaskularne bolesti, u periodu od 01.02. 2014-30.11.2014. godine. Podaci o vrednostima EuroSCORE II i relevantnim faktorima rizika preuzeti su bolničkog informacionog sistema.Podaci o sestrinskim aktivnostima u jedinici intenzivnog lečenja, nakon kardiohirurške intervencije, registrovani u odgovarajućim listama. Ispitivanje povezanosti nivoa operativnog rizika i aktivnost medicinskih setra vršeno je pomoću linearne korelacije. Uticaj pojedinih faktora iz modela EuroSCORE II na aktivnost medicinskih sestara ispitivan je multivarijantnom linearnom regresijom. Zavisnost specifičnih intervencija medicinskih sestara od nivoa EuroSCORE II i drugih parametara ocenjivana je pomoću binarne logističke regresije. Kvalitet prediktivnog modela, određivan je pomoću ROC krivih, uključujući određivanje optimalnog preseka, senzitivnosti i specifičnosti. Rezultati: EuroSCORE II je u pozitivnoj korelaciji sa ukupnim NEMS (r=0,207;p&lt;0,0005) i NAS (r=0,242;p&lt;0,005). Oslabljena funkcija bubrega, oslabljena sistolna funkcija leve komore i plućna hipertenzija, povezani su sa povećanim aktivnostima medicinskih sestara (p&lt;0,0005). EuroSCORE II i ukupna angažovanost medicinskih sestra bili su u korelaciji (r=0,098; p=0,005 za NEMS, odnosno r=0,100; p=0,004 za NAS). Multivarijantna binarna logistička regresija pokazuje da na povećani NAS utiču kombinovana kardiohirška procedura (p=0,005), prethodne operacije (p=0,009), oslabljena funkcija bubrega (p&lt;0,0005), NYHA klasa (p=0,007) i plućna hipertenzija (p &lt; 0,0005). Model ima dobru moć diskriminacije odnosno, dobar je marker za razlikovanje bolesnika kod kojih se, posle operacije na srcu, očekuje povećan ukupan NAS (area=0,702, p&lt;0,0005). Presečna tačka (cut-off) je 23, senzitivnost 0,624 a specifičnost 0,688. Zaključak: Postoji pozitivna korelacija između nivoa EuroSCORE II i ukupne aktivnosti medicinskih sestara u jedinici intenzivnog lečenja. Oslabljena funkcija bubrega, oslabljena sistolna funkcija leve komore i plućna hipertenzija, povezani su sa povećanim aktivnostima medicinskih sestara izraženim pomoću NEMS i NAS. EuroSCORE II i zbir specifičnih intervencija, odnosno ukupna angažovanost medicinskih sestara i EuroSCORE II bili su u korelaciji. Moguće je napraviti Model za predikciju verovatnoće povećanog ukupnog angažovanja medicinskih sestara u jedinici intenzivnog lečenja kardiohirurških bolesnika.</p> / <p>Introduction: Objective assessment of operative risk of cardiac surgery patients and assessment of the necessary postoperative nursing engagement in the intensive care units can contribute to rapid insight into the health status of the patients, ensuring optimal number of nurses, enabling quality health care, facilitating the work organization, providing the basis for contracting adequate number of personnel. The most commonly used physiological scores for assessment of the extent of involvement of nurses are: Nine Equivalent of Nursing Manpower Use Score (NEMS) and the Nursing Activities Score (NAS). In 2010, risk assessment model for cardiac surgery was developed - European System for Cardiac Operative Risk Evaluation (EuroSCORE II). Objectives of the research: 1. To examine the relationship between EuroSCORE II and the activities of nurses in the intensive care unit. 2. To determine the influence of relevant risk factors of EuroSCORE II model, to the activities of nurses in the intensive care unit. 3. To examine the relationship between EuroSCORE II and specific nursing interventions in intensive care unit. Methods: The study included consecutive series of 809 patients surgically treated at the Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases in Sremska Kamenica, from 01:02. 2014 to 30.11.2014. Data on EuroSCORE II values and relevant risk factors were taken from the hospital information system. Nursing activities in the intensive care unit after cardiac surgery were registered using the relevant lists. Correlation between operative risk and activity of the nursing staff was performed using linear correlation. The influence of certain factors from the EuroSCORE II model to the activity of nurses was investigated by multivariate linear regression. Dependence of specific nursing interventions on the level of EuroSCORE II and other parameters was evaluated using binary logistic regression. Quality of the predictive model was determined using ROC curves, including the determination of the optimum cross-section of sensitivity and specificity. Results:The EuroSCORE II was positively correlated with the total NEMS (r= 0.207; p &lt;0.0005) and NAS (r=0.242; p&lt;0.005). Impaired renal function, impaired left ventricular systolic function and pulmonary hypertension, were associated with increased activity of nurses (p&lt;0.0005). EuroSCORE II and the total involvement of nurses were correlated (r=0.098; p=0.005 for NEMS, respectively r =0.100; p = 0.004 for the NAS). Multivariate binary logistic regression showed that there is influence on the increased NAS by the following factors: combined cardiac suregry (p=0.005), previous surgery (p=0.009), impaired renal function (p&lt;0.0005), NYHA class (p=0.007) and pulmonary hypertension (p&lt;0.0005). Model showed good discriminative power, and is a good marker for distinguishing patients in whom, following the heart surgery, increased overall NAS might be expected (area=0.702, p &lt;0.0005). Intersection point (cut-off) is 23, the sensitivity and specificity 0.624 0.688. Conclusion: There is a positive correlation between the level of EuroSCORE II and the entire work of nurses in the intensive care unit. Impaired renal function, impaired left ventricular systolic function and pulmonary hypertension, are associated with increased activity of nurses expressed using NEMS and NAS. EuroSCORE II and the sum of specific interventions, and the engagement of nurses and EuroSCORE II were correlated. It is possible to make a model to predict the probability of increased overall engagement of nurses in the cardiac surgery intensive care unit.</p>

INTRODUÇÃO: Hérnia incisional (HI) é complicação relacionada às laparotomias e ocorre em cerca de 2 a 15% dos pacientes submetidos a procedimento operatório abdominal. A técnica de pneumoperitônio progressivo pré-operatório (PPP), descrita por Goñi Moreno em 1940, trouxe uma solução revolucionária e reprodutível para o tratamento da HI com perda de domicílio. Mesmo nos dias atuais, o tratamento das HI gigantes (com anel herniário maior que 10 centímetros) e com perda de domicílio representa um desafio ao cirurgião. Estabeleceu-se no Serviço de Cirurgia Eletiva da Divisão de Clínica Cirúrgica III do Hospital das Clínicas e Disciplina de Cirurgia Geral da Faculdade de Medicina da Universidade de São Paulo (SCE DCCIII DCG HC FMUSP) protocolo de tratamento deste tipo de doença, com realização de tomografia computadorizada (TC) de abdome total e cálculo de volume da cavidade abdominal (VCA) e do saco herniário (VSH), realização de PPP e ressecção visceral (ressecção total ou parcial de vísceras intraabdominais) em alguns casos, pelo risco de Síndrome Compartimental Abdominal (SCA). O objetivo do estudo foi encontrar fatores preditivos para avaliar a necessidade de ressecção visceral no tratamento operatório do paciente portador de hérnia incisional gigante com perda de domicílio submetido a PPP. MÉTODO: Foram coletados e analisados dados retrospectivos de 23 pacientes operados na clínica cirúrgica no período de fevereiro de 2001 a abril de 2008, que apresentavam perda de domicílio comprovado por estudo tomográfico demonstrando relação de volumes (RV) maior ou igual a 25% (VSH/VCA25%). Usamos o teste de qui-quadrado e teste exato de Fisher para avaliar a associação entre variáveis qualitativas e teste t de Student e o teste de Mann-Whitney para comparação de variáveis quantitativas. O tratamento operatório destes doentes contemplou realização de PPP, conforme protocolo. Foram então divididos em 2 grupos: Os submetidos a ressecção visceral (GRV) e os não submetidos a ressecção visceral (GNRV) no tratamento operatório. RESULTADOS: Dos 23 pacientes operados, 10 (43,5%) foram submetidos a ressecção visceral. Observou-se que os valores de duas variáveis dentre as analisadas: A pressão intra-abdominal após redução temporária do conteúdo herniário (PIAfechado) e a variação da pressão intra-abdominal do momento inicial ao momento da redução temporária do conteúdo herniário (PIA) estavam significativamente aumentados nos casos submetidos a ressecção visceral. CONCLUSÕES: A ressecção visceral deve ser considerada quando a PIAfechado é superior a 18 cm dágua e quando a PIA é superior a 9 cm dágua. A monitorização da PIA no início da operação, após o fechamento temporário e no pós-operatório é necessária e imprescindível neste tipo de operação. / INTRODUCTION: Incisional hernia (IH) occur in 2 to 15% of pacients that undergo abdominal surgery. Progressive preoperative pneumoperitoneum (PPP) was described in 1940 by Goñi Moreno for the treatment of incisional hernia with loss of domain (IHLD). Protocol for treatment of IHLD was stablished at Serviço de Cirurgia Eletiva da Divisão de Clínica Cirúrgica III do Hospital das Clínicas e Disciplina de Cirurgia Geral da Faculdade de Medicina da Universidade de São Paulo SCE DCCIII DCG HC FMUSP, using CT Scan for hernia sac volume (HSV) and abdominal cavity volume (ACV) calculation and PPP. Visceral ressection (parcial ou total ressection of intra abdominal organs) was associated in some cases to avoid abdominal compartment syndrome (ACS). The objective of this study was to find predictors that could evaluate the need of visceral ressection in patients submitted into surgical treatment of IHLD with PPP. Where analysed data of 23 patients with IHLD were operated from February 2001 to April 2008. We used the Chi-square test and Fisher\'s exact test to evaluate the association between qualitative variables and Students t test and Mann-Whitney test for comparison of quantitative variables. We stablished that only patients with CT Scan calculated volume relation (VR=HSV/ACV) greater than or equal to 25% (VR25%) should be included in this protocol. They were divided into 2 groups: The visceral ressection group (VSG) and not visceral ressection group (NVRG). RESULTS: Of the 23 patients, 10 (43.5%) were submitted to visceral ressection. The intra-abdominal pressure after temporary reduction of hernial content into and closure of the abdominal cavity (PIAfechado) and the increment of intra-abdominal pressure between the pressure at the begining of operation (PIAinicial) and PIAfechado (PIA) were different between the two groups analysed (VRG and NVRG). CONCLUSIONS: The PIAfechado and PIA can be used as predictors for visceral ressection. The visceral ressection should be considered when the PIAfechado is more than 18 cm of water and PIA is more than 9 cm of water. The monitoring of the PIA at the beginning of operation, after temporary closure and after surgery is necessary and essential in this type of operation.