Kranskärlsoperationen är för patienten en stor händelse som leder till många frågor och funderingar. Tidigare forskning har visat att patienter som genomgått en ranskärlsoperation har stort behov av information. Vårt syfte med studien var att beskriva informationen vid en kranskärlsoperation. Studien gjordes som en itteraturstudie. Resultatet av studien utföll i tre kategorier, informationsmetoder, vad informationen innehöll samt olika faktorer som påverkade patientinformationen. Information gavs skriftligt, muntligt, som videofilm, med Internet eller av en patient som tidigare gjort en kranskärlsoperation, ofta i kombination med varandra. Vad patienten ville att informationen skulle innehålla varierade från person till person beroende på i vilken fas patienten befann sig, pre- eller postoperativt. Flera faktorer framkom som var av betydelse. Det var viktigt för patienterna att personalen tog sig tid att lyssna och svara på frågor och funderingar. Patienter med litet socialt nätverk hade större behov av information än andra med stort socialt nätverk. En annan betydelsefull sak var att patienterna lätt skulle kunna komma i kontakt med kompetent personal både innan operationen och efter utskrivningen. Slutsatsen av resultatet var att informationen bör vara individuellt anpassad utifrån varje patients behov. Fortsatt forskning behövs för utveckling av en god patientinformation kring patienternas upplevelse av olika sorters informationssätt, samt att utveckla kontakt med patienter som tidigare gjort en kranskärlsoperation / Coronary artery bypass is for the patient a major event leading to many questions and concerns. Previous research has shown that patients who have undergone coronary artery bypass have great needs of information. Our aim of this study was to describe information before and after a coronary artery bypass. The study was done as a literature review. The results of the study were distributed into three categories, information methods, information content and the various factors that affect patient information. Information was given in writing, orally, by video, by Internet or by a patient previously undergoing a coronary artery surgery, usually in combination with each other. What the patient wanted the information should contain varied from person to person depending on what stage the patient was, pre- or postoperatively. Several factors emerged that were relevant. It was important for the patients that the staff took the time to listen and respond to questions and concerns. Patients with small social networks had a greater need for information than others with larger social network. Another important thing was that patients could easily get in touch with competent personnel both before surgery and after discharge. The conclusion of the result was that the information should be individualized based on each patient's needs. Continued research is needed to develop good patient information on patients' experience of different types of information means, and to develop contact with patients who have previously done a coronary artery bypass.

SAMMANFATTNING Bakgrund: Preoperativ fasta har under många år varit en traditionell metod för att minska risken för aspiration medan patienten är under generell anestesi och för att eliminera risken för postoperativ illamående och kräkningar. Studier visar att trots riktlinjer och rekommendationer gällande preoperativ fasta fastar många patienter i onödan i flera dagar än nödvändigt. Detta kan orsaka skador och obehag hos patienten som till exempel: törst, huvudvärk, illamående, svaghet och trötthet. Syfte: Syfte med denna studie var att undersöka hur patienter upplever fasta mer än 12 timmar innan en akutoperation. Metod: Arbetet hade en kvalitativ ansats där 12 patienter som genomgått akut operation inkluderades. Data samlades in genom en semistrukturerad intervju, med hjälp av öppna frågor enligt en intervjuguide och analyserades med hjälp av manifest innehållsanalys enligt Graneheim och Lundman. Resultat: Analyserna resulterade i fyra kategorier: Preoperativ information, upplevelse av fasta, hantering av preoperativ fasta och upplevelse av preoperativ tid och åtta underkategorier: Bristfällig information, tillräcklig information, bristfällig kunskap trots tidigare vårderfarenhet, fysisk påverkan, psykisk påverkan, strategi, väntetid och fastetid. Slutsats: Deltagarna i studien upplevde brist på information och kunskaper om den preoperativa fastans betydelse. Studien visade att patienterna som väntade på akut operation på akutvårdsavdelning fastade längre än nödvändigt trots riktlinjer och rekommendationer gällande preoperativ fasta från Svensk förening för Anestesi och Intensivvård (SFAI). Patienterna som genomgått apendectomi fastade mellan 13,5-28 timma (M=22,2), medan de som hade genomgått kolecystectomi fastade mellan 12-48 timmar (M=25,6). Detta orsakade fysiskt och psykiskt obehag hos patienterna. / ABSTRACT Background: Preoperative fasting for many years has been a traditional method of reducing the risk of aspiration while the patient is under general anesthesia, and eliminating the risk of postoperative nausea and vomiting. Studies indicate that despite guidelines regarding preoperative fasting, many patients fast longer than necessary. This can cause damage and discomfort for patients including: thirst, headache, nausea, weakness and fatigue. Aim: The aim of the current study was to investigate patients’ experience of fasting more than 12 hours before emergency surgery. Method: The study had a qualitative approach. In total, 12 patients who underwent emergency surgery were included. Data was collected through a semi-structured interview, using open-ended questions following an interview guide. Collected data were analyzed using manifest content analysis according to Graneheim and Lundman. Result:  Analyzes resulted in four categories: Preoperative information, experience of fasting, handles preoperative fasting and experiences of the preoperative period and eight subcategories: Lack of information, enough information, lack of knowledge despite previous nursing experience, physical impact, psychological impact, strategy, waiting time and fasting time. Conclusion: Participants in the study experienced lack of information and knowledge of the preoperative fasting importance. This study showed that patients,  waiting for emergency surgery in the emergency department fast longer than necessary despite existing guidelines and recommendations of the Swedish Society of Anaesthesia and Intensive care (SFAI) regarding preoperative fasting. Patients who have undergone appendectomy fasted between 13.5 to 28 hours (M = 22.2), whereas those which had undergone cholecystectomy attached between 12-48 hours (M = 25.6). This caused experience of physical and psychological discomfort for the patients.

ABSTRACT   The purpose of this medical record research was to study 30 patients with chronic subdural hematoma on a neurosurgical clinic, mapping documented nutritional status, preoperative fasting and hydration and energy supply before surgery. In addition peroperative administration of fluid and vasoactive drugs, as well as postoperative complications and length of hospital stay were studied. The mean age of the patients was 71 years. Nutritional status was evaluated in 12 patients, out of these seven were judged to be at risk for under nutrition. Fifteen patients had surgery day 1 (total fasting time on average m 11 h), eleven had surgery day 2 (29 h), three had surgery day 3 (35 h). One patient had surgery day 4 (61 h). Fluid and energy administration during the preoperative fasting did not meet the basic requirements. The majority of the patients received vasoactive drugs and more than twice the normal requirement of fluids during anesthesia. Postoperative complications were documented in 11/30 records. There was a significant correlation between preoperative fasting hours and length of hospital stay, however there may not be a causal relationship.   The conclusion is that the fasting period is significantly longer than the guidelines recommend and the patients do not receive their preoperative fluid and energy requirements, which may lead to an increased number of postoperative complications and prolonged hospital stay. A goal of the treatment should be that the preoperative fasting time is kept as short as possible and that the basal fluid and energy requirements are met. An evidence based strategy for this purpose should be created.

Bakgrund: Forskning tyder på att preoperativ ångest utgör ett vanligt förekommande problem hos patienter som skall genomgå kirurgi. Flera studier visade att den kan leda till olika postoperativa komplikationer. Det är sjuksköterskans ansvar att både identifiera och åtgärda ångest inför ett kirurgiskt ingrepp. Syfte: Att beskriva vilka icke-farmakologiska interventioner finns för att minska preoperativ ångest hos vuxna patienter. Metod: Studiens design var en litteraturöversikt som genomfördes enligt Fribergs metodbeskrivning. Litteraturöversikten bygger på tolv kvantitativa studier publicerade mellan 01/2007 och 09/2017. Sökningar utfördes i databaserna CINAHL Complete och PubMed. Resultat: Denna litteraturöversikt tyder på att det finns flera, olika interventioner som kan användas som komplement till farmakologisk behandling för att effektivt minska preoperativ ångest hos vuxna patienter. Ångest i den preoperativa fasen kan lindras om patienten får en utökad, individuell anpassad information. Ångest kan också minskas om patienten får ett känslomässigt stöd eller hjälp med att finna tröst i andlighet/religion. Litteraturöversiktens resultat tyder dessutom på att ångestnivå kan sänkas med hjälp av en lugn musik, naturljud eller vägledd dagdröm. Det framkom även att den preoperativa ångesten kan minskas genom avslappningsövningar, aromaterapi, akupunktur och zonterapi. Endast en fotografisk utställning har inte visats vara effektiv för att minska ångest i det preoperativa skedet. Diskussion: Resultatet av litteraturöversikten har diskuterats i relation till sjuksköterskans ansvarsområde. Resultatdiskussionen koncentreras kring praktiska frågor gällande implementering av de icke-farmakologiska metoderna i vården. Jean Watsons teori om mänsklig omsorg utgjorde översiktens teoretiska referensram som hjälpte författaren i resultatdiskussionen. / Background: Research indicates that preoperative anxiety is a widespread problem among patients undergoing surgery. It has been shown in several studies that preoperative anxiety may lead to different postoperative complications. It is the nurse's responsibility to identify and to reduce patients' anxiety. Aim: To describe which non-pharmacological interventions are available to reduce preoperative anxiety in adult patients. Method: The study was designed as a literature review performed according to the Fribergs method. This literature review is based on twelve quantitative articles published between 01/2007 and 09/2017. The search for the articles was conducted in CINAHL Complete database and PubMed database. Results: The result of this review indicates that there are several, different interventions that may be used in addition to pharmacological treatment in order to effectively reduce preoperative anxiety in adult patients. Anxiety in the preoperative phase can be alleviated by providing the patient with information tailored to the individual's needs. Anxiety can also be reduced by providing emotional support or by helping the patient to find comfort in spirituality/religion. The result of this review indicates moreover that the level of anxious can be minimized by listening to soothing music, nature sounds or guided imagery. Relaxation exercises, aromatherapy, acupuncture and reflexology were also found to reduce preoperative anxiety. Only the photographic display was not found to be effective in reducing anxiety in the preoperative phase. Discussion: The result of this review was discussed in relation to the nurse's responsibilities. The discussion of the results was focused on the practical issues about implementation of the non-pharmacological methods in the clinical practice. Jean Watson's Theory of Human Caring was used as a theoretical framework that helped the author in results analysis.

Trots likartade operativa ingrepp upplever vi att det kan skilja mycket mellan behovet av smärtlindring postoperativt. Kanske erhåller patienten otillräcklig preoperativ information vilket skulle kunna resultera i onödig oro, som i sin tur kan påverka den postoperativa smärtupplevelsen. Målsättningen med den postoperativa smärtbehandlingen bör vara att förebygga smärtan snarare än att lindra den. Det är viktigt att förhindra att postoperativ smärta uppstår överhuvudtaget vilket medför minskad risk för uppkomst av kroniska smärtsyndrom. En förberedd och välinformerad patient kan hantera den postoperativa situationen bättre. Syftet med litteraturstudien var att undersöka forskning om sambandet mellan preoperativ information till patienten och patientens upplevelse av postoperativ smärta. Sammanställningen av 10 vetenskapliga och kvalitetsgranskade artiklar resulterade i en analys där fem olika kategorier kunde urskiljas. Resultatet visade att preoperativ information ledde till minskad postoperativ smärta men andra vinster kunde också identifieras. Andra vinster var minskad oro, ökad rörlighet och en känsla av bättre preoperativ förberedelse. Vid snabbare mobilisering sågs ett samband med tidigare hemgång. Inför utskrivning efterfrågades mer information för att hantera smärta och eventuella komplikationer. Dessutom visade resultatet att patienten önskade mer information om vem som skulle kontaktas vid eventuella frågor eller komplikationer. I takt med att ett förändrat informationssamhälle utvecklas, kommer sannolikt nya informationsmetoder att behövas. / Despite similar surgical procedures, it is our experience that it may differ greatly between the need for postoperative pain relief. Perhaps the patients receive inadequate preoperative information, which could result in unnecessary anxiety, which in turn may affect the postoperative pain experience. The aim of the postoperative pain treatment should be to prevent the pain rather than alleviating it. It is important to prevent postoperative pain in general, result in reduced occurrence of chronic pain syndromes. A well prepared and informed patient can manage the postoperative situation better. The aim of this study was to examine research on the relationship between preoperative patient information and patient experience of postoperative pain. The compilation of 10 scientific and peer-reviewed articles resulted in an analysis in which five different categories could be discerned. The results showed that preoperative education led to reduced postoperative pain, but other gains were also identified. Other benefits were reduced anxiety, increased mobility and a sense of being better preoperative prepared. The rapid mobilization was associated with earlier discharge. Before leaving hospital, patients requested more information to manage pain and possible complications. In addition, results showed that the patient wanted more information about who should be contacted with any questions or complications. As a changing information society develops, new methods of information will likely be needed in practice.

A ansiedade pode ser considerada uma experiência leve ou intensa, no momento anterior ao procedimento cirúrgico eletivo; é um sentimento comumente relatado pelo paciente que será submetido a uma cirurgia. Assim, a forma como ele enfrenta-a pode interferir na recuperação pós-operatória, com altos níveis de dor, distúrbios no sono, nutrição e atividade física, além de dificuldades na cicatrização da ferida operatória. O presente estudo teve como objetivo avaliar a presença de ansiedade no préoperatório imediato em pacientes cirúrgicos. Tratou-se de uma pesquisa observacional e analítica, de delineamento longitudinal, realizada em um hospital geral de uma cidade do interior do Estado de Minas Gerais. Uma amostra consecutiva e não probabilística foi constituída por 64 pacientes, de ambos os sexos, internados na clínica cirúrgica de um hospital público, no período de julho e agosto de 2016, e que atenderam aos seguintes critérios de elegibilidade: idade igual ou superior a 18 anos e submissão à cirurgia eletiva de médio porte. Para a coleta de dados foi elaborado um instrumento que teve seu conteúdo e aparência validados por três especialistas na área de conhecimento do tema investigado. Dentre os itens desse instrumento, constava a avaliação da pressão arterial sistêmica e da frequência cardíaca. A ansiedade foi mensurada pelo Inventário de Ansiedade Traço-Estado (IDATE) versão reduzida (intervalo de 13 a 49, maiores valores, maior ansiedade) e pela análise da alfa-amilase salivar (de 0 a 299 Ku/l, maiores valores indicando maior ansiedade). A coleta de dados foi realizada pela pesquisadora em dois momentos: no período préoperatório imediato, obtendo-se as informações na enfermaria, após a admissão do paciente, cerca de 12 horas anteriores ao procedimento cirúrgico e no segundo momento, também na enfermaria, no dia da cirurgia, uma hora antes dele ser encaminhado ao centro cirúrgico, avaliando os dados mencionados anteriormente. Os dados foram analisados descritivamente e para os testes de hipóteses, utilizamos os testes t de Student e de Wilcoxon, ambos para amostras dependentes; Teste de Mann-Whitney para comparar dois grupos independentes; e o teste de Correlação de Spearman para quantificar a correlação entre as duas variáveis respostas (IDATE versão reduzida e alfa-amilase salivar) e as variáveis explanatórias. Análise de regressão linear múltipla foi conduzida para avaliar a contribuição das variáveis explanatórias na determinação da ansiedade, avaliada no segundo momento. O nível de significância adotado foi de 0,05. Como resultados, constatamos que houve diferenças estatisticamente significantes entre as medidas do IDATE versão reduzida (<0,001) e da pressão arterial sistólica (<0,001) e diastólica (<0,001), quando comparamos os valores em t1 e t2. Obtivemos correlação estatisticamente significante apenas entre o IDATE versão reduzida e a idade (r=-0,404; p=0,001), somente na primeira avaliação. Na avaliação das correlações com a medida de alfa-amilase salivar e pressão arterial, frequência cardíaca e idade não houve resultados estatisticamente significante nas duas avaliações. Ao avaliarmos a presença de ansiedade e o uso de psicofármacos durante a internação pré-operatória, constatamos média menor da alfa-amilase salivar no grupo que fez uso do medicamento (p=0,002). No modelo de regressão linear multivariada, tendo como variável dependente a ansiedade (IDATE versão reduzida), na segunda avaliação e como variáveis explanatórias a idade, pressão arterial sistólica (em t1) e ansiedade (IDATE versão reduzida em t1), explicou 48,7% da variância. Apenas a variável correspondente à primeira medida de ansiedade foi estatisticamente significante no modelo testado. Conclui-se que as duas medidas de ansiedade usadas não apresentaram correlação forte/moderada e estatisticamente significante. A avaliação da ansiedade nos dois momentos teve diferença quando mensurada pelo IDATE versão reduzida, sendo a média em t1 maior do que em t2, o que não ocorreu quando avaliada pela amilase salivar / Anxiety can be considered either as a mild or an intense experience at the time preceding an elective surgical procedure; this is a feeling commonly reported by patients who will be submitted to a surgical procedure. Hence, the way surgical patients face this anxiety can interfere with postoperative recovery, with high levels of pain, disorders regarding sleep, nutrition, and physical activity, and difficulty in healing the operative wound. The aim of this study was to assess the presence of anxiety in the immediate preoperative period of surgical patients. An observational analytical study, with a longitudinal design, was conducted in the general hospital of a city in the state of Minas Gerais. The study sample was consecutive and nonprobabilistic, and consisted of 64 patients, both male and female, who were hospitalized in the surgical ward of a public hospital between July and August 2016, and met the following eligibility criteria: being 18 years old or over, and being submitted to a medium-size elective surgery. An instrument was created for data collection, and its face and content were validated by three experts in the area of knowledge under study. The assessment of systemic blood pressure and heartbeat was included in this instrument. Anxiety was measured by means of the anxiety scale STAI-S revised (13-49 interval, higher values, higher anxiety), and by salivary amylase analysis (0-299Ku/l, higher values, higher anxiety). Data were collected at two different times by the researcher: in the immediate preoperative period, in which data were obtained in the nursing ward once patients were admitted, about 12 hours before the procedure, and at a second time, still in the nursing ward, on the day of surgery, one hour before they were sent to the surgical center, in order to assess the data previously mentioned. The data were analyzed descriptively and the Student\'s t and Wilcoxon tests were used for the hypotheses tests, both for dependent samples; the Mann-Whitney test was used to compare the two independent groups, and Spearman\'s correlation test was used to quantify the correlation between the two response variables (STAI-S revised and salivary amylase analysis) and the explanatory variables. A multiple linear regression analysis was conducted to assess the contribution of the explanatory variables in determining anxiety, assessed at the second time of collection. A 0.05 level of significance was adopted. According to the results, statistically significant differences were found between the STAI-S revised (<0.001) and systolic (<0.001) and diastolic (<0.001) blood pressure values, when comparing values at the two times of collection. There was a statistically significant correlation between the STAI-S revised and age (r=- 0.404; p=0.001), only at the first assessment. There were no statistically significant results, at both times, in the assessment of the correlations to the salivary amylase and blood pressure, heartbeat and age. When assessing the presence of anxiety and the use of psychotropics during the preoperative hospitalization, a lower mean of salivary alpha-amylase was found in the group that used medications (p=0.002). Multivariate linear regression analysis explained 48.7% of the variance, having anxiety as the dependent variable (STAI-S revised), in the second assessment, and age, systolic blood pressure (at time 1) and anxiety (STAI-S revised at time 1) as explanatory variables. Only the variable corresponding to the first assessment of anxiety was statistically significant in the tested model. In conclusion, both anxiety assessments did not present a strong/moderate and statistically significant correlation. The assessment of anxiety at two times was different when measured by the STAI-S revised, with the mean at time 1 being higher than that in time 2, which did not occur in the assessment by salivary amylase

A ansiedade pode ser considerada uma experiência leve ou intensa, no momento anterior ao procedimento cirúrgico eletivo; é um sentimento comumente relatado pelo paciente que será submetido a uma cirurgia. Assim, a forma como ele enfrenta-a pode interferir na recuperação pós-operatória, com altos níveis de dor, distúrbios no sono, nutrição e atividade física, além de dificuldades na cicatrização da ferida operatória. O presente estudo teve como objetivo avaliar a presença de ansiedade no préoperatório imediato em pacientes cirúrgicos. Tratou-se de uma pesquisa observacional e analítica, de delineamento longitudinal, realizada em um hospital geral de uma cidade do interior do Estado de Minas Gerais. Uma amostra consecutiva e não probabilística foi constituída por 64 pacientes, de ambos os sexos, internados na clínica cirúrgica de um hospital público, no período de julho e agosto de 2016, e que atenderam aos seguintes critérios de elegibilidade: idade igual ou superior a 18 anos e submissão à cirurgia eletiva de médio porte. Para a coleta de dados foi elaborado um instrumento que teve seu conteúdo e aparência validados por três especialistas na área de conhecimento do tema investigado. Dentre os itens desse instrumento, constava a avaliação da pressão arterial sistêmica e da frequência cardíaca. A ansiedade foi mensurada pelo Inventário de Ansiedade Traço-Estado (IDATE) versão reduzida (intervalo de 13 a 49, maiores valores, maior ansiedade) e pela análise da alfa-amilase salivar (de 0 a 299 Ku/l, maiores valores indicando maior ansiedade). A coleta de dados foi realizada pela pesquisadora em dois momentos: no período préoperatório imediato, obtendo-se as informações na enfermaria, após a admissão do paciente, cerca de 12 horas anteriores ao procedimento cirúrgico e no segundo momento, também na enfermaria, no dia da cirurgia, uma hora antes dele ser encaminhado ao centro cirúrgico, avaliando os dados mencionados anteriormente. Os dados foram analisados descritivamente e para os testes de hipóteses, utilizamos os testes t de Student e de Wilcoxon, ambos para amostras dependentes; Teste de Mann-Whitney para comparar dois grupos independentes; e o teste de Correlação de Spearman para quantificar a correlação entre as duas variáveis respostas (IDATE versão reduzida e alfa-amilase salivar) e as variáveis explanatórias. Análise de regressão linear múltipla foi conduzida para avaliar a contribuição das variáveis explanatórias na determinação da ansiedade, avaliada no segundo momento. O nível de significância adotado foi de 0,05. Como resultados, constatamos que houve diferenças estatisticamente significantes entre as medidas do IDATE versão reduzida (<0,001) e da pressão arterial sistólica (<0,001) e diastólica (<0,001), quando comparamos os valores em t1 e t2. Obtivemos correlação estatisticamente significante apenas entre o IDATE versão reduzida e a idade (r=-0,404; p=0,001), somente na primeira avaliação. Na avaliação das correlações com a medida de alfa-amilase salivar e pressão arterial, frequência cardíaca e idade não houve resultados estatisticamente significante nas duas avaliações. Ao avaliarmos a presença de ansiedade e o uso de psicofármacos durante a internação pré-operatória, constatamos média menor da alfa-amilase salivar no grupo que fez uso do medicamento (p=0,002). No modelo de regressão linear multivariada, tendo como variável dependente a ansiedade (IDATE versão reduzida), na segunda avaliação e como variáveis explanatórias a idade, pressão arterial sistólica (em t1) e ansiedade (IDATE versão reduzida em t1), explicou 48,7% da variância. Apenas a variável correspondente à primeira medida de ansiedade foi estatisticamente significante no modelo testado. Conclui-se que as duas medidas de ansiedade usadas não apresentaram correlação forte/moderada e estatisticamente significante. A avaliação da ansiedade nos dois momentos teve diferença quando mensurada pelo IDATE versão reduzida, sendo a média em t1 maior do que em t2, o que não ocorreu quando avaliada pela amilase salivar / Anxiety can be considered either as a mild or an intense experience at the time preceding an elective surgical procedure; this is a feeling commonly reported by patients who will be submitted to a surgical procedure. Hence, the way surgical patients face this anxiety can interfere with postoperative recovery, with high levels of pain, disorders regarding sleep, nutrition, and physical activity, and difficulty in healing the operative wound. The aim of this study was to assess the presence of anxiety in the immediate preoperative period of surgical patients. An observational analytical study, with a longitudinal design, was conducted in the general hospital of a city in the state of Minas Gerais. The study sample was consecutive and nonprobabilistic, and consisted of 64 patients, both male and female, who were hospitalized in the surgical ward of a public hospital between July and August 2016, and met the following eligibility criteria: being 18 years old or over, and being submitted to a medium-size elective surgery. An instrument was created for data collection, and its face and content were validated by three experts in the area of knowledge under study. The assessment of systemic blood pressure and heartbeat was included in this instrument. Anxiety was measured by means of the anxiety scale STAI-S revised (13-49 interval, higher values, higher anxiety), and by salivary amylase analysis (0-299Ku/l, higher values, higher anxiety). Data were collected at two different times by the researcher: in the immediate preoperative period, in which data were obtained in the nursing ward once patients were admitted, about 12 hours before the procedure, and at a second time, still in the nursing ward, on the day of surgery, one hour before they were sent to the surgical center, in order to assess the data previously mentioned. The data were analyzed descriptively and the Student\'s t and Wilcoxon tests were used for the hypotheses tests, both for dependent samples; the Mann-Whitney test was used to compare the two independent groups, and Spearman\'s correlation test was used to quantify the correlation between the two response variables (STAI-S revised and salivary amylase analysis) and the explanatory variables. A multiple linear regression analysis was conducted to assess the contribution of the explanatory variables in determining anxiety, assessed at the second time of collection. A 0.05 level of significance was adopted. According to the results, statistically significant differences were found between the STAI-S revised (<0.001) and systolic (<0.001) and diastolic (<0.001) blood pressure values, when comparing values at the two times of collection. There was a statistically significant correlation between the STAI-S revised and age (r=- 0.404; p=0.001), only at the first assessment. There were no statistically significant results, at both times, in the assessment of the correlations to the salivary amylase and blood pressure, heartbeat and age. When assessing the presence of anxiety and the use of psychotropics during the preoperative hospitalization, a lower mean of salivary alpha-amylase was found in the group that used medications (p=0.002). Multivariate linear regression analysis explained 48.7% of the variance, having anxiety as the dependent variable (STAI-S revised), in the second assessment, and age, systolic blood pressure (at time 1) and anxiety (STAI-S revised at time 1) as explanatory variables. Only the variable corresponding to the first assessment of anxiety was statistically significant in the tested model. In conclusion, both anxiety assessments did not present a strong/moderate and statistically significant correlation. The assessment of anxiety at two times was different when measured by the STAI-S revised, with the mean at time 1 being higher than that in time 2, which did not occur in the assessment by salivary amylase

<p>Abstrakt</p><p>Bakgrund: Länge har man varit medveten om vikten av god hygien och dess inverkan på</p><p>smittspridning. Det mest effektiva sättet att minska postoperativa sårinfektioner (SSI) är att arbeta</p><p>förebyggande och att ha en god hygien. Frekvensen av SSI ökar, och som en del av den förebyggande</p><p>vården ingår den preoperativa förberedelsen. Att inte ha kunskap och stöd till att utföra en sådan</p><p>åtgärd korrekt är en stor brist och kan leda till att patienter drabbas av SSI och därmed ett ökat</p><p>postoperativt lidande.</p><p>Syfte: Studiens syfte var att beskriva vårdpersonalens syn på betydelsen av hygienisk preoperativ</p><p>förberedelse hos ortopedpatienter.</p><p>Metod: Studien genomfördes på ett länssjukhus i mellersta norrland under våren 2008, där alla</p><p>ortopedavdelningar på sjukhuset deltog. En kvalitativ intervjumetod användes med manifest</p><p>innehållsanalys av materialet.</p><p>Resultat: All personal som ingått i studien anser att den hygieniska preoperativa förberedelsen är av</p><p>stor vikt. Trots faktorer som stress, personalbrist och hög arbetsbelastning kände personalen att de</p><p>ville vara noggrann i sitt arbete och göra det bästa för patienten, även genomföra en bra förberedelse</p><p>innan operation. Den största orsaken till att de frångick de skrivna rutinerna var att patienterna hade</p><p>ont, samt vid akuta situationer då det var svårt att planera sitt arbete.</p><p>Diskussion: Trots att personalen visste om förberedelsens betydelse för frekvensen av SSI och att de</p><p>tyckte att riktlinjerna inte förändrats på många år, valde de medvetet att vissa gånger frångå de rutiner</p><p>som finns och de tog inget eget ansvar för att hålla sig uppdaterad kring ny forskning.</p> / <p>Abstract</p><p>Background: Long has one been aware about the importance of good hygiene and its effect on</p><p>infection control. The most effective way to decrease surgical site infections (SSI) is to work</p><p>preventive and to have a good hygiene. The frequency of SSI increases and as a part of the preventive</p><p>care the hygienic preoperative preparation is included. To not have knowledge and aids to carrying out</p><p>such a measure correct is a big deficiency and can lead to patients being hit of SSI and with that</p><p>increased postoperative suffering</p><p>Aim: The study's aim was to describe the care personnel's view on the importance of hygiene</p><p>preoperative preparation at orthopaedic patients.</p><p>Method: The study was implemented on a county hospital in the north central part of Sweden during</p><p>the spring of 2008, where all orthopaedic departments on the hospital participated. A qualitative</p><p>interview method was used with a manifest content analysis of the material.</p><p>Results: All personnel as been included in the study were unanimous that hygienic preoperative</p><p>preparation was of big importance. Despite factors like stress, lack of personnel and high workload,</p><p>they wanted to be accurate in their work and do what’s best for the patient. That also implemented a</p><p>good preparation before operation. The major reason to not follow the guidelines where that the</p><p>patients was in acute pain, and in emergency situations when it were impossible to plan its work.</p><p>Discussion: Despite the knowledge about the importance of preparation for the frequency of SSI and</p><p>they thought that the guideline not been changed on many years, they sometimes deliberately chose</p><p>not to follow the guideline. The nurses took no responsibility in order to keep updated around new</p><p>research.</p>

Abstrakt Bakgrund: Länge har man varit medveten om vikten av god hygien och dess inverkan på smittspridning. Det mest effektiva sättet att minska postoperativa sårinfektioner (SSI) är att arbeta förebyggande och att ha en god hygien. Frekvensen av SSI ökar, och som en del av den förebyggande vården ingår den preoperativa förberedelsen. Att inte ha kunskap och stöd till att utföra en sådan åtgärd korrekt är en stor brist och kan leda till att patienter drabbas av SSI och därmed ett ökat postoperativt lidande. Syfte: Studiens syfte var att beskriva vårdpersonalens syn på betydelsen av hygienisk preoperativ förberedelse hos ortopedpatienter. Metod: Studien genomfördes på ett länssjukhus i mellersta norrland under våren 2008, där alla ortopedavdelningar på sjukhuset deltog. En kvalitativ intervjumetod användes med manifest innehållsanalys av materialet. Resultat: All personal som ingått i studien anser att den hygieniska preoperativa förberedelsen är av stor vikt. Trots faktorer som stress, personalbrist och hög arbetsbelastning kände personalen att de ville vara noggrann i sitt arbete och göra det bästa för patienten, även genomföra en bra förberedelse innan operation. Den största orsaken till att de frångick de skrivna rutinerna var att patienterna hade ont, samt vid akuta situationer då det var svårt att planera sitt arbete. Diskussion: Trots att personalen visste om förberedelsens betydelse för frekvensen av SSI och att de tyckte att riktlinjerna inte förändrats på många år, valde de medvetet att vissa gånger frångå de rutiner som finns och de tog inget eget ansvar för att hålla sig uppdaterad kring ny forskning. / Abstract Background: Long has one been aware about the importance of good hygiene and its effect on infection control. The most effective way to decrease surgical site infections (SSI) is to work preventive and to have a good hygiene. The frequency of SSI increases and as a part of the preventive care the hygienic preoperative preparation is included. To not have knowledge and aids to carrying out such a measure correct is a big deficiency and can lead to patients being hit of SSI and with that increased postoperative suffering Aim: The study's aim was to describe the care personnel's view on the importance of hygiene preoperative preparation at orthopaedic patients. Method: The study was implemented on a county hospital in the north central part of Sweden during the spring of 2008, where all orthopaedic departments on the hospital participated. A qualitative interview method was used with a manifest content analysis of the material. Results: All personnel as been included in the study were unanimous that hygienic preoperative preparation was of big importance. Despite factors like stress, lack of personnel and high workload, they wanted to be accurate in their work and do what’s best for the patient. That also implemented a good preparation before operation. The major reason to not follow the guidelines where that the patients was in acute pain, and in emergency situations when it were impossible to plan its work. Discussion: Despite the knowledge about the importance of preparation for the frequency of SSI and they thought that the guideline not been changed on many years, they sometimes deliberately chose not to follow the guideline. The nurses took no responsibility in order to keep updated around new research.

Orientador: Paula Schmidt Azevedo Gaiolla / Resumo: Introdução: A atual mudança no perfil epidemiológico, com aumento da expectativa de vida mundial e no Brasil, contribui para o crescimento da população de idosos e consequentemente de ampliação do espectro das comorbidades destes. Adicionalmente, independentemente da idade, existe aumento de doenças crônicas associadas principalmente aos hábitos modernos. Esses fatores elevam os riscos de complicações durante e após as cirurgias. Por outro lado, nota-se ainda avanço no que diz respeito às propostas e técnicas anestésicas e cirúrgicas, cada vez menos invasivas e mais resolutivas, permitindo aos idosos e portadores de doenças crônicas, serem submetidos a diferentes procedimentos. Portanto, é crucial que seja realizada criteriosa avaliação perioperatória individualizada, visando prever, intervir e minimizar efeitos indesejados associados aos procedimentos cirúrgicos e aos fatores de risco individuais de cada paciente. Objetivo: O presente trabalho propõe a criação de protocolo, de ficha de atendimento e de Manual para guiar a avaliação e manejo perioperatório dos pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Metodologia: O método utilizado na pesquisa foi a busca avançada em inglês no banco de dados da Pubmed, Cochrane, Lilacs e Scielo dos termos: “Preoperative risk screening”; “Preoperative Cardiovascular risk stratification”, “Preoperative pulmonary risk stratification”, “perioperative management of the cirrhotic patient”, “perioperative renal care”,... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The current change in the epidemiological profile, with an increase in life expectancy worldwide and in Brazil, contributes to the growth of the elderly population and, consequently, to a broader spectrum of their comorbidities. In addition, regardless of age, there is an increase in chronic diseases associated with modern habits. These factors raise the risk of complications during and after surgeries. On the other hand, there is still progress in regard to proposals and anesthetic and surgical techniques, which are becoming less invasive and more resolutive, allowing the elderly and patients with chronic diseases to undergo different procedures. Therefore, it is crucial that a careful individualized perioperative evaluation is performed, in order to predict, intervene and minimize unwanted effects associated with surgical procedures and individual risk factors of each patient. Objective: This paper proposes the creation of a protocol, an information sheet and a manual to guide the evaluation and perioperative management of patients at the Hospital das Clínicas, Botucatu Medical School. Methodology: The method used in the research was the advanced search in English in the database of Pubmed, Cochrane, Lilacs and Scielo of the terms: "Preoperative risk screening"; "Preoperative Cardiovascular risk stratification", "Preoperative pulmonary risk stratification", "perioperative management of the cirrhotic patient", "perioperative renal care", arranged in isolation a... (Complete abstract click electronic access below) / Mestre