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  • 1.
    Fagerberg, Anna
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Roskvist, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linneuniversitetet Institutionen för hälso- och vårdvetenskap.
    Beskriva operationssjuksköterskans upplevelse av den perioperativa dialogen med patienten2014Independent thesis Advanced level (degree of Master (One Year)), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Studier samt litteratur visar att patienten upplever oro, rädsla och ångestinför en operation. Genom att studera hur den perioperativa dialogen upplevs avoperationssjuksköterskan som innefattar preoperativ-, intraoperativ- och postoperativdialog så tror vi att tiden på operationsavdelningen kan förbättra den perioperativaprocessen.

  • 2.
    Good, Elin
    et al.
    Linköping University.
    Länne, Toste
    Linköping University.
    Wilhelm, Elisabeth
    Linköping University.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Jaarsma, Tiny
    Linköping University.
    De Muinck, Ebo
    Linköping University.
    High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 13, p. 1453-1460Article in journal (Refereed)
    Abstract [en]

    Background Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Design Cross-sectional retrospective study. Methods Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). Results A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. Conclusions The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.

  • 3.
    Karlsson, Frida
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Matre, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bryr vi oss om ett litet hår i ditt sår?: En tvärsnittsstudie av personalens följsamhet till hygienriktlinjer under pågående operation2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Florence Nightingale saved lives by keeping the environment clean before, during and after surgery in the mid-19th century. The knowledge in medicine has developed in exponential steps and the nursing care is trying to keep up. Studies show that compliance to hygiene guidelines are low. The routines to prevent surgical site infections need to be taken seriously, without exceptions, to prevent the infections to cause suffering both for individuals and the hospitals budgets. Aim: The purpose of this study was to study the OR staff´s compliance to hygiene guidelines at two south Swedish hospitals. Method: The study was a quantitative observational study. Data have been collected at two different southern Swedish hospitals during 152 surgeries. The observation was structured and followed a special protocol that observed if hair and beard is covered with a hood/other coverage and what type of shoes that the staff wear in the OR. It was also observed if surgeries that need ultraclean environment, as implant surgery, was respected with the extended guidelines. Results: The results showed that there where almost complete compliance to the hygiene guidelines during ultraclean surgeries. During other surgeries it showed that improvements could have been done by all staff in the OR. The staff that was working in the OR but not in the wound, close to the patient had lowest compliance. Conclusion: Knowledge and discipline to hygiene rules may lead to improvement in patient safety and diminished patient suffering.

  • 4.
    Karlsson, Sara
    et al.
    University of Kalmar, School of Human Sciences.
    Löfberg, Hanna
    University of Kalmar, School of Human Sciences.
    Patienters oro i samband med dagkirurgi: - En litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    På senare år har dagkirurgi blivit allt vanligare i Sverige. Dagkirurgi innebär att patienten kommer på morgonen för en planerad operation och får sedan gå hem igen, samma dag. Att bli opererad är ofta förknippat med oro för den som det berör. När denna oro inte blir tagen på allvar av sjukvårdspersonalen kan det leda till ett vårdlidande för patienten. Syftet med denna litteraturstudie var därför att belysa patienters oro i samband med dagkirurgi. Metod som användes var litteraturstudie och datasökning gjordes av publicerad klinisk omvårdnadsforskning, mellan åren 1995-2008, vilka motsvarade syftet. Sökningar gjordes i databaserna Cinahl, PsychINFO, PubMed och ELIN. Samtliga framtagna studier kvalitetsgranskades och resultatet bygger på 14 identifierade studier. Resultatet indelades i tre kategorier och visade att oro handlade om ovisshet inför vad som skulle hända. Orsaken berodde till stor del på bristande information och patienterna önskade både skriftlig och muntlig information. Brist på information resulterade i att patienterna kände sig övergivna. Det visade sig också att oro över att inte kunna påverka situationen och oro över illamående och smärta postoperativt, var vanligt förekommande. Slutsatsen påvisar vikten av information samt vikten av att sjuksköterskan finns till hands för patienten,

  • 5.
    Nilsson, Gunilla
    Lunds universitet, medicinska fakulteten.
    Laparoscopic or Open Antireflux Surgery - A Comparative Study with Special Reference to the Patient´s Perspective2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to compare the effects of laparoscopic versus open antireflux surgery in a randomized clinical trial focusing the patients&apos; subjective and objective outcome postoperatively, from a short-term and a long-term perspective. A further aim was to describe GORD patients&apos; experiences of illness and surgical treatment and if possible to find striking characteristics relating to laparoscopic or open surgery. Sixty patients with Gastro Oesophageal Reflux Disease (GORD) were randomized to laparoscopic or open 360º fundoplication. Subjective evaluations according to disease-specific and generic questionnaires, postoperative protocol, structured interviews, questionnaire and narratives as well as objective evaluations according to endoscopy, oesophageal manometry and 24-h pH monitoring were performed preoperatively, postoperatively, 1 month, 6 months and 5 years after surgery. Five patients were converted to open surgery. Two patients in the laparoscopic group were reoperated on because of hiatal strictures, one patient in the open group was reoperated on because of an incisional hernia and one patient in each group was operated on for having an intestinal obstruction. Operating time was longer for laparoscopic surgery 148 versus 109 minutes for open surgery (P<0.001), analgesics was less 33.9 versus 67.5 mg per total hospital stay for open surgery (P<0.001). Respiratory function was better in the laparoscopic group, FEV 2.6 versus 2.0 litres (P=0.008) and FVC 3.2 versus 2.2 litres (P=0.004); postoperative hospital stay was shorter 3 (2-6) versus 3 (2-10) days (P=0.021) for open surgery. No difference was found in sick leave between the groups. No differences were found in short- or long-term subjective outcomes in diet, sleep, medication, patient satisfaction and symptoms of GORD. Nor were there any differences found in short- or long-term objective outcomes from endoscopy, manometry or 24-h pH monitoring. Dysphagia, flatulence and difficulties to belch were new side-effects independent of type of surgery. Reasons for having surgery were a wish to avoid medication and to rid themselves of troubles and symptoms. All patients suffered from decreased well-being preoperatively that after surgery independent of invasiveness was restored back to or above norm values. Seven patients (25%) in the open group had complaints regarding the scar. The experts, the GORD patients themselves, described human responses to illness, surgical treatment and the outcome. No matter the type of invasiveness; elimination of the GORD symptoms led to increased well-being and for the majority of patients no need for daily acid-suppression medication. These results appeared one month after the operation and were still valid, five years after surgery.

  • 6.
    Nilsson, Gunilla
    University of Kalmar, School of Human Sciences.
    The patients´ perspective2006In: Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment / [ed] Frank A Granderath, Thomas Kamolz, Rudolph Pointner, Wien: Springer-Verlag , 2006, p. 299-308Chapter in book (Other academic)
  • 7.
    Nilsson, Gunilla
    et al.
    Lunds universitet, medicinska fakulteten.
    Larsson, Sylvia
    Johnsson, Folke
    Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period.2000In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 87, no 7, p. 873-878Article in journal (Refereed)
    Abstract [en]

    Background

    There is a widespread belief that introduction of the laparoscopic technique in antireflux surgery has led to easier postoperative recovery. To test this hypothesis a prospective randomized clinical trial with blind evaluation was conducted between laparoscopic and open fundoplication.

    Methods

    Sixty patients with gastro-oesophageal reflux disease were randomized to open or laparoscopic 360° fundoplication. The type of operation was unknown to the patient and the evaluating nurses after operation.

    Results

    The operating time was longer in the laparoscopy group, median 148 versus 109 min (P < 0·0001). The need for analgesics was less in the laparoscopically operated patients, 33·9 versus 67·5 mg morphine per total hospital stay (P < 0·001). There was no significant difference in postoperative nausea and vomiting. On the first day after operation patients in the laparoscopy group had better respiratory function: forced vital capacity 3·2 versus 2·2 litres (P = 0·004) and forced expiratory volume 2·6 versus 2·0 litres (P = 0·008). Postoperative hospital stay was shorter in the laparoscopic group, median (range) 3 (2–6) versus 3 (2–10) days (P = 0·021). No difference was found in the duration of sick leave.

    Conclusion

    Laparoscopic fundoplication was associated with a longer operating time, better respiratory function, less need for analgesics and a shorter hospital stay, while no reduction in the duration of postoperative sick leave was found compared with open surgery. © 2000 British Journal of Surgery Society Ltd

  • 8.
    Nilsson, Gunilla
    et al.
    Lunds universitet, medicinska fakulteten.
    Larsson, Sylvia
    Johnsson, Folke
    Randomized clinical trial of laparoscopic versus open fundoplication: evaluation of psychological well-being and changes in everyday life from a patient perspective2002In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, no 4, p. 385-91Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The laparoscopic approach in antireflux surgery might have an impact on the patient's daily activities and well-being. METHODS: Sixty patients were randomized to laparoscopic or open 360 degrees fundoplication. Data were collected by questionnaires and interviews preoperatively, 1 month and 6 months after operation. RESULTS: Five patients in the laparoscopic group were converted to open surgery. Psychological general well-being increased after surgery and reached norm values in both study groups. No significant differences were found between the two types of surgery in the per protocol analysis, while the domain self-control was significantly better after open surgery in the intention-to-treat analysis. There was improvement of diet and sleep in both study groups; after 6 months, disturbed sleep was significantly more uncommon after open surgery. Dysphagia and flatulence were new symptoms that were reported after surgery. Overall perception of the results of the operation did not differ between the groups. CONCLUSIONS: Psychological general well-being, diet and sleep improved after both laparoscopic and open surgery. There were only small differences between the groups, but in some respects the results were better after open surgery.

  • 9.
    Nilsson, Gunilla
    et al.
    Lunds universitet, medicinska fakulteten.
    Wenner, Jörgen
    Larsson, Sylvia
    Johnsson, Folke
    Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux.2004In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 91, no 5, p. 552-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to compare the long-term results of laparoscopic and open antireflux surgery in a randomized clinical trial by investigating subjective and objective outcomes. METHODS: Sixty patients with gastro-oesophageal reflux disease (GORD) were randomized to laparoscopic or open 360 degrees fundoplication. Subjective evaluation using disease-specific and generic questionnaires and structured interviews, and objective evaluation by endoscopy, oesophageal manometry and 24-h pH monitoring, were performed before operation and 1 month, 6 months and 5 years after surgery. RESULTS: Two patients in the laparoscopic group had reoperations for hiatal stricture; one patient in the open group had repair of an incisional hernia, and one patient in each group had surgery for intestinal obstruction. There were no differences in the subjective outcomes of diet, sleep, medication, patient satisfaction and symptoms of GORD after 5 years. Nor were there any differences in objective outcomes determined by endoscopy, manometry or 24-h pH monitoring. Well-being was decreased in all patients before operation but was restored to normal or above-normal values after fundoplication, regardless of the type of surgery. Seven of 28 patients in the open group had complaints regarding the scar. CONCLUSION: Elimination of GORD symptoms improved well-being and eliminated the need for daily acid suppression in most patients, no matter which procedure was employed. These results were apparent 1 month after the operation and were still valid 5 years later.

  • 10. Wenner, Jörgen
    et al.
    Nilsson, Gunilla
    Lunds universitet, medicinska fakulteten.
    Öberg, Sven
    Melin, Tor
    Larsson, Sylvia
    Johnsson, Folke
    Short-term outcome after laparoscopic and open 360 degrees fundoplication. A prospective randomized trial.2001In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 15, no 10, p. 1124-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite the lack of randomized trials supporting the laparoscopic approach, laparoscopic antireflux surgery has gained widespread acceptance during the last decade. The aim of this study was to compare the short-term symptomatic and objective outcome after laparoscopic and open 360 degrees fundoplication in a prospective randomized clinical trial. METHODS: Sixty patients with GERD were randomized to undergo either laparoscopic (LF) or open 360 degrees fundoplication (OF). Endoscopy, esophageal manometry, 24-h pH monitoring, clinical symptom evaluation, and symptom scoring according to a validated questionnaire (the Gastrointestinal Symptom Rating Scale [GSRS]) was performed preoperatively and 6 months after surgery. RESULTS: Five patients randomized to the laparoscopic group were converted to open surgery. Esophageal acid exposure was restored to normal in all patients. Lower esophageal sphincter length and resting pressure were significantly increased after both laparoscopic and open fundoplication (p < 0.001); there were no differences between the groups. No significant differences were seen in symptomatic outcome, although there was a trend toward a higher rate of mild dysphagia (p = 0.051) after laparoscopic surgery. GSRS revealed a decrease in reflux score (p < 0.001) and abdominal pain score (p < 0.001) postoperatively. There were no significant differences in GSRS scores between the two groups. CONCLUSION: Laparoscopic 360 degrees fundoplication is as effective in treating reflux disease as open fundoplication. Six months postoperatively, no significant differences were seen in symptomatic or objective outcome. Long-term evaluation is needed.

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