RESUMEN
PURPOSE: Extensive research results show quality improvements associated with advanced cancer nursing roles. Despite this, these roles are not implemented in many countries. The aim of this cross-sectional, population-based study was to compare patients' perception of care, before and after the introduction of a new advanced nursing role, the coordination contact nurse (CCN), in a region in Sweden. METHOD: All patients (with gynaecological, haematological, Head & Neck, upper gastrointestinal cancers) diagnosed in the region the year prior and one-year post introducing the new CCN role were identified from the Swedish Cancer Register. Data were collected using the European Organization of Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire (QLQ-C30 and QLQ-INFO25) and a study specific questionnaire. RESULT: The results, based on baseline (nâ¯=â¯869) and follow-up data (nâ¯=â¯1003), show statistically significant patient-reported improvements after the introduction of the CCN role, regarding health-related patient information (EORTC QLQ- INFO25 global mean score increased from 41.23 to 44.16, pâ¯=â¯0.0006). We found statistically significant improvements related to availability of supportive care resources, e.g. increased reported access to contact nurse (from 53% to 66%, pâ¯≤â¯0.0001) and individual written care plans (from 40% to 54%, pâ¯<â¯0.0001). We also found some improvements related to patient involvement and care coordination, but also room for further developments. CONCLUSION: The implementation of the new advanced cancer nursing role may have contributed to important improvements, but it has also identified areas in need of development. Further research with long-term evaluations of CCN roles in other contexts, are both needed and on-going.
Asunto(s)
Enfermería de Práctica Avanzada/normas , Neoplasias/enfermería , Rol de la Enfermera/psicología , Enfermería Oncológica/normas , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , SueciaRESUMEN
BACKGROUND: After an ischemia time of 1 h during aortic aneurysm surgery, muscle glutathione redox-status is not altered, indicating that this ischemic insult is well within the scavenging capacity of muscle glutathione, the most important endogenous scavenger. In the present study, the impact of elective aorto-bifemoral bypass surgery, involving a longer ischemia time, on muscle glutathione and its redox-status was investigated. METHODS: Leg muscle biopsies were obtained pre-operatively, at maximal ischemia, after 10 min and 24 h of reperfusion from 12 patients undergoing aorto-bifemoral bypass surgery. Muscle glutathione, free amino acids and energy-rich compounds were determined. RESULTS: Clamping times were 113 (99-120 min); median (quartiles). At maximal ischemia, muscle lactate increased by 7.5 (4.0-10.7) mmol/kg dry weight (dw) (P < 0.001) and phosphocreatine (PCr) decreased by 14.6 (8.9-23.3) mmol/kg dw (P < 0.001). At maximal ischemia, reduced glutathione (GSH) was unaltered but muscle glutamate decreased by 0.51 (0.30-0.85) mmol/kg wet weight (ww) (P < 0.001). At 24 h post-operatively, the reduced glutathione decreased by 0.47 (0.34-0.65) mmol/kg (ww) (P < 0.001) without changes in oxidized glutathione (GSSG) or in glutathione redox-status. Cysteine and glycine, the two other constituent amino acids to glutathione, did not change during the study period. CONCLUSION: Ischemia of 2 h during aorto-bifemoral bypass was associated with changes in muscle energy-rich compounds but without any changes in glutathione redox-status. A decreased antioxidative capacity, as reflected by a decrease in muscle glutathione concentrations, was seen 24 h post-operatively, still without changes in glutathione redox-status. This is not different from the changes seen after abdominal surgery not involving ischemia-reperfusion.
Asunto(s)
Glutatión/metabolismo , Isquemia/patología , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/metabolismo , Procedimientos Quirúrgicos Vasculares , Anciano , Aminoácidos/metabolismo , Anestesia General , Metabolismo Energético , Femenino , Humanos , Claudicación Intermitente/etiología , Ácido Láctico/metabolismo , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Oxidación-Reducción , Proyectos Piloto , Estudios Prospectivos , Flujo Sanguíneo Regional/fisiología , Reperfusión , Compuestos de Sulfhidrilo/metabolismoRESUMEN
BACKGROUND: Advanced medical simulators have predominantly been used to shorten the learning curve of endoscopy for medical students and young residents. Rarely have the effects of visuospatial ability and attitudes of intermediately experienced and experienced specialists been studied with regard to simulator training. The aim of this study was to assess the effects of visuospatial ability and attitude on performance in simulator training. METHODS: Eighteen surgical residents were included in the study. Prior to the simulated gastroscopy task, they performed a visuospatial test (the card rotation test). After the simulated gastroscopy task, they completed a questionnaire regarding flow experiences. Their results were compared with those of 11 expert endoscopists who performed the same tests. RESULTS: Total gastroscopy time was significantly shorter for the expert endoscopists compared to residents (2 min 11 sec, p = 0.003). There was also a trend of more mucosa inspected (p = 0.088) and higher efficiency of screening (p = 0.069) by the experts. The residents made fewer errors in the card rotation test than the expert endoscopists (2.5 +/- 0.8 vs 5.5 +/- 1.2, respectively; p = 0.034), and their visuospatial card rotation test results correlated better with their performance in the simulated gastroscopy. CONCLUSIONS: A virtual gastroscopy task presents more of an emotional as well as a psychomotoric challenge to intermediately experienced endoscopists than to senior experts. Our study demonstrates that these differences can be objectively assessed by the use of visuospatial ability tests, flowsheets, and an endoscopic simulator.
Asunto(s)
Competencia Clínica , Endoscopía/educación , Gastroscopía , Internado y Residencia , Desempeño Psicomotor , Percepción Espacial , Interfaz Usuario-Computador , Percepción Visual , Adulto , Actitud del Personal de Salud , Simulación por Computador , Femenino , Mucosa Gástrica/patología , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Diseño de Software , Factores de TiempoRESUMEN
The aim of this study is to describe cancer patients' existential reflections and how these reflections were met by the nursing staff. A qualitative method of data collection was used. Ten patients with breast- or prostate cancer who had completed curative treatment were interviewed. The results showed that the cancer diagnosis resulted in existential reflections in some of the patients. These reflections concerned the meaning of life, God/a higher power, health, work, relations and sexuality. Reflections on the cancer consisted in beliefs about the causes of cancer, treatment and cancer and sexuality. It could also be seen that loss of important life values, such as health and sexuality could lead to loss of meaning of life. Explicit reflections on sexuality were only made by two of the men in the study. The patients reported a need of existential support as well as obstacles for giving such support. Obstacles could be lack of time and lack of continuity, as well as lack of knowledge resulting in an inability to identify existential issues. Some of the patients had wanted existential support from nurses, while others received the support they needed from family and friends.
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Actitud Frente a la Muerte , Actitud Frente a la Salud , Neoplasias de la Mama/psicología , Existencialismo/psicología , Neoplasias de la Próstata/psicología , Adaptación Psicológica , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Comunicación , Miedo , Femenino , Pesar , Necesidades y Demandas de Servicios de Salud , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Rol de la Enfermera/psicología , Investigación Metodológica en Enfermería , Enfermería Oncológica , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/terapia , Investigación Cualitativa , Religión y Psicología , Apoyo Social , Encuestas y Cuestionarios , Suecia , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this prospective trial was to determine whether surgical approach (open versus laparoscopic) had an impact on morbidity and postoperative recovery after cholecystectomy for acute cholecystitis. METHODS: Seventy patients who met the criteria for acute cholecystitis were randomized to open or laparoscopic cholecystectomy. The type of operation was unknown to the patient and all hospital staff involved in the postoperative care. RESULTS: The two groups were similar with respect to demographic and clinical characteristics. There were no significant differences in rate of postoperative complications, pain score at discharge and sick leave. In eight patients a laparoscopic procedure was converted to open cholecystectomy. Median operating time was 90 (range 30-155) and 80 (range 50-170) min in the laparoscopic and open groups respectively (P = 0.040). The direct medical costs were equivalent in the two groups. Although median postoperative hospital stay was 2 days in each group, it was significantly shorter in the laparoscopic group (P = 0.011). CONCLUSION: Cholecystectomy for acute cholecystitis can be performed by either laparoscopic or open techniques without any major clinically relevant differences in postoperative outcome. Both techniques offer low morbidity and rapid postoperative recovery.
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Colecistectomía/métodos , Colecistitis Aguda/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colecistectomía/economía , Colecistectomía Laparoscópica/economía , Colecistectomía Laparoscópica/métodos , Colecistitis Aguda/economía , Costos y Análisis de Costo , Equipos Desechables/economía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Atención Perioperativa/economía , Atención Perioperativa/métodos , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Resultado del TratamientoRESUMEN
PURPOSE: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with subcritical or critical lower limb ischemia. MATERIALS AND METHODS: Ninety-two patients underwent 121 PTA procedures, 68 were of the superficial femoral artery (SFA), 13 of the popliteal and 40 of both arteries. Fifty-seven procedures were performed for treatment of occlusions. Eighty-four patients (94 procedures) were monitored with duplex scanning. RESULTS: Technical success rate was 88%. Primary success rates at 12 and 60 months in the whole series were 40% and 27%, respectively. The primary success rate in limbs with SFA occlusion of longer than 5 cm was only 12% after 5 years compared with 32% if the occlusion was
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Angioplastia de Balón , Arteria Femoral , Isquemia/terapia , Pierna/irrigación sanguínea , Arteria Poplítea , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Isquemia/diagnóstico por imagen , Tablas de Vida , Masculino , Persona de Mediana Edad , RadiografíaAsunto(s)
Cateterismo/instrumentación , Endoscopía Gastrointestinal/efectos adversos , Nutrición Enteral/instrumentación , Gastroscopios , Gastrostomía/instrumentación , Obstrucción Intestinal/etiología , Perforación Intestinal/etiología , Anciano , Cateterismo/efectos adversos , Enfermedades del Ciego/etiología , Enfermedades del Ciego/cirugía , Nutrición Enteral/efectos adversos , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Gastrostomía/efectos adversos , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Perforación Intestinal/diagnóstico por imagen , Persona de Mediana Edad , RadiografíaRESUMEN
BACKGROUND AND OBJECTIVES: Wound infiltration with bupivacaine is often used for pain relief after inguinal hernia surgery. We hypothesized that the lower systemic toxicity of another long-acting local anesthetic of similar potency (ropivacaine) would make it possible to increase the dose to above that recommended for bupivacaine and thereby achieve more effective pain control. METHODS: Elective unilateral open hernia repair was performed on 144 patients at 4 hospitals. Surgery was performed under general anesthesia and, in a double-blind manner, the operating field was infiltrated with 40 mL ropivacaine 7.5 mg/mL (in = 73) or bupivacaine 2.5 mg/mL (n = 71 ) for postoperative pain relief. Pain at rest, on mobilization, and on coughing was assessed repeatedly during 24 hours using a visual analog scale. The patients' ability to walk and the need for supplementary analgesics were also recorded. RESULTS: No statistically significant differences were found between the two groups with respect to pain scores, which the patients reported to be less than 15% (median) of the worst pain imaginable in all examinations performed at rest, or in the consumption of supplementary analgesics. Those who received ropivacaine could walk with no or only minor problems at an earlier stage than the bupivacaine patients (P < .03). Both treatments were well tolerated. CONCLUSIONS: Wound infiltration with long-acting local anesthetics resulted in low pain scores after hernia surgery. Bupivacaine 100 mg was as effective as ropivacaine 300 mg.
Asunto(s)
Amidas/uso terapéutico , Anestesia Local , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Hernia Inguinal/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Anciano , Amidas/administración & dosificación , Amidas/efectos adversos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Bupivacaína/administración & dosificación , Bupivacaína/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , RopivacaínaRESUMEN
OBJECTIVES: does open surgery for abdominal aortic aneurysm (AAA) influence coagulation? METHODS: in 23 patients operated on for AAA, cubital blood was sampled pre-, intra- and postoperatively. Femoral blood was also sampled intraoperatively. RESULTS: preoperatively, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and soluble fibrin (SF) were elevated in AAA patients. During aortic clamping all parameters increased significantly in cubital blood (p<0.01) as well as in femoral blood (p<0.001) and after aortic declamping F1+2 and TAT increased further. F1+2, TAT and SF were significantly higher in femoral than cubital blood. Postoperatively F1+2 and TAT returned to preoperative values, while SF still had a significantly higher level than preoperatively (p<0.001). Blood loss showed co-variation with F1+2 increase in femoral blood after aortic declamping (p<0.05). CONCLUSIONS: these data indicate that the coagulation system was strongly activated by the occurrence of an AAA. During AAA surgery a further extensive activation was seen. The activity was still high, but on decline, one week postoperatively. Ischaemia and reperfusion of the lower part of the body were the major stimuli for thrombin generation and activity.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Isquemia/sangre , Reperfusión , Trombina/análisis , Adulto , Anciano , Antitrombinas/análisis , Fibrina/análisis , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/análisis , Precursores de Proteínas/análisis , Protrombina/análisisRESUMEN
OBJECTIVES: To assess whether open abdominal aortic aneurysm (AAA) surgery influences cytokines and fibrinogen. METHODS: Twenty-three consecutive patients operated on for AAA were compared to 11 operated controls and 20 age-matched controls. Cubital blood was sampled pre-, intra- and postoperatively and femoral blood also sampled intraoperatively. RESULTS: Preoperatively, interleukin (Il)-6 was elevated in AAA patients. During aortic clamping, Il-6, Il-10 and monocyte chemoattractant protein-1 (MCP-1) increased significantly (p < 0.001, p < 0.01 and p < 0.05 respectively) while soluble interleukin-2 receptor (sIl-2R) and fibrinogen decreased significantly (p < 0.001 for both). After aortic declamping, Il-6, Il-10 and MCP-1 had further significant increases compared with levels during aortic clamping while sIl-2R had a further non-significant and fibrinogen a significant decrease (p < 0.05 in cubital and p < 0.001 in femoral blood). One week postoperatively Il-6, Il-10 and MCP-1 had all decreased but were still significantly elevated compared with baseline values while sIl-2R and fibrinogen showed an increase in comparison with baseline (p < 0.001 for both). Intraoperative levels of Il-6 and Il-10 showed a significant co-variation with the magnitude of operative trauma. CONCLUSIONS: These data indicate that open AAA surgery induces a profound inflammatory and coagulative response which persists at one week postoperatively.
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Aneurisma de la Aorta Abdominal/cirugía , Citocinas/sangre , Fibrinógeno/metabolismo , Complicaciones Intraoperatorias/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/inmunología , Biomarcadores/sangre , Humanos , Complicaciones Intraoperatorias/inmunología , Masculino , Persona de Mediana Edad , Daño por Reperfusión/sangre , Daño por Reperfusión/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/inmunologíaAsunto(s)
Arterias/lesiones , Adolescente , Angiografía , Arterias/cirugía , Niño , Preescolar , Humanos , Enfermedad Iatrogénica , Lactante , Recién Nacido , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico por imagen , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Heridas y Lesiones/cirugíaRESUMEN
PURPOSE: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). METHODS: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n = 39) or in combination with PTA of the superficial and/or popliteal artery (n = 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs. RESULTS: A technically successful PTA with at least one crural level was achieved in 88% of cases (n = 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. CONCLUSION: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.
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Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Isquemia/terapia , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/complicaciones , Presión Sanguínea , Enfermedad Crónica , Constricción Patológica/complicaciones , Constricción Patológica/terapia , Femenino , Arteria Femoral , Estudios de Seguimiento , Gangrena/etiología , Humanos , Isquemia/etiología , Rodilla , Úlcera de la Pierna/etiología , Masculino , Persona de Mediana Edad , Dolor/etiología , Arteria Poplítea , Seguridad , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of the study was to compare the postoperative muscle amino acid pattern, the ribosome concentration and size distribution, and postoperative nitrogen balance in patients who underwent either laparoscopic or open cholecystectomy. METHODS: Patients who underwent cholecystectomy by means of either laparoscopy (n=8;LAP) or laparotomy (n=8;OPEN) were studied. The concentrations of amino acids, ribosomes, and polyribosomes, reflecting protein synthesis, were determined in skeletal muscle tissue before operation and on postoperative day 2. The cumulated nitrogen balance was determined. RESULTS. Decreases in muscle glutamine (26.7% +/- 8.4% in the LAP group and 30.3% and +/- 4.5% in the OPEN group) and in polyribosomes (28.7% +/- 6.5% in the LAP group and 23.6% +/- 8.5% in the OPEN group) were observed without differences between the groups (mean +/- SEM). The nitrogen losses were similar in both groups (15.2 +/-1.6 gm in the LAP group and 15.5 +/- 1.2 gm in the OPEN group). CONCLUSION: A stress++ response with effects on amino acid and protein metabolism in muscle in present also after laparoscopic cholecystectomy. On postoperative day 2 this response is of similar magnitude after both the laparoscopic and the open procedures.
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Colecistectomía , Glutamina/metabolismo , Músculos/metabolismo , Nitrógeno/metabolismo , Ribosomas/metabolismo , Adulto , Anciano , Aminoácidos/metabolismo , Glucemia/análisis , Femenino , Glucagón/sangre , Humanos , Laparoscopía , Masculino , Persona de Mediana EdadRESUMEN
Generally vascular surgeons agree that the most rational way to treat a patient with an infected aortic graft or aortoenteric fistula is excision of the graft, closure of the aortic stump and construction of an axillobifemoral bypass. Due to the feared complication of blow-out of the aortic stump, other solutions have been proposed, such as in-situ reconstruction with homologous saphenous veins or even with a synthetic graft, provided the perigraft fluid is non-purulent. Since this alternative is not always feasible, various methods to reinforce the closure of the aortic stump have been proposed. The present report describes two cases, where fibrin glue (Tisseel) was successfully used to reinforce the suture row of the aortic stump.
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Anastomosis Quirúrgica/métodos , Aneurisma de la Aorta Abdominal/cirugía , Adhesivo de Tejido de Fibrina/administración & dosificación , Dehiscencia de la Herida Operatoria/prevención & control , Anciano , Aneurisma Roto/cirugía , Oclusión de Injerto Vascular/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/cirugía , Reoperación , Infección de la Herida Quirúrgica/cirugía , Técnicas de SuturaRESUMEN
Hyaluronic acid, a connective tissue component, in bronchoalveolar lavage fluid (BAL) is correlated with decreased lung volumes in sarcoidosis. To investigate whether hyaluronic acid could be a marker of fibrosis in another interstitial lung disease, silicosis, the level of the substance in BAL fluid from rats exposed to crystalline silica (n = 3), amorphous silica (n = 3), and in one sham injected rat was measured. There was an increase in the total number of alveolar cells recovered in the rats exposed to crystalline silica and also a pronounced increase in the proportions of neutrophils and lymphocytes. In addition, the concentration of hyaluronic acid was high in this group of rats, and electron microscopic investigation of the lungs showed fibrosis. Thus hyaluronate in BAL fluid in rats exposed to crystalline silica seems to be a possible marker of fibrotic changes.