Prediction of postoperative pain after radical prostatectomy

<p>Abstract</p> <p>Background</p> <p>There is a belief that the amount of pain perceived is merely directly proportional to the extent of injury. The intensity of postoperative pain is however influenced by multiple factors aside from the extent of trauma. The purpose of the study was to evaluate the relationship between preoperative factors that have been shown to predict postoperative pain and the self-reports of pain intensity in a population of 155 men undergoing radical prostatectomy (RP), and also to investigate if previous pain score could predict the subsequent pain score.</p> <p>Methods</p> <p>The correlation between potential pain predictors and the postoperative pain experiences during three postoperative days was tested (Pitmans' test). By use of a logistic regression analysis the probability that a Visual Analogue Scale (VAS) score at one occasion would exceed 30 mm or 70 mm was studied, depending on previous VAS score, age, depression and pain treatment method.</p> <p>Results</p> <p>Age was found to be a predictor of VAS > 30 mm, with younger patients at higher risk for pain, and preoperative depression predicted VAS > 70 mm. The probability that VAS would exceed 30 mm and 70 mm was predicted only by previous VAS value. Day two however, patients with epidural analgesia were at higher risk for experiencing pain than patients with intrathecal or systemic opioid analgesia.</p> <p>Conclusion</p> <p>The results show that it would be meaningful to identify RP patients at high risk for severe postoperative pain; i.e. younger and/or depressive patients who might benefit from a more aggressive therapy instituted in the very early postoperative period.</p

Feasibility of Bariatric Surgery as a Strategy for Secondary Prevention in Cardiovascular Disease: A Report from the Swedish Obese Subjects Trial

Aims. Evaluation of bariatric surgery as secondary prevention in obese patients with ischemic heart disease (IHD). Methods. Analysis of data from 4047 subjects in the Swedish Obese Subjects (SOSs) study. Thirty-five patients with IHD are treated with bariatric surgery (n = 21) or conventional treatment (n = 14). Mean follow-up is 10.8 years. Results. Bariatric surgery resulted in sustained weight loss during the study period. After 2 years, the surgery group displayed significant reductions in cardiovascular risk factors, relief from cardiorespiratory symptoms, increments in physical activity, and improved quality of life. After 10 years, recovery from hypertension, diabetes, physical inactivity, and depression was still more common in the surgery group. There were no signs of increased cardiovascular morbidity or mortality in the surgery group. Conclusion. Bariatric surgery appears to be a safe and feasible treatment to achieve long-term weight loss and improvement in cardiovascular risk factors, symptoms, and quality of life in obese subjects with IHD

Pain, psychological distress and health-related quality of life at baseline and 3 months after radical prostatectomy

BACKGROUND: Inadequate management of postoperative pain is common, and postoperative pain is a risk factor for prolonged pain. In addition to medical and technical factors, psychological factors may also influence the experience of postoperative pain. METHODS: Pain was measured postoperatively at 24, 48, and 72 hr in hospital and after 3 months at home in 140 patients undergoing radical prostatectomy (RP). Patients answered questionnaires about anxiety and depression (HAD scale) and health-related quality of life (SF-36) at baseline and 3 months after surgery. RESULTS: In the first 3 postoperative days, mild pain was reported by 45 patients (32%), moderate pain by 64 (45%), and severe pain by 31 (22%) on one or more days. High postoperative pain scores were correlated with length of hospital stay and with high pain scores at home. Forty patients (29%) reported moderate (n = 35) or severe (n = 5) pain after discharge from hospital. Patients who experienced anxiety and depression preoperatively had higher postoperative pain scores and remained anxious and depressed 3 months after surgery. The scores for the physical domains in the SF-36 were decreased, while the mental health scores were increased at 3 months. Anxiety and depression were negatively correlated with all domains of the SF-36. CONCLUSION: There is a need for nurses to be aware of the psychological status of RP patients and its impact upon patients' experience of postoperative pain and recovery. The ability to identify patients with psychological distress and to target interventions is an important goal for future research

Fastighetsvärdering i Sverige och i Spanien : En jämförande studie om fastighetsvärdering

Fastighetsvärderingar utförs av mäklare eller värderare inför försäljning, belåning, arvskiften, skilsmässor, etc. Genom olika metoder beroende på vilket värderingsobjekt det handlar om kan ett marknadsvärde uppskattas. Vid värderingar av småhus är ortsprismetoden genomgående den mest användbara metoden. Läget anses vara den absolut viktigaste värdefaktorn att ta hänsyn till när en värdering utförs, men även skicket, standard, tillgång till service och kommunikationer samt om objektet befinner sig i närhet av vatten. De värdehöjande faktorer, värderingsmetoder och regler kring detta kan skilja och skiljer sig även åt mellan länderna. Denna studie behandlar hur värderingsprocessen går till i Sverige respektive Spanien. Valet av länder motiveras med att det historiskt sett varit populärt för svenskar att investera i spanska fastigheter, främst i form av semesterhus. Då kunskapen är begränsad om hur ett marknadsvärde uppstår i Spanien samt hur köp och försäljningsprocessen går till är denna studie viktig för de som vill köpa en fastighet. Utan besittning av kunskaper om fastighetsmarknaden kan drömmen om det perfekta semesterboendet visas bli en dålig affär. För att skapa förståelse om hur ett värde uppkommer och vilka värdefaktorer som medför påverkan på fastigheten kan denna studie tillföra lyckade fastighetsköp, både i Sverige och i Spanien. För att bidra med relevant information och fakta som stämmer med verkligheten har intervjuer med värderare och mäklare som är aktiva i Sverige och i Spanien utförts. Detta resulterade i svar som var både oväntade och förväntade. I vissa aspekter var värderingsprocessen väldigt lik mellan länderna, medan det också fanns anmärkningsvärda skillnader som kunde diskuteras. Den största skillnad som identifierats i studien är hur mäklare erhåller sin licens i de båda länderna. I Sverige krävs utbildning för att kunna erhålla en mäklarlicens medan licensen i Spanien erbjuds till en försumlig summa. Andra märkbara skillnader är hur köpprocessen skiljer sig mellan länderna samt vilka värdefaktorer som efterfrågas av svenskar som köper bostad i Spanien.Property valuation is executed by real estate brokers or property valuaters before selling, mortgage, inheritance, divorce, etc. Different methods can be used when determing a market value depending on what kind of object it is. When valuating houses, the most common method in Sweden is called “ortsprismetoden”, which compares similar objects to the object that’s being valuated. The most important valuation factor is the location, and has to be considered when deciding the properties value. Other important factors are the properties condition, standard, orientation and if it’s close to water. These factors that enhance the value, the metods that conclude the value and the laws attached to properties could be different in Sweden and in Spain. This study manage how the valuation process is executed in Sweden and in Spain. The countries were chosen based on that it historically have been very popular for Swedes to invest in properties, mainly vacation homes, in Spain. The knowledge about how a market value developes, how the selling/buying process works in Spain is rather limited, therefore this study is important for people who wants to invest in a Spanish property. Without the understandig of the property market, the dream of a perfect vacation home could result in a bad purchase. This study could contribute to a successful purchase by contributing knowledge about the property valuating process, how a market value is determend and what factors increse the value. nterviews were executed with real estate brokers and property valuaters in both Sweden and Spain to provide valuable answers to the questions asked in this study. This resulted in both expected and unexpected answers. In some aspects the valuation process were very similar between the countries, but in other aspects there were some major differences that could be discussed. The biggest difference were if the real estate brokers needed a licens to value property or not. In Sweden the broker needs education to get a licens, while in Spain the licens could be bought. Other differences were the selling/buying aspects and what the most important valuation factors were