IRON NUTRITION DURING EARLY CHILDHOOD. Factors influencing iron status and iron intake.

The overall aim of this thesis was to describe the prevalence of iron deficiency (ID) and factors influencing iron status and iron intake among otherwise healthy children. The specific aim in paper I+II was to describe the prevalence of ID among 2 ½-year-old children in relation to intake of cow's milk and follow-on formula. The design in the first two papers were cross-sectional and 367 2 ½-year-old children participated. Data collection included blood samples in order to determine the child's iron status and the parents were asked to estimate the child's intake of cow's milk and follow-on formula. The results showed that ten percent of the children were iron deficient, with or without anaemia, and received iron treatment. Transferrin receptor levels were measured and 14% had elevated levels indicating an iron need in the cell. The intake of cow's milk was significantly higher among children with iron deficiency than among those with sufficient iron status. Eleven percent of the children with ID consumed follow-on formula compared to 43% of the iron-sufficient children. The specific aims in paper III were to describe iron status, iron intake and possible influencing factors among one-year-old children. Ten percent of the participating children (n=90) were iron depleted and 2.2% had ID. Furthermore, 27% of the non-breast fed children had a daily iron intake below the Nordic Nutrition Recommendations. Twenty-five percent reported that they experienced feeding problems when the child was 12 months old and some stated that they had to manipulate the child in order to make it eat. The children with mothers reported an education 9 years. Information about iron rich food from the Child Health Service to the parents improved the child's iron status. The specific aim in paper IV was to elucidate mothers experiences concerning feeding situations. The design was qualitative and interviews with 18 mothers were conducted. The interviews were transcribed verbatim and analysed with content analysis. Two main categories were identified, positive or negative experiences. The mothers with positive experiences trusted the child's ability to regulate food intake and they describe the child as easy to interpret. Mothers with negative experiences describe their child as petulant and felt difficulties in interpret the child's signals. They had to control the child's food intake and one way was to manipulate the child with treats or reward in order to make the child eat. In conclusion, ID still exists among healthy children in Sweden during early childhood. The children with ID drank more cow's milk than those with sufficient iron status. Fewer with ID received follow-on formula compared to those without ID. Low maternal education correlated with low iron intake. Twenty-seven percent of the children had an iron intake below recommendations. Iron fortified follow-on formula and porridge contributed with a large proportion of the total iron intake among one-year-old children. Information about iron rich food resulted in improved iron status

PENGARUH DISIPLIN KERJA TERHADAP KINERJA GURU DI SMA NEGERI SE-KECAMATAN COBLONG KOTA BANDUNG

Penelitian ini berjudul “Pengaruh Disiplin Kerja Terhadap Kinerja Guru di SMA Negeri se-Kecamatan Coblong Kota Bandung”. Masalah yang dikaji dalam penelitian ini adalah seberapa besar pengaruh disiplin kerja terhadap kinerja guru. Secara umum penelitian ini bertujuan untuk mengetahui gambaran yang jelas terkait pengaruh disiplin kerja terhadap kinerja guru di SMA Negeri se-Kecamatan Coblong Kota Bandung. Metode yang digunakan dalam penelitian ini yaitu metode deskriptif dengan pendekatan kuantitatif. Teknik pengumpulan data menggunakan angket tertutup dengan lima skala penilaian (Likert) yang disebar pada 56 guru yang berada di SMA Negeri Kecamatan Coblong sebagai sampel penelitian. Hasil perhitungan kecenderungan umum dengan menggunakan Weighted Means Scored (WMS), menunjukkan bahwa rata-rata kecenderungan variabel X (Disiplin Kerja) berada dalam kategori sangat baik, dan rata-rata kecenderungan variabel Y (Kinerja Guru) berada dalam kategori sangat baik. Hasil pengujian normalitas distribusi data bahwa variabel X dan variabel Y berdistribusi normal. Hasil perhitungan koefisien korelasi menunjukkan bahwa terdapat hubungan yang kuat antara variabel X dan variabel Y, serta nilai uji signifikansi yang terbukti signifikan. Perolehan analisis determinasi sebesar 40,5%, hal ini menunjukan bahwa besarnya pengaruh disiplin kerja terhadap kinerja guru adalah sebesar 40,5% dan sisanya dipengaruhi oleh faktor lain. Kesimpuln dari penelitian ini yaitu adanya pengaruh yang positif dan signifikan antara disiplin kerja terhadap kinerja guru di SMA Negeri se-Kecamatan Coblong Kota Bandung, hal telah tersebut dibuktikan secara perhitungan statistik. ;---This research “The effect of labor discipline on the performance of teachers in the District small hole SMA in Bandung”. Problem in this research is how much influence the discipline of work on teacher performance. In general, this study aims to determine a clear picture of work-related discipline influence the performance of teacher the District small hole SMA in Bandung. The method used in this research is descriptive method with quantitative approach. Data collection techniques using closed questionnaire with 5 rating scale (Likert) distributed in 56 high school teachers in the country districts as a small hole sample. The calculation results by using Weighted Means Scored (WMS),general trend shows that the average propensity variable X (Work Discipline) is the excellent category, and the average tendency of variable Y (Teacher Performance) is the excellent category. Results of testing the normality of the data distribution that the variables X and Y variables with normal distribution. Correlation coefficient there are shows that a strong relationship between the variables X and Y variables, as well as the significance test which proved significant. Acquition analysis of determination of 40,5%, this suggests that the influence of labor discipline on teacher performance was 40,5% and the rest influenced by other factors. Conclusions of this analysis, the influence of positive and significant correlation between discipline of work on teacher performance in SMA Bandung District of small hole it can be proven statistical calculations

Antibiotic use among 8-month-old children in Malmö, Sweden – in relation to child characteristics and parental sociodemographic, psychosocial and lifestyle factors

In the county of Scania, Sweden, antibiotic use among small children is among the highest in the country. The aim of this study was to investigate the associations between antibiotic use among 8-month-old children in Malmö and characteristics of the child as well as parental sociodemographic characteristics, lifestyle factors, and psychosocial support. The study was a population-based cross-sectional survey. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 8-month health checkup during 2003–2006 and whose parents answered a self-administered questionnaire (n = 7266 children). The questionnaire was distributed to parents of children registered with the CHC and invited for an 8-month checkup during the study period. The odds of using antibiotics increased as parental educational level decreased. Using high educational level as a reference group, low maternal educational level was associated with an increased antibiotic use for the child, odds ratio (OR) = 1.61 (95% CI: 1.34–1.93). Furthermore, children whose parents were born outside Sweden showed higher antibiotic use, OR = 1.43 (95% CI: 1.24–1.65), in comparison with children whose parents were born in Sweden. Exposure to environmental smoking, parental experience of economic stress, and a low level of emotional support increased the odds for antibiotic use. Boys had higher odds of use of antibiotics than girls, OR = 1.40 (95% CI: 1.25–1.57). Having a low birth weight, having an allergy and having siblings also increased the odds for early antibiotic use, while breastfeeding seemed to have a protective role. Conclusion There were clear associations between parental factors such as sociodemographic, psychosocial and lifestyle factors and antibiotic use at this early stage of life. Several characteristics of the child also affected the use of antibiotics

Children and pain in a 30 year perspective

Historiskt så har de kliniska besluten rörande huruvida ett barn upplever smärta eller inte varit baserade på de professionellas bedömning snarare än på vetenskapligt underlag. En vanlig missuppfattning är att barn inte upplever smärta i samma utsträckning som vuxna. Emellertid, definitionen på smärta är att det är en subjektiv och emotionell upplevelse associerad till verklig eller potentiell vävnadsskada, eller beskriven som sådan. Trots detta genomgår många barn smärtsamma procedurer under sin sjukhusvistelse utan smärtlindring. En litteraturgenomgång från 1985 baserad på 40 artiklar visade att 77 % av nyfödda barn endast fick muskelrelaxantia före hjärtkirurgi och ingen smärtlindring. Forskning från 1994 visade att, även intrauterint, invasiva procedurer är smärtsamma då fostret reagerade med förhöjda halter stresshormoner. Vidare, forskning från 1997 visade att barn som blivit utsatta för smärta tidigt i livet reagerade med ett starkare smärtsvar jämför med de som inte blivit utsatta. Studier från 2003 beskrev att nyfödda på en neonatal intensivvårdsavdelning blev utsatta för mer än 14 smärtsamma procedurer per dag. Forskning har visat att sjuksköterskors attityder är viktiga för smärthanteringen av barn. Andra studier har visat att sjuksköterskor saknar kunskap avseende smärtbehandling av barn. En nyligen genomförd studie visade att sjuksköterskor tyckte att mindre ingrepp kunde utföras utan smärtlindring. Dock har det visat sig att avancerad utbildning för sjuksköterskor och erfarenhet av att arbeta med barn påverkar deras attityder i viss mån. Barn är en sårbar grupp och sjuksköterskor har, eller borde ha, en stor betydelse för hanteringen av smärta hos barn. Hur kommer vi dit?Historically, the clinical decision regarding whether a child experience pain or not has been based on professional’s perception rather than on scientific evidence. A common misunderstanding has been that children do not experience pain to the same extent as adults. However, the definition of pain is that it is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. In spite of this, many children are going through painful procedures during hospital stay without any pain relief medication. A literature review from 1985 based on 40 articles showed that 77 % of newborns only received muscle relaxantia before heart surgery and no pain medication. In 1994 it was shown that, even in utero, invasive procedures are painful since the fetus respond with increased level of stress hormones. Furthermore, in 1997 research revealed that a child who has been exposed to pain early in life show a stronger pain response later during childhood. Yet, in 2003 it was shown that newborns at a neonatal intensive care unit were exposed to more than 14 painful procedures per day. Research has shown that nurses´ attitudes are important to pain assessment in children. Others have shown that nurses show a lack of knowledge in pain treatment for children. A recent study showed that nurses believed that minor procedure can be carried out without pain medication. In addition, advanced education for nurses and experience in working with children affect attitudes to some extent. Children are a vulnerable group and nurses have, or should have, an important impact on pain management among children. How do we get there

Do nurses change a child´s peripheral intravenous catheter when clinically indicated?

Syfte. Syftet med studien var att undersöka om sjuksköterskor byter barns perifera venkateter vid klinisk indikation. Bakgrund. Att sätta en perifer venkateter är en vanligt förekommande procedur på sjukhus idag men detta kan vara smärtsamt och traumatiskt för barn. Det finns gudielines för när dessa ska bytas när det gäller vuxna men inga sådana riktlinjer för barn kunde identifieras. En Cochrane review från 2010 konkluderade att den perifera venkatetern ska bytas när det finns en klinisk indikation. Detta innebär vid tromboflebit men även vid smärta, rodnad, infiltration, svullnad läckage och ocklusion. Metod. Designen var prospektiv och observerande. Dagliga observationer gjordes på sjukhuset av en av forskarna och noteringar gjordes i ett protokoll. Resultat. Trettiotre barn med sammalagt 47 perifera venkatetrar deltog och 104 observationer gjordes. Sammanlagt utvecklade 42% (14/33) av barnen komplikationer. Bland de barn som fick grad 2 och 3 bytade sjuksköterskan inte den perifera venkatetern när det fanns klinisk indikation. Konklusion. Denna studie visar att tromboflebit kan utvecklas bland barn med en perifer venkateter och att den inte bytades när det fanns klinisk indikation. Det är de professionellas ansvar att reducera smärtsamma upplevelser för barn i samband med sjukhusvistelse och ytterligare forskning kring sjuksköterskors kliniska beslut behöver göras.Aim. The aim of this study was to investigate if nurses change a child´s peripheral intravenous catheter when clinically indicated. Background. Today, inserting a peripheral intravenous catheter is a common procedure in hospital care, but this can be a painful and traumatic for children. There are guidelines when to change the peripheral catheter in adults, but no similar guidelines was found concerning children. A Cochrane review from 2010 concludes that the policy should be to change the peripheral intravenous catheter when clinically indicated. This includes phlebitis, but also pain, redness, infiltration swelling, leakage and blockage. Method. The design was prospective and observational. Daily observations were made at the hospital by one of the researchers and notes were made in a protocol. Findings. Thirty-three children with a total of 47 peripheral intravenous catheters participated, and 104 observations were made. Of the children, 42 % (14/33)developed complications. Among the children with phlebitis grad 2 and 3 the nurses did not change the peripheral intravenous catheter when clinically indicated. Conclusion. This study shows that phlebitis occurs in children with a peripheral intravenous catheter and the PIC were not changed when clinically indicated. It is the professional´s responsibility to reduce the painful experiences for children during hospital care, and more research concerning nurses´ clinical decisions needs to be conducte

Pain Management at Skåne University Hospital, Malmö/Lund, Sweden

1. Sjuksköterskors attityder till smärta bland barn. Tidigare forskning har visat att sjuksköterskor som arbetar med barn saknar kunskap kring smärthantering i viss utsträckning. Barn uttrycker smärta annorlunda än vuxna och forskning har visat att sjuksköterskors attityder är viktiga för att hantera smärta hos barn. Denna studien syftade till att undersöka sjuksköterskors attityder till smärta hos barn. Metoden utgjordes av en enkät till sjuksköterskors som arbetar med barn på en barnavdelning vid ett universitetssjukhus i södra Sverige. Enkäten, Views and knowledge about pain in children” översattes till svenska. Total 357 enkäter delades ut och 153 enkäter besvarades. Detta motsvarar en svarsfrekvens på 43 % av utdelade enkäter. Data analyserades deskriptivt och jämförelser mellan grupper gjordes. Resultatet visade att majoriteten av sjuksköterskor inte tyckte att barn yngre än en månad kunde bli intuberade utan narkotiska preparat men hela 22 % svarade att de inte visste. De uttryckte också vikten av frånvaro av smärta vid postoperativ och kronisk smärta. En del sjuksköterskor tyckte dock att mindre ingrepp kunde göras utan smärtlindring. Utbildning på avancerad nivå och erfarenheter påverkade i viss mån. Var sjuksköterskorna arbetade påverkade inte. 2. Barns smärta från barnets och från förälderns perspektiv. Smärthantering är viktigt för barnet ur många aspekter och kan leda till långvariga problem och påverkar livskvaliteten för barnet. Sverige saknar optimal hantering av akut och långvarig smärta avseende barn och tonåringar. Syftet med studien var att beskriva barns och föräldrars upplevelse av smärta på sjukhus och genomfördes som en prevalensstudie med hjälp av en enkät bestående av sju frågor. Totalt 182 enkäter lämnades ut och 146 besvarades. Resultatet visade att68 % av barnen hade upplevt smärta i samband med sjukhusvistelsen och smärtskalor användes inte i större utsträckning. "Frågade personalen dig och ditt barn om smärta?" 82% (79/97) svarade ja. "Fick du och ditt barn möjlighet att under de först 24 timmarna bedöma smärta med hjälp av en skala e.g. VAS?" Bara 23 % (22/97) svarade att de hade fått den möjligheten. Dessa resultat kan bidra till ökad kunskap om smärta och smärthantering av professionella, vilket kan utgöra en bas för fortsatta diskussioner och öka kvaliteten av smärtbehandling av barn på sjukhus.1. Nurses´ attitudes towards pain in children. Previous research has shown a lack of knowledge in pain treatment among nurses working with children. Children express pain different compared to adults and research has shown that nurses´ attitudes are important to pain assessment in children. The present study aimed to explore nurse’s attitudes towards pain in children. The study was conducted as a questionnaire study on nurses working with children at a pediatric ward at a university hospital in the south of Sweden. The questionnaire ”Views and knowledge about pain in children” was selected and translated into Swedish. A total of 357 surveys were handed out and 153 were answered, which provided a response frequency of 43 % of the total population. Data was analyzed descriptively and comparisons between groups were conducted The results showed that a majority of nurses don’t think that a child less than one month of age may be intubated without narcotics or pain medication but 22 % answered that they did not know. They also express the importance of total elimination of pain when treating post-operative and chronic pain. Some nurses´ believed that minor procedure can be carried out without pain medication. Advanced education and experience affect attitudes to some point. Place of work didn’t affect nurses attitudes towards pain in children. 2. Childrens´s pain from the children and parents perspective. Pain management is important for the child in many aspects and may lead to long term problems and affect quality of life for the child. Sweden is lacking optimal management of acute and chronic pain in children and adolescents. The aim of this study was to describe children´s and parent´s perception of pain in hospital be performing a prevalence study using a questionnaire containing seven questions. Totally 182 questionnaires were administrated and 146 were returned. The results showed that 68 % of children have experienced pain during hospital stay and rating scales concerning pain are not used in particularly high degree. "Did the staff ask you or your child about pain?" - 82 % ( 79/97) answered yes. Did you or your child during the last 24 hours had the possibility to assess pain with a scale e.g. VAS?" Only 23 % (22/97) have had the possibility. These results can provide increased knowledge of pain and pain assessment by health professionals, which may provide a basis for further discussion and increase quality of pain management for children in hospital

To publish a scientific article

ABSTRACT FOR CROATIA CONFERENS OCTOBER 2016 Att publicera en vetenskaplig artikel Flera av er har säkert någon ide´ för att förbättra vården eller kanske redan har genomfört något kvalitetsarbete. Denna workshop är tänkt att inspirera er att genomföra en studie alternativt att ta beslutet att publicera det arbete ni redan har genomfört. År 2014 publicerades en studie (Eiken et al, 2014) som konkluderade att sjuksköterskors utbildningsgrad och arbetsbelastning var relaterade till patientdödligheten. Detta resultat betyder att sjuksköterskors insatser är betydelsefulla och därmed bör det arbete som sjuksköterskor gör bli möjligt för andra att ta del av. För att komma vidare behövs strategier och under denna workshop ska vi diskutera hinder och möjligheter samt att dela med oss av våra erfarenheter. Ann-Cathrine Bramhagen, RN, PhD, Associated professor Malmö University Eiken et al (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Published Online February 26, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)62631-8ABSTRACT FOR CROATIA CONFERENS OCTOBER 2016 To publish a scientific article Many of you have probably some idea how to increase the quality of care or have perhaps already conducted some quality work. This workshop aims to inspire you to perform a study or to decide to publich work you already has conducted. In 2014, a study by Eiken et al concluded that nurses education and work load was related to the mortality of their patients. This results indicate that nurses actions are valuable and therefore, should nurses publish their work so that others can get benefit of it. In order to develop the scientific skills we need to strategies and during this workshop we shall discuss obstacles and possibilities and share our experiences

Mothers' experiences of feeding situations - an interview study.

SYFTE: Syftet med studien var att beskriva föräldrars upplevelser av matsituationerna och kontakten med sjuksköterskan inom barnhälsovården (BHV). BAKGRUNDEN: Några av de viktigaste uppgifterna för sjuksköterskan inom BHV är att följa tillväxten, identifiera uppfödningsproblem och att ge råd om kost och uppfödningsrutiner. METOD: Arton mödrar med varierande ålder, utbildning etnicitet och antal barn och rekryterades från olika barnavårdscentraler blev intervjuade. Berättelserna skrevs ut ordagrant och analyserades med innehållsanalys på manifest och latent nivå. RESULTAT: Alla mödrar beskrev att kost och uppfödning var väsentliga delar i deras liv vilka krävde en hel del tid och engagemang. Två huvudkategorier avseende mödrars förhållningssätt kunde identifieras - ett flexibel förhållningssätt ett kontrollerande förhållningssätt. Mödrar som uttryckte ett flexibelt förhållningssätt var mer öppna för sina barns signaler och svarade på dem för att skapa en god kommunikation. Mödrar som uttryckte ett behov av kontroll skapade regler och rutiner kring matsituationerna. Mödrar med ett kontrollerande förhållningssätt uttryckte att de fick otillräckligt stöd från sjuksköterskan inom BHV. KONKLUSION AND KLINISKA IMPLIKATION: Denna studie visade att några mödrar beskrev otillräckligt stöd från sjuksköterskan inom BHV. Kunskap kring mödrars upplevelser av matsituationerna och deras olika förhållningssätt gentemot sitt barn i samband med måltider kan öka kunskapen hos sjuksköterskorna inom BHV och bidra till ökad förståelse och adekvat stöd till mödrar som upplever uppfödningsproblematik.AIM: The aim of the study was to describe parents' experiences concerning feeding situations and their contact with the nurse at the Child Health Service (CHS). BACKGROUND: Some of the most important tasks for the nurse at the CHS are to monitor growth, detect feeding difficulties and give advice concerning food intake and feeding practices. METHOD: Eighteen mothers differing in age, education, ethnicity and number of children and recruited from different CHS were interviewed. The narratives were transcribed verbatim and analysed by content analysis at manifest and latent levels. RESULT: All mothers' described that food and feeding were essential parts of their lives requiring a great deal of time and involvement. Two major categories of mothers' attitudes in feeding situations were identified - a flexible attitude and a controlling attitude. Mothers with a flexible attitude were sensitive to the child's signals and responded to them in order to obtain good communication. Mothers who expressed a need for control established rules and routines regarding the feeding situations. Mothers with a controlling attitude expressed receiving inadequate support from the nurse at the CHS. CONCLUSION AND CLINICAL IMPLICATION: This study shows that some mothers experience inadequate support from the nurse at the CHS. Knowledge about mothers' experiences of feeding situations and their different attitudes towards the child during feeding might improve the CHS nurses' knowledge and help them understand and more adequately support mothers who experience feeding difficulties

Förekomst av lokala komplikationer efter kranskärlsintervention via artären i handleden

Kardiovaskulär sjukdom är en av västvärldens vanligaste sjukdomar. Diagnos och behandling av förträngda kranskärl kan tillföras med kontraströntgen och perkutan koronar intervention (PCI). Punktion via arteria radialis har i studier visat minskade blödningskomplikationer och minskade kardiella händelser jämfört med transfemoral punktion. Uppföljning avseende lokala komplikationer vid transradial procedur är angeläget. Syftet med denna studie var att retrospektivt utvärdera förekomsten av lokala komplikationer efter transradial kranskärlsintervention efter utskrivning. Patienterna (n=139) kontaktades per telefon efter 2-4 månader. Förfrågan gjordes enligt frågeformulär om lokala symtom relaterat till området kring handleden efter transradial kranskärlsintervention samt om palpabel radialispuls fanns I denna studie hade patienterna hade 91.4 % av patienterna inga lokala komplikationer efter transradial kranskärlsintervention. Alla patienterna hade palpabel radialispuls varav en hade svag radialispuls som verifierades med doppler. Tolv patienter (8.6 %) uppgav symtom på lokala komplikationer av något slag. Sju patienter (5 %) hade olika besvär som smärta känselnedsättning svullnad och hematom från handen. Två patienter (1.4 %) hade besvär från handleden och ytterligare två hade symtom från underarmen samt en hade smärta i axeln. Åtta patienter (6 %) hade olika typer av kvarstående besvär. Konklusionen är att radialispunktionen vid kranskärsintervention har fördelar som minskade blödningskomplikationer och förebyggande minskad hjärtrelaterad död jämfört med femoralispunktionen som vistas i flera studier. Resultatet i denna studie visade lindriga lokala komplikationer, framför allt i handen, hos knappt en tiondel av alla patienterna. Dessutom med tillägg av ökat välbefinnande postoperativt borde transradial procedur vara första handaval vid kranskärlsintervention.Cardiovascular disease is one of the West's most common diseases. Diagnosis and treatment of constricted coronary arteries can be performed with contrast imaging and percutaneous coronary intervention (PCI). Studies have shown that puncture through the radial artery reduces complications such as bleeding and decreased cardiac events compared with a punction of arteria femoralis. A follow-up regarding local complications of trans-radial procedure is important. The aim of this study was to retrospectively evaluate the incidence of local complications after trans-radial coronary intervention after discharge. A total of 139 patients were contacted by telephone after 2-4 months. Inquiry was made according to a questionnaire concerning local symptoms related to the area around the wrist for trans-radial coronary intervention and whether the pulsations in arteria radialis were palpable or not. In this study, 91.4% of patients had no local complications after trans-radial coronary intervention. All patients had palpable pulsations in arteria radialis, and one of them had a weak radial pulse which had to be verified by Doppler. Twelve patients (8.6%) reported local symptoms of any kind. Seven patients (5%) had various problems such as pain, numbness, swelling and hematoma from the hand. Two patients (1.4%) had symptoms of wrist and another two had symptoms from the forearm and one had pain in the shoulder. Eight patients (6%) reported different persistent symptoms. The conclusion is that a punction of arteria radialis in coronary intervention has benefits such as bleeding complications and preventing decreased cardiac death versus a punction of femoral which has been shown in several other studies. The results of this study showed that nearly 10 % experienced mild local complications, especially in the hand. Furthermore, since the patients reported increased well-being postoperatively trans-radial procedures should be first choice in coronary intervention