Day surgery, variations in routines and practices a questionnaire survey

AbstractBackgroundDay surgery is expanding however little is known about every day practice and routines.MethodsA web-based questionnaire including 34 questions with fixed multiple choice responses around routine and practice for the perioperative handling of patients scheduled for day case surgery was send to 100 hospitals.ResultsThere was an overall response rate of 70%. Most centres had a dedicated day surgery unit (87%). Preoperative assessment routines, when, how and by whom varied. Patient self-assessment questionnaires were common practice (87%). Upper age limit was uncommon (10%), lower age limit common (77%), and fixed high body mass index-limitation showed a mixed pattern, mean 40%. Postoperative nauseas and vomiting-risk stratification varied mean 46%. Anxiolytic premedication was uncommon. Administration of oral analgesics varied, mean 70%; paracetamol (94%), NSAIDs (80%) and opioid (28%). Preferred general anaesthesia technique varied considerable. Laryngeal mask airway was consistently used. Management of pain while in hospital was consistently performed. A majority centres provided take-home analgesics “tablet-package” (69%) or as prescription (80%). Strong opioids to be taken at home were given or prescribed by 59% of units. Written information about the postoperative care was common practice (90%), written instruction about management of pain was less frequently provided (69%). Most hospitals (93%) had standardised discharge criteria, including demand of an escort (75%) and not being alone first postoperative night (81%).ConclusionsWe found that regime for day surgical anaesthesia practice varied between as well as within countries. There is obvious room for further research on how to achieve safe and cost-effective logistics and practice for day case surgery

Desempenho de concentradores de oxigênio com óxido nitroso em volume de 50:50

ResumoJustificativa e objetivospoucas pesquisas abordaram a segurança do oxigênio a partir de concentradores para uso em anestesia em associação com óxido nitroso. Este estudo avaliou a porcentagem de oxigênio a partir de um concentrador em associação com óxido nitroso em um circuito de reinalação semifechado.Métodospacientes adultos submetidos à cirurgia de baixo risco foram alocados aleatoriamente em dois grupos e receberam um fluxo de gases frescos de concentradores de oxigênio (O293) ou de concentradores de oxigênio e óxido nitroso (O293N2O). A fração inspirada de oxigênio e a porcentagem do fluxo de gases frescos de oxigênio foram medidas a cada 10 minutos. O razão da concentração liberada de FiO2/oxigênio foi comparada em diferentes intervalos de tempo e entre os grupos.Resultadosforam avaliados em cada grupo 30 pacientes. Não houve diferença em oxigênio a partir dos concentradores ao longo do tempo para ambos os grupos, mas houve uma melhora significativa da FiO2 (p<0,001) no grupo O293, enquanto houve uma queda significativa (p<0,001) no grupo O293N2O. A razão FiO2/oxigênio variou em ambos os grupos e atingiu um patamar no grupo O293. A oximetria de pulso não caiu abaixo de 98,5% em ambos os grupos.Conclusãoa FiO2 na mistura de O293 e óxido nitroso caiu durante o período de observação, embora a saturação de oxigênio tenha ficado acima de 98,5% durante todo o estudo. Os concentradores podem ser considerados uma fonte estável de oxigênio para uso durante procedimentos anestésicos de curta duração, tanto puro quanto em associação com óxido nitroso em volume de 50:50

Non-Metabolic Membrane Tubulation and Permeability Induced by Bioactive Peptides

BACKGROUND: Basic cell-penetrating peptides are potential vectors for therapeutic molecules and display antimicrobial activity. The peptide-membrane contact is the first step of the sequential processes leading to peptide internalization and cell activity. However, the molecular mechanisms involved in peptide-membrane interaction are not well understood and are frequently controversial. Herein, we compared the membrane activities of six basic peptides with different size, charge density and amphipaticity: Two cell-penetrating peptides (penetratin and R9), three amphipathic peptides and the neuromodulator substance P. METHODOLOGY/PRINCIPAL FINDINGS: Experiments of X ray diffraction, video-microscopy of giant vesicles, fluorescence spectroscopy, turbidimetry and calcein leakage from large vesicles are reported. Permeability and toxicity experiments were performed on cultured cells. The peptides showed differences in bilayer thickness perturbations, vesicles aggregation and local bending properties which form lipidic tubular structures. These structures invade the vesicle lumen in the absence of exogenous energy. CONCLUSIONS/SIGNIFICANCE: We showed that the degree of membrane permeabilization with amphipathic peptides is dependent on both peptide size and hydrophobic nature of the residues. We propose a model for peptide-induced membrane perturbations that explains the differences in peptide membrane activities and suggests the existence of a facilitated “physical endocytosis,” which represents a new pathway for peptide cellular internalization

Day surgery; routines, pain and recovery

ABSTRACT Day surgery in Sweden is increasing both in numbers and in types of procedures. Also older and sicker patients are often included in day case surgery programs, which puts an extra demand on good practice. Methods: Study I: Questionnaires regarding routines used in 2005 were sent to all day surgery clinics in Sweden. Studies II, III, IV: These studies (in 355 patients) were designed as prospective, multi centre, self-assessed follow-up studies, where questionnaires were answered by the patients preoperatively and up to 6 months after surgery. Three typical day surgery procedures were chosen; inguinal hernia repair, arthroscopic procedures, cosmetic breast augmentation. A preoperative health profile was the starting point. An extended 8-item EQ-5d questionnaire was used. The questions focused on quality of life and on pain. Study V: This interventional pain study after hallux valgus surgery was designed as a prospective, randomized double blind study in 100 patients. Results: In study I was shown that a high degree of standardization is present among Swedish day surgery units with pain being the most common postoperative problem. Study II showed that tobacco use by smoking or snuffing decreased postoperative nausea but had no effect on postoperative pain. In study III, unplanned hospital contacts were recorded for 70/355 patients while 3 patients were readmitted. Postoperative pain was reported in 40%, 28% and 20% of included patients after 1, 2 and 4 weeks respectively. Presence of pain preoperatively was identified as the main predictor for postoperative pain. In study IV, longitudinally changes in 8-item health profile was shown to be different between procedures during 6 months follow-up. In study V we showed that in treating postoperative pain, etoricoxib was more effective with fewer side effects than tramadol. Conclusions: Day surgery as presently performed is safe and without major morbidity. The preoperative health profile is important for the recovery course. Pain is the main reported postoperative problem followed by mobility problems. Recovery is divergent for different surgery and calls for different follow-up times. In treatment of pain after foot surgery, the NSAID etoricoxib is shown to be more efficient than tramadol without deleterious effects on healing. Key words: day surgery, postoperative pain, analgesics, tramadol, etoricoxib, postoperative nausea and vomiting (PONV), nicotine, snuff, recovery, EQ-5d, health profile, self-assessed questionnaire, follow-up

The same foundation but still so different! : A qualitative study about physical education teachers interpretation and assessment on the basis of the knowledge demands concerning pace and rhythm.

Syfte och frågeställningar Syftet med studien var att undersöka hur nyexaminerade lärare i idrott och hälsa arbetar med kunskapskraven för takt och rytm samt hur de bedömer elever i årskurs 6 utifrån dessa. Hur bedömer lärarna elever utifrån värdeorden ”till viss del”, ”relativt väl” och ”väl” inom kunskapskravet för takt och rytm i Lgr 11? Hur definierar lärarna begreppen takt och rytm? Vilka resurser upplever lärarna har betydelse för arbetet med bedömning utifrån kunskapskraven för takt och rytm? Metod En film producerades där två elevers kunskaper och färdigheter inom takt och rytm var i fokus. Sex stycken nyexaminerade idrottslärare fick sedan titta på filmen och bedöma eleverna utifrån värdeorden ”till viss del”, ”relativt väl” och ”väl” i kunskapskraven för takt och rytm i Lgr11. Sedan genomfördes intervjuer med samtliga idrottslärare för att få en inblick i hur de använde värdeorden och hur de arbetar med bedömning inom takt och rytm samt hur de resonerar om vilka resurser som kan inverka på undervisningen och bedömningen. Resultat Idrottslärarna hade skilda meningar både gällande vad värdeorden innebar och i bedömningen av eleverna. De hade kriterier för vad som krävdes för respektive värdeord. Det gjorde att samma elev tilldelades både det högsta och det lägsta värdeordet utifrån vad lärarna sett på filmen.  Lärarnas definition av takt och rytm som begrepp var också något som tolkades olika. Hur man definierat begreppen var något som korrelerade med hur man resonerat i bedömningen av eleverna. Vad gäller resurser så tog lärarna upp bland annat speglar, musikanläggning, danssal och rekvisita som betydelsefulla för undervisningen inom takt och rytm. Lärarna menar att goda resurser kan underlätta, men att det även går att undervisa inom takt och rytm med väldigt enkla medel. Slutsats Definition av begrepp och tolkning av värdeorden i kunskapskraven är något som skiljt sig åt mellan lärarna. Detta kan få konsekvenser när det kommer till hur likvärdig bedömningen av eleverna blir. Resurser kan underlätta men behöver inte vara en avgörande faktor för undervisningen inom takt och rytm.  Aim: The purpose of the study was to examine how newly graduated physical education teachers are working with the demands of knowledge concerning pace, rhythm and how they appraise students in year 6 on the basis of these; How do teachers judge students on the basis of the value words ”quite well”, ”relatively well” and ”well” within the demands of knowledge for pace and rhythm in Lgr 11? How do the teachers define the concepts of pace and rhythm? Which resources do the teachers think are of importance when judging on the basis of the demands of knowledge for pace and rhythm. Method: A film was produced where the knowledge and skill of two students concerning pace and rhythm, were in focus. Newly graduated physical education teachers then got to study the movie and judge the students from the value words ”ok”, ”relatively well” and ”well” within the demands of knowledge for pace and rhythm in Lgr 11? After that, interviews were carried out with all the participating teachers, in order to get an insight to how they used the value words and how they work with appraising pace and rhythm and also how they reason about which resources can affect the education and the judgment. Results: The physical education teachers had different opinions on both the definition of the value words and in appraising the students. They had individual demands on what was required for each value word. This resulted in that the same student was given both the highest and the lowest value word on the basis of what the teachers had seen in the film. The teachers definitions of pace and rhythm was also interpreted differently. How they defined the concepts was also something correlated with how they had been reasoning in appraising the students. When it came to resources, the teachers mentioned mirrors, music equipment, dancing ward and props as valuable for the education of pace and rhythm. The teachers said that resources can aid but that it still is possible to teach pace and rhythm with simple means. Conclusion: Definition of concepts and interpretation concerning the value words in the knowledge demands was differentiated between the teachers. This could result in consequences when it comes to the intention of judging the students equally. Resources can aid the education of pace and rhythm but does not have to be a decisive consideration for the education of these abilities

Konsten att klara av en livsstilsförändring i samband med övervikt. En empirisk intervjustudie om vad som verkar för och emot en viktnedgång

Bakgrund: Prevalensen av fetma och övervikt ökar i hela världen och i Sverige lider ca 47 % av männen och 35 % av kvinnorna av övervikt eller fetma. Risken att dö i förtid är stor och följdsjukdomarna till övervikt och fetma är många, bland annat en markant ökad risk för insulinresistens, diabetes typ 2, hjärt-kärlsjukdomar eller stroke. Syfte: Att få ökad kunskap om vad som verkar för respektive emot en livsstilsförändring hos överviktiga. Metod: Fem semistrukturerade djupintervjuer som analyserades och kategoriserades med innehållsanalys. Resultat: Informanterna berättade att deras främsta drivkraft var hälsan och ett längre liv. De som lyckats gå ner i vikt menade att en kontinuerlig och engagerad vårdkontakt varit deras främsta stöd. Tröstätning och ett passivt sätt att hantera problem samt avsaknad av stöd från familj och vård var det största hindret för en viktnedgång. Fysiologiska faktorer, som t ex metaboliska förändringar och smärta nämndes även. Slutsats: Övervikt är ett komplext område som ofta har en psykologisk grund. Informanterna i denna studie behövde främst hjälp att öka sin förmåga till empowerment och coping, någonting som vården bör erbjuda.Overweight is today a constantly increasing problem in societies over the world. In Sweden, men are suffering of overweight with a percentage at 47 percent of the population. Among women 35 percent are overweight and these groups together are more likely to die at a younger age. Persons who are overweight also own a greater risk to get ill and these illnesses are linked to overweight. Such illness can be: diabetes, heart disease or stroke. The aim of this study is to get a greater knowledge about the difficulties around making a change of lifestyle being overweight. What are the factors standing in the way for a change in lifestyle? What is functioning as motivation? Five interviews took place and the material was analysed with content analysis. The result of the analysed interviews led to six categories: knowledge, society, medical factors, empowerment, coping and health care. The major obstacle for being successful with a change in lifestyle was low coping abilities and lack of empowerment. Lack of social support was also a factor that worked against weight loss as well as medical factors. The fact that motivated respondents the most, was to stay healthy in the future and to be able to live longer. The conclusion of this study is that being overweight is linked to the lack of empowerment and low coping abilities. Therefore people being overweight need support from the health care system in order to be able to handle a weight loss