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- Brattwall, Metha, 1952, et al.
(författare)
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Safe Perioperative Practice, How Can We Further Improve Clinical Every Day Work?
- 2016
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Ingår i: Journal of Perioperative & Critical Intensive Care Nursing. - : OMICS Publishing Group. - 2471-9870. ; 1:2, s. 1-4
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Tidskriftsartikel (refereegranskat)abstract
- Anaesthesia has become reassuringly safe. All modern anaesthetic agents are effective and associated to only minor side effects, anaesthetic machines and monitors helps delivery and closely in real time observation of vital signs. Anaesthesia practice has expanded and includes today perioperative care, preoperative assessment and optimisation, anaesthesia and postoperative care. Following the postoperative course up to day 30 after surgery is today of increasing interest and importance to document value based perioperative. Interprofessional care where the perioperative nurse has a major commitment will help to further improve the perioperative process.
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| 2. |
- Brattwall, Metha, 1952, et al.
(författare)
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What can a mobile App add to improve quality of care, with focus on ambulatory surgery?
- 2018
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 6:1, s. 20-24
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives: Many surgical procedures are nowadays performed as ambulatory or short stay procedures, reducing hospital length of stay. Patient safety and quality of care remain imperative especially when adopting enhanced recovery pathways. Patients should be adequately informed and prepared prior to admission. Recovery is to a major extent dependent after discharge on self-care and thus techniques to follow the post-operative course after leaving hospital are warranted. Telemedicine has grown tremendously over recent years and the incorporation of mobile telephone app technology for the pre- and post-operative coaching of the ambulatory surgical patient may represent an effective means of assisting patients. The present paper presents a feasibility study of a mobile telephone app providing pre-operative information and following the post-operative recovery following day surgery. Method: Patients scheduled for elective day surgery were asked to participate, testing the app and to assess its usefulness on visual analogue scales. Results: Sixty-nine patients aged 18 to 73 years tested the app. Patients aged 30 to 50 where the most frequent users and patients < 30 less frequent. The app was in general assessed as useful and most users expressed an interest in the option of having an app as a source of information before undergoing a scheduled procedure. General pre-operative information was assessed as the most important. A willingness to submit follow-up information decreased rapidly, only 26 and 16 responded at day 10 and 30, respectively. Conclusion: A mobile telephone app is a feasible and appreciated tool for pre-operative information and coaching as part of person-centered healthcare, but its use for follow-up after discharge is challenging and requires further investigation.
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| 6. |
- Sellbrant, Irene, et al.
(författare)
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Brace versus cast following surgical treatment of distal radial fracture: A prospective randomised study comparing quality of recovery
- 2022
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Ingår i: F1000Research. - : F1000 Research Ltd. - 2046-1402. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immobilisation following surgical treatment of distal radial fractures (DRF) is traditionally performed with a dorsal cast splint. There is an interest in changing the rigid cast to a removable brace. This can reduce the risk for cast-corrections, complications and improve recovery of function. The aim of the study was to compare quality of recovery (QoR) between brace and traditional cast for immobilisation during the first postoperative week. Methods: 60 patients with American Society of Anesthesiologists (ASA) physical status 1-3, scheduled for surgical treatment of DRF under a supraclavicular block (SCB) in a day-surgery setting were randomised into two groups of immobilisation post-surgery; brace (n=30) versus traditional cast (n=30). Study objectives were: differences in self-assessed QoR using the QoR-15 questionnaire, postoperative oral oxycodone consumption, perioperative time events and unplanned healthcare contacts one week postoperatively. Results: 54 patients, 46 females/eight males were included in the analysis; 27 with brace and 27 with traditional cast. QoR-15 median scores improved significantly from baseline/preoperative to day 7 (brace p=0.001, cast p=0.001) with no differences between the two groups. The only difference found was that patients in the brace group had significantly worse pain score 24-hours post-surgery (p=0.022). No significant differences were seen in total median oxycodone consumption the first three postoperative days. No differences were found in perioperative events or unplanned healthcare contacts. Conclusions: Brace appears to be a feasible option to traditional cast for immobilisation following surgical treatment of DRF. The early QoR was similar in both groups apart from more pain in the brace group the first 24 postoperative hours. © 2022 Sellbrant I et al.
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| 8. |
- Sellbrant, Irene
(författare)
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lmprovement in perioperative care of the day case patient; logistics and quality of care. : Anaesthesia impact in Day Surgery.
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The “Day surgery concept” is increasing and nowadays numerous of surgical procedures in patients of all ages, with different comorbidities are performed as day case surgery. Day surgery (DS) is a process; not a procedure. Anaesthetic method, multi-modal analgesia, new surgical minimally invasive techniques and a mind-set to facilitate a rapid recovery are all of importance. Thus, multiple factors influence a safe, effective and successful perioperative course combining high quality of care with rapid recovery, enabling patients to be safely discharged on the day of surgery. Aim: To investigate how different parts of the perioperative care per se affects resource utilisation, logistics and quality of recovery in three common DS procedures. Methods: Paper I; A retrospective observational study in patients scheduled for pelvic organ prolapse (POP) surgery assessing discharge on day of surgery, impact of “annual changes” (2012-14) and anaesthetic techniques in 4 different hospitals. Paper II; A prospective randomised study in male patients scheduled for open hernia repair assessing the impact of surgical scrub/sterile covering before vs. after induction of general anaesthesia on haemodynamic changes, medication, logistics and quality of care. Paper III; A prospective randomised study performed on patients scheduled for surgery of distal radial fractures (DRF) investigating the impact of 3 different anaesthetic methods on postoperative pain, postoperative opioid consumption and logistics the first postoperative week. Paper IV; A subgroup of study III patients, prospectively randomised to 2 different immobilisation methods, brace vs cast, assessing patients self-assessed Quality of recovery (QoR-15), postoperative opioid use and logistics the first postoperative week. Results: Paper I; The use of local anaesthesia and sedation (LAS) significantly increased the by-passing of PACU to a step-down unit and discharge day of surgery during the study period. Paper II; No differences in vasoactive medications was found between groups, but there was a significant decrease in PACU-time in awake patients. Both patients and surgical nurses found the awake procedure acceptable. Paper III; The pain scores and postoperative opioid consumption were significantly higher in the supraclavicular block (SCB) group with long-acting local anaesthetic agent (long-LA) compared to short-acting (short-LA) 24-hours post-surgery and during the first 3 postoperative days. The long-LA-group also had most unplanned healthcare contacts postoperatively. Most SCB-patients could by-pass PACU. Paper IV; The median QoR-15 score increased over time from baseline to 1 week post-surgery with no significant differences between brace/cast-groups of patients. Conclusion: The use of LAS in POP-surgery improved both theatre and PACU efficacy and increased discharge on day of surgery. Surgical scrub/sterile covering before induction can be performed without jeopardizing patient´ quality of care and probably improve the perioperative care. SCB with long-LA for surgical repair of DRF provide effective analgesia during early postoperative course, but the patients that received SCB with short-LA had less pain at 24-hours post-surgery, a better pain profile and consumed less opioids during the first 72 hours postoperatively. An immobilisation with brace instead of cast directly after DRF-surgery appears to be a feasible and attractive option.
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| 10. |
- Sellbrant, Irene, et al.
(författare)
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Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study
- 2021
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Ingår i: Bmc Anesthesiology. - : Springer Science and Business Media LLC. - 1471-2253. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. Methods: Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepi-vacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. Results: The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24h was significantly lower for the SCB-mepivacaine group (p = 0.01 8). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.01 7) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). Conclusions: The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution.
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