Kvinnors erfarenhet av postoperativ smärta och smärtlindring efter kejsarsnitt

Background: Many women experience high levels of pain after caesarean birth. Adequate postoperative pain treatment is important for the mother to be able to breastfeed, take care of the infant and experience a positive birth. Objective: The overall aim is to study women’s experience of postoperative pain and pain relief after caesarean birth. Method: A quantitative retrospective survey. Data were collected thru a questionnaire from Centralsjukhuset in Karlstad and Falu Larsarett in Sweden. Ninety-eight women participated in the study. Data was analysed with descriptive and comparative statistic. Result: Eighty percent of the women rated the pain with VAS = 4 during the first 24 hours post operative. Those who had to undergo acute caesarean birth rated significant higher levels of pain compared with those who had undergone planned caesarean birth. Despite high level of pain the women were satisfied with the pain relief they received. Both the ability to breastfeed and take care of the infant were affected by pain the first 24 hours post operative. Those who had undergone emergency caesarean birth experienced in greater extend the birth in a negative way. Conclusion: Postoperative pain affects the women’s ability to breastfeed and takes care of here infant. Adequate pain management is therefore important. The women who had to undergo emergency caesarean birth have a more negative birth experience. Midwifes have an important role to inform and support the women in processing here experience.

Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Post tenebras spero lucem : Alquimia y ritos en el Quijote y otras obras cervantinas

This study focuses on two areas: alchemy (Part I) and rituals of initiation (Part II) in the works of Miguel de Cervantes, focusing on Don Quijote de la Mancha as my main case study. The first part analyses the function of alchemy and how it can be interpreted throughout the works and various literary genres of Cervantes. It will demonstrate that the texts of Cervantes contain both explicit and implicit allusions to, as well as different aspects of alchemy, such as operative and spiritual alchemy and how these are ultimately used by Cervantes as a means of expression. The author draws from this rich source and modifies these means of expression in order to achieve various results: sometimes with wit or in relation to fraud; at other times it focuses on inner alchemy relating to chivalry in what I have called spiritual chivalry, which has the aim of self-improvement and ultimately, gnosis. Regarding the chivalric rituals of initiation, according to this investigation chivalry serves as both satire and representation of the alchemical process in the case of Don Quijote, which finds its key moments during the rituals. In this sense alchemy and chivalry are studied as two sides of the same coin, in which the search for something higher, an object (the philosopher stone, the beloved), subjects the protagonist to continuous transmutations and puts him in contact with the transitory, that is, liminal states, people and spaces. From this perspective Don Quixote de la Mancha is built upon liminal poetics. My approach, which follows the tenets of analogical hermeneutics, is included within the framework of the Western Esotericism Studies. The 16th and 17th centuries were a fertile age for alchemy throughout Europe. In Spain, alchemy and other esoteric disciplines co-existed with the Spanish Inquisition and its body for the control of ideas and texts: censorship. By being ambiguous and putting into dialogue different ideas of alchemy, Cervantes not only allowed readers to reach their own conclusions, he also protected his work from censorship.