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Risks and limits of laparoscopy in the treatment of gynecological cancers
Charvát, Martin ; Robová, Helena (advisor) ; Kužel, David (referee) ; Mlynček, Miloš (referee)
The thesis evaluates the results of experimental protocol involving the fertility sparing treatment procedure in early stage cervical carcinoma (LAP I protocol). Sentinel lymph node detection and experimental extirpation of afferent channels using laparoscopy and its technical aspects were analysed in prospective group of 85 women. The oncologic results and early/late morbidity show that established surgical procedures can be considered safe with minimal morbidity, provided that the indication criteria are met. The second part analyses the results of 148 women with no further pregnancy plans suffering from cervical tumors less than 2 cm in size with invasion less than half of the stroma (LAP II protocol). The oncological results in our defined group are very good and comparable to 'standard' procedure of modified radical hysterectomy type B or C with lower morbidity. In the separate section the thesis analyses the possibilities of laparoscopy in endometrial cancer treatment including the potentials of use of sentinel lymph node detection and technical aspects of laparoscopy in obese women. Currently the biggest controversy is the use of laparoscopy in malignant ovarian tumors. Our oncogynaecological study group at FN Motol prefers the laparotomic approach and we chose to include the set of advanced...
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Peroperative nurse work demands
VELÁTOVÁ, Simona
My thesis has two parts. Part One explains the concept of "perioperative nurse" and her competences set forth in the Decree no.55/2011 Coll., on the activities of healthcare workers and other professional workers. The following chapters discuss the working environment of perioperative nurses, job principles of perioperative nurses, preparation of the operating room, treatment and preparation of instruments and technical equipment. Theory Part One is concluded by the chapter that explains the concept of perioperative care. Part Two is focused on education and training of perioperative nurses. It provides historical information, conditions and opportunities for specialized training of perioperative nurses. The last chapter deals with lifelong learning. Objectives of the Thesis The first objective was to map the range of activities performed by perioperative nursesduring selected types of surgery. The second objective was to identify differences in perioperative nurses' activities during standard and laparoscopic surgery. The last objective was to identifyopportunities for further training of perioperative nurses. The method of qualitative research was used. Research data were collected from non-standardized in-depth interviews. The research covered perioperative nursesof three operating rooms in the Hospital of České Budějovice a. s., namely surgery, urology and gynaecology. The research was carried out in collaboration with 3 perioperative nurses of each of the above mentioned operating rooms. Responses were recorded in writingand interviews with individual nurses were numbered followed then by verbatim transcriptionof interview data. The evaluation and analysis of interviews were categorized and categories were supplemented with subcategories. The results of research focused on duties of perioperative nurses show that perioperative nurses' workencompasses many duties they have to performandfollow. The duties of perioperative nurses include activities before, during and after surgery. They smoothly follow one after another and have a predefined sequence. The Scrub Nurse and CirculatingNursejointly perform most activities. Checking was identified as the most frequent activity of perioperative nurses. Checking on the patient, checking on instruments, checking on equipment / devices, but no surgery check-listsare used in the workplaces fornow. For laparoscopic surgery, no great differences in activities were mentioned by perioperative nurses. There would only be some additional activities related to deployment, checking and control of devices. The spatial arrangement must ensure safety of the patient as well as personnel. The operation and control of devices and equipment is very challenging for perioperative nurses in terms of their technical skills and competences. The research concerning opportunities for further training of perioperative nurseshas showed that perioperative nurses prefer specialized training. As another method to refresh their knowledge, participation in workshops was mentioned by perioperative nurses. No other activities are pursued. The purpose of my thesis was to describe activities (duties) performed by perioperative nurses in their daily routine work and establish how they learn and addnew information and knowledge. Perioperative nursesmanage theactivities / operation of operating rooms. They are required to be familiar with the technique and operating procedures and faultlesslyhandle various types of instruments. Professional knowledge supports a smooth course and good quality results of surgery. All of that requires continuous control, training and expanding their knowledge. This thesis points out the need for employer'sinvestments in training and more proactive approach of perioperative nurses to lifelong learning. The research results could provide the basis for preparation of a lecture for perioperative nurses.
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