Introduction Nurse anesthetists (NAs) rely on various tools to perform their daily tasks effectively, with communication being one of the most essential during the perioperative phase. The study aimed to explore NAs' experiences with the perioperative dialogue with patients and how this dialogue has evolved over the past 30 years. Materials and methods The study employed a qualitative design, with data gathered through three group interviews focusing on NAs' experiences. Interpretive content analysis, following the approach of Graneheim and Lundman, was used. Initially, 27 NAs were recruited, and 18 (three men and 15 women) participated in the interviews. Their ages ranged from 33 to 72 years, with work experience spanning 17 to 42 years. Results The text analysis identified three categories: advantages of perioperative dialogue, disadvantages of its absence, and suggestions for improvement. Key challenges included maintaining continuity of care, ensuring a high level of patient and NA safety, reducing care-related complications, minimising patient socialisation, providing incomplete care, and increasing stress for both NAs and patients. The NAs also offered several suggestions for improvement. Conclusion Perioperative meetings should be better structured to improve communication and assess outcomes. Enhancing patient involvement, developing NAs' skills, and providing clearer information in multiple languages could improve satisfaction and safety. Further research is needed to establish the dialogue’s role as a guiding principle for staff and patients.

Introduction Inflammation can arise as a consequence of both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) treatments. Alterations in inflammatory parameters may serve as indicators of kidney injuries and the ensuing inflammation. This study aims to investigate the effects of ESWL and URS procedures on inflammatory parameters for proximal ureteral stone treatment. Materials and methods A prospective interventional study comprised 120 patients with confirmed stones measuring less than 10 mm in the upper half of the proximal ureter. These patients were randomly assigned to either the ESWL or URS treatment groups. Laboratory analyses encompassed interleukin-6 (IL-6), leukocyte count, fibrinogen levels, and erythrocyte sedimentation rate (ESR), which were assessed prior to the intervention, on the first postoperative day, and six months later. IL-6 levels in the serum were determined using a chemiluminescence immunoassay (CLIA). Results There was no significant difference in IL-6 levels between pre-intervention and the first post-intervention day in patients treated with ESWL (1.8 (1.4-2.59) pg/mL vs. 2.33 (1.22-3.19) pg/mL). However, for patients treated with URS, the pre-intervention IL-6 value was 2.9 (1.9-3.34) pg/mL, and it increased significantly to 7.1 (3.85-28.07) pg/mL on the first post-intervention day (p<0.001). On the first post-intervention day, levels of IL-6, CRP, leukocyte count, and ESR were significantly higher in patients treated with URS compared to ESWL (p<0.001; p<0.001; p=0.03; p=0.03, respectively). Conclusion Our research findings suggest that monitoring IL-6 levels can offer valuable insights into the degree of inflammation and tissue damage during and following observed procedures, particularly among patients undergoing URS, even within the initial days post-procedure.

Background: The Lung adenocarcinoma, a subtype of non-small cell lung cancer, exhibits diverse histopathological patterns, impacting prognosis and therapeutic outcomes. Objective: This study explores the correlation between smoking habits and the prevalence of different histopathological subtypes in invasive lung adenocarcinoma (IAC). Methods: A single-center, cross-sectional study included 140 patients with surgically treated, histopathological verified lung adenocarcinoma. The patients were classified based on the World Health Organization’s (WHO) histopathological patterns, and smoking status data were collected from medical records. Descriptive and inferential statistical analyses were performed using SPSS software. Results: The predominant histopathological subtypes were acinar (47.9%) and solid (30.7%) IAC. Smokers constituted 84.3% of the patients, with a majority (61.7%) consuming more than 20 cigarettes per day. A weak, statistically significant correlation was found between histopathological patterns and smoking habits among smokers (rho=0.054; p=0.04). Acinar IAC was more common in those consuming up to 20 cigarettes daily, while the solid pattern predominated in those smoking more than 20 cigarettes (rho=0.189; p=0.04). No significant correlation was observed with the duration of smoking history. Conclusion: The study reveals a predictive relationship between smoking habits, including the number of cigarettes consumed, and the histopathological pattern of IAC in resected specimens. Acinar and solid subtypes were more prevalent, with distinct associations to smoking behaviors. Understanding these relationships can contribute to personalized treatment approaches and further research on lung adenocarcinoma.

Background: As a surgical nurse in a healthcare team, it is helpful to position the patient, depending on the nature of the procedure, and to prepare independently both the instrumentation and the site of surgery with drapes prior to the surgical procedure. Objective: To examine the experience of surgical nurses in their work with the WHO surgical checklist in Sweden. Methods: Data were collected from one hundred and ninety-six healthcare professionals, including thirty-nine surgical nurses, using a self-administered questionnaire. The Mantel-Haenszel and Pearson χ2 tests were used for ordered and unordered categorical variables. The qualitative data was presented in the form of the positive and negative contribution of the checklist and the text was analyzed according to Graneheim and Lundman. Results: Surgical nurses (61.6%) answered “no” to the question about being educated and trained in using checklists. Almost the same answer was given when it came to adapting the checklist to the department and the fact that the assistant nurse was responsible for ensuring the checklist was used (61.5%). 89.9% of them did not know who was responsible for implementing the checklist before surgery. According to (56.4%), the checklist was used all the time in emergencies, while (12.8%) of them stated that they did not believe that the checklist improved patient safety. Conclusions: Compliance with the WHO’s checklist varies, and the observed compliance is lower than that documented. The surgical nurses gave the same responses as others in the team. Clearer procedures are needed during surgery, specifying how the checklist should be used in practice, and there should be a designated person who is responsible for implementing the checklist.

Introduction The World Health Organization (WHO) Surgical Safety Checklist is a tool developed by the WHO to promote safer surgical practices and reduce the incidence of surgical errors and complications. This study aims to describe the role of assistant nurses in the implementation of this checklist by surgical teams. Materials and methods This descriptive study utilized a questionnaire-based survey conducted between September 2018 and March 2019 among 196 healthcare professionals at two surgical units in a university hospital in Sweden. The questionnaire covered demographic information such as age, gender, and occupation, as well as details about their workplace, experience, education/training on using the WHO checklist, the adaptation of the checklist to their department, their responsibilities in implementing and using the checklist, the frequency of use in emergency situations, and the impact on patient safety. Results The results of the study showed that assistant nurses, despite having the lowest level of education among healthcare professionals, were highly trusted and valued by other members of the surgical team. Most healthcare professionals were unsure who was responsible for using the WHO checklist but believed it was the assistant nurse's responsibility to ensure its implementation. Assistant nurses reported little to no training on using the checklist but noted that it had been adapted to the department's needs. Almost half (48.8%) of assistant nurses believed that the checklist was often used in emergency surgery, and most believed that it improved patient safety. Conclusions Improved understanding of the significance of assistant nurses in implementing the WHO Surgical Safety Checklist may enhance adherence to the checklist and potentially improve patient safety, as they were the most valued and trusted healthcare professionals in the surgical team according to the study's findings.

Abstract Background Small renal masses (SRMs) are defined as contrast-enhanced masses with a diameter of ≤4 cm, usually consistent with clinical stage T1a renal cell carcinoma (RCC). This study aimed to explore the histopathological features of a contemporary series of SRMs and investigate parameters that could predict their pathological nature, metastatic potential, and recurrence potential. Materials and methods Small renal masses were identified in 166 of 427 patients who underwent surgery for suspected RCC. The radical nephrectomy/partial nephrectomy ratio was 1:44, and autotransplantation was performed in a single case. Variables associated with metastatic recurrence of SRM were analyzed using χ2 and logistic regression models. Results Renal cell carcinoma was confirmed in 86% (n = 143) of cases, whereas benign tumors were present in 14% (n = 23) of cases. Seventeen percent of the RCC cases were high-grade (Fuhrman G3–4). Among SRMs with a diameter of >2 cm, 71% were malignant. The mean ± standard deviation diameter of the removed SRMs was 28 ± 12 mm, significantly higher in the malignant SRMs group (31 ± 8 vs. 24 ± 9 mm) (p = 0.005). During follow-up, local recurrence was identified in 4 patients versus new distant metastasis in 11 patients. Metastatic lesions were detected in the lungs (1.8%), bone (1.2%), distant (1.9%) and regional lymph nodes (1.2%), liver (0.6%), and multiple organs (2.4%). Patients with malignant SRMs were significantly older than those with benign tumors (p = 0.036). The multivariate analysis identified tumor size, Fuhrman grade, stage, nodal and distant metastasis status, tumor localization, and treatment modality as characteristics significant for tumor recurrence. Conclusions The majority of treated neoplasms were malignant, but their incidence was low among SRMs with a diameter of <2 cm. Our results emphasized the importance of histopathological features and treatment modalities in predicting malignant recurrence.

Background: Bleeding and hematuria can be a consequence of both ESWL and URS treatment.Changes in hematological parameters may be indicative of bleeding events.Objective: The aim of the present study was to explore the hematological parameters after ESWL and ureterorenoscopy for the treatment of kidney stones. Methods: A prospective study included patients (120) with verified ureterolithiasis <10 mm in the upper half of the proximal third of the ureter. Patients were divided into two groups using the random sample method for the application of active stone removal methods ESWL or URS with contact disintegration.Patients were evaluated with routine hematological, biochemical blood parameters, and non-contrast enhanced computed abdominal tomography (CT) before the procedure.Routine laboratory analyzes were performed using standard methods and included determination of the number of erythrocytes, platelets, hemoglobin, hematocrit, glucose, INR, APTTwhich were measured preintervention, the first postoperative day and six months after the intervention. Results: The preintervention hemoglobin value in patients with urolithiasis treated with URS treatment was 140 g/L (136.2–155.7), and was statistically significantly higher compared to the measurement on the first post-intervention day [137.5 g/L (127, 2–156.7) (p<0,05)], as well as in relation to the measurement after six months [139 g/L (134.2–151.7), (p<0,05).The pre-interventional hematocrit value in patients with urolithiasis treated with URS treatment was 0.42 (0.41–0.47), but it dropped statistically significantly on the measurement on the first post-intervention day to a value of 0.41 (0.38–0, 47) (p=0.003). The hematocrit value after six months was 0.44 (0.41–0.47) and was statistically significantly higher compared to the pre-intervention measurement (p=0.002), as well as compared to the measurement on the first post-intervention day (p< 0.001). The pre-intervention INR value in patients with urolithiasis treated with URS treatment was 0.90 (0.86–1.1), and on the first post-intervention day, it increased statistically significantly to a value of 0.99 (0.89–1.1), (p=0.005).The INR value after six months continued to grow to a value of 1.02 (0.96–1.2), which was statistically significantly higher compared to the INR value measured on the first post-intervention day (p<0.001), as and in relation to the INR value measured before the intervention (p=0.007).Conclusion: The results of this study, in terms of hematological parameters, showed more favorable outcomes in patients treated with ESWL compared to URS lithotripsy. Significantly lower hemoglobin values six months after URS treatment, as well as a decrease in the number of platelets on the first postoperative day, lead to the conclusion that URS lithotripsy, which represents a more aggressive method compared to ESWL, may have less favorable consequences for patients.

Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.

Objectives. The present study aimed to assess changes in the perception of and willingness to participate in organ donation (OD) among immigrants from Bosnia and Herzegovina living in Sweden from the perspective of gender differences. Materials and Methods. A cross-sectional study with 60 participants born in Bosnia and Herzegovina and living in Sweden was performed. Data were collected using a self-administrative questionnaire, providing demographic characteristics, information about opinions, awareness, and knowledge on the donation process and religious approach to the subject, willingness to donate/receive organs, and possession of a donor card. Results. Our results showed significant differences between genders regarding the definition of transplantation (P<0.0001), information about OD (P<0.0001), knowledge (P<0.0001) and importance of OD (P<0.003), religious permitting (P=0.0001), and religious opposing (P=0.0007) to OD. Furthermore, a significant difference was observed regarding the preferred recipient (P=0.0062) and the possession of the donor card (P<0.0001). Regression analysis showed that female gender and higher income were statistically significant in prediction of positive attitudes toward OD (P=0.0027, P=0.0002, respectively). Conclusion. Change of social background and integration into Swedish society undoubtedly led to change in the attitudes toward OD, regardless of the perspective of gender differences. However, women were found to have more positive attitudes toward OD.