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Sylaidis, Peter. "Multi media applications in medical education : evaluation of an interactive CD-ROM on practical skin wound management for medical undergraduate learning /." Title page, contents and summary only, 1999. http://web4.library.adelaide.edu.au/theses/09MS/09mss984.pdf.
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Lou, Meei-Fang. "Cognitive disturbance among elderly Taiwanese patients after elective surgery /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7360.
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Lindblad, Alex J. "Increasing the functionality of finite element based surgical suturing simulators /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/10127.
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Otto, Stephanus Daniel. "Chewing gum therapy in third molar surgery." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_4769_1222844033.
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The aim of this study was to determine how effective a chewing gum regime is in treating the common minor complaints of third molar surgery. The efficacy of a six-day chewing gum regimen in reducing pain, swelling and trismus after third molar surgery was compared to no chewing gum therapy. Third molar surgery is an important part of any maxillofacial surgery practice. There is an ongoing quest to find new and innovative methods to treat the minor complaints of this procedure.
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Haggart, Paul C. "Myocardial injury in abdominal aortic surgery." Thesis, University of Aberdeen, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288261.
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Background: Peri-operative myocardial infarction (PMI) may be under- and/or mis-diagnosed because WHO criteria are often not met and creatinine kinase (CK/CK-MB) ratios can be difficult to interpret. Cardiac troponin (cTn) I is the most sensitive and specific marker of myocardial cell necrosis but is not yet widely available. Aims: 1. To examine the use of pre-operative risk indices, including ASA score, POSSUM score and Goldman’s cardiac risk index and compare these with peri-operative cTnI rise. 2. To compare cTnI levels with CK/CK-MB levels peri-operatively in the diagnosis of MI. 3. To explore the role of the fibrinolytic system in patients undergoing emergency surgery for ruptured aneurysm and relate this to cTnI levels. 4. To examine the use of the polymerase chain reaction (PCR) in the identification of bacteraemia and to relate this to systemic endotoxin levels and septic episodes. Methods: Prospective observational study of 67 patients undergoing aortic surgery (29 elective AAA, 31 emergency AAA, 7 aorto-occlusive). cTnI and endotoxin were measured pre-operatively and at 6, 24, 48, 72 and 96 hours postoperatively. Blood for PCR was also collected at these time points. CK and CK-MB were measured where cTnI was detectable. Fibrinolytic markers were measured up to 24 hours post operatively. Clinical, septic, ECG and cardiac events were prospectively documented. Results: ASA score was correlated with perioperative cTnI rise. Over 50% of patients undergoing emergency, and more than a quarter undergoing elective, aortic surgery will suffer myocardial injury as determined by cTnI rise. This is accompanied by CK/ CK-MB ratio in less than a fifth of cases. eTnI rise is associated with inhibition of fibrinolysis with emergency AAA repair. No relationships were observed with the presence of bacterial DNA, endotoxin response and sepsis.
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Nassif, Mohammed. "Early post operative findings in retroperitoneal sarcoma surgery." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121244.
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INTRODUCTION: Retroperitoneal sarcomas (RPS) are large in size and often involve adjacent organs or vital structures. Completeness of resection is critical for long-term survival. However, this often involves extensive operations. OBJECTIVE: The objective of this study was to determine the incidence of early postoperative complications after RPS surgery and identify their predictors. Return to the operating room (OR) and all-cause mortality within 30 days were also examined. METHODS: Administrative claims from the universal health insurance program that covers all residents in the province of Quebec (Canada) were used to identify patients who underwent surgery for retroperitoneal sarcoma. ICD9 and standardized billing codes were utilized. Using multivariate logistic regression analysis the association between patient characteristics and intraoperative variables with severe postoperative complications (Clavien grade ≥ 3 within 30 days) was assessed. RESULTS: 233 patients were included (median age 57). 33% had no comorbidities and 38% had a Charlson comorbidity index (CCI) ≥ 3. Overall, 34% of patients had ≥ 1 adjacent organs resected at surgery and 7% had > 3 organs removed. Early severe postoperative complications occurred in 33% of patients and there were 7 deaths (3%). In comparison to patients who had a CCI of 0, those with a score of ≥ 3 were more likely to have postoperative complications, (OR 2.58, CI 1.05-6.36). Patients who avoided elective post operative admission to the intensive care unit (ICU) within 24 hours of surgery had fewer complications postoperatively, (OR 0.07, CI 0.02-0.25). Male patients had a higher risk as well, (OR 2.4, CI 1.05-5.48). On the other hand, multiple organ resection during surgery and patients' age had no impact on the occurrence of severe complications. CONCLUSION: This study showed that patients' age and extent of surgical resection had no impact on the occurrence of postoperative complications after RPS surgery. While CCI patients sex and early ICU admission did. This suggests that age and extent of resection should not be used as a sole determinant of patient's eligibility for curative surgery in RPS.INTRODUCTION: Les sarcomes rétropéritonéaux (SRP) sont de taille importante et impliquent souvent des organes adjacents ou des structures vitales. La résection est critique pour la survie à long terme mais il, s'agit souvent de vastes opérations. OBJECTIF: Le but de cette étude était est-de déterminer l'incidence des complications postopératoires précoces après la chirurgie SRP et d'identifier leurs facteurs prédictifs. Le retour à la salle d'opération (SO) et mortalité de toutes les causes dans les 30 postopératoires ont également été examinés. MÉTHODES: Les réclamations administratives du programme d'assurance-santé universel qui couvrent presque tous les résidents du Québec (Canada) ont été utilisées pour identifier les patients qui sont eu une chirurgie pour une sarcome rétropéritonéal. Le ICD9 et les codes manuelles de facturation standardisé ont été utilisés. L'analyse multivarié par régression logistique de l'association entre les caractéristiques des patients et les variables peropératoires souffrant de graves complications post-opératoires (Clavien ≥ grade 3 dans les 30 jours) a été évaluée. RÉSULTATS: 233 patients ont été inclus (âge médian 57). 33% n'avaient pas de comorbidités et 38% avaient un indice de comorbidité de Charlson (ICC) ≥ 3. Dans l'ensemble, 34% des patients avaient ≥ 1 des organes adjacents réséqués pendant la chirurgie et 7% avaient > 3 subit une ablation d'organes. Les premières complications postopératoires se sont produits chez 33% des patients et il y a eu 7 décès (3%). La comparaison avec les patients qui avaient un CCI de 0, suggère que ceux qui ont un score ≥ 3 étaient plus susceptibles d'avoir des complications post-opératoires, (OR 2,58, IC 1,05 à 6,36). Les patients qui ont évité une admission post-opératoire élective à l'unité de soins intensifs (USI) dans les 24 heures suivant l'intervention ont eu moins de complications post-opératoires, (OR 0,07, IC 0,02 à 0,25). En plus le sexe masculin présente un facteur de risque plus élevé, (OR 2,4, IC 1,05 à 5,48). Finalement, la résection multiviscérale pendant la chirurgie et l'âge des patients ont n'a pas eu d'effet sur la survenue de complications graves. CONCLUSION: Cette thèse a montré que l'âge des patients et l'étendue de la résection chirurgicale ont n'a pas d'incidence sur la survenue de complications postopératoires après une chirurgie SRP. Ceci suggère que l'âge et l'étendue de la résection ne dovent pas être utiliser comme seul déterminant de l'admissibilité des patients pour une chirurgie curative dans SRP.
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Chow, Yuen-yi, and 周婉儀. "Pre-operative music intervention to reduce patients' pre-operative anxiety in acute care setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623021.
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Hunt, Judith Mary. "The pathophysiology of equine post-operative ileus." Thesis, Royal Veterinary College (University of London), 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309273.
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Steen, Alexander, and Marcus Widegren. "3D Visualization for Pre-operative Planning of Orthopedic Surgery." Thesis, Linköpings universitet, Medie- och Informationsteknik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-94556.
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This report presents a master thesis on 3D visualization for pre-operation planning of orthopedic surgery done for Sectra Medical Systems AB. The focus is on visualizing clinically relevant data for planning a Total Hip Replacement (THR). The thesis includes a pre-study and the implementation of a prototype using the Sectra IDS7 workstation.
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Moonda, Zaheer. "Does the Intra-operatively measured Leg Length Correction compare to the Post-operative radiograph in Total Hip Replacement surgery?" Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33852.
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Aims This study aims to compare the leg length correction (LLC) measured intra-operatively using the Vertical Measurement SystemTM (VMS) in total hip arthroplasty (THA), with the LLC measured on a 6-week post-operative Xray. We also wanted to quantify any residual leg length discrepancy (LLD) using this method. Patients and Methods A prospective cohort study was conducted, in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THA's were performed by four surgeons. Pre-operative leg length discrepancy measurements were obtained in 92 patients. The VMS was used to predict intra-operative leg length correction (LLC), and this measurement was compared to the post-operative leg length correction measured on the 6-week follow-up X-ray. These measurements were statistically compared using Mann-Whitney U Test. Results The difference between the intra-operative VMS calculation and the 6-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.07 ± 3.26mm. In the cohort, 81.52% of the patients (n=75) were within 5mm of the target LLC, and 95.65% of patients (n=88) were within 10mm of the target LLC. The mean absolute residual LLD at 6 weeks was 3.22 ± 3.13mm. Conclusion The intra operative LLC measurement obtained using the VMS accurately predicts the 6-week post op radiographic LLC measurement.
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Hughes, Michael John. "Enhanced recovery after liver surgery." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22803.
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Introduction Liver resection offers curative treatment to a number of malignant conditions. It has traditionally been associated with poor post-operative outcomes. More recently a mortality rate of less than five per cent has become established but morbidity remains high. Enhanced Recovery After Surgery (ERAS) has become established practice in a number of surgical specialties and has shown improvement in post-operative outcomes. ERAS has been introduced for liver resection however practice is less well established and liver surgery has several complexities that need to be accommodated in order to optimise post-operative care. The following thesis aims to identify areas that require clarification and investigate peri-operative care components to establish optimum practice. Methods Systematic review and meta-analysis were performed to identify areas that required clarification and were lacking in sufficient evidence to guide practice. A randomised controlled trial was performed to compare established areas of practice. Prospective observational studies were performed when exploratory investigation was required. Retrospective analysis of a prospectively collected database was performed to identify risk factors for post-operative morbidity. Patients included in the above trials underwent liver resection at the Royal Infirmary of Edinburgh, UK, between December 2012 and August 2014. Results Post-operative analgesia after liver resection was identified as being an area that was controversial. Continuous wound infiltration was shown to offer improved recovery times when compared to epidural with no significant associated disadvantages. After retrospective review of 603 liver resections, extended resection was observed to be associated with high morbidity rates. It was hypothesised that post-operative nutritional requirements might be higher in these patients. This was not found to be the case but post-operative energy requirements were found to be difficult to predict after liver resection, suggesting the benefits of real-time monitoring of energy expenditure. Finally acetaminophen metabolism was suspected of being altered after major resection. An observational study suggested that despite altered metabolism, glutathione deficiency was not observed after major resection and so liver volume was not a contra-indication to acetaminophen administration. Summary Liver resection offers a complex set of conditions on which to base an enhanced recovery protocol. Current ERAS literature does not completely address these issues. This thesis has investigated several aspects of care unique to liver surgery in an attempt to optimise peri-operative care and improve post-operative outcome after liver surgery.
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Cairncross, Lydia Leone. "Pre-operative diagnosis of thyroid cancer : clinical, radiological and pathological correlation." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10230.
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Primary Aim: assess the accuracy of pre operative diagnosis of thyroid cancer in a single centre. Secondary Aims: evaluate the impact of preoperative diagnosis on surgical interventions for thyroid carcinoma; develop locally applicable guidelines for patients with nodular disease of the thyroid.
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Dilworth, John Paul. "Studies on post-operative chest infection after upper abdominal surgery." Thesis, University of Oxford, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316884.
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Lee, Alex Chi Hang. "Ergonomics of the operative field in paediatric minimal access surgery." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/8461.
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This thesis studies the physical and sensorial aspects of surgical ergonomics in relation to paediatric MAS. The aims of the project are to optimise the choice of instrument size, to evaluate alternative illumination sources in paediatric MAS, and to investigate the role of shadows in potentially assisting visual perception in MAS. The ergonomic limitation of the small size of the endoscopic operative field is evaluated and a paediatric simulator is developed using anthropometric data from healthy infants to provide the experimental workspace for ergonomic studies. A study on the effect of the size of instruments on paediatric endoscopic intra-corporeal knot tying shows that using smaller instruments results in faster performance and less discomfort for the surgeon without compromising knot quality, suggesting that smaller instruments should therefore be used when operating on infants. The development of solid-state semiconductor lighting technology as an alternative to the conventional arc-lamp light source is discussed. A light-emitting diode (LED) based endoscopic illumination system, the LED endo-illuminator, is developed with favourable characteristics and fine details recognition is shown to be better compared to the conventional illumination methods. A study on distance estimation in static images does not show that the presence of endoscopic shadows improves depth perception. A further experiment shows that when the light source moves, the resultant shadow movements can give conflicting information to the viewer in the interpretation of the endoscopic scene. Therefore the light source should be stationary if endoscopic shadow is produced in the MAS illumination system. A laser-based illumination system is also developed and proof-of-concept tests show promising characteristics. Its low intensity precludes its use in large cavities but would suit the small endoscopic field in paediatric MAS.
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Nduka, Charles. "Operative dissemination of cancer : the impact of microenvironmental manipulation on post-operative tumour growth." Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391634.
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Ismail, Zarina. "Pre-operative anxiety and uncertainty in gynecological cancer patients /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36396692.
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Indja, Ben. "Subclinical brain injury after cardiac surgery." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/24086.
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Brain injury continues to be one of the most feared complications following cardiac procedures. While clinically overt cerebrovascular accidents are extremely well characterised and relatively rare under optimised conditions, at the other end of the spectrum, subclinical brain injury – which consists of post-operative cognitive dysfunction and silent brain infarcts (SBIs) – is poorly defined but of greater incidence. The lack of knowledge of subclinical brain injury is in large part due to lack of an objective means of measurement, meaning it is quantified using variable definitions and generally subjective clinical assessments. Structural magnetic resonance neuroimaging techniques are a potentially useful tool that can objectively characterise subclinical brain injury by providing a means to measure the neural network disruption that underlies even subtle cognitive and emotional deviations. The aim of this thesis was (i) to frame the true extent of the problem that is subclinical brain injury after cardiac surgery and (ii) to develop structural MRI techniques that might produce a biomarker to objectively measure neural network changes associated with subclinical brain injury.
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Idsoe, Tore, University of Western Sydney, of Science Technology and Environment College, and School of Engineering and Industrial Design. "Teleoperated system for visual monitoring of surgery." THESIS_CSTE_EID_Idsoe_T.xml, 2002. http://handle.uws.edu.au:8081/1959.7/396.
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In this thesis the development of a remotely controlled system used for visual monitoring of surgical procedures at distant locations in described. The system has been developed for laboratory testing, where in the longer term it is to be verified under field conditions. Using existing technology in areas of serial communication and videoconferencing in a new configuration, it has been possible to achieve such a system. The system is intended to assist in performing complex surgical procedures at remote locations where specialist surgeons are normally unavailable. With the prototype system developed in this thesis, a remotely based general surgeon performing an operation can consult and interact with other specialist surgeons through visual operation and voice communications. The teleoperated system consists of two computers, a commercially available robot and a videoconferencing unitMaster of Engineering (Hons)
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Baxendale, Sally Ann. "The neuropsychology of temporal lobectomy : preoperative correlations and post operative predictions." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286670.
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Haddad, Michel. "Peri-operative amiodarone in cardiac surgery patients at high risk for post-operative atrial fibrillation, clinical and economic analysis." Thesis, University of Ottawa (Canada), 2008. http://hdl.handle.net/10393/27691.
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Atrial fibrillation (AF) affects up to 50% of post-operative cardiac surgery patients. AF is rarely fatal and most cases are transient and clinically benign. AF however could occasionally lead to many serious complications such as thromboembolic strokes, ischemic bowel, hypotension, or hemorrhage secondary to the required anticoagulation therapy. In addition, hospital length of stay is often prolonged due to the need to control this arrhythmia prior to discharge. Many strategies to prevent the onset of this condition have been the subject of intense research in recent years. Many pharmacologic and non-pharmacologic agents have been studied with varying degrees of success. Amiodarone, a very effective class III anti-arrhythmic agent, has been shown to reduce the onset of this condition by half in this patient population. Most Amiodarone studies were conducted on coronary artery bypass grafting (CABG) patients and the uptake of this intervention strategy by clinicians has been poor at best. The purpose of this study was to examine the possible benefit of using Amiodarone in a select group of cardiac surgery patients who were deemed to be at a higher risk of developing post-operative AF using a randomized controlled trial model. This select group of patients included valve patients, patients with poor left ventricular function, and the elderly. In addition, the possible economic benefit of such selective prophylactic strategy was evaluated. No clear clinical or economic benefits were demonstrated at the conclusion of the trial. The required a priori sample size was not achieved at the conclusion of the trial and hence many of the results did not achieve statistical significance.
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Stock, Simon E. "Post-operative fatigue and its' relationship to nutrition and disease state." Thesis, University of Newcastle Upon Tyne, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329232.
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Janse, van Rensburg Karina. "Pre-operative urodynamic studies : is there value in predicting post-operative stress urinary incontinence in women undergoing prolapse surgery." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85662.
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Thesis (MMed)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: Aims of the study Urodynamic studies (UDS) have been suggested to be performed as part of the pre-operative work-up of patients undergoing prolapse surgery. Some women with POP have occult stress urinary incontinence (OSUI) and even if subjectively continent, have a higher incidence of developing de novo stress urinary incontinence (SUI). The aim of this study was to describe the outcome of a group of patients who had pre-operative UDS and manual prolapse reduction. Methods This was a retrospective descriptive study including all women who had prolapse surgery during the period January 2006 to December 2011. Patients received routine pre-operative UDS and manual reduction of prolapse, performed at maximum bladder capacity determined by UDS. Patients demonstrating urodynamic SUI or OSUI were offered a concomitant anti-incontinence procedure. Post-operative follow-up data included symptoms of SUI and clinical evidence of SUI. Results The final group consisted of 131 women. The mean age of the patients was 57 years (range 33 to 79) and parity 3.6 (range 0 to 7). The mean body mass index was 32 (range 19 to 53). Twenty-four (18.3%) women had demonstrable SUI on clinical examination at initial presentation in the clinic. At the time of urodynamic studies, forty patients (30.5%) had evidence of SUI determined by either UDS and/ or cough test in the standing position at maximum bladder capacity. Ninety-one women (69.5%) had no evidence of UI on UDS, of which 20(15.3%) demonstrated OSUI (SUI on manual reduction of prolapse at maximal bladder capacity determined by UDS). Of the 40 women with UI on UDS, 36 had 1-step surgery (combination of anti-incontinence procedure and prolapse repair) and 4 had prolapse surgery alone. Of the 20 women with OSUI on UDS, 16 had 1-step (combined) surgery and 4 prolapse surgeries only. Of the 4 who had prolapse surgery alone, 3 complained of post-operative SUI. In the group with no SUI on UDS and manual reduction of POP, 69 of the 71 women had follow-up data. Only 1 had demonstrable SUI on examination. The manual reduction test had a sensitivity of 42.9% and a specificity of 98.5% (95% CI, 92.0-99.9%). The positive predictive value was 75.0% (95% CI, 19.4-99.3%), with a high negative predictive value of 94.4% (95% CI, 86.2-98.8%). Conclusion The numbers in our study are too small to determine sensitivity and positive predictive value of UDS and manual prolapse reduction for the detection of OSUI. However, our data shows promise in identifying POP patients without OSUI, which is a complement of the hypothesis. We recommend that UDS can be performed pre-operatively in women undergoing prolapse surgery, to identify patients with urodynamic stress incontinence. Manual reduction of the prolapse at maximum bladder capacity can then be done to identify a subgroup of patients without OSUI. Future research is needed on the true predictive value of reduction stress testing with larger numbers.
AFRIKAANSE OPSOMMING: Doel van die studie Urodinamiese studies (UDS) word voorgestel as deel van die pre-operatiewe ondersoeke voor prolaps chirurgie gedoen word. Sommige vroue met genitale prolaps het verborge druklek, en selfs as hulle subjektief kontinent is, het hulle ‘n groter insidensie van de novo druklek. Die doel van die studie was om die uitkoms van ‘n groep pasiënte wat pre-operatiewe UDS en manuele prolaps reduksie gehad het, te beskryf. Metodes Die studie was ‘n retrospektiewe beskrywende studie. Al die pasiënte wat prolapse chirurgie in die tydperk Januarie 2006 tot Desember 2011 gehad het, is ingesluit. UDS en manuele prolaps reduksie tydens maksimale blaaskapasiteit, bepaal deur UDS, was deel van die roetine pre-operatiewe ondersoeke. In die gevalle waar urodinamiese druklek of verborge druklek demonstreer is, is die opsie van ‘n meegaande prosedure vir kontinensie tydens prolaps chirurgie aangebied. Post-operatiewe opvolg inligting het simptome van druklek en kliniese bewys van druklek ingesluit. Resultate Die finale groep was 131 vroue reikwydte. Die gemiddelde ouderdom van die pasiënte was 57 jaar (reikwydte 33 - 79) en pariteit 3.6 (reikwydte 0 - 7). Die gemiddelde liggaamsmassa indeks was 32 (reikwydte 19 - 53). Vier-en-twintig (18.3%) vroue het aantoonbare druklek gehad met kliniese ondersoek tydens die eerste kliniek afspraak. Tydens UDS het 40(30.5%) pasiënte druklek getoon tydens UDS en/ of hoestoets in die staande posisie teen maksimale blaaskapasiteit. Een-en-negentig (69.5%) het geen tekens van urinêre inkontinensie tydens UDS demonstreer nie, waarvan 20(15.3%) verborge druklek demonstreer het (druklek met reduksie van prolapse tydens maksimale blaaskapasiteit, bepaal deur UDS). Veertig pasiënte het urodinamiese druklek gehad, waarvan 36 een-stap chirurgie (‘n kombinasie van prolaps herstel en meegaande kontinensie prosedure) en 4 prolaps chirurgie alleenlik gehad het. Uit die 20 vroue met verborge druklek tydens UDS, het 16 een-stap (kombinasie) chirurgie en 4 prolaps chirurgie alleen gehad. Uit die 4 wat prolaps chirurgie alleen gehad het, het 3 post-operatiewe klagtes van druklek gehad. In die groep wat geen inkontinensie tydens UDS en manuele prolaps reduksie gehad het nie, het 69 van die 71 vroue opvolg data gehad. Druklek kon net by een pasiënt met ondersoek demonstreer word. Die manuele reduksie toets het ‘n sensitiwiteit van 42.9% en ‘n spesifisiteit van 98.5% (95% CI, 92.0-99.9%) gehad. Die positiewe voorspellingswaarde was 75.0% (95% CI, 19.4-99.3%), en die negatiewe voorspellingswaarde was 94.4% (95% CI, 86.2-98.8%). Gevolgtrekking Die getalle in ons studie was te min om te bepaal wat die sensitiwiteit en positiewe voorspellingswaarde van UDS and manuele prolaps reduksie is om verborge druklek te demonstreer. Die belowende data om pasiënte te identifiseer met genitale prolaps sonder verborge druklek (‘n kompliment van die hipotese). UDS kan pre-operatief gedoen word in pasiënte wat prolapse herstel chirurgie benodig, om pasiënte met urodinamiese druklek te identifiseer. Manuele reduksie van die prolaps tydens maksimum blaas kapasiteit kan dan volg, om ‘n subgroep van pasiente sonder verborge druklek, uit te ken. Verdere navorsing, met groter getalle word benodig om die werklike voorspellende waarde van die reduksie toets te ondersoek.
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Baker, R. C. "Modulation of peri-operative renal injury in a model of vascular surgery." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396890.
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Rafferty, Pauline. "Recovery following gynaecological surgery : an evaluation of pre-operative intervention by physiotherapists." Thesis, Open University, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384864.
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Mouratoglou, Vassilis M. "A longitudinal study of primary lower-limb amputees : inter-relationships and predictive abilities of pre-operative psychological, physical and social variables on amputees' post-operative rehabilitation characteristics." Thesis, University of Surrey, 1989. http://epubs.surrey.ac.uk/844230/.
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The nature of, indications for, and aims of amputation and prosthetic rehabilitation are described. The influence of those procedures on patients' physical, psychological and social states are examined over time. Psychological theories of the coping techniques of surgical patients are used to develop an understanding of the influence of patients' pre-surgical characteristics on their post-operative rehabilitation. The Roehampton Functional Assessment Scale has been developed and validated on three separate samples of primary lower-limb amputees. The developmental sample consisted of 121 patients, the reliability sample of 50 amputees and the validity sample of 25 patients. The 10-point Body Barrier Test, Family Environment Scale, General Health Questionnaire, Multidimensional Health Locus of Control, Minnesota Multiphasic Personality Inventory, State-Trait Anxiety Inventory and the Roehampton Functional Assessment Scale were used to assess patients' pre- and post-operative physical, psychological and social parameters. 109 patients were assessed before their amputation, whom were re-assessed six months after amputation, and 27 followed-up at eighteen months or more after their operation. The results indicated that patients' psychological profiles differed at each assessment stage, and the changes observed were not always in the same direction. Patients appeared to suffer from worse physical symptoms, sleep disturbances, State Anxiety and body-image before their amputation than after, while still functioning independently from their family environment. At the first post-operative assessment, amputees wore found to fare better than at any other assessment stage. Nevertheless, inter-personal difficulties, indicated by reduced Individuality scores, became evident at this stage. At the final stage, amputees appeared to continue physically and psychologically functioning on levels similar to the previous stage, except for significantly increased Trait Anxiety scores. The three pre-operative variables accounting for most of the variance in the first post-operative assessment variables were Trait Anxiety, Anxiety and Dysphoria and Sleep Disturbances [the later two are subscales of the General Health Questionnaire (GHQ)]; while for the second post-operative assessment the variables were State Anxiety, Somatic Symptoms (a subscale of the GHQ) and Chance Locus of Control. Male and non-vascular patients and those with below-the-knee amputations achieved the best physical rehabilitation and lowest levels of psychopathological disturbances at both re-assessment stages. Additionally, younger patients were found to do better that older amputees at the first post-operative assessment. This clear age difference was not maintained at their second post-operative assessment. Explanations of the possible relationships of the results obtained and a comparison with the results of previous research studies are provided. Clinical applications and recommendations for future research are also included.
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Keller, Evelyn E. "Anxiety and post-operative delirium in the elderly patient: is there a link?" Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92141.
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Ebert, Jay Robert. "Post-operative load bearing rehabilitation following autologous chondrocyte implantation." University of Western Australia. School of Sport Science, Exercise and Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0196.
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[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.
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Hawley, Torrey. "Pediatric Obesity and Peri-Operative Adverse Events." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/453.
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Most surgeries and many medical procedures commonly make use of some form of anesthesia to maximize patient comfort and safety. However, all are associated with risks. Obesity and related health care problems are relatively common in anesthesia and also have a negative effect on morbidity and mortality. Trends in pediatric obesity show increases in both the prevalence and risks for the development of other disease. Using the 1997 through 2009 Kids’ Inpatient Database (KID), this study will assess diagnostic codes to identify complications related to anesthesia in the obese pediatric population. Information gained from this study may serve to advance research and the development of anesthetic techniques to improve both safety and overall health for this population.
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Mwangi, Grace Wangari. "Post-operative Trachomatous Trichiasis in Africa: a systematic review and online survey." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30108.
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Background
High incidence of post-operative trichiasis and other poor outcomes after surgery in most trachoma-endemic settings poses a major challenge to global elimination of trachoma. This systematic review aimed to assess the incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa, based on findings of observational and interventional studies.
Search methods
We searched PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science [all databases], and Cochrane Central Register of
Controlled Trials for relevant studies on the subject. We also searched the reference lists of included
studies to identify further potentially relevant studies. We included all observational and interventional studies that measured post-operative trichiasis as one of the primary outcomes. Only studies conducted in Africa were included in this review.
Data collection and analysis
Two reviewers independently screened the titles and abstracts, selected and assessed the articles for inclusion in this review. Any disagreements were resolved through discussion or by consulting a third reviewer. Where necessary, the corresponding authors of included studies were contacted to provide any missing data. Our primary outcome was post-operative trichiasis, which was defined as any eyelash touching the globe at different time points after surgery.
Main results
Thirty-five studies, including 12,943 participants, met the inclusion criteria. A number of the studies included in this review utilized the same data to measure the incidence of post-operative trichiasis and other poor outcomes over different follow-up periods.
Overall, a review of the included studies revealed a pattern of high incidence of post-operative trichiasis and other poor outcomes ranging from 2.3 at 6 weeks to 65% at 7 years. This incidence varied by type of study design, surgical procedure and technique used as well as the follow up period among other factors.
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GUANA, RICCARDO. "Three-Dimensional Minimally Invasive Surgery Enhances Surgeon’s Performances, Reducing Operative Time and Errors. Comparative Study in a Pediatric Surgery Setting." Doctoral thesis, Politecnico di Torino, 2018. http://hdl.handle.net/11583/2710944.
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Assumptions
Advanced MIS procedures in neonates & infants <5 kg are a very demanding field because of:
• very small anatomical structures
• limited operative spaces (5-7 cm3)
Postulate
3D laparoscopy improves operative time & precision in small spaces
Advantages in 3D laparoscopy are mostly described in adults for better depth perception, more precise visualization of anatomical structures, as well as for complex manoeuvres such as suturing.
In the pediatric field these data are lacking.
In collaboration with Neuromed (Neuromed Spa, Torino) and Storz (Karl Storz, Tuttlingen, Germany) we tested 3D 4mm scopes specific for pediatric laparoscopy with a 3D HD camera, with the possibility to shift from 3D to 2D.
In vitro setting – 1
With Visionsense III Stereoscopic Endoscopy System (Neuromed Spa), FDA and CE approved for pediatric surgery, we performed a comparative study between surgical skills achievements in subjects without any surgical experience, using 2D and a 3D laparoscopic equipment.
3 skills were evaluated in 2D and 3D modalities.
20 pediatrics residents without any previous laparoscopic experience were randomly divided in two groups and evaluated doing object transfer and basic surgical manoeuvres in a laparoscopic simulator validated for pediatric surgery.
Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities.
Time and error rates (missed attempts, dropped objects, and failure to complete the task) were recorded.
In vitro setting – 2
Experimental project comparing 2D vs 3D laparoscopic camera in a set-up standardized and validated for Pediatric Surgeons.
With Storz TipCam 4mm, we performed a comparative study between surgical skills achievements in experienced pediatric surgeons.
Four skills were evaluated in 2D and 3D modalities.
10 pediatric surgeons with more than 50 MIS procedures were randomly divided in two groups and evaluated doing 3 training modules (“threading”, “suturing”, “tension suturing” and “intestinal anastomosis”) in a laparoscopic simulator (iSIM2 – iSurgicals, Chorley, UK).
Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities.
Time and error rates (missed attempts and failure to complete the task) were recorded.
Inconveniences related to the 3D vision were also recorded.
Surgical Application
Using Visionsense III Stereoscopic Endoscopy System and Storz TipCam 4mm we performed 40 laparoscopic/thoracoscopic procedures in children and neonates hospitalized at the Regina Margherita Children’s Hospital.
Operative time and intra- or post-operative complications were recorded.
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Idsoe, Tore. "Teleoperated system for visual monitoring of surgery." Thesis, View thesis View thesis, 2002. http://handle.uws.edu.au:8081/1959.7/396.
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In this thesis the development of a remotely controlled system used for visual monitoring of surgical procedures at distant locations in described. The system has been developed for laboratory testing, where in the longer term it is to be verified under field conditions. Using existing technology in areas of serial communication and videoconferencing in a new configuration, it has been possible to achieve such a system. The system is intended to assist in performing complex surgical procedures at remote locations where specialist surgeons are normally unavailable. With the prototype system developed in this thesis, a remotely based general surgeon performing an operation can consult and interact with other specialist surgeons through visual operation and voice communications. The teleoperated system consists of two computers, a commercially available robot and a videoconferencing unit
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McAllen, Patricia Ann. "The Relationship of Self-efficacy and Weight Loss Maintenance in Post-operative Bariatric Patients." Kent State University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=kent1239288487.
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Taipale, Priscilla Gail. "Nursing care and post-operative delirium in the cardiac surgery intensive care unit." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/29278.
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Post-operative delirium is a debilitating and costly adverse event that has detrimental effects on patients’ recovery and complicates nursing care. Its numerous risk factors make the disorder seem unavoidable and unpreventable. Although pre-operative and intra-operative risk factors for delirium may not be controllable, the post-operative risk factors directly related to nursing practice are directly controllable. Practices to control pain through analgesia and sedation administration given at nurses’ prerogative may be associated with the onset of delirium in the immediate post-operative period.
This study examined opioid and benzodiazepine administration given pro-re-nata (PRN) (“as needed”) by nurses to cardiac surgery patients to determine whether a relationship exists between delirium and nurses’ drug administration. One hundred twenty-two patients were assessed during the first three days following cardiac surgery for delirium with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Data were collected regarding potential risk factors and opioid analgesia and benzodiazepine dosages given to the patients. A retrospective chart review was conducted to determine whether the patients had a physician’s clinical assessment and diagnosis of delirium.
Post-operative delirium occurred in 37.7% to 44.3% of the study sample, depending on how the cases that had positive CAM-ICU assessments and no clinical diagnoses of delirium were handled. The amount of opioid analgesia given to these patients varied widely; however, the total dosage over the 72-hour study period had no statistically significant relationship with the development of delirium (Median = 77.2 morphine equivalents (MEs) for group without delirium vs. 79.3 MEs for group with delirium; Mann-Whitney U = 1697, Z = -0.72, p = .47). The amount of Midazolam administered also varied widely. There was a statistically significant and positive relationship between the dosage of Midazolam given and the development of post-operative delirium (Median = 2.0 mg. for group without delirium vs. 4.0 mg. for group with delirium; Mann-Whitney U = 1393, Z = -2.31, p = .021).
The results of this study indicate that better nursing education and changes in nurses’ practice may be required to protect patients from experiencing drug-induced post-operative delirium.
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Fan, Ka Lun. "Characterisation of a human/robot co operative system for total knee replacement surgery." Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272405.
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Shuldham, Caroline. "The impact of pre-operative education on recovery following coronary artery bypass surgery." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312550.
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Husson, Malinda. "Evaluating Dental Surgery Post-operative Pain in Children Following Treatment Under General Anesthesia." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2481.
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Purpose: The purpose of this pilot study was to determine if there is a difference in post-operative pain experience for children following dental restorations and/or extractions under general anesthesia (GA), with and without local anesthetic (LA). The alternative hypothesis is that children will experience less post-operative discomfort and soft tissue trauma when using intra-ligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria, children age 2-6 years requiring general anesthesia for dental treatment. Patients were randomized into categories of either receiving a standardized local anesthetic or no local anesthetic for the dental procedure. A Wong-Baker Faces Pain Scale (Figure 1) was utilized to evaluate pre-operative and post-operative pain. Data were compared using a pooled t-test and two way mixed model ANOVA controlling for sex, ethnicity, and intra-op meds given. Results: Currently, 33 patients have been enrolled in the study. No difference was found in the LA versus the no LA groups, and significantly more pain was reported in the extraction versus non-extraction groups. With the limited sample size, current trends indicate that pain scores do depend on whether or not treatment included the extraction of a tooth. Conclusion: When adequately powered (n=100), this study could assist clinicians providing dental surgeries under general anesthesia care by providing evidence based criteria for the provision of local anesthetic during general anesthesia to reduce need for intra-operative pain medication to relieve post-operative pain.
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Van, Wyngaard Tirsa. "Pre-operative localization and surgical outcomes for primary hyperparathyroidism (PHPT): An 11-year review at a South African hospital." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29225.
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Introduction:
Primary Hyperparathyroidism (PHPT) is characterized by hypersecretion of PTH leading to hypercalcaemia with successful surgery being the only definitive cure. Broadly, three techniques of parathyroidectomy exist: open bilateral neck exploration and minimally invasive parathyroidectomy, which is subdivided into open focused approaches and endoscopic focused approaches. A focused parathyroid gland exploration guided by pre-operative imaging is associated with less morbidity compared to a bilateral approach. Focused explorations may target either the side or the specific parathyroid gland identified.
Aim:
The primary aim of this study was to evaluate the accuracy of pre-operative localisation for PHPT in a single centre. The secondary aim was to review the type of parathyroid surgery performed and the final Parathyroid Hormone (PTH) levels in patients who have undergone parathyroidectomy for PHPT.
Methods:
This is a retrospective review of all patients who underwent primary surgery for PHPT between 2005 and 2015. Patients were identified from a general operative database. Data was collected from pathology records, operative notes, nuclear medicine and radiology reports and captured on a confidential data sheet.
Results:
Records of 98 patients were found and included. Sestamibi had a sensitivity of 88%, a positive predictive value of 83% and an accuracy of 75%. Ultrasound had a sensitivity of 52%, a positive predictive value of 78% and an accuracy of 44%. The total number of cases in which both ultrasound and sestamibi were done was 73. Sestamibi and ultrasound showed concordant results in 25 cases. The overall surgical success rate was 94% (92/98). The cure rate for patients in whom sestamibi and ultrasound were concordant, was 96% (24/25). The minimum and maximum calcium levels in the cohort were 2.2 and 4.41 respectively, with a mean of 2.86. PTH levels ranged between 4.2 and 186 with a mean of 33.8. One double adenoma was proven on histology. The rest were all single adenomas. The total number of malignancies were 3 of which 1 was part of a MEN syndrome.
Conclusion:
Our surgical success rate was 94%. When imaging modalities were concordant, surgical success was achieved in 24 cases, thus in 96% of the subgroup. Our figures compare favourably with international standards. There is scope for improvement in the accuracy of both ultrasound (46%) and sestamibi (75%) localization. Currently a combination of both imaging modalities is still recommended.
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Smith, Brian Patrick. "Surgery Improves Survival Among Patients With Intestinal Obstruction." Master's thesis, Temple University Libraries, 2010. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/84371.
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Clinical Research and Translational MedicineM.S.
Introduction: Intestinal obstruction is a common cause of hospital admissions and carries a mortality rate around 5%. We hypothesized that surgical intervention reduces mortality among these patients. Methods: We conducted a retrospective cohort study using the 2006 Nationwide Inpatient Sample (NIS) to analyze patients with a diagnosis of intestinal obstruction without hernia. We used multiple variable logistic regression to calculate the odds ratio for surgery as a predictor of death after adjusting for illness severity. Results: Among 38,931 patients, 17,544 (45.1%) underwent operative intervention for intestinal obstructions. Surgical patients were slightly younger than non-surgical patients (65 vs. 68 years), and had more severe illness, as measured by the disease staging: mortality scale (115.45 vs. 97.95, p<0.001). After adjusting for illness severity, surgery was protective from mortality (adjusted odds ratio 0.617, 95% CI 0.535-0.710, p<0.001). This finding was validated with 2 other methods of severity adjustment. Among surgery patients, there were fewer days to surgery among survivors (1 day) than non-survivors (2 days), p<0.001. The risk of bowel necrosis increased as time from admission to surgery increased. A greater percentage of surgical patients (77.5%) were discharged home compared to non-surgical patients (76.3%), p=0.007. Conclusion: Surgery is associated with a reduced odds of in-hospital mortality among patients urgently or emergently admitted with intestinal obstruction without hernia. Delaying operative intervention is associated with an increased odds of bowel necrosis and death in these patients.
Temple University--Theses
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Gibson, Simon C. "Peri-operative cardiac morbidity : prediction, prevention and the novel role of B-type natriuretic peptide." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/446/.
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Cardiovascular disease is the leading cause of death in surgical patients and because of this a number of strategies have been utilised to attempt to predict the cardiac risk of surgery. Theoretically, accurate pre-operative risk stratification would allow patients at low risk to have their surgery expedited efficiently, whilst those at higher risk could have a change made to their treatment plan such as peri-operative cardiac optimisation or in some cases, modification of the operative procedure. Despite this rationale, no guidelines currently exist in the United Kingdom for the management of the surgical patient at high cardiac risk. This may partly reflect the limited methods of risk stratification currently available. Clinical scoring systems are simple and inexpensive but limited by their predictive value. Trans-thoracic echocardiography provides prognostic information but is inconsistent, adding little to clinical information alone. The most accurate methods of pre-operative cardiac risk prediction at the present time are dobutamine stress echocardiography and dipyridamole thallium scanning. However they are expensive, time consuming and have shown poor positive predictive ability, even in high risk cohorts. Few studies have studied the usefulness of biochemical markers in the prediction of post-operative cardiac events. In particular, no information was available in the literature regarding the role of B-type natriuretic peptide (BNP) in the prediction of cardiac events in non-cardiac surgical patients; despite the fact that its measurement has been shown to be an important prognostic tool in both non-surgical and cardiac surgical cohorts. In this thesis the aim was to determine whether pre-operative BNP concentration related to cardiac outcome following non-cardiac surgery; and also to determine whether measurement of other markers such as C- reactive protein (CRP) and cardiac troponin I (CTnI) would be of benefit in pre-operative cardiac risk stratification. To assess the effectiveness of plasma BNP measurement in the prediction of peri-operative cardiac morbidity a pilot study of 41 patients undergoing vascular surgery was conducted. To ensure that any post-operative rise in CTnI was due to operative stress, this was measured pre-operatively along with CRP. Median pre-operative BNP concentration was significantly higher in patients who suffered a post-operative cardiac event (cardiac death, non-fatal myocardial infarction (MI)) than in those who did not (210 (165-380) pg/ml vs. 34.5 (14-70) pg/ml, p<0.001). On the basis of these results a single-centre, prospective, observational cohort study was performed of all patients undergoing non-cardiac surgery. Of the 149 patients recruited to this study, 15 had a cardiac event. The median BNP in those patients having a cardiac event was more than ten-times higher than in those who did not (351 (127-1034) vs. 30.5 pg/ml (11-79.5), p<0.001). A BNP concentration of 108.5pg/ml was the best performing cut-off value having a sensitivity and a specificity of 87%. Although CTnI had originally been measured to ensure that any post-operative rise was due to operative stress, 3 patients had a pre-operative elevation all of whom underwent lower extremity amputation. The amputation group, and in particular those patients who had a raised pre-operative cTnI were therefore analysed further. Amputation patients in general had a high cardiac event rate (23%); however the outcome in those patients who had a raised pre-operative cTnI was particularly poor with 2 suffering a cardiac death post-operatively and one suffering a non-fatal MI. A pre-operative rise in CTnI was the only significant single predictor of peri-operative cardiac events in patients undergoing amputation (p= 0.009). Pre-operative CRP concentration was measured routinely in vascular patients. The concentration in those who had a cardiac event was significantly higher than those who did not (69 (0-260) vs. 12 (0-285), (p=0.003). The cardiac event rate rose with each logarithmic increment in CRP concentration (0-10mg/l (5.7%); 11-100mg/l (22.4%), >100mg/l (55.6%) (p=0.002). Measurement of CRP was of most potential benefit in patients undergoing aortic aneurysm surgery. In conclusion, this thesis has shown that pre-operative measurement of biochemical markers (BNP, CTnI, and CRP) can allow accurate peri-operative risk stratification. BNP concentration in particular was a sensitive and specific predictor of cardiac outcome. Careful case selection using a combination of clinical assessment and the results of these markers may lead to a reduction in the cardiac event rate.
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Machoki, Mugambi Stanley. "Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control : a randomised control trial." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13787.
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Post-operative analgesia currently relies on multimodal therapy including epidural analgesia, intravenous morphine and/or paracetamol (Perfalgan ®) infusion. Local wound infusion has been effectively utilized in adults with promising results but has not been prospectively tested in children undergoing different abdominal operations. The aim of this study was to compare continuous local anesthetic wound infusion to the current standard of care in post-operative pain control in children. Methods: We conducted a prospective randomized, pain assessor blinded trial comparing Bupivacaine wound infusion {Continuous Local Anaesthetic Wound Infusion - CLAWI) in addition to intravenous paracetamol (Perfalgan®) and morphine for rescue analgesia. This was compared to: (a) epidural bupivacaine plus intravenous morphine and Perfalgan® [EPI] for children undergoing open abdominal surgery and (b) intravenous morphine and Perfalgan® infusion alone [standard post-operative analgesia - SAPA] in children undergoing Lanz incision laparotomy for complicated appendicitis. Patients aged between 3 months and 12 years undergoing laparotomy or open appendectomy were randomly selected for local anesthetic wound infusion (CLAWI) versus EPI or CLAWI versus (SAPA) respectively. Exclusion criteria were neurological impairment, post-operative ventilation and history of adverse reaction to bupivacaine. Consent from the guardian, assent from patients above the age of 7 years and ethics approval from the University of Cape Town Human Ethics Research Committee was obtained. The wound infusion catheter ('lnfiltralLong', PANJUNK®) was placed sub-fascially after suture of the peritoneum and 0.2 % bupivacaine 2mls/kg infused on anesthetic reversal followed by 0.2ml/kg/hour thereafter for 48 hours. Pain assessments were performed for each patient at regular intervals by a single assessor who had training in pediatric pain management and who was blinded to the group allocation. The duration of surgery, length of incision, perioperative antibiotics, wound class risk of surgical site infection, time to return to full feeds, drug reactions; hospital stay, surgical site infection and wound catheter and epidural catheter complications were recorded for each patient. Primary outcome measure was total morphine used in the appendectomy-SAPA vs appendectomy-CLAW! group and rescue morphine requirements in the laparotomy-EPI vs laparotomy-CLAWI group. The secondary outcomes were pain control as measured using the FLACC scale, time to full feeds, mobilization and requirement for urinary catheter.
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Wu, Lily. "Metabolic profile and post-operative outcomes in contemporary patients with peripheral arterial disease and critical limb ischaemia." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28147.
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Background: Peripheral arterial disease (PAD) is an established occlusive disease of the peripheral arteries and is not uncommon in the elderly. Atherosclerosis accounts for 90% of the pathology. Only 15% of affected individuals become symptomatic. Most symptomatic individuals present with intermittent claudication (IC). Only a small proportion (1%) of affected individuals present with critical limb ischaemia (CLI). Revascularization aimed at limb salvage, and recovery of ambulation and independent living is the ultimate therapeutic option for the advanced form of PAD (CLI). Traditionally, the success of revascularization for CLI has been defined by graft patency rates and limb salvage rates. Functional outcomes such as ischaemic wound healing and recovery of ambulatory function for independent living have been the focus in more recent publications. However, these assessments do not consider the patients' pre-operative metabolic profile as a predictor of postoperative outcomes. Purpose: The purpose of this study was to determine, in a prospective manner, the influence of preoperative metabolic profile on post-operative outcomes in contemporary patients with peripheral arterial disease presenting with critical limb ischaemia at a tertiary hospital in South Africa. Methods: All consecutive patients, ≥ 18 years, with CLI admitted to the vascular unit at Groote Schuur Hospital over a two-year period (1st January, 2015 to 31st December, 2016) with reconstructable disease were recruited for the study. Written informed consent was obtained from all participants. Revascularization entailed either open surgical revascularization, endovascular interventions or both (hybrid procedures). Data was analyzed according to the clinical level of disease and the type of surgical intervention. Post-operative outcome measures were determined. Primary endpoints (functional and technical outcomes) • Ambulatory recovery at six months and one year • Complete ischaemic wound healing at six months and one year • Limb salvage rate at six months and one year • Primary graft patency rate at six months and one year Secondary endpoint • The influence of pre-operative metabolic profile on the post-operative outcomes The association between pre-operative metabolic profile and post-operative outcomes was determined by Pearson Chi-square statistical test and logistic regression model. Results: A total of 73 consecutive patients were recruited for this study with a mean age of 58 ± 9 years (Range: 30 - 75 years). Seventeen patients (23.3%) had rest pain and 56 (76.7%) had tissue loss [Minor tissue loss was 47 (64.4%) and major tissue loss was 9 (12.3%)]. Current smokers and previous smokers constituted 86% of the sample population with a male to female ratio of approximately 1:1. Our study population was generally overweight based on the BMI. There was high prevalence of abdominal obesity and high body fat for both males and females. Recovery of ambulatory status was 69% and 67% at six months and one year follow-up respectively. The rate of ischaemic wound healing at six months and one year was 48.2% and 75.0% respectively. Surgical site sepsis was the most common local wound complication. Limb salvage rate was 78% and 79% at six months and one year respectively. Overall primary graft patency at six months was 69.0% but reduced to 60.0% at one year. Major amputation rate at one year was 21%. Most of the postoperative wound-related complications occurred among patients with diabetes. More diabetic patients had major amputations compared to non-diabetic patients (57.9% vs 42.1%). One year amputation-free survival (AFS) was 69.9%. There were no statistically significant associations between metabolic profile of patients and post-operative clinical outcomes. Conclusion: Demographics, co-morbidities, and procedural details of our study population, reflected a relatively younger population with CLI. The profile of this contemporary vascular surgery patients is that of overweight, high abdominal obesity, and high prevalence of smoking among both gender. The technical and functional outcomes observed in this study are consistent with available western literature. Diabetes was associated with prolonged ischaemic wound healing, higher risk of major amputation and local wound complications. A statistically significant association was not found between patients' metabolic profile and post-operative outcome but this could be due to the small sample size and short follow up period.
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Jayaram, Raja. "Effects of peri-operative statin treatment on atrial electrical properties, post-operative atrial fibrillation and in-hospital clinical outcomes in patients undergoing elective cardiac surgery." Thesis, University of Oxford, 2014. https://ora.ox.ac.uk/objects/uuid:224a03c7-30f5-456b-a996-0679591ea6a8.
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Surgical myocardial revascularization remains the standard of care for patients with multi-vessel coronary artery disease. A growing body of evidence indicates that systemic inflammation and myocardial oxidative stress are associated with the development of postoperative atrial fibrillation (POAF) and low cardiac output syndrome in patients undergoing cardiac surgery. Statins have been shown to exert rapid anti-inflammatory and antioxidant effects by inhibiting myocardial NOX2 oxidases and by increasing the bioavailability of nitric oxide (NO). However, whether these so-called pleiotropic effects of statins result in improved patient outcomes remains to be established. To provide further insights into the mechanisms of action and impact on clinical outcomes of peri-operative statin treatment in patients undergoing cardiac surgery, I studied the molecular mechanisms underlying the myocardial nitroso-redox balance in samples of the right atrial appendages (RAA) obtained before (PRE) and after cardiopulmonary bypass (CPB) and reperfusion (POST) and setup two double-blind randomised placebo-controlled trials: 1) STARR (Statin Treatment on Atrial Refractoriness and Reperfusion injury), which tested the effect of Atorvastatin (80 mg once daily for up to 6 days before surgery and 5 days after) on the atrial effective refractory period (AERP, over 4 post-operative days) and superoxide production in paired PRE- and POST- RAA samples from 60 patients 2) STICS (Statin Treatment In Cardiac Surgery), which assessed the effects of peri-operative treatment with Rosuvastatin (20mg od) on POAF (assessed by continuous holter ECG monitoring for 5 days postoperatively) and myocardial injury (assessed by serial troponin I measurements) in 1922 patients undergoing elective cardiac surgery. I observed that atrial superoxide production increased significantly after reperfusion due to increased mitochondrial and NOX2 oxidase activity and to uncoupling of NOS activity. NOS activity in RAA samples decreased significantly after reperfusion (by 60%), but this reduction was not prevented by BH4 supplementation (10 μM) or NOX2 inhibition. Instead, I identified increased endothelial NOS S-glutathionylation as the main mechanism responsible for NOS uncoupling after reperfusion. In STARR, atorvastatin prevented increase in RAA superoxide production, maintained the functionally coupled status of NOS and NO bioavailability after reperfusion but had no measurable effect on postoperative AERP. In STICS, treatment with rosuvastatin significantly reduced LDL-C concentration by 48 hours after surgery but had no effect on the incidence of POAF (203 (21%) of the Rosuvastatinallocated patients vs. 197 (20%) of the placebo-allocated patients) or on perioperative myocardial damage (P = 0.80). Pre-defined subgroup analyses (age, sex, prior statin use, baseline troponin concentration, duration of randomized treatment before surgery, type of cardiac surgery, and postoperative use of anti-inflammatory drugs) did not identify any category of patient who benefited from perioperative rosuvastatin treatment. Nor were there beneficial effects on any of the other in-hospital clinical outcomes that were assessed. In conclusion, cardiac surgery on CPB is associated with myocardial nitroso redox imbalance that is reversed by perioperative intensive therapy with statins. However, these effects have no beneficial effects on common in-hospital complications after elective cardiac surgery. Although the benefits of long-term statin therapy in patients requiring myocardial revascularization are well established, the work presented in this thesis does not support routine use of perioperative intensive therapy with statins for the prevention of postoperative complications in patients undergoing elective cardiac surgery.
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Itobi, Emmanuel Onome. "The impact of post-operative oedema on clinical recovery and its potential causes." Thesis, University of Southampton, 2007. https://eprints.soton.ac.uk/63838/.
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The postoperative period is characterized by massive shifts of fluid between body compartments and accumulation of fluid in the extracellular space, which may manifest clinically as central and or peripheral oedema. The incidence of oedema in patients undergoing routine major abdominal surgery (MAS) is unknown and there are no objective means of quantifying or monitoring its presence. Furthermore, the aetiological factors responsible for post-surgical oedema formation in patients with no overt signs of cardiovascular disturbance are poorly understood and the relationship between the development of oedema and clinical outcomes such as the recovery of gastrointestinal function, postoperative complications and duration of hospital stay is unclear. Observational studies were therefore conducted on patients undergoing MAS. The presence of oedema was related to changes whole-body impedance (Z), obtained at four frequencies (5, 50, 100 and 200 kilohertz (kHz)) using bioelectrical impedance analysis (BIA) and to clinical outcomes. The fluid intake and output and changes in plasma concentration of albumin, total protein, C-reactive protein (CRP) and reduced glutathione in whole blood (GSH) were compared before and after surgery in patients who subsequently developed oedema (OD group) and patients who consistently remained free of oedema (NOD group) Oedema occurred in 40 per cent of the patients observed prospectively and was significantly related to age (odds ratio 1.087 (95 per cent confidence interval (c.i), 1.016 -1.163; P =0.016). The preoperative ratio of Z at 200 kHz to 5 kHz (Z200/Z5) was higher in patients who subsequently developed oedema than those who did not (0.809 v 0.799; P = 0.015), suggesting that it may be possible to identify patients who are prone to abnormal fluid shifts preoperatively. The change in (Z) was greater in the oedematous than non-oedematous groups (at all frequencies (P < 0.001)), and more so at lower frequencies (5kHz) than higher frequencies (100 kHz) (P < 0.001). The impedance quotient (ht2/Z) in the whole group changed in a similar direction at each frequency but to a greater extent in the OD compared to NOD groups. The total volumes of administered fluids in both groups of patients were similar but the average urine output per kg body weight was significantly lower in the OD compared to NOD patients (29.4(2.3) versus 40.5(3.7) mls/kg, P = 0.023). There were no significant differences before and after surgery in the concentrations of albumin, total proteins and GSH in both patient groups. Preoperative CRP concentration in the OD and NOD patients were similar but the mean (s.d) CRP concentration over duration of observation in the OD compared to the NOD patients was significantly greater (148 (54.1) versus 89.6 (43.8) mg/L, P = 0.006). Oedema was associated with a significant delay in the recovery of gut function (median (range) 6(3-17) versus 5(1-13) days, P = 0.020) and prolonged hospital stay (17(8-59) versus 9(4-27) days, P = 0.001) and increased incidence of postoperative complications (65 versus 22%, P = 0.011). This study shows that the incidence of early postoperative oedema is high and preoperative identification and monitoring of surgical patients vulnerable to abnormal fluid shifts may be possible with non-invasive techniques. Age, impaired ability to excrete administered fluid load and an exaggerated inflammatory response to surgical trauma rather than hypoalbuminaemia and hypoproteinaemia were significant factors for oedema formation. Postoperative oedema was associated with a significant increase in postoperative morbidity.
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Harrison, Michael J. "The enhancement of intra-operative diagnostics and decision-making using computational methods." Thesis, University of Auckland, 2005. http://hdl.handle.net/2292/74.
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The data presented and views expressed in this document are the result of multiple published and unpublished studies over the last 25 years. My over-arching goal in this research was to use modern computing power to create functionally useful diagnoses, in real time, from the monitoring systems used during routine anaesthesia and to present these diagnoses in an ergonomic manner. In addition it was intended to incorporate into the anaesthetic monitor, expert systems that help with the management of uncommon situations. The Australian and New Zealand College guidelines on monitoring during anaesthesia dictate those measurements that should be made during every anaesthetic; from these data evidence can be gathered, integrated, and presented to the clinician. Constraints in this field of research include the inability of the monitors to see, hear or understand the context of operating theatre activities, and computer processing time. Because many studies are involved the methods are detailed in the main text, and are not summarized here. Physiological 'envelopes' have been developed, in which the 'normal' variation in physiological variables, during anaesthesia, are enclosed. They have enabled the creation of intelligent alarm systems that can suggest diagnoses. A retrospective off-line study showed that it was possible to diagnose the onset of malignant hyperpyrexia, using fuzzy logic templates, about 10minutes earlier than the clinician. Some variables may be more important than others in making a diagnosis, and the strength of a diagnosis depends on the amount of supporting evidence, the amount of evidence not against the diagnosis and the amount of missing data. Decision-making (for example to transfuse or not transfuse blood) can also be mathematically modelled so that decision making is more consistent. Finally, investigation of the ways of displaying data indicates that the output can be very explicit. My overall conclusion is that real time decision support systems for the management of clinical dilemmas are possible. They can be instantly and easily accessible and can sit discretely in the background of anaesthetic monitors to be activated at will by the anaesthetist.
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Rushforth, Helen Elizabeth. "An exploration of an expanded nursing role in paediatric pre-operative assessment." Thesis, University of Southampton, 2000. https://eprints.soton.ac.uk/50633/.
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This thesis explores the appropriateness of suitably trained children's nurses undertaking the pre-operative assessment of children prior to day case and minor surgery. The central focus of the study is a 60 subject hypothesis refining randomised controlled trial (RCT), comparing the pre-operative assessment of children carried out by suitably trained nurses with the assessment carried out by senior house officers (SHO's). Findings demonstrate significantly greater accuracy by nurses in the detection of abnormalities in children's history, when compared with the SHO's. No significant difference is demonstrated between the performance of nurses and SHO's in detecting abnormalities within the physical examination, or in the correct identification of children who have no detectable abnormalities. However, these findings of 'no significant difference' must be substantiated within a larger equivalence trial before assurances can be given that paediatric pre-operative assessment might safely be transferred from SHO's to nurses. Supplementary data explores the perspectives of parents and practitioners with regard to children's nurses undertaking a pre-operative assessment role. The views of parents, gathered via questionnaires, are supportive of the initiative. The views of nurses and SHO's involved in the RCT are similarly supportive, although the conduct of in-depth interviews with the nurses also reveals insights into their perceived vulnerability when carrying out such expanded roles. The views of anaesthetists are less positive, and convey a reluctance to accept nurses carrying out the pre-operative assessment of children. Finally, a national survey explores the views of nurses and SHO's involved in paediatric pre-operative assessment, revealing that nurses attribute significantly greater importance and enjoyment to the pre-operative assessment role when compared with SHO's. This factor may in part explain the greater accuracy demonstrated by nurses in the RCT, but such speculation must be substantiated by further enquiry. This study contributes to the nursing literature in offering what is thought to be the first systematic UK exploration of the role of the paediatric nurse within pre-operative assessment. It is also the first study, as far as the author is aware, to demonstrate significantly greater accuracy in history taking by nurses when compared with doctors, in a paediatric specific UK study. It therefore makes a meaningful contribution to both the paediatric and expanded role evidence bases. It also offers systematically informed hypothesis generation to underpin the ongoing exploration of an expanded nursing role within paediatric pre-operative assessment.
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Rosha, Deepinder Singh. "Chemoprophylaxis for the prevention of endophthalmitis after cataract surgery: patterns of use and economic costs." Thesis, Curtin University, 2006. http://hdl.handle.net/20.500.11937/2135.
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Objectives: The objectives of study were to (i) examine the regional differences in methods of performing cataract surgery across different jurisdictions in Australia and New Zealand (ii) identify risk factors for post-operative endophthalmitis and (iii) explore the implication of changes in surgical practice on the number of cases of post-operative endophthalmitis and resultant net cost to health system. Methods: Cataract surgeons across Australia and New Zealand were surveyed about their demographics, surgical techniques, use of pre- and post-operative antibiotics and antiseptics and cases of post-operative endophthalmitis. Statistical analysis was conducted to determine the regional variations in the use of methods of chemoprophylaxis and surgical practices. Multivariate Poisson regression was performed to identify factors associated with the incidence of post-operative endophthalmitis. A cost analysis was conducted to determine the impact of an increased use of chemoprophylatic treatment on the number of cases of post-operative endophthalmitis and net cost savings to the health system from its use. In addition, the results of the current survey of surgical practices of cataract surgeons was compared with those from an earlier survey conducted approximately 10 years ago. Result: The response to the survey of ophthalmologists was 82%, but after excluding ophthalmologists who did little or no cataract surgery, the study sample comprised 540 participants of the 896 who were initially sent the survey. Participating cataract surgeons reported 162,120 cataract surgeries and 92 cases of post-operative endophthalmitis, an incidence rate of 0.056%. Regional variations were found in the methods of chemoprophylaxis and surgical techniques.Chloramphenicol was the most frequently used topical antibiotic in Australia, while neomycin was used by majority of cataract surgeons in New Zealand. The only notable change found over the past decade was a sharp fall in use of subconjunctival antibiotics from 75% to 45% in the current survey. A slight increase in use of post-operative topical antibiotics was noticed. Subconjunctival injection of antibiotics was the only form of chemoprophylaxis associated with a reduction in incidence of endophthalmitis. Results from this survey indicated that cataract surgeons routinely using corneal or limbal incisions had an incidence of endophthalmitis considerably higher than those surgeons routinely using scleral wounds, whilst surgeons routinely using temporally sited wounds had almost half the incidence of endophthalmitis compared to surgeons using superior wounds. The cost implications of subconjunctival gentamycin injection for chemoprophylaxis were examined. Additional costs of subconjunctival antibiotics were subtracted from the reduced cost of treating fewer cases endophthalmitis. There would potentially be a net saving to the Australian health system of $ 110,354 if all cataract surgeons used subconjunctival chemoprophylaxis. Conclusion: Regional variation in chemoprophylaxis and surgical techniques did not entirely explain differences in post-operative endophthalmitis incidence. Subconjunctival antibiotics would only need to reduce the incidence of endophthalmitis by 15% for it to be cost-effective.
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Idsoe, Tore. "Teleoperated system for visual monitoring of surgery /." View thesis View thesis, 2002. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030506.155915/index.html.
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Thesis (M. E.) (Honours) -- University of Western Sydney, 2002.Thesis submitted in fulfilment of the requirements for the degree of Master of Engineering (Honours), University of Western Sydney, School of Engineering & Industrial Design, March 2002. Bibliography : p. 99-104.
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Lui, Wai-kay Wilkie, and 雷偉基. "A cephalometric study of stability after maxillary impaction." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31954030.
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Challand, Christopher Philip. "Pre-operative cardiopulmonary exercise testing and oesophageal doppler guided fluid therapy in elective colorectal surgery." Thesis, Exeter and Plymouth Peninsula Medical School, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.566045.
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Recent advances in peri-operative care and surgical technique have influenced the short-term outcomes for patients undergoing elective major colorectal surgery. Intraoperative Goal Directed fluid Therapy (GDT) has been shown to reduce length of stay and decrease morbidity in elective colorectal resections. Pre-operative Cardiopulmonary Exercise testing (CPET) characterises baseline aerobic fitness and may identify 'high-risk' patients more likely to benefit from GDT. COMPETE-C was a randomised, single-centre trial comparing the effect of oesophageal Doppler guided GDT against standard care in patients stratified by CPET as Unfit (AT 8.0-10.9 mI02/kg/min) or Fit (AT >11.0 mI02/kg/min). There was no observed benefit to administration of GDT, and it was associated with prolonged length of stay in patients classified as aerobically fit (8.8 vs. 6.0 days; p=0.06). PicoPEX was a pilot study to evaluate the effect of mechanical bowel preparation and carbohydrate-loading on aerobic fitness as measured by CPET in healthy volunteers. Neither intervention significantly worsened aerobic fitness but their clinical significance on patients undergoing major colorectal surgery was not addressed. A retrospective analysis of patients who underwent elective colorectal surgery during the study period revealed that decreased aerobic fitness was associated with prolonged total postoperative stay, particularly amongst "Very Unfit" patients with AT <8 mI02/kg/min and those undergoing rectal resections. Inability to pe arm a CPET was associated with significantly worse short- and medium- term mortality compared to those who completed the test. Concerns exist regarding the robustness of the evidence from GOT studies due to heterogeneity in the trial design and as the initial clinical benefits observed may have been offset by advances in surgical techniques and peri-operative care, and the type of resection performed. A meta-analysis was conducted to address whether Doppler guided GOT influenced total postoperative stay and complications rates when stratified according to type of resection performed. GOT did not improve outcome in terms of length stay but there was a reduction in complications suffered by those undergoing rectal surgery (p=O.04). Our results highlight the need for a large multi-centre study into the role of GOT with patients stratified according to aerobic fitness, surgical technique and planned resection.
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Coll, Anne Marie. "Patient's experiences of day surgery : a study of three operative procedures in three geographical locations." Thesis, University of South Wales, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393778.
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