Dissertations / Theses on the topic 'Surgery Practice'
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Pockney, Peter Graham. "Aspects of minor surgery in general practice." Thesis, University of Southampton, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403822.
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Lau, Sze-lok Alfred. "Evidence-based practice in oral and maxillofacial surgery /." View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B32222154.
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Lau, Sze-lok Alfred, and 劉思樂. "Evidence-based practice in oral and maxillofacial surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45007755.
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Mac, Donald Tanya. "Standardized functional capacity outcome measures in post-operative cardiac surgery: A survey of current clinical practice and development of a clinical practice guideline (CPG)." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28369.
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The objectives of the thesis were to determine the prevalence of functional capacity outcome measure use among physiotherapists working with post-operative cardiac surgery clients and to develop evidence-based recommendations regarding their use in clinical practice. The thesis consisted of a systematic review of the literature; a survey of outcome measure use in clinical practice; and the development of a clinical practice guideline. Thirty-one functional capacity outcome measures were included in the review. Only 2.6% of survey respondents reported almost always using outcome measures in their clinical practice. The Six Minute Walk Test, the modified Borg Rating Scale of Perceived Exertion and vital signs were recommended for routine use in clinical practice. A variety of outcome measures are available for use in clinical practice however their use in clinical practice continues to be less than optimal. There is a need for continued training in outcome measure use in clinical practice.
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Jacka, Michael J. "A survey of monitoring practice of anesthesiologists during cardiovascular surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0007/MQ45908.pdf.
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Roy, Rajneesh, and n/a. "Theory and practice of resecting and managing root ends." University of Otago. School of Dentistry, 2007. http://adt.otago.ac.nz./public/adt-NZDU20071221.144604.
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Contemporary methods of resection and management of the root end during apical surgery were reviewed. Two studies are reported here, one on the amount of peripheral root structure remaining after root-end cavity preparation in maxillary central incisors and canines, and the other on the effect of the dimensions of the cut root face on the size of the root-end cavities cut by experienced endodontists.
To investigate the amount of peripheral root structure remaining after root-end cavity preparation, three senior endodontic graduate students were asked to prepare conservative root-end cavities in thirty root-treated maxillary central incisors and thirty canines. Not a single tooth had the recommended 2 mm circumferential root dentine after 3 mm resection. Sixty two percent of the central incisors did not have a 2 mm dentine periphery around the root-end cavity preparations after 6 mm resection.
To investigate the effect of the dimensions of the cut root face on the size of root-end cavities, five practicing endodontic specialists prepared conservative root-end cavities in thirty single-rooted teeth each after resection of the apical 3 mm. The endodontists prepared larger cavities in larger root faces. More precisely, the cavity sizes suggested that the endodontists were suffering from the effects of a visual illusion, the Delboeuf illusion.
There are two major conclusions. First, the theory concerning the amount of circumferential dentine in a resected root face needs revision. Second, endodontists need to be aware of how the appearance of a cut root face can influence the size of cavities they cut.
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Pumper, Candace. "PROTOCOLS FOR PERIOPERATIVE NUTRITIONAL CARE PRACTICE IN ACCREDITED BARIATRIC SURGICAL CENTERS: A SURVEY OF CURRENT PRACTICE." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1500560856156472.
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Farrell, Anita Helen. "Coping after breast surgery: a portfolio of study, practice and research." Thesis, University of Surrey, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484283.
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Gemmill, Elizabeth H. "Minimally invasive gastro-oesophageal surgery for cancer : current evidence and practice." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/55424/.
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Background Since its introduction in the early 1990s, minimally invasive gastro-oesophageal surgery for cancer has been growing in popularity. Despite this, published evidence on this type of technique is weak and its role in the management of gastric and oesophageal cancer remains controversial. Aims The aim of this thesis was to test the hypothesis that: minimally invasive gastro- oesophageal cancer surgery has superior outcomes compared to control studies of conventional open surgery; but current studies are methodologically inadequate to confirm this. Methods The first study (chapter 3) is a systematic review of the literature on minimally invasive gastro-oesophageal cancer surgery, outlining the differences between literature published in Eastern and Western countries. The following 3 chapters outline and use a phase II surgical study to obtain data on minimally invasive gastro-oesophageal cancer (MIGOCS.) The MIGOCS group was set up in 2005 amongst UK surgeons. An online database was developed to enable data collection and comprises 5 sections: demographics; pre-operative staging and assessment; surgical intervention; post-operative course; pathology and clinical outcome. The first study is retrospective collecting data up to December 2006; the second study is prospective with data obtained between December 2006- July 2008 from centres around the UK utilising the MIGOCS database. Chapter 7 involves analysis of the learning curve in laparoscopic gastro-oesophageal cancer surgery using CUSUM (continuous surveillance monitoring) assessment. By studying operative time at each centre, improvement or deterioration in quality were detected. Results The systematic review of minimally invasive gastro-oesophageal surgery consists in the majority of case reports, with no randomised controlled trials of oesophagectomies and 4 (low quality) randomised controlled trials of gastrectomies. It demonstrates a mortality and morbidity of 2.3% and 46.2% respectively for oesophagectomies; 0.1% and 12.7% respectively for gastrectomies. Data from this review suggests that the minimally invasive approach is beneficial compared to open surgery in terms of reduced mortality, respiratory complications, blood loss and quicker return to a good quality of life (but not reduced hospital stay as expected.) There are currently 60 MIGOCS member consultant surgeons from over 40 UK centres. The retrospective study obtained data from 7 UK centres with an overall mortality and morbidity of 6.0% and 57% respectively for oesophagectomies and 7.7% and 13% respectively for gastrectomies. The prospective study collected data from 7 UK centres, comprising a total of 258 minimally invasive oesophagectomies and 33 minimally invasive gastrectomies. Overall mortality and morbidity were 2.5% and 56.6% respectively for oesophagectomies and 10.8% and 27.3% respectively for gastrectomies. CUSUM analysis varied considerably between centres. The two larger volume centres however demonstrated an improvement in their operative time with experience, with a possible pateau at around 30 procedures. Conclusions Published data suggests that the minimally invasive approach to gastro-oesophageal cancer has advantages over conventional open surgery. Data collected in this thesis does not overwhelmingly support published evidence, but does demonstrate that this technique is both safe and feasible even during the early part of a surgeon's learning curve. It is the first study to provide an insight into outcomes of this type of surgery in a multicentre setting in the UK; and has made progress towards a randomised controlled trial.
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Pope, Catherine Jane. "Assessing evidence based medicine : an investigation of the practice of surgery." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://researchonline.lshtm.ac.uk/682272/.
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Objectives: The thesis seeks to provide an analysis of surgical work and decision making, to identify the basis of the widely observed variation in surgical practice and to indicate what surgeons see as the source(s) of that variation. Against this background, it examines the strengths and limitations of the approach promoted by the evidence-based medicine movement to surgical work. Methods: A qualitative study of surgical practice by urological and gynaecological surgeons in England and the USA involved in the treatment of female urinary stress incontinence. Depth interviews with 29 English surgeons and five American surgeons. Interviews were recorded and transcribed. Observation of 23 operations and additional ethnographic data collection at the hospitals and clinics where these surgeons worked. The observational data consist of near verbatim notes. All these data were analysed using the constant comparative approach described by Glaser and Strauss (1967). A variant of the split-half technique was used to test emerging themes. Results: Surgical practice is contingent: it is dependent on a range of variables, and, it is serendipitous. Three categories of contingency are identified (case, surgeon and external contingency). It is argued that surgical practice entails the complex interplay of these conditional factors and chance happenings. In order to learn to deal with contingency, surgeons learn or acquire practice skills through first hand experience. The thesis explores the role of the surgical apprenticeship and models of learning used by surgeons. Conclusion: The nature of surgical practice presents some fundamental challenges to EBM. The contingent and experiential features of surgical work raise serious doubts about the applicability of EBM to surgery.
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Pickard, Henri Du Plessis. "The management of desmoid tumours at Groote Schuur Hospital: A retrospective review of current practice." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30790.
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Background: Desmoid tumours (DTs) are rare soft tissue tumours that do not metastasise but are locally aggressive. Management options are varied and the response to treatment can be unpredictable. Aim: The aim of this study was to describe the clinical presentation, management strategies and outcomes for adult patients who were treated for DT. Setting: The study was conducted at Groote Schuur Hospital in Cape Town, South Africa and all patients from 2003 to 2016 who presented with DT were included. Method: This was a retrospective review of records. Data collected included: demographics, DT-associated conditions, site and size of tumour, histological findings, treatment modalities, follow-up and outcomes. Results: Seventy patients with histologically confirmed DT were identified. The majority were women (86%) and 77% presented with a painless mass. The commonest site was the anterior abdominal wall (47%). Definitive surgery was performed in 46 (66%) patients, whereas 13 (19%) had definitive radiotherapy. Nine patients received adjuvant radiotherapy post-surgery for involved or close margins. Recurrence developed in 20% patients post-surgery. In the primary radiotherapy group, one patient had disease progression. Two patients with mesenteric DT died because of bowel obstruction. Conclusion: This retrospective review of patients affected by DT at a single centre demonstrates the rarity of the condition, the unpredictable natural history and the variety of treatment options available. Many of our findings are similar to other published studies, except the mean size of DT which was bigger. Treatment outcomes following surgery or radiotherapy seem acceptable, although study limitations are noted.
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Scout, Earl. "What is the current practice of inguinal hernia repair at University of Cape Town affiliated hospitals?" Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31788.
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Background: Various inguinal hernia repair techniques exist, without one ‘single best’ option. Hernia society guidelines recommend laparoscopic repair as one of its mainstays, provided surgeons are adequately trained. The current practice for hernia repair in South Africa as well as the surgical resident exposure to laparoscopic repair training is unknown. Aim: To quantify the current practice of inguinal hernia surgery in hospitals affiliated to the University of Cape Town (UCT) and to assess trainee exposure to laparoscopic repair. Methods: All adult patients who underwent inguinal hernia repair during the 12-month study period, at the four UCT affiliated hospitals (Groote Schuur, Mitchell’s Plain, Victoria and New Somerset) were included. Collected data parameters included age, gender, primary or recurrent hernia, uni- or bilaterality, primary surgeon consultant or non-consultant, operative time, and open or laparoscopic technique used. Results: 380 patients were included. Eighty-eight (23.2%) repairs were performed laparoscopically, of which 5 (5.7%) were converted to open. Non-consultants were present at 70/88 (79.5%) cases performed laparoscopically and were primary surgeon at 15 (17%). Laparoscopic repair was performed for 63.6% of bilateral versus 19.3% of unilateral hernias, 39.3% of recurrent hernias and 45% of hernias in females. Conclusion: Inguinal hernias in our setting are predominantly repaired by open surgery. The likelihood of laparoscopic repair varies significantly depending on which hospital the patient is referred to. Non-consultants have limited exposure to performing laparoscopic hernia repairs as the primary surgeon.
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Moloo, Husein. "Laparoscopic Colorectal Surgery -- Canadian Practice Patterns and the Role of the Hand Assist Device." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28599.
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Objectives: 1) To identify laparoscopic colorectal surgery practice patterns in Canada, 2) To systematically review the literature comparing hand assisted laparoscopic surgery to conventional laparoscopic surgery and 3) To design a randomized controlled trial protocol comparing conventional laparoscopic to hand assisted laparoscopic colorectal resections.
Methods: A national cross sectional study was undertaken of Canadian General Surgeons with respect to their practice patterns specific to laparoscopic colorectal surgery. A systematic review comparing Conventional laparoscopic to Hand-Assisted Laparoscopic colorectal resections. A randomized controlled trial protocol with methodological discussions regarding issues in surgical trials was written.
Results: The majority of Canadian General Surgeons are offering laparoscopic colorectal resections although the volume per surgeon appears to be low. The main barriers to adoption are operating time and lack of formal minimally invasive surgery training. There were two trials identified for inclusion in the systematic review with a total of 94 subjects with some methodological weaknesses. A potential trend towards decreased conversion to open surgery in the hand assisted group was identified. A protocol is presented for a trial comparing hand assisted to conventional laparoscopic colorectal surgery.
Conclusion: A large percentage of Canadian surgeons perform laparoscopic colorectal resections although many perform less than one case per month. The limited number of trials performed and their associated methodological weaknesses and heterogeneity does not allow a reliable assessment of the relative benefits of hand-assisted and conventional laparoscopic resections for colorectal disease. Additional adequately powered and methodologically sound trials are needed to determine if there is a clinically important difference in perioperative outcomes.
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Smith, Susan Lee. "Lived Experience of the Advanced Practice Provider on the Burn Surgery Service." Diss., NSUWorks, 2017. https://nsuworks.nova.edu/hpd_hs_stuetd/7.
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The purpose of this qualitative dissertation study was to examine the lived experience and meaning making of challenges, benefits, satisfaction, and professional sustainability for the advanced practice provider in the burn surgery specialty service. The problem addressed was the knowledge gap resulting from a lack of literature describing aspects of the advanced practice provider role in the burn specialty. An interpretive phenomenological analysis, informed by the philosophy of Dr. Martin Heidegger, was undertaken. Participants were solicited from the American Burn Association Advanced Practice Provider (APP) special interest group site. The results provided a thick description of the lived experience of the Burn APP offering, illuminating commonalities and distinctions to promote role gratification and fulfillment leading to professional success and prolonged engagement. Keywords: advanced practice provider, nurse practitioner, physician assistant, interpretive phenomenology, hermeneutics.
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Erian, Mark. "Contributions to the practice of endoscopic surgery in gynaecology : based on personal published work 1990-2005 /." [St. Lucia, Qld.], 2006. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19784.pdf.
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Velzen, Jeena. "Anaesthetic rooms : a systems approach to improving design and practice in the United Kingdom." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/40888/.
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The use of anaesthetic rooms as the standard site of anaesthetic induction in the United Kingdom has been criticised and debated over several decades, and yet practice has remained largely unchanged. The impacts of the anaesthetic room on cost, efficiency, patient experience, and patient safety are either conflicting or unknown. This research utilised a systems approach to evaluate the efficacy of anaesthetic rooms and make recommendations for the improvement of both the design and practice of surgical suites in the UK. The study incorporated mixed methods to investigate the qualitative and quantitative benefits of anaesthetic rooms for all stakeholders. A survey of consultant anaesthetists investigated current practice and attitudes regarding the use of anaesthetic rooms and the importance of various types of ‘evidence’ for affecting change in practice. This study revealed the wide diversity of current anaesthetic practice and the factors that influence the selection of the site of induction. A second study, which used interviews with anaesthetists and perioperative managers explored the decision making surrounding the continued use of anaesthetic rooms and the relationship between design and practice. Factors influencing the perpetuation of anaesthetic rooms were shown to exist systemically across individual, organisational, and external levels. Willingness to change and the relevance of evidence for decision making is discussed. In a third study, a modified participatory design Delphi was used to investigate the decision making priorities of multiple anaesthetic room stakeholders to reach a consensus for the design of theatres in a new fictional hospital. The novel Delphi technique presented conflicting research findings to participants in order to require them to evaluate and come to agreement regarding the incorporation of anaesthetic rooms. A critique of this method is presented along with suggestions for future application. A cost-benefit analysis of anaesthetic rooms was then conducted in one NHS Trust. This was supplemented by ethnographic observations of its surgical suites to provide context to the historical timing data gathered retrospectively for financial and productive evaluations. The cost-benefit analysis revealed that there are missed opportunities associated with anaesthetic rooms, as downtime and delay mean that the potential financial gain and return on investment of anaesthetic rooms cannot be realised. An investigation of patient experience with surgical anaesthesia was conducted through a multi-part questionnaire evaluating patients’ expectations, anxiety, and satisfaction with their anaesthetic care. The study focused on the impact of the site of induction on patient experience and revealed that anaesthetic rooms do not appear to have a significant effect on patient anxiety and satisfaction. Opportunities for improving patient experience were identified, with the majority of these being unrelated to the site of induction of anaesthesia. Through a number of separate studies, this research provides a complete evaluation of anaesthetic rooms. It has identified the contradictions between stated priorities for anaesthetic rooms that stakeholders report and the actual choices that they make for the use and design of surgical suites. The human factors methods and systems approach that has been taken to this thesis has shown that it is a valuable way of investigating deeply embedded practices in healthcare. In addition, this research has set forth a novel method for integrating four dominant paradigms of healthcare improvement. The integration of participatory ergonomics and evidence-based practice may provide a useful method for reaching consensus of contentious issues, aligning systems design with individual and organisational priorities, and encouraging evidence evaluation as a part of the decision making process.
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Berezowski, Brian Mark. "The pathological outcomes related to symptomatic impacted third molars and follicles as found in a private practice in South Africa." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/10140.
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Includes abstract.Includes bibliographical references.
The aim of this study primarily was to review pathological reports of all symptomatic third molar teeth removed in a private practice, and to use the data to support or refute routine removal of third molar teeth. All patients who underwent third molar tooth removal for symptoms,either systemic or local ,in a private practice over a twenty year period between 1987 and 2007 were included in the study. Specimens were sent for histological assessment by Oral Pathologists. The patient records were reviewed retrospectively. A total of 3427 third molar teeth were included in the study. There were 68.75% specimens which had some sort of pathology. Only 0.3% of specimens were reported as normal dental follicular tissue. There were 31.25% specimens of hyperplastic follicular tissue which was considered non pathologic as they consisted of normal dental follicular tissue with a mild chronic inflammatory cell infiltrate. However the 68.75% pathologic lesions consisted of 14.44% specimens with early dentigerous cysts, 8.11% with dentigerous cysts, 42.80% of paradental cysts and the remainder with other pathologies. The majority of the patients were in the second and third decades and mostly female. The age distribution of the patients suggested a progression from hyperplastic follicular tissue with a peak occurring at 17 years, to early dentigerous cysts at 19 years, to dentigerous cysts at 21 years. Paradental cyst formation, with a peak incidence at 19 years of age formed a large number of the pathological lesions found, and accounted for a large number of patients seeking treatment, owing to the symptoms associated. This study represents an analysis of the largest number of symptomatic third molar teeth submitted for histological assessment known. The data obtained was used to review the guidelines for the management of third molar teeth. From this study it can be concluded that symptomatic impacted third molar teeth should be removed early in the third decade in order to avoid general or local symptoms suffered by these patients.
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Bachmann, Oscar Max. "Survival, clinical practice and costs in patients with pancreatic, oesophageal and gastric cancer." Thesis, University of Bristol, 1999. http://hdl.handle.net/1983/73526584-90fe-412a-8fd9-0687d61816ab.
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Davies, Sheila. "Transitional Care for the Cardiac Surgery Population: Development of a Clinical Practice Guideline." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5068.
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Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital's cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to 5 stakeholders from the inpatient cardiac surgery care team for initial review. After initial review and revisions an edited version was then distributed to 5 additional stakeholders. Those stakeholders provided an assessment utilizing the AGREE II tool to assess the 6 domains of scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application and editorial independence, and overall quality. Four domains indicated a high level of agreement (96%-100%) and 2 domains indicated a response of < 76% for domains related to rigor and organizational resources. The overall guideline assessment of the quality of the CPG received a score of 96%, with a recommendation to adopt the guideline. Advanced practice nurses will utilize this guideline to provide a systematic process in bridging gaps in care for the transition of the cardiac surgery patient population from hospital to home. Social change will be promoted through improved patient management by using evidence-based transitional care, decreased readmissions, and improved health outcomes for the cardiac surgical population.
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Lear, Jonathan. "Intersex : Problems of theory become problems in practice." Thesis, Linköping University, Centre for Applied Ethics, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9061.
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This paper discusses the medical treatment of intersex infants: children born with ambiguous genitalia, chromosomes, or hormones. The central thesis is that unnecessary surgery, defined as surgery that is not necessary to preserve the life or physical health of the infant, is unethical when performed on infants and should be postponed until the patient is able to participate in, and contribute to, the decision. Three lines of argument are presented: One based on the lack of clinical evidence supporting unnecessary surgery; one based on how unnecessary surgery limits the child’s future choices; and one based on how problematic notions of gender have resulted in problems in practice. Together and separately, the three arguments lead to the conclusion that performing unnecessary surgery on intersex infants is unethical, and wherever possible surgery should be delayed until the patient can participate in the decision.
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Tamayo, y. Ortiz Renee Isabel. "Divining the martyr : a multimedia installation presentation on contemporary makeover surgery." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/29815/1/Renee_Tamayo_y_Ortiz_Thesis.pdf.
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Divining the Martyr is a project developed in order to achieve the Master of Arts (Research) degree. This is composed of 70% creative work displayed in an exhibition and 30% written work contained in this exegesis. The project was developed through practice-led research in order to answer the question “In what ways can creative practice synthesize and illuminate issues of martyrdom in contemporary makeover culture?” The question is answered using a postmodern framework about martyrdom as it is manifested in contemporary society. The themes analyzed throughout this exegesis relate to concepts about sainthood and makeover culture combined with actual examples of tragic cases of cosmetic procedures. The outcomes of this project fused three elements: Mexican cultural history, Mexican (Catholic) religious traditions, and cosmetic makeover surgery. The final outcomes were a series of installations integrating contemporary and traditional interdisciplinary media, such as sound, light, x-ray technology, sculpture, video and aspects of performance. These creative works complement each other in their presentation and concept, promoting an original contribution to the theme of contemporary martyrdom in makeover culture.
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Tamayo, y. Ortiz Renee Isabel. "Divining the martyr : a multimedia installation presentation on contemporary makeover surgery." Queensland University of Technology, 2008. http://eprints.qut.edu.au/29815/.
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Divining the Martyr is a project developed in order to achieve the Master of Arts (Research) degree. This is composed of 70% creative work displayed in an exhibition and 30% written work contained in this exegesis. The project was developed through practice-led research in order to answer the question “In what ways can creative practice synthesize and illuminate issues of martyrdom in contemporary makeover culture?” The question is answered using a postmodern framework about martyrdom as it is manifested in contemporary society. The themes analyzed throughout this exegesis relate to concepts about sainthood and makeover culture combined with actual examples of tragic cases of cosmetic procedures. The outcomes of this project fused three elements: Mexican cultural history, Mexican (Catholic) religious traditions, and cosmetic makeover surgery. The final outcomes were a series of installations integrating contemporary and traditional interdisciplinary media, such as sound, light, x-ray technology, sculpture, video and aspects of performance. These creative works complement each other in their presentation and concept, promoting an original contribution to the theme of contemporary martyrdom in makeover culture.
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MacGuire, Colin Iain. "The Incidence of Inguinal hernia recurrence after Laparoscopic herniorrhaphy - a retrospective multicentre cohort study of patients operated on at a private practice in Cape Town." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/13848.
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Includes bibliographical references.The primary outcome will be the incidence of hernia recurrence. Secondary outcomes will be the incidence of post-operative and long-term pain and complications.
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Grove, Amy L. "A multicentre case study of evidence-based decision-making : exploring the process of knowledge mobilisation in NHS orthopaedic practice." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/99177/.
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Background: Healthcare policy encourages the use of scientific evidence in clinical practice. The complex reality of practice means that dissemination of this evidence in clinical guidelines is insufficient to change behaviour and reduce variation. This study took a knowledge mobilisation perspective to assess the role of evidence- based medicine in orthopaedic practice decisions for hip replacement surgery. Objectives: The research sought to identify where, when and how evidence and knowledge were used in decision-making and how this contributed to variation in practice. It discovered factors which influenced orthopaedic surgery decision-making through an in-depth exploration of real life evidence use in practice. Methods: Three in-depth case studies were conducted at NHS hospitals over 12-months. Data collected included 64 interviews with surgeons and NHS staff, observations of day-to-day practice and the collection of 121 supplementary documents. A case study road map method was performed using thematic analysis to generate four themes: individuals, groups, organisations and regulation. Results: The findings combined individuals and groups, the organisational dynamics and environmental regulation to provide a nuanced understanding of knowledge mobilisation in orthopaedics. Group level knowledge was crucial in explaining variation to evidence based medicine, specifically how it influenced organisational capacity and the socialisation of medical professionals. The characteristics of surgeons also contributed to the wider definition of evidence which was important for clinical decisions. Conclusion: This empirical study of knowledge mobilisation demonstrated that orthopaedic practice was contingent and mediated at different levels, each of which contributed to variation. Decision-making was dependent on a range evidence and knowledge sources that were influential across the entire knowledge domain. A conceptual framework was produced to demonstrate how knowledge is mobilised in a highly professionalised organisationally regulated context.
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Seth, Akshay. "Learning New Skills in Practice: Surgeons Adopting and Integrating New Procedures." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/37023.
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Surgeons regularly make changes in their practice to ensure they are providing high quality patient care. This includes the process of learning and safely integrating new skills, techniques and technologies into practice. When faced with the challenge of integrating a new surgical procedure into practice, surgeons must determine when they are ready to overcome the associated risks. This study sought to understand how surgeons experience risk when learning and integrating a new procedure into practice.
A modified constructivist, grounded theory approach was utilized. Eighteen surgeons were purposively sampled from two Canadian academic medical institutions. Semi-structured interviews were conducted and interpreted through constant comparative analysis. Emergent themes were identified and a conceptual framework was developed for understanding the surgeon experience associated with adopting and integrating a new procedure into practice.
Regardless of personal risk tolerance, surgeons described a similar approach to learning and implementing new skills. The experience of risk was one of several factors that affected their adoption of new techniques. They also described being influenced by individual, personality-driven factors, logistical considerations and the culture inherent to their departmental, institutional, professional and societal contexts.
A framework for understanding the surgeon experience when adopting and integrating new skills was constructed. The complex, nuanced multifactorial interplay between a surgeon’s individual willingness to engage risk, his/her motivations and the systemic and cultural factors that serve to facilitate or hinder the implementation of a new surgical skill is at the core of this experience. An increased awareness of these factors highlights the challenges that surgeon face in adopting new procedures and may lead to the development of policies which support surgeons learning and implementing new skills, techniques and technologies while maximizing patient safety.
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Sin, Tak-nam, and 冼德藍. "Evidence-based clinical practice guidelines for care of skeletal pin sites in orthopaedic patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626332.
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Coleman, David John. "An evaluation of the delivery of pharmaceutical care from a general practice surgery based pharmacy." Thesis, University of Portsmouth, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311077.
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A longitudinal study was carried out on a population of 4,922 patients served by a general practice surgery with three doctors. The purpose was to investigate the opportunity which domiciliary care of elderly and infirm patients offers to UK pharmacists working in primary care. The aims of the study were: - 1) To identify indicators that could be used to identify patients in the community who might benefit from domiciliary pharmaceutical care, and which do not leave patients excluded. 2) To identify specific issues that would lead to better pharmaceutical care 3) To deliver a package of pharmaceutical care to these most "at risk" patients in the population over approximately a year. 4) To evaluate the interventions made considering the viewpoints of all parties found to be stakeholders. 5) To measure the scale of the challenge of domiciliary managed pharmaceutical care in relation to the population in the study. 6) To provide indicators for the development of pharmaceutical care including cost/ benefit and potential training requirements. A simple qualitative study design was pursued, based upon semi-structured interviews and field notes. A cohort of patients (n=149) identified as candidates for domiciliary visiting, represented 3% of the surgery population. After de-selection of unsuitable candidates, visits were made to 100 patients. Three concepts for the organisation of information and three clusters of criteria were identified and developed which would identify 94 out of 100 patients visited. A large number of indicators for pharmaceutical care were identified and described qualitatively under 14 headings. Though typical, these were not claimed as a comprehensive set of issues which could have been encountered. It was generally perceived that more of the pharmacist's interventions produced positive effects than those that were neutral or actually did harm. Some of the interventions were accepted by the GPs as very important, and developing the extended role to include for instance a cardiovascular review clinic; "in house" medication reviews was discussed. Domiciliary visits were deemed useful though the GPs pointed out that making visits was time consuming and, by implication, expensive. Patients reported a high level of satisfaction with the visiting programme. Satisfaction was explored in an attempt to differentiate sociometric issues from professional ones. Rating satisfaction with a domiciliary pharmaceutical service required that specific issues were identified and dealt with which reflected the main concerns of patients about their medicines. Most of the patients' concerns appeared to be centred around multiple medication, widely perceived (in this cohort) to have potential to cause harm. The author recommends that PCGs consider allocating part of the prescribing budget to fund a domiciliary pharmaceutical care service to a small targeted population through community pharmacies. This could be a first step in offering new professional opportunities through community pharmacies and might revitalise some which are currently in decline.
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Cathcart, Paul. "The value of the hospital episode statistics to study practice and outcome of urological surgery." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2009. http://researchonline.lshtm.ac.uk/1620627/.
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Introduction: Despite the growing emphasis on the collection, monitoring and reporting of outcomes of surgical care within the UK, few data exist for such purposes. Equally, few data are available on disease occurrence and surgical practice in England. In this thesis, the hypothesis that Hospital Episode Statistics (HES) data can be used for such purposes is tested. Methods: The objectives of this thesis were twofold. Firstly, to review the literature to establish to what extent lIES data has been used to study incidence, surgical treatments and their outcomes. Secondly, to evaluate - using a number of individual lIES-derived case studies, to what extent the lIES database can be utilised to answer clinical questions concerning incidence, practice and outcome of urological surgery. Strengths and weaknesses of the lIES database were subsequently sought on which to generate recommendations concerning the future clinical use of the database. Results: The review highlighted the completeness of the database identifying very low underascertainment when compared to local audit data although did identify that use of Finished Consultant Episodes (FCE'S) resulted in over-estimation of disease incidence. lIES-derived case studies suggested, first, the incidence of hypospadias was considerably higher than previously reported and furthermore, did appear to be on the increase. Second, boys continue to undergo clinically inappropriate foreskin surgery. Third, the shift away from surgery for men with symptomatic BPlI has not resulted in more men experiencing an episode of acute urinary retention. Fourth, high-volume cancer centres appear to achieve improved outcomes following cystectomy by reducing the risk of "failure-to-rescue" following an adverse event. Recommendations on the future clinical use of HES data drawn from the HES-derived case studies were first, if incidence is to be calculated using HES data, there must be no or minimal ambiguity regarding diagnostic or procedural coding. Second, a number of diagnostic and procedural codes can be "operationalised" to define an event provided coding practice is not identified in advance. Third, the incidence of a condition can be identified using HES data provided all patients or at least the majority of patients undergo hospital treatment for that condition. Fourth, for HES data to comment on clinical appropriateness of treatment, the prevalence of the condition requiring treatment must be known. Fifth, if HES data is to be used to analyse trends in disease incidence over time, there must be no changes in coding practice over the study period. Sixth, HES data should not be used in isolation to report long-term oncological outcomes. Seventh, HES data is suitable to investigate the determinants of short-term surgical outcome such as mortality. Conclusion: Evaluation of the use of HES data to answer specific questions concerning the incidence, practice and outcome of urological surgery suggests HES is a useful source of data provided caveats concerning the strengths and weaknesses of the database are considered at the time of data analysis.
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Al-Kasadi, Mohammed Saleh Salim. "Modeling the propagation of the consumption of two emergent businesses: Fitness Practice and Plastic Surgery." Doctoral thesis, Universitat Politècnica de València, 2014. http://hdl.handle.net/10251/39795.
Full textAbstract:
In recent years there has emerged a new trend focused on the body image in the Western countries. Our society is concerned with people's physical appearance and ideal body image. As consequence of this trend, two businesses emerge: fitness centers and plastic surgery clinics.
Traditionally the consumers' expenditure in these services and goods has been considered a luxury especially during the economic slowdown. However, in the recent times, (at end of 2000s both service sectors are showing an increasing trend in terms of activity and business size). Thus, customers have seen the practice of fitness and plastic surgery procedures as a necessity rather than a luxury.
The two kinds of products considered: fitness practice and plastic surgery procedures are of different nature; however they share several commonalities from the analysis point of view.
In particular, referred to the fitness practice business, this involves a parallel increase of related economic sectors such as sports clothing, energy drinks and sports equipment. Related to the Spanish population who exercise regularly, this has evolved from 27% in 2005 to 35% in 2010, which shows a significant increase of the population sportive practices. A significant example of this trend is the fact that in 2009 the 74% of the Spanish public gyms had a fitness room for bodybuilding.
On contrast, related to the market of plastic surgery measured by volume of activity, Spain occupies the level 13th position of the international ranking, which is headed by USA.
The plastic surgery market embraces low invasive (non surgical) and high invasive (surgical) plastic surgery procedures; between both types, more than 300,000 thousands procedures are performed annually mainly by women in Spain.Al-Kasadi, MSS. (2014). Modeling the propagation of the consumption of two emergent businesses: Fitness Practice and Plastic Surgery [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/39795
TESIS
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Spies, Anri. "Audit of transfusion practice during burns surgery at the Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27015.
Full textAbstract:
Rationale: Major burn surgery can be associated with significant blood loss, often requiring transfusion of blood products. In an effort to decrease aforementioned blood loss, various blood conservation strategies have been developed, rendering older formulae to predict intraoperative blood loss ineffective and outdated. Currently there are no clear guidelines on when to transfuse burn victims but, the trend is towards employing a more conservative transfusion practice in an attempt to reduce transfusion related complications. The predicament has become one of containing cost by not ordering blood unnecessarily and/or excessively, versus putting a patient at risk by not having blood available when he or she needs it. A guideline, based on haemoglobin and extent of surgery, was drawn up at the Red Cross War Memorial Children's Hospital in an effort to rationalise preoperative blood ordering. The aim of this audit was to assess how well the implemented guideline was adhered to, and how accurately the guideline predicted the need to have blood products available in theatre during burns surgeries of varying extent. Methods: After a guideline, based on expert opinion, had been drawn up and implemented, a prospective audit of practice was done from April 2014 to June 2015. Two hundred separate burn surgeries were audited. Data collected included haemoglobin levels, extent of surgery, pre-and intra-operative instructions to blood bank, and whether patients were transfused. Pre-operative instructions were compared to the guideline to test adherence, and to the ultimate need for blood to test accuracy. Additional data recorded were the adherence to surgical plan (extent of surgery). Results: Five of the 200 cases were excluded due to incomplete data, leaving 195 cases. Blood was ordered according to the guideline in 131 (67.2%) cases. There were two groups where adherence was particularly poor. In these patients the guideline suggested that only a group and screen was necessary - a category for which it would also be difficult to assess how accurately the guideline predicts the need for blood. After excluding these two groups, the preoperative instructions to the blood bank were appropriate in 119 (94.4%) of the 126 cases where the guideline was followed. Blood was ordered preoperatively in 83 of the 195 cases, but only used in 50 cases (60.2%). Of the 33 cases where blood was not used, 23 cases were not in keeping with the guideline. In 50 (83%) of the 60 cases where blood was ordered according to the guideline, it was appropriate. The performed surgery proceeded as planned in 162 (83.1%) cases. Discussion: Blood transfusion exposes the recipient to transfusion-related risks and is expensive. In an attempt to avoid these risks there has been a trend towards conservative transfusion practices. It has been shown to be cost effective and safe to employ a restrictive transfusion practice during major paediatric burn surgery. During our study period one unit of blood cost R1096,00 and a group and screen R172,00. Significant savings could therefore be incurred if blood is ordered according to the proposed guideline. Conclusion: This audit confirmed that the guideline is an appropriate one to use for preoperative ordering of blood products for burns surgery at the Red Cross War Memorial Children's Hospital.
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Gokavarapu, Venkatamanikanta Subrahmanyakartheek. "Computer Graphics and Visualization based Analysis and Record System for Hand Surgery and Therapy Practice." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1464354599.
Full text
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Ransom, Kay Johnson. "Imagery/Mental Practice: A Cognitive Technique for Teaching Adaptive Movement to Postoperative Spinal Patients." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc332028/.
Full textAbstract:
Postoperative spinal patients were randomly assigned to one of three treatment conditions and were taught five adaptive movements by occupational therapists. The Control group received routine hospital occupational therapy; the Placebo group participated in an imagery relaxation task unrelated to the mental practice task of the Imagery group, which was shown line drawings of the adaptive movements under study, provided movement instructions, and asked to mentally practice each movement in a familiar, daily living situation. Thirty-five patients returned for follow-up, and a measure of outcome was obtained through the use of a quantified movement assessment instrument. Subjective ratings for anxiety, rumination, and imagery were made by the occupational therapists. An occupational motoric-symbolic rating scale was developed to assess the symbolic portion of the patient's job experience. Statistical procedures including chi square, analysis of variance, and Pearson correlation were performed. Results were in the predicted direction although statistical significance was not achieved. Possible explanations for the obtained results were discussed.
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Ghaderi, Iman. "Toward excellence as the standard for medical practice variation in documentation and surgeons' opinion in the breast clinic." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=18196.
Full textAbstract:
Recently, there has been a growing movement toward an Electronic Health Record (EHR) to improve quality of care. The paper-based medical record is still the primary source of information in today’s medical practice. In order to design the EHR, knowledge with regard to the current medium of documentation is required. In the MUHC Cedars Breast Clinic, 112 medical records for 7 surgeons were audited to determine what was recorded in the initial visits between year 2002 and 2003. A Likert scale questionnaire was developed and included 46 questions derived from the chart review. It was introduced to assess their opinions on important variables in managing breast patients. The correlation between the medical records and surgeons’ opinions was then sought. The majority of data points had a low rate of documentation with wide variation; breast cancer risk factors were recorded in less than one third of charts. Family history and physical examinations had relatively high rates of documentation. The survey showed a considerable variation among surgeons’ opinions. Surgeons reported that they addressed 63% of all data points (29 of 46 questions) very often/always. There was weak correlation between what each surgeon records and what he/she thinks is important.Récemment, il y a eu un mouvement grandissant vers le dossier électronique de santé (EHR) pour améliorer la qualité du soin. Le dossier médical sur papier est toujours la source primaire d'information dans la pratique en matière, aujourd'hui. Afin de concevoir EHR, la connaissance en ce qui concerne le milieu courant de la documentation est exigée. Dans la Clinique du sein de l'Institut des cèdres du CUSM, 112 disques médicaux pour 7 chirurgiens ont été apurés pour déterminer ce qui est enregistré dans les visites initiales en l'année 2002 et l'année 2003. Un questionnaire de balance de Likert comprenant 46 questions dérivées des dossiers a été présenté pour évaluer leur avis sur des variables importantes dans les patients de gestion de sein. La corrélation entre ces deux a été cherchée. La majorité de points de repères a eu un bas taux de documentation avec une grande variation; des facteurs de risque de cancer de sein ont été enregistrés dans moins d'un tiers de dossiers. Les antécédents familiaux et les examens physiques ont eu des taux relativement élevés de documentation. L'aperçu a montré une variation considérable parmi l'opinion des chirurgiens. Les chirurgiens ont rapporté qu'ils ont adressé 63% de points de repères (29 de 46 questions) très souvent/toujours. Il y avait corrélation faible entre ce que chaque chirurgien enregistre et quel il/elle pense est important. fr
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Wilson, Angela Marie. "Thoracic surgery as a nursing specialty : perceptions of senior nurses and surgeons of specialist nursing practice." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/54320.
Full textAbstract:
With the continual advances in medical technology and specialized procedures, surgical patients have increasingly complex and specific needs. The questions that surfaces are: 1) Do surgical nurses now require advanced knowledge and skills to meet the needs of the thoracic surgery patient population? 2) And if so, do nurses and surgeons perceive value in recognizing thoracic surgery as a specialty for nurses? In this study, the perceptions of senior thoracic nurses and surgeons regarding nursing specialization were examined. Nurses’ and surgeons’ perceptions of what characterize a nursing specialty, if and why they consider thoracic surgery a nursing specialty, and what they identify as the outcomes and value of nursing specialization and related outcomes were also explored. An inductive approach was used, with data collected through a quantitative web-based questionnaire, using the 18-item Perceived Value of Certification Tool © (PVCT) as well as specific additional Likert scale and multiple-choice questions related to thoracic surgery. Study findings revealed that thoracic nurses and surgeons value nurse certification for similar intrinsic and extrinsic reasons as nurses in other specialties and in other countries, identifying several intrinsic rewards, such as “enhances feelings of personal accomplishment,” “provided a professional challenge,” and “validates specialized knowledge,” as motivators for certification. Findings from this study also suggest that nurses and surgeons perceive that additional nursing education related to knowledge and skills is required to meet the care needs of the thoracic surgery patient population, and improve the overall nursing care provided. Additionally, study results also suggested that nurses and surgeons believe that nursing specialty recognition may promote better patient outcomes. Finally, study findings demonstrated that thoracic nurses and surgeons believe that thoracic surgery should be formally recognized as a certified nursing specialty.Applied Science, Faculty of
Nursing, School of
Graduate
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Chasapis, Emmanouil. "Small animal internal medicine and surgery - Osteosarcoma in ex-racing greyhounds." Master's thesis, Universidade de Évora, 2017. http://hdl.handle.net/10174/22912.
Full textAbstract:
This report is an effort to describe most of the clinical procedures that took place during the integrated externship of the Master’s degree in Veterinary Medicine at the University of Evora. The externship had a duration of sixteen weeks and was realized in the “A&A Veterinary Hospital” which has a substantial caseload of Retired Racing Greyhounds with Osteosarcoma. The first part, of the report, relates to the casuistics of Small Animal Internal Medicine and Surgery, divided per area of interest. The second part, is a current bibliographic review on canine Osteosarcoma, followed by three case-studies of Osteosarcoma in Retired Racing Greyhounds, with different survival times; Resumo:
Medicina Interna e Cirurgia em Pequenos Animais Osteosarcoma em cães de raça Greyhound, ex- corredores
O presente relatório é uma descrição da maioria dos procedimentos clínicos, que se realizaram durante o estágio curricular do Mestrado Integrado em Medicina Veterinária da Universidade de Évora. O estágio, teve a duração de dezasseis semanas e realizou-se em “A&A Veterinary Hospital” que apresenta na sua casuística muitos cães de raça Greyhound, Ex- corredores, com Osteosarcoma. A primeira secção relata a casuística, em Medicina Interna e Cirurgia de Pequenos Animais, dividida por área de interesse. A classificação dos casos foi realizada com base no sistema somático afetado ou no motivo da visita. A segunda secção é uma revisão bibliográfica sobre Osteosarcoma canino, acompanhada por três casos de Osteosarcoma em cães ex-corredores, de raça Greyhound, com diferentes tempos de sobrevivência.
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Ichim, Daniela. "Uncontrolled blood pressure among hypertensive older adult patients in family practice settings: The contribution of physician and patient characteristics." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28557.
Full textAbstract:
Objective: To determine the patient and physician characteristics associated with blood pressure control among older hypertensive patients in family practice, the prevalence of hypertension and the percent of hypertensive patients with controlled blood pressure.
Methods: A systematic review has been performed of published studies which reported an analysis of the association between patient and physician characteristics and hypertension control;
Data collected in a retrospective review of patients' health records in 28 family practices and a questionnaire for the participating family physicians has been analyzed. Hierarchical logistic modeling has been conducted to determine the predictors for blood pressure control.
Results: More than half of the patients were hypertensive. Among hypertensive patients, almost half had their blood pressure under control. The predictors for good blood pressure control were male gender, presence of cardiovascular disease or nephropathy, less than five blood pressure readings/year and young age of the physician. Diabetes predicted poor blood pressure control.
Conclusion: Although blood pressure control has improved considerably, more than half of hypertensive patients remain poorly controlled. Selected patient characteristics and physician practice behavior and characteristics were predictors of the blood pressure control.
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Kenealy, Timothy William. "Systematic opportunistic screening for type 2 diabetes in general practice." Thesis, University of Auckland, 2004. http://wwwlib.umi.com/dissertations/fullcit/3155372.
Full textAbstract:
Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’.Subscription resource available via Digital Dissertations only.
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Wareham, Campbell John. "Cardiovascular assessment in podiatric surgery : a study of current practice amongst podiatric surgeons practicing the United Kingdom." Thesis, Ulster University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487700.
Full textAbstract:
This work presents a study of the current practice of cardiovascular examination of pre-surgical patients by UK Podiatric Surgeons. Podiatric Surgeons trained and educated in the United Kingdom are unique in that whilst they are specialist qualified, they do not hold a degree in medicine. As such certain peripheral examinations which involve the peri-operative process but may not actually effect the outcome of the surgical procedure are performed in a brief but effective manner in a style which may be considered as 'non traditional'. This thesis examines, not only the current practice, but explores the current 'thinking' behind the practice and seeks to put reasons forward as to why podiatric surgeons practice in the manner in which they do.
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Al-Khatib, Talal. "Does pneumatic otoscopy improve the diagnostic accuracy of otitis media with effusion in clinical practice? A randomized single-blind control trial." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92342.
Full textAbstract:
The study objective was to determine whether pneumatic otoscopy would improve the diagnostic accuracy of otitis media with effusion (OME) in clinical practice over otoscopy only. A randomized single-blind control trial was undertaken in 30 pediatric residents. Residents were randomized into pneumatic otoscopy (intervention) or otoscopy-only (control) groups. Both study groups received one hour of theory on OME; the intervention group also received a 30-minute teaching session that included both video-otoendoscopic examination (VOE) pneumatic assessments and one practice session. Each resident examined 10 ears and made a diagnosis of either normal or OME ears. Tympanograms were considered as the gold standard. The percent correct diagnoses in the intervention and control groups were 60% and 59%, respectively (p = 0.85).In conclusion, pneumatic otoscopy did not significantly improve the diagnosis of otitis media with effusion in clinical settings. Further studies are needed to confirm these findings.
L'objectif de l'étude était de déterminer si l'apprentissage et la formation portant sur l'otoscopie pneumatique pouvaient augmenter la précision du diagnostic de l'otite moyenne séreuse (avec épanchement) en pratique clinique. Une étude de contrôle, à sélection aléatoire, à simple insu, a été entreprise auprès de 30 résidents en pédiatrie de l'Université McGill. Les résidents ont été affectés de façon aléatoire, soit au groupe d'otoscopie pneumatique (groupe d'intervention), soit au groupe d'otoscopie uniquement (groupe témoin). Les deux groupes de l'étude ont suivi un cours théorique d'une heure portant sur l'otite moyenne séreuse (avec épanchement). Le groupe d'intervention a également pris part à une séance d'enseignement de 30 minutes, y inclus une évaluation de l'examen otoendoscopique avec système vidéo et de l'otoscopie pneumatique et une séance d'entraînement. Chaque résident devait examiner 10 oreilles et poser un diagnostic, soit de normalité, soit d'otite moyenne séreuse (avec épanchement). Le tympanogramme a été utilisé comme norme d'excellence. Le pourcentage de diagnostics justes dans les groupes d'intervention et de témoin était de 60 % et de 59 % respectivement (p = 0,85). En conclusion, l'otoscopie pneumatique n'a pas augmenté la précision du diagnostic de l'otite moyenne en pratique clinique. fr
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Dowling, Bernard David. "Health authorities and general practice fund-holders as purchasers of elective surgery : a case study of waiting times." Thesis, London School of Economics and Political Science (University of London), 1999. http://etheses.lse.ac.uk/1541/.
Full textAbstract:
The 1991 reforms to Britain's health service established a quasi-market where the purchasing function was performed by health authorities and those general practices that joined the fund-holding scheme. Whilst the literature lacked any direct comparison of the performance of these agencies as purchasers, there was much controversy about the equity implications of the system. Most notably this focused upon alleged differences in the waiting times for hospital services of patients registered with fund-holding and non fund-holding practices. However, such allegations were based on anecdotal evidence and open to contradiction. The thesis moves this debate beyond a reliance on anecdotal evidence and for one service, elective surgery, redresses the lack of evaluation in the relative merits of fund-holders and health authorities as purchasers. The waiting times of fund-holding and non fund-holding patients for operations covered by the fund-holding scheme were compared at four public providers over a four-year period. Fund-holding patients from the elective waiting list generally had significantly shorter waits than their non fund-holding counterparts. Because such trends became evident after practices joined the scheme, shorter waits were linked to fund-holding status. Another important aim was to ascertain why this tendency occurred. A series of hypotheses were tested, including the generosity of fund-holders' budgets, contrasts in the surgical case mix of each population, plus differences in the way fund-holders and health authorities perform their purchasing roles. An aspect of this last hypothesis was confirmed. Hospitals admitted fund-holding patients sooner to dissuade fund-holding practices from referring elsewhere. This connects to the income hospitals receive from fund-holders being more closely attributable to actual patient throughput than was the case with their income from health authorities. In discussing the policy implications of the study, the thesis then addresses how public sector quasi-markets can work in the contexts of both equity and efficiency.
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Raymond, Paul Douglas. "Haemostatic activation and its relationship to neuropsychological changes following cardiopulmonary bypass surgery." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16405/1/Paul_Raymond_Thesis.pdf.
Full textAbstract:
Neuropsychological impairment following cardiopulmonary bypass (CPB) remains a serious consequence of otherwise successful surgery. The incidence of neuropsychological decline is poorly understood due to varied measurement intervals, and perhaps more importantly the use of unreliable detection and classification methods. The reported incidence varies considerably, ranging anywhere from 30% to 90% of subjects. While the nature of this impairment has not been fully elucidated, recent evidence suggests that microembolism during surgery may be the principal causative agent of postoperative cerebral dysfunction. The work described in this thesis investigates one possible source of microembolism leading to postoperative decline, namely thromboembolism arising from excessive activation of the haemostatic mechanism. Crucial to the accurate detection of significant decline in individual patients, this work also focuses on the development and use of meaningful criteria to be used when describing change in neuropsychological performance measures.
The strong haemostatic activation during CPB is controlled by heparin anticoagulation. The clinical performance of the Hepcon heparin-monitoring instrument was compared to the activated clotting time (ACT), which is used in most cardiac centres. An analysis of samples from 42 elective coronary artery bypass grafting (CABG) patients shows that the ACT does not detect the significant decline in heparin concentration seen upon connection to CPB, in comparison to the Hepcon. The Hepcon appears to be in satisfactory agreement with laboratory anti-Xa analysis of heparin concentration, with the mean difference for the Hepcon at -0.46 U/ml, and the limits of agreement +/- 1.12 U/ml. Further analysis shows that that for 95% of cases, the Hepcon will give values that are between 0.53 and 1.27 times the value for anti-Xa.
The loss of relationship between ACT and heparin concentration was further investigated by converting ACT values to heparin concentration. The results provide data on the degree of prolongation in ACT times brought about by factors associated with CPB. A methodology is presented by which users can adjust for the loss of relationship between ACT and heparin. This work also demonstrates that under normal usage of the ACT, the user may obtain values up to 3 times appropriate for the plasma heparin concentration.
The computer-administered neuropsychological testing tool (the MicroCog) was validated using 40 age-matched control subjects. Using a two-week interval, the summary score correlation coefficients ranged from .49 to .84, with all scores demonstrating significant practice effects. Also presented are retest normative data that may be used to determine significant change in a homogeneous sample using both reliable change and regression models of analysis. The performance of four different models of change analysis was then analysed using data from the clinical group. The regression technique of analysis was shown to be the most useful prediction model as it provides correction for both practice effects and regression toward the mean in each individual. A novel statistical rationale is presented for the choice of criteria in the identification of patients that may be defined as overall impaired when using a battery of test scores. When using one-tailed prediction models for decline, the binomial distribution of scores was shown to be a useful descriptive statistic providing an estimate of change due to chance. When applied to a suitable selection of scores that minimise shared variance, a value +/- 20% of test scores used was demonstrated to be a rational cut-off for an individual to be classified as impaired. Using this methodology, 32.7% of patients were identified as significantly deteriorated in neuropsychological test function immediately prior to discharge from hospital. Patient age was shown to be a significant predictor of neuropsychological decline following CPB. No significant relationship was identified between thrombin generation and neuropsychological change scores, however problems with patient recruitment and retention limited the statistical power of this study. An intriguing relationship with heparin concentration was noted that might warrant further investigation.
This work highlights the complex nature of post-bypass neuropsychological dysfunction and the complexities in assessing decline. The regression-based model was shown to be highly useful in the analysis of data from a suitably validated neuropsychological testing tool. The argument that no suitable criterion exists for the identification of patients as overall impaired has been challenged with the development of a rational cut-off based on the likely distribution of change scores across a series. The work presented here confirms the need for standardised testing methods based on sound statistical criteria. This work also highlights the problems associated with current methods for monitoring anticoagulation therapy during bypass surgery. Methodology is presented that allows adjustment of ACT results to account for CPB-induced prolongation of clotting times. Current techniques for heparin monitoring overestimate heparin levels on bypass by up to threefold, which may predispose to subclinical coagulation and increased delivery of protamine.
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Raymond, Paul Douglas. "Haemostatic activation and its relationship to neuropsychological changes following cardiopulmonary bypass surgery." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16405/.
Full textAbstract:
Neuropsychological impairment following cardiopulmonary bypass (CPB) remains a serious consequence of otherwise successful surgery. The incidence of neuropsychological decline is poorly understood due to varied measurement intervals, and perhaps more importantly the use of unreliable detection and classification methods. The reported incidence varies considerably, ranging anywhere from 30% to 90% of subjects. While the nature of this impairment has not been fully elucidated, recent evidence suggests that microembolism during surgery may be the principal causative agent of postoperative cerebral dysfunction. The work described in this thesis investigates one possible source of microembolism leading to postoperative decline, namely thromboembolism arising from excessive activation of the haemostatic mechanism. Crucial to the accurate detection of significant decline in individual patients, this work also focuses on the development and use of meaningful criteria to be used when describing change in neuropsychological performance measures.
The strong haemostatic activation during CPB is controlled by heparin anticoagulation. The clinical performance of the Hepcon heparin-monitoring instrument was compared to the activated clotting time (ACT), which is used in most cardiac centres. An analysis of samples from 42 elective coronary artery bypass grafting (CABG) patients shows that the ACT does not detect the significant decline in heparin concentration seen upon connection to CPB, in comparison to the Hepcon. The Hepcon appears to be in satisfactory agreement with laboratory anti-Xa analysis of heparin concentration, with the mean difference for the Hepcon at -0.46 U/ml, and the limits of agreement +/- 1.12 U/ml. Further analysis shows that that for 95% of cases, the Hepcon will give values that are between 0.53 and 1.27 times the value for anti-Xa.
The loss of relationship between ACT and heparin concentration was further investigated by converting ACT values to heparin concentration. The results provide data on the degree of prolongation in ACT times brought about by factors associated with CPB. A methodology is presented by which users can adjust for the loss of relationship between ACT and heparin. This work also demonstrates that under normal usage of the ACT, the user may obtain values up to 3 times appropriate for the plasma heparin concentration.
The computer-administered neuropsychological testing tool (the MicroCog) was validated using 40 age-matched control subjects. Using a two-week interval, the summary score correlation coefficients ranged from .49 to .84, with all scores demonstrating significant practice effects. Also presented are retest normative data that may be used to determine significant change in a homogeneous sample using both reliable change and regression models of analysis. The performance of four different models of change analysis was then analysed using data from the clinical group. The regression technique of analysis was shown to be the most useful prediction model as it provides correction for both practice effects and regression toward the mean in each individual. A novel statistical rationale is presented for the choice of criteria in the identification of patients that may be defined as overall impaired when using a battery of test scores. When using one-tailed prediction models for decline, the binomial distribution of scores was shown to be a useful descriptive statistic providing an estimate of change due to chance. When applied to a suitable selection of scores that minimise shared variance, a value +/- 20% of test scores used was demonstrated to be a rational cut-off for an individual to be classified as impaired. Using this methodology, 32.7% of patients were identified as significantly deteriorated in neuropsychological test function immediately prior to discharge from hospital. Patient age was shown to be a significant predictor of neuropsychological decline following CPB. No significant relationship was identified between thrombin generation and neuropsychological change scores, however problems with patient recruitment and retention limited the statistical power of this study. An intriguing relationship with heparin concentration was noted that might warrant further investigation.
This work highlights the complex nature of post-bypass neuropsychological dysfunction and the complexities in assessing decline. The regression-based model was shown to be highly useful in the analysis of data from a suitably validated neuropsychological testing tool. The argument that no suitable criterion exists for the identification of patients as overall impaired has been challenged with the development of a rational cut-off based on the likely distribution of change scores across a series. The work presented here confirms the need for standardised testing methods based on sound statistical criteria. This work also highlights the problems associated with current methods for monitoring anticoagulation therapy during bypass surgery. Methodology is presented that allows adjustment of ACT results to account for CPB-induced prolongation of clotting times. Current techniques for heparin monitoring overestimate heparin levels on bypass by up to threefold, which may predispose to subclinical coagulation and increased delivery of protamine.
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Fernandes, Helen M. "Primary intracerebral haemorrhage : a study of its effects upon intracranial haemodynamics, current clinical practice and a trial of early surgery." Thesis, University of Newcastle upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247837.
Full text
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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.
Full textAbstract:
Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.
Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.
Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.
Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.
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Nuttall, Martin Chandler. "Practice and outcomes for radical urological cancer surgery in England : a study based on hospital episode statistics and a review of the literature." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1445854/.
Full textAbstract:
Complete, timely and accurate data are needed to monitor the quality of surgical care in the UK. However, large-scale national audits are labour-intensive and expensive. Furthermore, within surgery many studies have noted wide variation between post operative outcomes amongst hospitals. Studies have also tried to determine whether the number of cases performed at a hospital is one component that can influence surgical outcomes. With this in mind, the overall aims of this thesis were to describe the practice and outcomes for radical urological cancer surgery in England, and to determine whether the number (or 'volume') of procedures that a hospital carries out is a potential determinant of outcomes. The objectives of this thesis were fivefold. Firstly, to use administrative data from Hospital Episode Statistics (HES) of the English Department of Health between 1995 and 2002 to report activity and outcomes for patients recorded as having undergone a radical prostatectomy (RP), radical cystectomy (RC) or radical nephrectomy (RN). Secondly, to develop and validate a comorbidity index for the first time within the HES database. The obtained index, based on the Charlson score, increased with age, was higher in patients admitted as an emergency, and also predicted outcomes. Thirdly, to review the literature to establish to what extent volume could be an explanation for variation in outcomes between surgical providers. This review concluded that surgical outcomes, on average, should improve with increasing hospital or surgeon volume, although the evidence for RN was weakest. Fourthly, to establish, through conducting a national survey, the views of the surgeons performing these procedures regarding 'volume and outcome' relationships. This survey discovered that most consultants supported the principle of volume thresholds, but with wide variation as to where thresholds should be set. Finally, to determine through analysis of the HES data whether post-operative outcomes in England depend on the volume of procedures that a hospital performs. In brief, hospital volume was inversely related to in-hospital mortality following RC. No similar effect was demonstrable following RN. No effect of volume on length of stay after RC or RN was identified, but length of stay after RP was shorter in high volume hospitals. Data from this thesis provides some evidence in support of volume-based health policies for RC, but less support for such policies relating to RN or RP.
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Murphy, Nancy. "Studying and facilitating the development, installation, and initial implementation of an interdisciplinary buprenorhine treatment/practice with a publicly funded, HIV primary care, designated AIDS center in New York City| A practice-focused, action research, implementation study." Thesis, City University of New York, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561905.
Full textAbstract:
Using Action Research, Implementation Science, and Institutional Ethnography, this practice-focused research explored inhibiting and promoting factors related to implementing buprenorphine treatment within HIV primary care while simultaneously developing, installing and initially implementing an interdisciplinary buprenorphine treatment/practice. Data was collected and analyzed using constructivist grounded theory method strategies. Data collection/generation included documentary analysis, key informant interviews, field data from collaborative interdisciplinary team processes, researcher reflective practice, a patient focus group, and an interdisciplinary buprenorphine treatment/practice manual.
The research had several achievements. It identified three key implementation inhibiting categories, (1) significant and persistent bias, (2) plaguing and difficult questions, and (3) buprenorphine expectionalism. It also developed countering implementation promoting categories, (1) be an educated advocate and dispel myths, (2) identify core components of interdisciplinary buprenorphine treatment and uniformity of care, and (3) dementionalizing interdisciplinary treatment/practice. It exposed scope of practice issues and mapped out the specifics of the types of services each discipline would provide, the detail of those practices, their coordination, as well as the areas of practice where there was joint responsibility and overlap. It increased the capacity and competences of the research organization and the 18 interdisciplinary buprenorphine team members. It also explicated the many forms of power operating in the study and the importance of power sharing, adapting treatment, leadership support, structural components and resources on the development and implementation process.
This study shed light on the reality that prescribing buprenorphine and taking up the practice of treating opioid dependence/addiction means that clinicians must be prepared and skilled to provide care where issues of life and death, emotional distress, and significant uncertainties are part of the landscape. The study findings also highlight that balancing safety (both patient and staff) with control and authority is an important aspect of buprenorphine treatment. An interdisciplinary focus expanded the concept of treatment and addressed many important aspects of caring for people with opioid dependence/addiction that often go unaccounted for and/or unnoticed. Without an interdisciplinary frame, patients are at risk for receiving substandard care. This study demonstrated that the interdisciplinary practices needed to provide quality care and improve health outcomes are interdependent.
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Stringer, Bernadette. "Use of the hands-free technique in hospital operating rooms : a study of the effectiveness of a recommended work practice." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0015/NQ44601.pdf.
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Dresner, Alexandra. "Cefazolin plasma concentrations in children less than 25 kilograms undergoing elective cardiac surgery: an audit of current clinical practice at Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3025.
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Gouveia, Sara Raquel Aveiro. "Clínica de animais de companhia." Master's thesis, Universidade de Évora, 2018. http://hdl.handle.net/10174/24367.
Full textAbstract:
O presente relatório foi realizado no âmbito da unidade curricular de Estágio Curricular, integrante do plano de estudos do Mestrado Integrado de Medicina Veterinária da Universidade de Évora. O estágio foi efetuado na clínica Vetfunchal – Centro Médico Veterinário, durante cinco meses. Encontra-se dividido em dois capítulos. O primeiro engloba o relatório da casuística acompanhada pelo estagiário e, o segundo, é constituído por uma monografia acerca das obstruções urinárias em animais de companhia, incluindo ainda a apresentação de um caso clínico. A obstrução urinária é mais frequente em felídeos machos, devido à sua conformação anatómica. É considerada uma emergência em veterinária, sendo essencial proceder rapidamente à estabilização do animal e tratamento da causa subjacente. É recomendado, primeiramente, realizar sempre tratamento médico, todavia, por vezes, é necessário recorrer a intervenção cirúrgica para resolução definitiva; Abstract:
Small animal practice
The present report was elaborated following the curricular externship, part of the Integrated Master in Veterinary Medicine of the University of Évora. The internship was performed at the Vetfunchal – Centro Médico Veterinário, with a total length of five months. This report is divided in two chapters: the first one covers the casuistry accompanied during the externship and the second includes a monography about urinary obstructions in small animals, including the presentation of a case report. Urinary obstruction is more common in male cats, due to their anatomic conformation. This represents a veterinary emergency, implying a quick stabilization and treatment of the cause. In such cases, medical treatment is the recommended procedure, however, some cases need surgery for definitive resolution.
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Rosado, Ana Teresa Jeremias. "Clínica de animais de companhia." Master's thesis, Universidade de Évora, 2016. http://hdl.handle.net/10174/19584.
Full textAbstract:
A clínica veterinária de pequenos animais é um mundo vasto e complexo que necessita
de um estudo contínuo. Este relatório de estágio está dividido em duas partes. A primeira
parte contém a descrição das atividades realizadas durante o estágio curricular realizado
na clínica AlcabidecheVet. A segunda parte corresponde a uma monografia cujo tema é
doença renal crónica em animais de companhia.
A doença renal crónica acomete tanto cães como gatos em idade avançada, tendo uma
progressão irreversível. Vários estudos científicos têm sido realizados para melhorar a
sua prevenção e diagnóstico, como o estudo de biomarcadores da função renal. A
utitilização de biomarcadores no diagnóstico e controlo da doença renal é essencial para
o seu estadiamento e para demarcar o avanço dos danos renais. É também necessário
conhecer os mecanismos patológicos em ação nesta doença para que o seu tratamento e
monitorização providenciem o máximo bem-estar e o prolongamento da vida do animal; Abstract: (Small Animal Practice and Surgery – Kidney Chronic
Disease)
The world of small animal veterinary practice is vast and complex and needs a continuous
study. This report is divided in two parts. The first describes the activities performed
during the curricular internship at the clinic AlcabidecheVet. The second consists of a
monograph which theme is chronic kidney disease.
Chronic kidney disease affects both dogs and cats of declining age, and has an irreversible
progression. There’s been scientific advances in its prevention and diagnosis with the
study of biomarkers of kidney function. It’s also necessary to understand the pathological
mechanisms in action in this disease, so its treatment and control can aim towards the
welfare and the life extension of pets.