Dissertations / Theses on the topic 'Surgical instrument'
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Xu, Yunwei. "Safety evaluation of surgical instruments." Thesis, University of Dundee, 2017. https://discovery.dundee.ac.uk/en/studentTheses/bfb1e112-315e-4380-ac2b-9457d2f44762.
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Spurred by recent press reports and other concerns this thesis focuses on the quality of surgical instruments. The current situation is reviewed by considering the regulatory framework and by investigating the quality of newly purchased instruments. A range of test protocols based on British Standards and best practices from industry were developed. These were designed to be practical in the real world situation and a user-friendly database was built to collate all the relevant data and inform the Supply Chain. The conditions experienced by instruments during their lifetime in the health care environment, especially in cleaning and disinfection were studied and as many instruments implicated in Incidents as possible investigated to understand the possible root causes of failure. During this work the importance and debate over surface finish, passivation and disinfection processes became apparent and research was carried out into the effect on wettability and drying mechanism of passivation and repeated disinfection cycles on various typical surface finishes. This concentrated on the environment within the health service unlike other studies which have been concerned with more aggressive industrial situations. Standards and Procedures on the care of instruments have been established in order to improve the current management of surgical instruments and to ensure that they are and remain fit for purpose.
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Becker, Theresia Caezilia. "Surgical instrument surface modification for use with ultrasound visualization." Thesis, Boston University, 2003. https://hdl.handle.net/2144/27589.
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Boston University. University Professors Program Senior theses.PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
2031-01-02
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Chan, Kenneth Ling-Man. "A vision system for a surgical instrument-passing robot." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/25083.
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To help control the high cost of health care delivery, a robotic system is proposed for use in passing surgical instruments in an operating room. The system consists of a vision system, a robotic arm, a speech recognition and synthesis unit, and a microcomputer. A complete vision system has been developed using standard and new techniques to recognize arthroscopic surgical instruments.
Results of the vision system software evaluation gave an overall recognition accuracy of over 99%. Also, error conditions were analysed and found to be consistent with the results of a clinical survey on the proposed instrument-passing robot. As well, a payback and cost benefit analysis using estimated system costs and potential labour savings showed that the instrument-passing robot is economically feasible.
Based on the results of this thesis, it was concluded that the instrument-passing robot would be beneficial for reducing the high cost of health care.Applied Science, Faculty of
Electrical and Computer Engineering, Department of
Graduate
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Buckley, Darragh. "Development of a collapsible guard component for a novel surgical instrument." Thesis, Massachusetts Institute of Technology, 2007. http://hdl.handle.net/1721.1/40395.
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Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2007.Includes bibliographical references (p. 17).
The Endoblend is a novel surgical device for use in laparoscopic hysterectomy surgery. Laparoscopic hysterectomy surgery requires that the uterus be removed through a laparoscopic port. To achieve this, the Endoblend liquefies the uterus through the use of cutting blades. The Endoblend has a stem containing aspiration tubes, irrigation tubes and power transmission elements. A spinning blade is attached at the end of this stem for the purpose of liquefying previously separated tissues such that they can be removed from the abdominal cavity through the aspiration tubes. In order to effectively process the tissues, they must be placed with a sealed enclosure. This enclosure is at risk of being compromised by the spinning blades and therefore the need arises for a guard module to prevent this. The guard module must function to direct the tissue towards the blades and prevent any tearing of the enclosure. It must also be capable of fitting through a 15 mm laparoscopic port. A guard has been developed comprising of three Nitinol rings and an ultra-high molecular weight polyethylene fiber. The guard's functionality has been tested and the guard is capable of meeting all the functional requirements.
by Darragh Buckley.
S.B.
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Smith, Phillip R. "Instrument tracking and analysis in minimal access surgery for surgical skill assessment." Thesis, University of Surrey, 2016. http://epubs.surrey.ac.uk/809462/.
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For this project, we analyse cataract surgery videos. It is known that the motions of both camera and surgical instruments are indicative of surgical skill in simulated environments. Through the application of computer vision algorithms, we attempt to automatically measure these motions. Video data from cataract surgery videos have many sources of noise that complicate the observation of such motion. As no 'de facto' method exists for tracking surgical instruments we investigate the validity of applying cues based upon colour, shape and motion to identify surgical instruments. In addition, we develop a iris tracker based upon Histogram of Gradients object detection to measure the changes in camera state throughout a procedure. A methodology based upon invariant characteristics of surgical instrument motion is developed and applied to a large dataset of procedures. Metrics such as path length and number of motions for surgical instruments in cataract surgery are measured with this fully automatic methodology. Path length and number of movements are compared with surgeon's experience and skill level as measured with a manual surgical skill marking scheme. These metrics are shown to be proportional to a surgeon's experience and in agreement with manual measures of surgical skill.
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Allain, B. "Re-localisation of microscopic lesions in their macroscopic context for surgical instrument guidance." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1338127/.
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Optical biopsies interrogate microscopic structure in vivo with a 2mm diameter miniprobe placed in contact with the tissue for detection of lesions and assessment of disease progression. After detection, instruments are guided to the lesion location for a new optical interrogation, or for treatment, or for tissue excision during the same or a future examination. As the optical measurement can be considered as a point source of information at the surface of the tissue of interest, accurate guidance can be difficult. A method for re-localisation of the sampling point is, therefore, needed. The method presented in this thesis has been developed for biopsy site re-localisation during a surveillance examination of Barrett’s Oesophagus. The biopsy site, invisible macroscopically during conventional endoscopy, is re-localised in the target endoscopic image using epipolar lines derived from its locations given by the tip of the miniprobe visible in a series of reference endoscopic images. A confidence region can be drawn around the relocalised biopsy site from its uncertainty that is derived analytically. This thesis also presents a method to improve the accuracy of the epipolar lines derived for the biopsy site relocalisation using an electromagnetic tracking system. Simulations and tests on patient data identified the cases when the analytical uncertainty is a good approximation of the confidence region and showed that biopsy sites can be re-localised with accuracies better than 1mm. Studies on phantom and on porcine excised tissue demonstrated that an electromagnetic tracking system contributes to more accurate epipolar lines and re-localised biopsy sites for an endoscope displacement greater than 5mm. The re-localisation method can be applied to images acquired during different endoscopic examinations. It may also be useful for pulmonary applications. Finally, it can be combined with a Magnetic Resonance scanner which can steer cells to the biopsy site for tissue treatment.
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Tanner, Jordan D. "Design and Analysis of Robotically-Controlled Minimally Invasive Surgical Instruments." BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/6249.
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Robot-assisted minimally invasive surgery is used to perform intricate surgical tasks through small incisions using long, slender instruments. The miniaturization of these instruments is advantageous to both surgeon and patient because smaller instruments reduce trauma to surrounding tissue, decrease patient recovery times, and can be used in confined spaces otherwise inaccessible using larger instruments. However, miniaturization of existing designs is limited by friction between moving parts, the volume occupied by the end effector, and manufacturing and assembly constraints. The objective of this work is to develop and analyze concepts that can be used in robot-assisted needlescopic surgery. The concepts are intended for instrument shafts no larger than 3 mm in diameter. An ideal concept is one with large ranges of wrist and gripping motion. Concepts should also minimize friction and swept volume while maintaining a focus on manufacturability and ease of assembly. Multiple concepts were generated and evaluated using a tree classification scheme, proof-of-concept prototypes, and simplified mathematical models. Three unique concepts were further developed and tested—the Split CORE Grips, the Inverted Flexure Grips, and the Crossed Cylinders Wrist. The two grip concepts are instruments that incorporate one rotational degree of freedom and one gripping degree of freedom. The wrist concept incorporates two rotational degrees of freedom and could be coupled with a single DOF grip mechanism to form a functional instrument. In addition to concept development, a variety of fabrication techniques were investigated to better understand the challenges that arise when designing and fabricating devices at the 3 mm scale. To augment existing techniques, a novel fabrication technique was developed which uses layers of lithographically patterned carbon nanotube (CNT) composite material to form a 3D part. This method was used to prototype some of the designs at a 1:1 size scale.
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Mayson, Scott A. "Design of an orthopaedic instrument for image guided anterior cruciate ligament reconstruction." Australian Digital Thesis Program, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20061006.130922/index.html.
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Thesis (PhD) - Swinburne University of Technology, Industrial Research Institute Swinburne - 2006. Thesis (PhD) - National School of Design, Swinburne University of Technology, 2006.A thesis submitted to the Industrial Research Institute Swinburne (IRIS) and the National Institute of Design in fulfilment of the requirements for the degree of Doctor of Philosophy, - 2006. Typescript. Includes bibliographical references (p. 192-199).
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Jabbary-Aslani, Farnaz. "Design attributes of spinal fusion cages and a surgical instrument to aid thier screw fixation." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/2952/.
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Spinal fusion cages are used to aid spinal fusion where the joint between the vertebrae is fused by bone graft. The design and material of these cages are of great importance to the fusion process. Methods such as screw fixation are sometimes used to secure these cages in vivo. However, access to the cage screw holes is partially obscured by the vertebral bodies. This study aimed to evaluate the effect of side-holes on the design of a cage, assess the feasibility of a bioactive/biodegradable composite as a cage material and develop an instrument to aid screw access to the cage screw holes. Computer models of cages with between 0 and 10 side-holes were produced to model compression between adjacent vertebrae. The bioactive/biodegradable composite as a cage material was analysed using a range of Young’s modulus values for the composite. The results suggested that the number of side-holes had a negligible effect on the stress distribution within the cage and the bioactive/biodegradable composite as a cervical cage material is unlikely to fail in static compression. A cutter instrument was developed in compliance with regulatory standards. It neatly removed the targeted vertebral edge adjacent to the cage screw holes allowing screw insertion.
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Mayson, Scott Anthony, and na. "Design of an orthopaedic instrument for image guided anterior cruciate ligament reconstruction." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20061006.130922.
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This is an interdisciplinary research project in which the methods of Industrial and
Product Design Engineering are focused upon a problem in Orthopaedics.
One of the most controversial areas in Orthopaedics is the reconstruction of the anterior
cruciate ligament (ACL). The current twin-instrument method for locating the ACL is
difficult for surgeons with fewer than 500 surgical experiences. This was clearly
demonstrated by Kohn, Busche and Cans (1995), and confirmed by Sommer,
Friederich and Muller (2000), Sudhahar, Glasgow and Donell (2004), and Kuga,
Yasuda, Hata et al. (2004). The above research indicates that the problem is not only
one of anatomical location, but of how the operation takes place. The aim of the
research was, therefore, to develop a new and improved surgical instrument and
technique for locating the ACL anatomical landmarks.
The research described in this thesis employs a number of design methods that can be
used separately or in combination (hybrid process). They form the theory base that
guides the design process. This allows the designer to engage in a flexible process that is
effective in finding design solutions to the problem. Within this process, iterative case
studies were employed in order to design a new surgical device for ACL reconstruction.
The thesis describes a series of designed devices (case studies) that were iteratively
developed and surgically tested, leading to a penultimate device. This latter device was
tested via a number of surgical operations. The device provides a new method for
externally locating the internal ACL attachment points.
The research has resulted in a commercial association with Smith and Nephew Surgical
Australia and BrainLAB AG Germany for the commercialisation of this technique. At
the time of writing, the next stage of research and development is under way. This is
using a frameless computer-aided image guidance system in the place of X-ray.
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Barnes, Spencer Charles. "Viscoelastic properties of the bladder and design of a surgical instrument for the removal of bladder tumours." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6641/.
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There are various problems with the treatments for bladder cancer. The studies in this thesis aimed to decrease these problems or conduct research that would aid future work and development in the area. The mechanical properties of normal and malignant bladder tissue were quantified using dynamic mechanical analysis (DMA). A uniaxial testing machine applied sinusoidally varying strains to specimens and the response stresses were measured; from this the elastic and viscous components of the soft tissues were calculated. \(Porcine\) bladder tissue was used as a model for normal bladder and exhibited a higher modulus than tumourous bladder tissue. Potentially these viscoelastic properties have many utilities, which include but are not limited to: diagnosis of bladder tumours, computational modelling of the bladder, comparison to current replacement materials, manufacture of more appropriate bladder replacement materials and manufacture of synthetic tumours for surgical trainers. One problem with the procedure for removing non-muscle invasive bladder cancer (NMIBC) is tumour re-implantation. An add-on instrument was designed, manufactured and tested to attempt to stop the travel of tumourous cells which could then re-implant. A prototype of the device was manufactured using the shape memory metal nickel titanium in conjunction with latex. The device would open into a cone shape once inside the bladder to physically prevent the movement of tumour cells away from the tumour site. The prototype was successfully tested in replica surgical conditions with blue dyes. With development, it is hoped that this design can assist in reducing the high recurrence rate of NMIBC.
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Schneider, Hans-Christian [Verfasser]. "Modellgestützte Analyse und Implementierung der roboterbasierten Echtzeitnachführung chirurgischer Instrumente : Model-aided analysis and implementation of robot-based real time surgical instrument tracking / Hans-Christian Schneider." Aachen : Shaker, 2010. http://d-nb.info/1098040015/34.
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Klovhall, Johan, and Susanne Tegeskog. "Patientsäker hantering av sterila instrument i ett uppdukningsrum : En experimentell studie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-74735.
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Bakgrund: Vid operationer är patienten utsatt för risk att drabbas av en postoperativ infektion som kan leda till ohälsa och ett ökat lidande för patienten. Operationssjuksköterskan som arbetar förebyggande mot smittspridning behöver ha kunskap om sterila instrument och hur länge de kan vara uppdukade. Detta för att motverka postoperativa infektioner. Idag finns inga nationella riktlinjer för hur länge en övertäckt uppdukning kan stå i uppdukningsrum i väntan på användning. Syfte: Syftet med studien är att undersöka hur tiden påverkar bakteriekontaminationen på ett uppduktat och övertäckt instrumentbord i ett uppdukningsrum. Metod: Studien utgick från en kvantitativ ansats där experiment utfördes med hjälp av agarplattor under två, fyra och sex timmars intervall. Totalt användes 79 agarplattor under 6 olika experiment. Resultat: Resultatet visar att efter sex timmar är ett övertäckt instrument bord utan kontamination på agarplattorna. Emellertid finns det andra faktorer som kan påverka en uppdukning som kan leda till en infektion hos patienten och orsaka ohälsa och lidande. Slutsats: I operationssjuksköterskans ansvar ingår det att ha goda kunskaper kring hantering av sterila instrument samt aseptik eftersom detta kan vara avgörande för smittspridning som kan orsaka patienten ett onödigt vårdlidande. Resultatet kan ge en vägledning för evidensbaserad hantering av sterila instrument och hur länge ett övertäckt instrumentbord kan stå i ett uppdukningsrum, men studien är liten och det behövs mer forskning i ämnet.Background: At surgery the patient is exposed to develop a surgical site infection. This can cause the patient illness and suffering. The theatre nurse is working to prevent these infections and needs knowledge about how long sterile instruments can be unpacked, covered with a sterile cloth without getting contaminated with bacteria causing surgical site infections. Today there are no national guidelines for how long a covered instrument table can stand in a set-up room before operation. Aim: The aim of the study is to examine how time affects bacterial contamination of a covered instrument table up in a set-up room. Method: The study has a quantitative approach were the experiments where conducted on agar in two, four or six hour. A total of 79 agar plates were used in 6 different experiments. Results: The result shows that after six hours there is no contamination on the agar plates on covered instrument table. However, there are other factors that may affect a covered instrument table and can lead to an infection and cause the patient illness and suffering. Conclusion: The theatre nurse must have knowledge about how to handle with sterile instruments and aseptic who can be crucial for surgical site infection that may cause the patient an unnecessary suffering from care. The result can provide guidelines and evidence for how long a covered instrument table can stand in a set-up room, however the study is small and more research is needed in the subject.
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Sánchez-Margallo, Juan A. [Verfasser], Francisco M. [Verfasser] Sánchez-Margallo, del Pozo José [Verfasser] Moreno, and Aguilera Enrique J. [Verfasser] Gómez. "Methods for laparoscopic instrument tracking and motion analysis for objective assessment of surgical technical skills / Juan A. Sánchez-Margallo, Francisco M. Sánchez-Margallo, José Moreno del Pozo, Enrique J. Gómez Aguilera." München : GRIN Verlag, 2015. http://d-nb.info/1180733940/34.
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Rankin, Timothy M. "Three dimensional printing surgical instruments| Are we there yet?" Thesis, The University of Arizona, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1564614.
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Background: The applications for rapid prototyping have expanded dramatically over the last 20 years. In recent years, additive manufacturing has been intensely investigated for surgical implants, tissue scaffolds, and organs. There is, however, scant literature to date that has investigated the viability of 3D printing of surgical instruments.
Materials and Methods: Using a fused deposition manufacturing (FDM) printer, an army/ navy surgical retractor was replicated from polylactic acid (PLA) filament. The retractor was sterilized using standard FDA approved glutaraldehyde protocols, tested for bacteria by PCR, and stressed until fracture in order to determine if the printed instrument could tolerate force beyond the demands of an operating room.
Results: Printing required roughly 90 minutes. The instrument tolerated 13.6 kg of tangential force before failure, both before and after exposure to the sterilant. Freshly extruded PLA from the printer was sterile and produced no PCR product. Each instrument weighed 16g and required only $0.46 of PLA.
Conclusions: Our estimates place the cost per unit of a 3D printed retractor to be roughly 1/10th the cost of a stainless steel instrument. The PLA Army/ Navy is strong enough for the demands of the operating room. Freshly extruded PLA in a clean environment, such as an OR, would produce a sterile, ready to use instrument. Due to the unprecedented accessibility of 3D printing technology world wide, and the cost efficiency of these instruments, there are far reaching implications for surgery in some underserved and less developed parts of the world.
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Grames, Clayton L. "Design and Manufacture of Mesoscale Robot-Actuated Surgical Instruments." BYU ScholarsArchive, 2015. https://scholarsarchive.byu.edu/etd/5689.
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Minimally Invasive Surgery (MIS) is a growing field including both laparoscopic androbotic operations. Surgeons and engineers are making continual efforts to reduce the negative effects of procedures on patients. Reducing the size of the surgical instruments is one effective method pursued in this effort. When the instruments approach 3 mm in diameter, they reach a threshold where the entry incisions can be small enough that no scar is left on the patient. Laparoscopic instruments on this scale exist but typically lack wrist articulation and only have 1 degree of freedom (DoF). Alternatively, robotic surgical instruments can achieve high levels of dexterity but at a greater diameter. Smaller diameter robotic instruments employ snake wrists but this results in large swept volumes. There is a need for smaller robotic instruments with 3 DoF that preserve a small operational volume. Several unique challenges result when trying to develop small-scale instruments. Friction forces due to the relative motion of actuation cables and other parts in the mechanisms become more significant, as do the challenges of producing and assembling parts with extremely small features. These challenges have been limiting factors for the size of instruments. Traditional mechanisms use pin joints and pulleys which result in higher part counts and higher internal friction. To overcome these challenges, two alternative designs that reduce part count and minimize friction are presented as potential mechanisms that could be used as surgical instruments on the mesoscale (1-5 mm). Both designs implement rolling contact and gearing in place of pin joints and pulleys to realize their motion. Additionally, alternative manufacturing methods that are ideally suited to mesoscale production are presented. Micro metal laser sintering and composite carbon nanotude structures are shown to have the resolution required to create the detailed features necessary for these new designs. The result are two mechanisms suited to be produced as mesoscale, robotically actuated, surgical instruments. One of the two designs has been physically prototyped and has demonstrated clinical capabilities at 4 and 5 mm diameter instrument sizes.
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Kuang, Yang. "Resonance tracking and vibration stabilisation of ultrasonic surgical instruments." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/aa5a07a5-9a0e-45c4-9581-cf7dc8250c57.
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Ultrasonic surgical instruments actuated by piezoelectric transducers are usually driven at relatively high power levels to generate high vibration amplitude at the probe, which interact with biological tissues to achieve the desired effects. In operation, the high power level introduces nonlinearities into the behaviours of the piezoelectric transducer and the biological tissues place a load onto the transducer. Both the nonlinearities and the load result in variations in resonant frequency and electric impedance, which negatively affect the performance of the ultrasonic surgical instrument. The aim of this work was to develop an adaptive driving system to address the issue of the resonant frequency shift and impedance variation and to study its effectiveness in optimising the performance of ultrasonic surgical instruments. An ultrasonic planar tool based on piezocrystal PMN-PT was designed with various configurations as an alternative to the existing ultrasonic scalpels. To address the problem of resonant frequency shift and impedance variation observed on the planar tools in characterisation stage, an adaptive driving system was developed to track the resonant frequency and stabilise the vibration velocity. The system was carefully calibrated, and its effectiveness in optimising the performance of unloaded transducers in a broad frequency range was validated. The performance variation of the planar tool under the combined influence of high power level and external tissue loads was then investigated. The capacity of the adaptive driving system to optimise the performance of the planar tool under such conditions was then accessed by performing soft tissue penetrating test. Furthermore, a needle actuating device was designed to increase the visibility of medical needles in ultrasound guided percutaneous procedures. Its modal behaviour was studied in finite element analysis and verified by experimental characterisation. The ability of the adaptive driving system to improve the performance of the needle actuating device was accessed in pre-clinical trials. The results demonstrate that the adaptive driving system developed can track the resonant frequency and stabilise the vibration velocity of ultrasonic surgical instruments in frequency up to 5 MHz and power up to 300 W. By using the adaptive driving system, optimal performance of the planar tool and needle actuating device can be achieved in both unloaded and loaded conditions. The ultrasonic planar tool with PMN-PT is potentially useful in surgical operations. However, its performance is limited by the intensive heat generated in the joint area and the low Curie point of PMN-PT. The needle actuating device can increase the visibility of standard medical needles in colour Doppler imaging.
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Al, hasan Hasan. "Surgical case scheduling with medical instruments sterilizing activities constraints." Thesis, Angers, 2019. http://www.theses.fr/2019ANGE0025.
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Les blocs opératoires sont l’un des principaux postes de dépenses du système hospitalier, rationaliser et optimiser leur gestion permet donc une réduction des coûts pour la structure. S’aidant de l’unité de chirurgie orthopédique du CHU d’Angers, nous proposons donc des outils d’aide à la planification des interventions chirurgicales prenant aussi en compte les contraintes liées à la stérilisation d’instruments médicaux tels que les kits d’intervention. Le but de ces outils est de baisser les coûts de fonctionnement des blocs opératoires, optimiser le recours aux heures supplémentaires et les stérilisations de matériels en urgence, etc. Nous considérons premièrement que toutes les données sont connues et nous proposons un modèle de type MILP et une heuristique de construction de solutions dont les résultats obtenus améliorent la planification du CHU. Nous adaptons ensuite une approche permettant d’assimiler l’arrivée dynamique des patients et montrons, résultats à l’appui, que cette technique permettrait d’améliorer le processus de prévision des opérations du bloc, si les durées opératoires sont connues. Cette dernière hypothèse ne tenant pas dans le cas réel, nous suggérons de la lever en proposant de robustifier tout d’abord notre approche statique de deux façons que nous adaptons au cas dynamique. A l’issue de ces travaux, une amélioration de 54% est constatée du processus de planification en termes d’heures supplémentaires tout comme une réduction du nombre de stérilisations à effectuer dans l’urgence (90%) et d’une hausse significative du taux d’occupation des blocs opératoires (5.7%)The operating theater is considered as the most expensive and important resource in hospitals as it counts as the main source of income and expenses. This critical rule and the increase in costs urge hospitals to organize their processes more efficiently and effectively. In this thesis, we will be working with the Centre Hospitalier Universitaire d’Angers (CHU) of Angers in France. We focus on the surgery scheduling problem at the orthopedic surgery unit. The main contribution of this work is the consideration of the activities of the sterilizing unit as a hard constraint and a performancemeasure for the problem. In the first part of this work, we present a multidimensional classification of the current literature on the surgical case scheduling problem. In the second part, we solve the deterministic version of the problem. Starting with the static problem, we propose a MILP and a constructive heuristic and show that the obtained results significantly improve over the ones of the CHU.Next, we solved the deterministic dynamic version by implementing our MILP in a rolling horizon approach. Again, the results were superior to the CHU ones. We then showed that a non-deterministic approach is a must due to the big degradations caused by surgeries duration uncertainties. In the third part, we tackled the non-deterministic version of the problem. Similarly, we started with the static problem and proposed two robust models. Finally, we implement both robust models in a rolling horizon method to solve the dynamic scheduling problem. The results of the both non-deterministic versions show much more robustness compared to the deterministic ones and better values overall
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Madhani, Akhil J. (Akhil Jiten) 1968. "Design of teleoperated surgical instruments for minimally invasive surgery." Thesis, Massachusetts Institute of Technology, 1998. http://hdl.handle.net/1721.1/10097.
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Vieira, Sandro Dias. "Projeto conceitual de uma célula flexível de manufatura para acabamento de instrumentos cirúrgicos por Sandro Dias Vieira." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/34742.
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Neste trabalho foram utilizados os conceitos de célula flexível de manufatura e de automação utilizando a robótica para desenvolver uma célula robotizada de acabamento de instrumentos cirúrgicos forjados, com o objetivo de obter aumento de produção e flexibilizar o sistema de manufatura. Na produção manual de acabamento dos instrumentos cirúrgicos incluídos no estudo são realizados processos de lixamento, eletropolimento, polimento vibratório, jateamento e polimento com manta sintética e escova. Foi identificado que o sistema utilizando trabalho manual restringe a produtividade a um número de pinças insuficiente para atender à demanda do mercado. Desse modo, foi desenvolvida uma célula robotizada de acabamento, com a intenção de suprir a necessidade do aumento de produção dos instrumentos cirúrgicos. Em paralelo ao desenvolvimento da célula flexível de manufatura, estudaram-se os processos de acabamento utilizados, resultando na eliminação de etapas de acabamento no processo automatizado. Com a célula flexível de manufatura desenvolvida se obteve um aumento de produção de 96,87 % e uma redução nos custos de 50,53 % em relação à linha manual. Os produtos cuja manufatura se deseja automatizar são pinças hemostáticas, de apreensão e de campo que foram selecionadas através da análise da demanda produtiva. A matéria-prima utilizada nestes instrumentos é aço inoxidável martensítico, de denominação AISI 420D. O processo de fabricação utilizado nos componentes é o forjamento, que permite a melhora das propriedades mecânicas, modificando a disposição dos constituintes do material deformado. No entanto, foi avaliada de forma experimental a viabilidade de substituição do forjamento pelo corte laser, visando a eliminação do processo de lixamento dos componentes, com consequente aumento na taxa de produção, o que não foi possível devido à menor resistência obtida pelos componentes assim produzidos.In this study, were used the concepts of flexible cell manufacturing and automation using robotics to develop a finishing in forged surgical instruments robot cell, in order to get increased production and a more flexible manufacturing system. On completion of the manual production of surgical instruments included in the study of processes are performed grinding, electropolishing, vibratory polishing, sandblasting and polishing synthetic blanket and brush. Was identified that the system using manual labor productivity to a limited number of tweezers insufficient to meet market demand. Thus, was developed a robotic finishing cell, with the intention of meeting the need for increasing production of surgical instruments. In parallel to the development of flexible manufacturing cell, were studied the finishing processes used, resulting in the elimination of finishing steps in the automated process. With the flexible manufacturing cell development was obtained an increase of 96.87% and production cost savings of 50.53% compared to the online manual. The products whose manufacture is desirable to automate hemostat, apprehension and field tweezers that were selected by analyzing the production demand. The raw material used in these instruments is martensitic stainless steel, designations AISI 420D. The manufacturing process used in the components is forginig, which allows the improvement of mechanical properties by modifying the arrangement of the constituents of the deformed material. However, it was experimentally evaluated the feasibility of replacing the forging by laser cutting, in order to eliminate the process of grinding the components, with consequent increase in production rate, which was not possible due to a lower resistance obtained by the components thus produced.
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Carlander, Johan. "Energy based surgical instruments : With particular focus on collateral thermal injury." Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122147.
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Iatrogenic post-operative nerve dysfunction is a significant problem in many areas of surgery and can be caused by collateral thermal injury from activation of energy based surgical devices (EBD). The aims of this thesis were to: create an animal model in order to compare mono- and bipolar electrosurgery (ES) and an ultrasonic dissection (UD) with regard to collateral thermal nerve injury, and with data of a national multicenter register to study the use of EBD and their potential effects on operation time and complication rates in thyroid surgery.urgical devices (EBD). Material and Methods: The biceps femoris muscle of 104 anesthetized rats was cut in a standard manner adjacent to the sciatic nerve using clinical relevant settings of mono- and bipolar ES and UD. The sciatic nerve was stimulated supramaximally and the electromyographic (EMG) potential recorded before and after each experiment. Nerve dysfunction was defined as > 10% reduction of the evoked EMG potential. In Paper II and III temperature was measured before, during and after instrument activation. The sciatic nerves were coded and examined blinded with light (LM) and electron microscopy (EM). Advanced temperature measurements were conducted in Paper II and III. In Paper IV, the use of EBD was specifically registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) during one year and 1297 patients were included. Operation time, recurrent laryngeal nerve (RLN) injury, post-operative hypoparathyroidism and the use of topical haemostatic agents were compared between bipolar ES, electric vessel sealing (EVS) and UD. Clamp and Tie technique (C-A-T) being without thermal risk constituted the control group. Results: In Paper I the EMG potential was significantly more frequent reduced in the monopolar and bipolar ES group compared to the UD group and LM showed significantly less nerve damage in the UD group. In Paper II exact temperature measurements was possible with thermoelectric micros sensors and the thermal dose was significantly less and with less variation for the UD compared to the bipolar ES. Similar to the Paper I the EMG potential was significantly more frequent reduced in the ES group. Moderate and severe morphological damage was significantly less common in the UD group compared to monopolar ES. We found no statistical correlation between the highest temperatures/doses and the degree of morphological damage or functional loss. In Paper III the temperature increase was significantly less and with shorter duration in the UD group, compared to bipolar ES. LM and EM demonstrated loss of density in the myelin sheet only in a small number of nerves in all groups after instrument activation 1 mm from the nerve. In Paper IV, operation time was significantly shorter in the UD group and significantly longer in the EVS and bipolar ES group, compared to C-A-T. Postoperative hypoparathyroidism with need for Calcium treatment at discharge and at 6 weeks was significantly higher with ES instruments compared to UD. The incidence of reported RLN injury was 2.5% at 6 weeks postoperatively without statistical differences between the groups. Topical haemostatic agents were more frequently used in the EBD groups compared to C-A-T. Conclusion: The experimental Papers (I-III) demonstrated a lower risk of adverse collateral thermal nerve injury with activation of the mechanical UD technique compared to ES techniques. In the nationwide multicenter register Paper (IV), the use of UD shortened end EVS increased operation time compared to the low cost C-A-T. The UD instruments had a lower risk of hypoparathyroidism than electrosurgery.
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Vaitekunas, Jeffrey J. "Ultrasonic surgical instruments a mutli-variate study for cutting-rate effects /." Cincinnati, Ohio : University of Cincinnati, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=ucin1052935131.
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VAITEKUNAS, JEFFREY J. "ULTRASONIC SURGICAL INSTRUMENTS: A MULTI-VARIATE STUDY FOR CUTTING-RATE EFFECTS." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1052935131.
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Goyard, David. "Localization of flexible surgical instruments inendoscopic images using machine learning methods." Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-142470.
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The work presented in this document deals with Machine learning algorithms used in surgical robotic problems, especially here in the Isis project. The aim of the project is to replace manual handles for endoscopic operations by a set of motors commanded via high-tech interface. The main aim of the thesis is to solve the problem of the estimation of the pose of flexible surgical instrument, using only the video flux from an endoscopic camera. After a short introduction about the system its environment and the definition of the pose problem, the work is divided in two chapters. Machine learning algorithms and learning systems are used in both parts. The first chapter deals with image processing and video tracking. Usage of colored markers and how the learning is made to perform the best segmentation is explained. It starts with simple linear classification to end with an Adaboost algorithm. The learning database construction and all the challenges it raises are explained too. Then the tracker used in the system is decomposed and its structure explained. The results of the whole tracking system are presented at the end of the chapter. The second chapter deals with function approximation: we build Radial Basis Function networks in order to approximate the final position of the instrument (or its mechanic parameters) from the data extracted by the tracking system. Learning algorithms are used too. The learning training set is built in a laboratory environment where the real position of the instrument can be measured. The last chapter is a collection of improvements that could be added to the system and opens on future perspectives about the project in general.
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Greenish, Stephanie. "Acquisition and analysis of cutting forces of surgical instruments for haptic simulation." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0022/MQ50611.pdf.
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Ahmadi, Ehsan. "Optimization-based Decision Support Tools for Managing Surgical Supplies and Sterile Instruments." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1564482727428522.
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van, den akker Dennis, and Riad Samir Wakim. "Sustainable Public Procurement as a Driver of Change : The Case of Surgical Instruments." Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-388442.
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Although Sustainable Public Procurement (SPP) is often seen as a powerful tool to drive sustainability across its supply chain, there is little available research in terms of how SPP actually influences its suppliers’ sustainability practices and what challenges are being faced during the process. In this study, we shed light on both issues by exploring SPP using Institutional and Power Dependence Theory in the context of the surgical instrument industry in Sweden. Methodologically, the study is grounded in an exploratory design and employs in-depth interviews with multiple stakeholders to gain a holistic understanding of the phenomena being studied. The study revealed that SPP mainly influences suppliers by requiring them to evaluate their own sustainability practices, engage in collaborative actions and make alterations when they fail to comply with the contractual terms.The most significant challenge resulted to be the lack of resources, resulting in the inability to perform sufficient follow-ups, engage in meaningful conversations with suppliers and procurers having to buy unsustainable products because of their tight budgets. Another major challenge was Sweden’s forerunner position when it comes to SPP on an international level, resulting in reluctancy on the part of international suppliers to alter their sustainability practices.
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Hsu, Jeff Kuang-chen. "Toward integration of a surgical robotic system with automatic tracking, tool gesture and motion recognition /." Burnaby B.C. : Simon Fraser University, 2007. http://ir.lib.sfu.ca/handle/1892/4140.
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Lopes, Lillian Kelly de Oliveira. "Instrumental ortopédico de conformação complexa: avaliação do processamento, formação de biofilme e suas implicações." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/7317.
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INTRODUCTION: Depth gauge and flexible drill bite cutter are orthopedic surgical instruments of complex conformation and they are into loanered instrumentation box to different healthcare facilites. The challenge is to ensure that appropriatly cleaning was done to prevent the formation of biofilm in these instruments´models. There are no experimental or clinical studies analyzing the impact of different cleaning protocols on formation of biofilm on surfaces those two surgical instruments. OBJECTIVES: To validate and to evaluate laboratory method to formation of biofilms in stainless steel. To evaluate microbial load and to determine formation of biofilms after laboratory contamination and processing for several cycles in surgical instruments of complex conformation used in surgeries of orthopedic implants. METHOD: Experimental study was developed from November/2014 to March/2016, at the Laboratory of Macquarie University, Sydney (AU). Method´s validation: new forceps halsted hemostatic mosquito were contaminated within contaminant solution containing S. aureus (ATCC 25923) and sterilized in saturated steam. Forceps were divided into three groups according to cleaning: 1) rinsing, 2) manual cleaning and 3) manual cleaning followed by automated cleaning. After 6th, 13th and 20th three forceps from each protocol were analised for microbial load and protein amount (Bicinchoninic Acid Assay) and visual analysis by scanning electronic microscopy. The same method was used on new flexible drill bite cutters and depth gauges, and analised after 10th and 20th reprocessing. RESULTS: Method´s validation: forceps submitted to protocols 1 (positive control of cleaning) and 2 showed coccus in biofilms and forceps sumitted to protocol 3 showed organics residues after 20 reprocessing. No microbial load or residual protein was found. Complex instruments: flexible drill bite cutters submitted to rinsing presented high amount of protein with increase of 1699μg of protein from 10th to 20th reprocessing (P = 0.03). Depth gauge submitted protocol 1 presented high amount of protein, however there was no statistically significant difference from 10th to 20th processing (P = 0.60). All instruments submitted to manual and/or automated cleaning did not present residual protein. It was possible to identify residue and biofilm into lumen of surgical instruments after 20 reprocessing. CONCLUSION: Experimental techniques to formation and evaluation of biofilm in surgical instruments manufactures in stainless steel were validated and 20 inappropriated cleaning processing were enough to buildup biofilm. Biofilm was formed within lumens of flexible drill bite cutter and depth gauge, after 20 processing despite the instruments were submitted to “gold standard” cleaning, also accumulation of protein on flexible drill bite cutters. Depth gauge lumen allowed accumulation of waste using manual cleaning followed by automation cleaning and manual cleaning allowed buildup residue on its external surface. Manual cleaning allowed accumulation residue on deep gauge. It was not possible to recover viable S. aureus in biofilm on instrumental surface, but it indicates that design of instruments evaluated is not safe to processing. It is presumed have risk ratio for aseptic loss of prostheses and infection related to healthcare, since they are instruments of difficult cleaning control and circulate in numerous healthcare facilites using different cleaning protocols.
INTRODUÇÃO: O medidor de profundidade e a fresa flexível são instrumentos cirúrgicos ortopédicos de conformação complexa e integram as caixas cirúrgicas fornecidas por distribuidores aos diferentes serviços de saúde. O desafio é garantir limpeza adequada, impedindo a formação de biofilmes nesses modelos de instrumental. Não existem estudos experimentais ou clínicos analisando o impacto de diferentes protocolos de limpeza na formação de biofilme nas superfícies desses modelos de instrumental. OBJETIVOS: Validar método laboratorial de formação de biofilme e análise em instrumento de aço inoxidável, avaliar a carga microbiana e determinar a formação de biofilme após contaminação laboratorial e processamento por múltiplos ciclos em instrumental cirúrgico de conformação complexa utilizado em cirurgias ortopédicas com implantes. MÉTODO: Estudo experimental realizado de novembro/2014 a março/2016, no laboratório da Universidade Macquarie, Sydney (AU). Validação do método: pinças halsted mosquito novas foram contaminadas em solução contendo S. aureus (ATCC 25923) e esterilizadas em vapor saturado sob pressão. As pinças foram separadas em três grupos segundo a limpeza: 1) enxágue, 2) limpeza manual e 3) limpeza manual seguida de automatizada. Após os 6°, 13° e 20° processamentos, três pinças de cada protocolo foram submetidas à análise de carga microbiana, proteína (Bicinchoninic Acid Assay) e análise visual por microscopia eletrônica de varredura. A mesma metodologia foi seguida no experimento com a fresa flexível e medidor de profundidade novos, sendo as análises realizadas após os 10° e 20° processamentos. RESULTADOS: Validação do método: Pinças submetidas aos protocolos 1 (controle positivo da limpeza) e 2 apresentaram biofilmes, e a pinça submetida ao protocolo 3 apresentou resíduo após 20 processamentos e não foram identificados micro-organismos nem proteína. Experimento com instrumental de conformação complexa: fresa flexível submetida ao protocolo 1 apresentou elevada quantidade de proteína com aumento de 1699µg de proteína do 10° para o 20° processamento (P=0,03). Medidor de profundidade submetido ao mesmo protocolo também apresentou elevada quantidade de proteína, não sendo significante a diferença entre o 10° e o 20° processamento (P=0,60). Todo instrumental submetido à limpeza manual e/ou automatizada não apresentou resíduo de proteína. Foi possível identificar resíduo nos três grupos de limpeza após 20 processamentos. CONCLUSÃO: Técnicas, para formação e avaliação de biofilme em instrumental cirúrgico fabricado em aço inoxidável, foram validadas, e 20 processamentos inadequados formam biofilmes. Houve formação de biofilmes nos lúmens da fresa flexível e no medidor de profundidade após 20 processamentos, mesmo utilizando o padrão ouro da limpeza, bem como acúmulo de proteína na fresa flexível ao longo dos processamentos. O lúmen do medidor de profundidade desmontável permitiu acúmulo de resíduos, mesmo usando limpeza manual seguida de automatizada. Limpeza manual permitiu o acúmulo de resíduos no medidor de profundidade. Não foi possível recuperar S. aureus viáveis no biofilme aderido à superfície de instrumental, porém sinaliza que o design do instrumental avaliado não é seguro para o processamento. Presume-se relação de risco para perda asséptica de próteses e infecção relacionada à assistência à saúde, pois são instrumental de difícil controle da limpeza e circulam em inúmeros serviços de saúdes com diferentes protocolos de limpeza.
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Tarabein, Karim A. "Towards the automatic control of laser ablation for surgical applications." Digital WPI, 2019. https://digitalcommons.wpi.edu/etd-theses/1325.
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The goal of this thesis is to propose and investigate a method of predicting depth of a laser dissection pulse in soft tissue without acquiring material properties of the tissue target or measuring the laser output. The method proposed is similar to what is used by laser surgical operators today, but uses regression learning to perform on-the fly predictions in place of a skilled laser surgeon. Power of the laser and the ablation depth were recorded for 57 samples and fed into the regression algorithm. Data exclusion was performed using Temperature before laser action as criteria. A linear and logarithmic model was explored using random points from the data post-exclusion, validation RMSE ranged from 135-200 micrometer. A linear and logarithmic model was explored using data points below a moving power threshold and validated with data points above said threshold, validation RMSE ranged from 108-170 micrometer. The t.test performed showed there was not a significant difference between the linear and the logarithmic models' goodness of fit metrics, but it did show there was a significant difference between the model building methods (randomly selected data points, moving power threshold). The method of building a model using lower power levels to predict larger power levels had better goodness of fit metrics than the method of selecting data points at random. In the future, this method could be used to help approximate the laser settings for surgery on a procedural basis, and allow for surgeons to perform at a higher skill level with less training.
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McKintosh, E. "Evaluation of methods suitable for the sterilisation of surgical instruments contaminated with human prions." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/19220/.
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Human prion disease is associated with the accumulation in brain of an abnormal glycoprotein known as prion protein. Prions are far more resistant to physical and chemical inactivation than conventional pathogens. In 1996 a new disease, variant Creutzfeldt-Jakob disease was recognised as distinct from sporadic Creutzfeldt-Jakob Disease and initially showed a rapid rise in incidence. The potential for iatrogenic transmission of prion disease via surgical instruments, despite presumed adequate sterilisation, is well documented. The long asymptomatic incubation periods seen in human prion diseases therefore provide a significant risk of transmission. This project investigated the disinfection of prion-contaminated surfaces, with the goal of developing a process applicable to medical instruments on a large scale. It also aimed to investigate the susceptibility of different brain regions to infection and the spread of peripheral infection to brain, as well as the mechanisms of disease transmission from infected surfaces to tissues. Potential sterilisation procedures were tested on steel wires that had been incubated in infectious brain homogenate. These wires were then inserted into the brains of appropriate indicator mice, which were observed for the clinical signs of prion disease and subsequently investigated using immunohistochemistry. To investigate the susceptibility of different brain regions to infection, steel and plastic spheres were inserted stereotaxically and mice culled at different time points and subjected to immunohistochemical examination. Intraperitoneal and subcutaneous insertion of these spheres was used to investigate the travel of infectivity from peripheral tissues to the central nervous system. Attempts were made to develop a high sensitivity cell culture assay, to enable quantification of the amount of sterilisation produced by different methods, and to investigate their kinetics.
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Korzeniowski, Przemyslaw. "Modelling and simulation of flexible instruments for minimally invasive surgical training in virtual reality." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/58344.
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Improvements in quality and safety standards in surgical training, reduction in training hours and constant technological advances have challenged the traditional apprenticeship model to create a competent surgeon in a patient-safe way. As a result, pressure on training outside the operating room has increased. Interactive, computer based Virtual Reality (VR) simulators offer a safe, cost-effective, controllable and configurable training environment free from ethical and patient safety issues. Two prototype, yet fully-functional VR simulator systems for minimally invasive procedures relying on flexible instruments were developed and validated. NOViSE is the first force-feedback enabled VR simulator for Natural Orifice Transluminal Endoscopic Surgery (NOTES) training supporting a flexible endoscope. VCSim3 is a VR simulator for cardiovascular interventions using catheters and guidewires. The underlying mathematical model of flexible instruments in both simulator prototypes is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. The efficient implementation of the Cosserat Rod model allows for an accurate, real-time simulation of instruments at haptic-interactive rates on an off-the-shelf computer. The behaviour of the virtual tools and its computational performance was evaluated using quantitative and qualitative measures. The instruments exhibited near sub-millimetre accuracy compared to their real counterparts. The proposed GPU implementation further accelerated their simulation performance by approximately an order of magnitude. The realism of the simulators was assessed by face, content and, in the case of NOViSE, construct validity studies. The results indicate good overall face and content validity of both simulators and of virtual instruments. NOViSE also demonstrated early signs of construct validity. VR simulation of flexible instruments in NOViSE and VCSim3 can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. Moreover, in the context of an innovative and experimental technique such as NOTES, NOViSE could potentially facilitate its development and contribute to its popularization by keeping practitioners up to date with this new minimally invasive technique.
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Albrecht, Lucimara. "Máquinas lavadoras ultrassônicas de instrumentos odontológicos, médicos e cirúrgicos: avaliação do desempenho do processo de limpeza." Universidade Tecnológica Federal do Paraná, 2013. http://repositorio.utfpr.edu.br/jspui/handle/1/517.
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A limpeza de instrumentos odontológicos, médicos e cirúrgicos (IOMC) em máquina lavadora ultrassônica (MLUS) utiliza energia mecânica (vibrações sonoras - cavitação), química (soluções detergentes) e térmica (temperatura) associadas ao tempo de exposição. A eficácia deste processo é certificada por meio de testes de controle recomendados por normas internacionais. Neste estudo buscou-se avaliar o desempenho da MLUS quanto aos parâmetros mínimos aceitáveis nas condições práticas de uso através de testes descritos em normas e discutir os fatores de interferência durante o processo que podem comprometer a eficiência da limpeza dos IOMC. Uma pesquisa inicial analisou as condições operacionais da MLUS por meio de questionário auto-aplicado nos estabelecimentos assistenciais à saúde (EAS) de Curitiba mostrando amplo uso da MLUS, com procedimentos técnicos de preparo do processo de limpeza, relação de tempo/temperatura e perfil dos ciclos com a carga de acordo com recomendações da literatura. Entretanto, não houve consenso sobre testes e normas técnicas a serem aplicadas. Assim, foram realizados testes de tiras e folhas de alumínio, indicadores químicos Sono Check® e TOSI® Lum Check para instrumentais canulados baseados em normas internacionais. Os resultados mostraram que todas as folhas de alumínio testadas apresentaram padrão uniforme de perfurações (100%), indicando a eficiência da cavitação. Nas tiras de folhas de alumínio houve perfurações semelhantes na maioria delas (89%) e uma apresentou poucas alterações (11%) apontando falhas no teste e/ou no funcionamento do equipamento. Em 3 testes de indicadores químicos Sono Check® foi obtido resultado positivo (37,5%), em outros três houve demora na alteração da cor mas acabaram positivos (37,5%) e dois indicadores de 2 testes não alteraram a cor (25%). Os resultados positivos (75%) comprovaram a eficácia da atividade ultrassônica e os negativos indicaram pontos cegos no processo de cavitação, o que pode ser atribuído a fatores interferentes na limpeza como: uso da mesma solução de limpeza em vários ciclos, tipo e disposição da carga, nível de preenchimento da solução no tanque, temperatura e divergência das ondas ultrassônicas entre instrumentais e paredes do equipamento. Os resultados dos testes TOSI® Lum Check foram negativos pois apresentaram resíduos de fibrina na superfície das placas de aço que pode estar relacionado a um reduzido tempo de exposição, temperatura não adequada, qualidade da água, diluição incorreta da solução de limpeza, teste mal posicionado, sobrecarga e/ou carga incorreta de IOMC e ineficiência da solução limpante. Concluiu-se que os testes de controle comprovam a eficácia da atividade ultrassônica na limpeza e detectam falhas no desempenho da MLUS atribuídas a fatores interferentes citados e para tanto é recomendado a elaboração de uma norma técnica no Brasil com a implementação da monitoração da atividade ultrassônica para a garantia da qualidade do processo de limpeza ultrassônica.The cleaning of dental, medical and surgical instruments (DMSI) with ultrasonic cleaning equipment (UCE) makes use of mechanical (sound vibrations – cavitation), chemical (detergent solutions) and thermal (temperature) energies associated with exposure time. To check the performance of the cleaning process it is necessary the use of tests recommended by international standards. In this study we have evaluated the performance of UCE concerning its minimal acceptable parameters by means of tests described on standards as well as discussing the interfering factors which could compromise the cleaning process of DMSI. Initially, a survey analyzed the operating conditions of UEC through a questionnaire answered by professionals of several health care establishments (HCE) of Curitiba city. The results showed wide use of UCE in the investigated HCE, technical procedures for preparation of the cleaning process, time/temperature relationship and load cycle profiles according to literature recommendations. However there was no agreement on the type test selection or adoption of technical standards. Considering those results, practical tests were carried out for aluminium foils and strips, Sono Check® chemical indicators and TOSI® Lum Check for cannulated instruments, based on international standards. Aluminium foils (100%) and strips (89%) have showed uniformity in the produced holes, indicating efficiency of the cavitation. Some strips presented few modifications (11%), indicating failures in the test and/or functioning of the equipment. Chemical indicators Sono Check®| presented positive results (75%) proving the effectiveness of ultrasonic activity, however some (25%) presented negative results indicating blind spots due to difficulties in the cavitation process, which can be attributed to interfering factors such as: use the same cleaning solution in several cycles, type and disposition of the load, level of the solution in the tank, temperature and divergence of ultrasonic waves between instrument and walls of the equipment. TOSI® Lum Check for cannulated instruments showed negative results which can be attributed to reduced exposure time, not adequate temperature, water quality, incorrect dilution of the cleaning solution, test bad positioned, overload and/or incorrect load of the instruments, and inefficiency of the cleaning solution. It was concluded that the control tests can prove the effectiveness of the ultrasound in the cleaning activity and detect performance failures for UCE assigned to the cited interfering factors. Therefore, it is recommended the development of a technical standard in Brazil which should include types of tests, procedures and operational control of the cycle parameters in order to ensure the quality control of the ultrasonic cleaning process.
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Higgs, Robin JED Law Faculty of Law UNSW. "Implantable surgical devices issues of product liability." Awarded by:University of New South Wales. School of Law, 2005. http://handle.unsw.edu.au/1959.4/24292.
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Patients who have undergone treatment that has included the surgical implantation of a prosthetic device can become dissatisfied for many reasons. One cause for dissatisfaction is any adverse event where there is a demonstrable causal nexus with the failure of a device that is defective or at risk of being so. The magnitude of therapeutic product failure is considerable and therapeutic goods such as Vioxx, Thalidomide, silicon-gel-filled breast implants, contaminated blood products, cardiac pacemakers and valves, and orthopaedic devices are testimony to this. Many of these events have exposed a greyish area of Australian law that balances medical negligence with consumer protection and contract law. Australian product liability legislation that regulates the use of therapeutic goods is a complex amalgam of law that has at its foundations the Trade Practices Act 1974 (Cth) and the Therapeutic Goods Act 1989 (Cth). When a surgical device fails there can be exposure to liability. This thesis explores those important issues that can impact on individuals or on organisations and it is evident that where issues of product liability concern implanted surgical devices the current regulations for consumer protection may not always be the most appropriate. It is evident that there is a culture of under-reporting of adverse events to a Therapeutic Good Administration that does not have the resources to investigate the cause for failure of a surgical device. Furthermore, there is a potential for bias and conflict of interest in an environment where the regulator depends on the regulated for the funding of its existence. Other issues include the complex and often undesirable consequences of those partnerships that can evolve with the development of an implantable device and with the undertaking of clinical trials, the role of the learned intermediary, that interface between manufacturer and consumer, and the role of the expert witness, that interface between justice and injustice. These and other matters that can significantly influence any debate of implantable surgical device product liability are explored and recommendations are made that might form the basis of a Therapeutic Goods (Safe Medical Devices) Amendment Act.
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Köver, Pierre-François. "Polymeric nano-composites and contrast enhancement studies contributing to MRI-compatible minimally-invasive surgical instruments /." [S.l.] : [s.n.], 2000. http://e-collection.ethbib.ethz.ch/show?type=diss&nr=13090.
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Sun, Yan, and 孙彦. "Wound healing of osteotomy defects prepared with piezo- or conventional surgical instruments in the rabbit." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B4961633X.
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Aims: To evaluate and compare the wound healing process following osteotomies performed with either conventional rotary burs or piezoelectric surgery in a rabbit model mimicking access to the maxillary sinus cavity for sinus floor augmentation.
Materials and methods: On the nasal bone of 16 adult New Zealand white rabbits, two types of osteotomy window defects of nasal cavities were marked to critical size with a Trephine drill (ø 5 mm) and then prepared with either a conventional rotary bur or piezo-surgery (PIEZOSURGERY® Insert OT5 of PIEZOSURGERY® 3 unit, Mectron s.p.a., Genova, Italy). The defects were covered with a resorbable membrane (Bio-Gide®, Geistlich Pharma AG, Wohusen LU, Switzerland). Four animals were sacrificed at one, two, three and five weeks after surgical procedure, respectively. Histological and morphometric evaluations were performed to assess the volumetric density of various tissue components: the blood clot (BC), vascularized structures (VS), provisional matrix (PM), osteoid, mineralized bone (MB), bone debris (BD), residual tissue, old bone (OB).
Results: at the 1 week, more BC detected after piezo- surgical preparation. However, the difference did not reach statistical significance. A tendency of higher proportions of osteoid in the conventional bur defects was noted, but not statistically significant. Significantly more BD was found in the conventionally compared to the piezo-surgically prepared defects. At two weeks, new bone formation was noted, and the process of modeling of the newly formed bone had started. More MB was detected in the defect prepared by piezo-surgery than by conventional bur, but without any statistically significant difference. In the marginal areas of defect, slightly more osteoblasts (Obl) were present in piezo-surgically prepared defect than in conventional prepared defect, although there is no significant difference. At 3 week, a newly formed hard tissue bridge mainly composed of woven bone was seen. A high volumetric density of mineralized bone (MB) presented in all the specimens, At the 5 week, the defects were completely filled with newly formed bone.
Conclusion: the defect prepared by piezo-surgery showed a significantly decreased proportion of bone debris at one week compared to conventional rotary bur defect. Increased volumetric densities of mineralized bone were observed in the piezo-surgical compared to the conventional bur defect after two weeks, although not statistically significant. Irrespective of the preparation modality of the defect performed, the defect was almost filled with newly formed bone at three weeks. At five weeks, complete regeneration of the calvaria defects was achieved.published_or_final_version
Dental Surgery
Master
Master of Dental Surgery
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Dearden, Jason Lon. "Design and Analysis of Two Compliant Mechanism Designs for Use in Minimally Invasive Surgical Instruments." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/7383.
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Minimally invasive surgery (MIS) has several advantages over traditional methods. Scaling MIS instruments to smaller sizes and increasing their performance will enable surgeons to offer new procedures to a wider range of patients. In this work, two compliant mechanism-based minimally invasive surgical instrument wrist or gripper mechanisms are designed and analyzed.The cylindrical cross-axis flexural pivot (CCAFP) is a single-degree-of-freedom wrist mechanism that could be combined with existing gripper mechanisms to create a multi-degree-of freedom instrument. The simplicity of the CCAFP mechanism facilitates analysis and implementation. The flexures of the CCAFP are integral with the instrument shaft, enabling accessories to be passed through the lumen. The CCAFP is analyzed and determined to be a viable wrist mechanism for MIS instruments based on research results. A finite element (FE) model of the mechanism is created to analyze the force-deflection and strain-deflection relationships. Experimental results are used to verify the FE model. A 3 mm design is created that could undergo an angular deflection of +/- 90 degrees. The addition of cam surfaces to help guide the flexures and limit the maximum stress during deflection is explored. These cam surfaces can be integral to the instrument shaft along with the flexures. A 2 degree-of-freedom (DoF) CCAFP with intersecting axes of rotation is also introduced. The inverted L-Arm gripper compliant mechanism has 2 DoF, one wrist and one gripping. Three challenges associated with using compliant mechanisms in MIS instruments are considered: inadequate performance in compression, large flexure deformations, and a highly variable mechanical advantage. These challenges were resolved in the L-Arm design by inverting the flexures, tailoring flexure geometry and employing nitinol, and integrating pulleys into each jaw of the mechanism. The L-Arm was prototyped at several sizes to demonstrate functionality and scalability. A finite element model of the L-Arm flexure was created to determine the strain-deflection relationship. A fatigue test was completed to characterize nitinol for use in compliant mechanism MIS instruments.These concepts demonstrate the ability of compliant mechanisms to overcome the design and manufacturing challenges associated with MIS instruments at the 3 mm scale. The models and principles included in this work could be used in the application of compliant mechanisms to design new MIS instruments as well as in other areas that employ compliant mechanisms in a cylindrical form factor.
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Bruna, Camila Quartim de Moraes. "O impacto do uso de diferentes tipos de luvas e das mãos nuas na inspeção e preparo do instrumento cirúrgico limpo." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-09062015-115530/.
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Introdução: A inspeção e o acondicionamento dos instrumentais cirúrgicos limpos em caixas e bandejas, implicam na manipulação desses produtos. Na prática, é possível observar grande descompasso entre o cuidado dispensado a essa etapa, quando comparado ao rigor exigido para remoção completa de contaminantes por meio da limpeza. A falta de consenso quanto ao uso de luvas nessa etapa do processo chama a atenção e não se sabe se esse detalhe repercute na qualidade final do material quanto à segurança para o paciente cirúrgico. Objetivos: Determinar se há diferenças na resposta citotóxica relacionada ao uso de distintos tipos de luvas e das mãos nuas na inspeção e preparo do instrumental cirúrgico limpo e avaliar a carga microbiológica de instrumentais cirúrgicos preparados sem luvas e sua repercussão na esterilização. Método: Esta pesquisa realizou um experimento laboratorial com abordagem pragmática, utilizando cânulas de oftalmologia que foram manipuladas com diferentes tipos de luvas e com as mãos nuas. Posteriormente, o teste de citotoxicidade foi realizado por meio da difusão em ágar. Pinças anatômicas também fizeram parte da amostra para a análise exploratória microbiológica, após serem manipuladas sem luvas, e posteriormente, submetidas à avaliação de sua esterilidade, após autoclavação. Resultados: Nenhuma das amostras de cânulas de oftalmologia manipuladas por diferentes tipos de luvas e por mãos nuas apresentou efeito citotóxico.Todas as culturas microbiológicas das pinças anatômicas manipuladas sem luvas apresentaram crescimento de microrganismos aeróbios e anaeróbios, embora nenhum microrganismo tenha sido recuperado após a autoclavação. Conclusão: Não houve evidências de diferenças de resposta citotóxica relacionada ao uso de diferentes tipos de luvas e das mãos nuas na manipulação do instrumental cirúrgico limpo que sinalizasse risco de iatrogenia. Ressalta-se que o uso de luvas implica aumento dos custos do processo e na geração de resíduos, além do potencial risco alergênico ao látex. Esta pesquisa teve como relevância subsidiar a elaboração de protocolos para a etapa de preparo de instrumentais cirúrgicos limposIntroduction: The aim of reprocessing surgical instruments is to provide instruments that are clean, in good working condition and ultimately sterile thus ensuring patient safety. During instrument there is no agreement about the necessity for glove use. Therefore, there is little reason for employees to wear gloves to protect themselves from possible residual contaminants on cleaned instruments that had previously been used during clean or sterile surgery. On the other hand, the use of the gloves to handle surgical instruments during preparation increases medical waste, increases medical costs and could increase the prevalence of glove allergies in staff. Aim: In this study we investigated the risk posed to patients from staff wearing different types of gloves or no gloves to prepare surgical kits. Method: Five cleaned ophtalmic cannulas were handled using different kinds of gloves and with bare hands, package and steam sterilized. An in vitro cytotoxicity test was conducted, using the agar diffusion test. Microbiological tests were conducted as well, in samples handled with bare hands. Results: All test samples showed the same mild reactivity (grade 2) indicating that handling instruments with gloves or bare hands did not leave any residual toxic products on the instrument surface. Conclusion: We found no difference in the iatrogenic risk to patients of either increased toxicity or increased risk of microbial contamination if surgical instruments are prepared with or without gloves. However, the use of gloves has some inherent disadvantages, such as the risk of latex sensitization of the workers and increased medical costs due to purchase and waste disposal
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Panza, Ana Maria Marchetti. "Padrões de enfermagem em centro cirúrgico e instrumentos para sua operacionalização: proposta e ajuizamento." Universidade de São Paulo, 1990. http://www.teses.usp.br/teses/disponiveis/6/6131/tde-19122017-174846/.
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Este estudo refere-se a proposta de padrões de enfermagem em centro cirúrgico e de instrumentos para sua operacionalização. Sua elaboração tem como objetivos básicos: a definição de padrões de enfermagem em centro cirúrgico, para nortear as ações de enfermagem e avaliação da assistência no período perioperatório, a estruturação de instrumentos que auxiliem a operacionalizacão desses padrões na prática e o estabelecimento de outros, que subsidiem a avaliação da assistência de enfermagem no período perioperatório. Foram definidos três tipos de padrões: os estruturais, compreendendo 6 padrões, os do processo de assistência de enfermagem, envolvendo 4 e os de resultados, composto por 3. Os instrumentos elaborados para a operacionalizacão dos padrões, são em número de três (1, 2 e 3), com duas partes distintas cada um (PARTE A e B) e os de avaliação da assistência, em número de 2, sendo que o número 4 apresenta parte A e B e o 5, A B e C. Tendo em vista a avaliação dos padrões e instrumentos propostos com a finalidade de detectar possíveis deficiências e propor medidas corretivas, foram elaborados questionários que foram respondidos por enfermeiras especialistas em centro cirúrgico, para a realização do ajuizamento da proposta. Este ajuizamento foi realizado, considerando-se a adequação, clareza, especificidade, objetividade, validade e viabilidade dos padrões e instrumentos. Com base nos resultados do ajuizamento, pode-se inferir que os padrões e instrumentos propostos, foram aceitos pela maioria das enfermeiras. Foram apontadas algumas deficiências e sugeridas medidas corretivas e estas, analisadas.This work concerns to the proposition of nursing standards in operating roorn and the instruments for their efficiency. The work ellaboration has as basic goals: the definition of nursing standards in operating room to guide the nursing activities during the perioperative time, the instrument organization that may produce the efficiency of these practice standards and the establishment of others which may help the nursing assistance\'s evaluation during the perioperative period. There hinds of standards were defined, structural with 6 standards, standard process with 4 and the standard results formed by 3. The instruments prepared for the standards efficiency are theree (1, 2, 3) and each one has two differente parts (Part A and B) and the assistance\'s evaluation standards are two considering that the number 4 is divided into part A and B and number 5 A, B and C. For having a successful judgement of the proposal, questions were prepared in order to get the specialist nurses\'answers in operating roorn considering the evaluation of the standards and the instrurnents proposed with the objetive of making known some defficiencies and to propose correting actions as well. This judgement was gotten considering the adequacy clearness, specification, objectivity, vality and possibility of the standards and instruments. Based on the judgement results we may infer that the standards and the instruments proposed were accepted by most of the nurses. Some defficiencies and correcting actions were pointed and these analysed.
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Comella, Laura [Verfasser], and Thomas [Akademischer Betreuer] Bauernhansl. "Position sensor and control system for micro hydraulic drives in surgical instruments / Laura Comella ; Betreuer: Thomas Bauernhansl." Stuttgart : Universitätsbibliothek der Universität Stuttgart, 2019. http://d-nb.info/1206183993/34.
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Konh, Bardia. "Smart Surgical Needle Actuated by Shape Memory Alloys for Percutaneous Procedures." Diss., Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/375030.
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Mechanical EngineeringPh.D.
Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Needle insertion is known as one of the recent needle-based techniques that is used in several diagnostic and therapeutic medical procedures such as brachytherapy, thermal ablations and breast biopsy. The difficulty in most of these procedures is to attain a precise navigation through tissue reaching target locations. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle’s body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Development of a model to predict the behavior of the needle steering in the soft tissue has been always a point of interest as it could improve the performance of many percutaneous needle-based procedures. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility. Design parameters influencing the steerability include the needle’s diameter, wire diameter, pre-strain, and its offset from the needle. A simplified model was developed to decrease the computation time in iterative analyses of the optimization algorithm. In the fourth part of this work a design of an active needling system was proposed where actuation forces of SMAs as well as shape memory polymers (SMPs) were incorporated. SMP elements provide two major additional advantages to the design: (i) recovery of the SMP’s plastic deformation by heating the element above its glass transition temperature, and (ii) achieving a higher needle deflection by having a softer stage of SMP at higher temperatures with less amount of actuation force. Finally, in the fifth and last part of this study, an Arbitrary-Lagrangian-Eulerian formulation in LS-DYNA software was used to model the solid-fluid interactions between the needle and tissue. A 150mm long needle was considered to bend within the tissue due to the interacting forces on its asymmetric bevel tip. Some additional assumptions were made to maintain a reasonable computational time, with no need of parallel processing, while having practical accuracies. Three experimental tests of needle steering in a soft phantom were performed to validate the simulation. Results: The finite element model of the active needle was first validated experimentally with developed prototypes. Several design parameters affecting the needle’s deflection such as the needle’s Young’s modulus, the SMA’s pre-strain and its offset from the neutral axis of the cannula were studied using the FE model. Then by the integration of the SMA characteristics with the automated optimization schemes an improved design of the active needle was obtained. Real-time experiments with different prototypes showed that the quickest response and the maximum deflection were achieved by the needle with two sections of actuation compared to a single section of actuation. Also the feasibility of providing actuation forces using both SMAs and SMPs for the surgical needle was demonstrated in this study. The needle insertion simulation was validated while observing less than 10% deviation between the estimated amount of needle deflection by the simulation and by the experiments. Using this model the effect of needle diameter and its bevel tip angle on the final shape of the needle was investigated. Conclusion: The numerical and experimental studies of this work showed that a highly maneuverable active needle can be made using the actuation of multiple SMA wires in series. To maneuver around the anatomical obstacles of the human body and reach the target location, thin sharp needles are recommended as they would create a smaller radius of curvature. The insertion model presented in this work is intended to be used as a base structure for path planning and training purposes for future studies.
Temple University--Theses
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Vigier, Elise. "Instrumentum d'hygiène et de médecine en Gaule romaine." Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE2062.
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À la fin de l'âge du Fer, les changements affectant la culture matérielle de la Gaule préromaine témoignent de l'importance des influences et des échanges avec les mondes hellénistique et romain. Après quelques imports dès la fin du IIe s. av. J.-C., l'arrivée d'objets et de produits liés aux soins du corps s'intensifie, surtout à partir de l'époque augustéenne. Par leur quantité et leur variété, ils se démarquent des rasoirs, coupe-ongles, pinces et nécessaires de toilette connus jusqu'alors et laissent deviner les transformations profondes dans la manière de paraître, d'entretenir et de soigner son corps, allant notamment de pair avec le développement de la pratique thermale. À partir du Ier s. ap. J.-C., l’usage des strigiles, des cuillères à parfum ou des pyxides se propage en effet largement au sein de la société : leur généralisation montre qu'ils ne sont plus réservés à une élite.Rares sont les sites romains ne livrant pas de matériel destiné aux soins du corps. Ces traces tangibles viennent compléter les sources historiques sur ces aspects de la vie quotidienne. Le présent travail, par un nouvel examen de cette documentation archéologique, cherche à obtenir une vision d'ensemble d'une situation abordée jusqu'ici par des études thématiques, ponctuelles ou régionales. Cette recherche propose ainsi de réviser et compléter le cadre typologique et chronologique de ces catégories de mobiliers.Le dépouillement des Cartes Archéologiques de la Gaule, d'une large bibliographie et l'examen direct d'une partie du mobilier ont permis la constitution d'un corpus de près de 8000 objets datés entre le Ier s. av. et le Ve s. ap. J.-C., répartis sur 2850 sites dans la zone étudiée. Bien que l'exhaustivité ne soit pas recherchée, les importantes séries de données mises au jour lors des fouilles récentes permettent d'assoir plus solidement les réflexions typologiques et chronologiques. Le recensement ne s'est pas restreint à la Gaule romaine mais a été élargi dans un but comparatif à l'ensemble du monde romain. Les contextes de découverte ont été réexaminés et les données compilées de manière à proposer des fourchettes de datation pour la production, la circulation et le rejet des différents types.Cette "mise à plat" s'avère d'autant plus nécessaire qu'il existe un biais historiographique persistant : certains objets ont été interprétés dans le passé comme des instruments chirurgicaux alors qu'il s'agit majoritairement d'accessoires liés à la cosmétique. Textes, instruments et substances montrent que les pratiques d'hygiène et de médecine ne sont pas toujours clairement dissociées à l'époque romaine : la limite est parfois ténue entre embellissement et soin du corps. Si la fonction hygiénique ou médicale d’objets comme les miroirs ou les scalpels est aisément identifiable, d’autres sont polyvalents et ont pu théoriquement servir dans ces deux sphères d’activités. À l’issue de ce travail, il a été possible de proposer une attribution cosmétique ou médico-chirurgicale type par type pour les formes de cuillères-sondes et spatules-sondes recensées.Du fait de leur abondance et de leur variété morphologique interne, certaines catégories fonctionnelles (miroirs, strigiles, cuillères-sondes, spatules-sondes, tablettes à broyer, scalpels) ont donné lieu à une analyse typo-chronologique plus détaillée. La succession et la contemporanéité de différents modèles ont ainsi pu être mises en évidence. L'analyse de la répartition spatiale des formes les plus fréquentes permet d'appréhender les modalités de leur diffusion, mais aussi de discerner parfois les importations de Grèce ou d'Italie des probables productions provinciales. En répondant à une demande, ces objets témoignent des pratiques d’hygiène et de médecine dans la société gallo-romaineAt the end of the Iron Age, the changes affecting the material culture of pre-Roman Gaul attest the importance of influences and exchanges with the Hellenistic and Roman cultures. After a few imports at the end of the 2nd century BC, the arrival of objects and products related to body care intensified, especially from the Augustan period onwards. By their quantity and variety, they stand out from the razors, nail clippers, pliers and toiletries known until then and hints at the significant transformations in the way people look, maintain and care for their bodies, which go hand in hand with the development of thermal practice in particular. From the 1st century AD onwards, the use of strigils, perfume spoons or pyxides spread widely within society: their generalized use shows that they were no longer reserved for the elites.Most of Roman sites provide body care implement. These tangible remains complement the historical sources on these aspects of daily life. Thanks to a new examination of this archeological documentation, this work aims to obtain an overview of a situation that has been so far addressed by thematic, site-specific or regional studies. This research thus intends to revise and enhance the typological and chronological framework of these categories of artefacts.The examination of the "Cartes archéologiques de la Gaule", of a large bibliography and the direct examination of part of the small finds have allowed to create a corpus of nearly 8000 objects dated between the 1st century BC and the 5th century AD, covering 2850 sites in the investigated area. Although our work does not intend to be exhaustive, the large series of data uncovered during recent excavations provide a more solid basis for typological and chronological analysis. The survey is not restricted to Roman Gaul but is extended to the whole Roman world for comparative purposes. The finding contexts have been reviewed and the data compiled to propose time ranges for the production, circulation and discarding of the different object types.This re-examination is all the more necessary since there is a persistent historiographical bias: in the past some objects have been considered to be surgical instruments, whereas most of them in fact are accessories related to cosmetics. Texts, instruments and substances show that hygiene and medical practices were not always clearly dissociated in Roman times: the boundary between embellishment and body care can be faint. While the hygienic or medical function of some objects such as mirrors or scalpels is easily identifiable, others are versatile and can theoretically be used in both areas of activity. At the outcome of this study, it has been possible to propose a type-by-type classification – either cosmetic or medico-surgical – for the identified types of spoon-probes and spatula-probes.Due to their abundance and internal morphological variety, some functional categories (mirrors, strigils, spoon-probes, spatula-probes, grinding tablets, scalpels) have led to a more detailed typo-chronological analysis. The succession and contemporaneity of different models have been therefore highlighted. The analysis of the spatial distribution of the most frequent types allows us to understand the conditions of their distribution, but also, sometimes, to sort out imports from Greece or Italy from probable provincial productions. By responding to demand, these objects bear witness to the medical and hygienic practices within the Gallo-Roman society
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Camargo, Tamara Carolina de. "Eficácia da esterilização a vapor de instrumental laparoscópico montado versus desmontado: um estudo experimental." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-20042007-140745/.
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A vídeo-laparoscopia é uma inovação tecnológica que trouxe indiscutíveis vantagens e também novos desafios, incluindo nestes, as diretrizes para o reprocessamento adequado dos instrumentais e seus acessórios. A autoclavação dos instrumentais laparoscópicos desmontados é mais segura, uma vez que a condução térmica é facilitada. No entanto, são artigos complexos, compostos por múltiplas peças e a sua remontagem no momento da cirurgia traz transtornos às equipes cirúrgicas, correndo o risco do não funcionamento ou de danos às peças pela montagem inadequada. Existe um arraigado conceito, entre os profissionais da saúde, que para o sucesso da esterilização ser alcançado, é necessário o contato direto do vapor com todas as superfícies dos materiais submetidos à autoclavação sem considerar também o raciocínio do calor latente. A destruição microbiana por meio da esterilização pelo vapor está essencialmente relacionada ao calor latente, gerado pela condensação deste em contato com a superfície fria do material, promovendo a termocoagulação das proteínas microbianas. É uma prática comum nos hospitais brasileiros a realização da autoclavação de instrumentos previamente montados, apesar de não haver comprovação científica consistente dessa prática. Isto posto, esta investigação teve o objetivo de avaliar a eficácia do processo de esterilização a vapor dos instrumentais laparoscópicos previamente montados, comparando os seus resultados com os desmontados, considerada neste estudo a melhor prática. Tratou-se de uma pesquisa experimental, laboratorial, com abordagem quantitativa. Foram selecionados dois modelos de maior complexidade dentre os instrumentos laparoscópicos para realização do estudo, sendo eles: trocarte com válvula tipo janela rosqueada de 5mm, composto por cinco peças desmontáveis e pinça para dissecção de 5mm, composta por quatro peças desmontáveis. Cada peça dos instrumentais foi considerada como uma unidade amostral na análise microbiológica. Este estudo teve então como Grupo Montado: instrumentais laparoscópicos montados; Grupo Desmontado: instrumentais laparoscópicos desmontados; Grupo Contagem Microbiana: instrumentais laparoscópicos submetidos aos procedimentos de contaminação desafio, encaminhados diretamente para o teste de contagem microbiana. O inóculo para a contaminação desafio constitui-se de suspensão do Geobacillus stearothermophilus, na forma esporulada, acrescido de sangue de carneiro desfibrinado esterilizado. Todos os instrumentais foram contaminados desmontados com o inóculo desafio. Os grupos Montado e Desmontado foram submetidos aos processos de limpeza manual, complementada pela limpeza automatizada em lavadora ultra-sônica com retrofluxo, enxágüe em água corrente e sob pressão. Por fim, foi realizado o enxágüe com água destilada esterilizada e secagem com ar comprimido medicinal. Na seqüência, foi realizado sorteio para composição dos Grupos Montado e Desmontado. Os instrumentais foram embalados individualmente em papel grau cirúrgico e submetidos à esterilização a vapor em autoclave com pré-vácuo. Após a esterilização, os instrumentais foram avaliados quanto à eficácia da esterilização, por meio dos resultados dos testes de cultura microbiológica, utilizando o método de inoculação direta. No Grupo Montado foram recuperados os microrganismos teste em três peças de uma mesma pinça (3/48) e em três peças de um mesmo trocarte (3/60), enquanto que no Grupo Desmontado o microrganismo teste não foi recuperado nas unidades amostrais estudadas. Nas condições desse experimento, os resultados obtidos refutaram a hipótese inicial da pesquisa quanto à segurança da autoclavação das pinças e dos trocartes utilizados em cirurgia laparoscópica previamente montadosThe video laparoscopy is a technological innovation that brought unquestionable advantages and, also, new challenges, like: the policies for the adequate reprocessing of the instruments and its permanent accessories. The steam sterilization of disassembled laparoscopic instruments is much safer, once that the thermal conduction is facilitated. However, laparoscopic instruments are quite complex articles; they are composed by many parts and the reassemblage in site at the moment of the surgery brings many inconveniences to the surgical team, like the possibility of the instruments malfunctioning or non functioning at all, or even damages to the instruments due to inadequate assembling. There is a strong belief among the Healthcare Professionals about the necessity of the direct contact of the steam with all the surface of the materials submitted to the steam sterilization, which is correct, however it doesn´t consider the latent heat assumption as well. The destruction of the microbiological material throughout the steam sterilization is essentially related to the latent heat, created by the vapor condensation when in contact with the instrument´s cold surface, promoting the thermal-coagulation of microbiological proteins. Many hospitals use the steam sterilization of previously mounted instruments, although there´s not any consistent scientific evidence about the efficiency of this practice. Once stated this point, this investigation´s aim was: evaluate the effectiveness of the steam sterilization process of the previously mounted, permanent laparoscopic instruments. It was an experimental laboratorial research, using a quantitative approach. Two models of permanent laparoscopic instruments of major complexity were chosen for the experiments: a trocar with a 5mm screw window valve, composed by five dismountable parts and a 5mm dissection clamp, composed by four dismountable parts. Each part of the instruments was considered as a sample unit on the microbiological analysis. This study it had the Assembled Group was: mounted laparoscopic instruments; the Disassembled Group was: disassembled laparoscopic instruments; the Microbiological Counting Group was: laparoscopic instruments submitted to the - challenge contamination - procedures, being directed straight to the test of microbiological counting. The inoculants material used for the challenge contamination consisted on the suspension of the Geobacillus stearothermophilus, in its spore form, plus defibrinated and sterilized sheep blood. All the instruments were contaminated, disassembled with the challenge inoculants material. The Assembled and Disassembled groups were submitted to the manual cleaning processes, enhanced by the automatic cleaning in an ultrasonic washer with retro-flux, rinsed in running and under pressure water. At last, a rinsing with distilled water was performed; the drying process was made with medicinal compressed air. Then, a sorting was performed to decide about the composition of the Assembled and Disassembled groups. The instruments were individually packed in surgical paper and submitted to the steam sterilization in a pre-vacuum sterilizer machine. After the sterilization, the instruments were evaluated according to sterilization effectiveness throughout the microbiological culture test´s results, using the straight inoculation method. In the Assembled Group the microorganism´s tests were recovered in three parts of one same clamp (3/48) and in three parts of the same trocar (3/60), in the Disassembled Group the test microorganism wasn´t recovered in any of the sample unities. The results, under the conditions of the experiment, refuted the hypothesis of safety in the usage of the steam sterilization in previously mounted used clamps and trocar in laparoscopy
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Vilas-Boas, Vanessa Aparecida 1981. "Carga microbiana de trocartes reprocessaveis apos laparoscopias ginecologicas." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311014.
Full textAbstract:
Orientador: Maria Isabel Pedreira de FreitasDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A transmissão de infecções hospitalares está relacionada à sobrevivência de microrganismos nas superfícies ambientais e no instrumental cirúrgico. Nos últimos anos, o Brasil tem se deparado com um cenário disperso em relação à validação do processo de limpeza e esterilização de instrumentos cirúrgicos utilizados em acessos minimamente invasivos, principalmente os procedimentos realizados por vídeo. Para implantação de medidas eficazes no reprocessamento é necessário saber como está o material em termos de contaminação e verificar se a carga microbiana trazida por esse instrumental é superior ao desafio microbiano imposto pelos indicadores biológicos. Deste modo, espera-se que a análise quanti-qualitativa dos microrganismos presentes em instrumentos cirúrgicos laparoscópicos após o uso clínico possa nortear a tomada de decisão pelos profissionais de saúde a contribuir para a melhoria do processo de trabalho visando à segurança do paciente. Objetivo: Identificar a carga microbiana presente nos trocartes reprocessáveis de 5 mm e 10 mm, usados para realização de laparoscopias ginecológicas. Material e Método: Tratase de um estudo exploratório descritivo. Um total de 57 trocartes de 5 mm e 10 mm de diâmetro foi recolhido na sala de operação, imediatamente após o uso na paciente, sendo acondicionados separadamente em embalagem plástica esterilizada, acrescentado 250 ml de água destilada estéril, lacrado e agitado a 120 rpm por 10 minutos. Com técnica asséptica, os trocartes foram retirados da embalagem e o lavado obtido foi levado ao Laboratório de Microbiologia onde foi filtrado por um filtro contendo uma membrana de celulose de 0,22 µm que foi colocada em placa Petri contendo ágar sangue. As placas foram incubadas em estufa e encaminhadas para contagem de microrganismos, expressa em unidades formadoras de colônias (UFC) e identificação seguindo técnicas laboratoriais padrão. Resultados: Em 52,63% dos trocartes não foram recuperados microrganismos viáveis, 45,62% apresentaram crescimento microbiano de 1-100 UFC, e somente em 1,75% dos trocartes recuperou-se carga microbiana maior que 100 UFC. Os microrganismos mais frequentemente isolados foram o Staphylococcus coagulase negativo (28%) e o Bacillus sp (22%). Outros microrganismos de importância clínica conhecida incluíram: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli e Aeromonas hidrophyla. Discussão: O estudo demonstrou que o desafio microbiano enfrentado pelos Centros de Material e Esterilização é baixo quando comparado com o desafio imposto pelos indicadores biológicos que monitoram os ciclos de esterilização, correspondentes a 106 UFC de bacilos esporulados. Além disso, apesar dos trocartes, utilizados em laparoscopias ginecológicas consideradas limpas, apresentarem baixa carga microbiana, não se pode inferir que os riscos de complicações infecciosas sejam mínimos. Conclusão: Os trocartes aparoscópicos utilizados em laparoscopias ginecológicas limpas apresentaram carga microbiana baixa (?10 a ?102 UFC)
Abstract: The transmission of hospital infections is related to survival of microorganisms on environmental surfaces and surgical instruments. In recent years, Brazil has been facing a scenario scattered on the validation of cleaning and sterilizing surgical instruments used in minimally invasive procedures performed primarily for video. For implantation of effective reprocessing and need to know how this stuff in terms of contamination and whether the microbial load brought by this instrument is superior to the microbial challenge imposed by biological indicators. Thus, it is expected that the quantitative and qualitative analysis of microorganisms in laparoscopic surgical instruments after use to guide the surgical decision-making by health professionals to contribute to the improvement of the work aimed at patient safety. Objective: To identify the microbial load present in reprocessable trocars of 5 mm and 10 mm, used for realization of gynecological laparoscopy. Material and Method: This is an exploratory descriptive study. A total of 57 trocars of 5 mm and 10 mm in diameter was collected in the operating room, immediately after use in the patient, and packed separately in sterile plastic bag, added 250 ml of sterile distilled water, sealed and shaken at 120 rpm for 10 minutes. With aseptic technique, the trocars were removed from the pack and washed obtained was taken to the microbiology laboratory where it was filtered through a filter containing a cellulose membrane of 0,22µm which was placed in Petri dishes containing blood agar. The plates were incubated in and sent to the microorganism counts expressed as colony forming units (CFU) and identification following standard laboratory techniques. Results: In 52.63% of the trocars were not recovered microorganisms, 45.62% had microbial growth of 1-100 UFC, and only 1.75% of the trocars recovered microbial counts greater than 100 CFU. The microorganisms most frequently isolated were coagulase negative Staphylococcus (28%) and Bacillus sp (22%). Other organisms known clinically important included: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Aeromonas hidrophyla. Discuss: The study showed that the microbial challenge faced by the Centers for Sterilization is low compared with the challenge posed by biological indicators that monitor the sterilization cycle, corresponding to 106 CFU of sporulated bacilli. Moreover, despite the trocars used during gynecological laparoscopy considered clean, have lower microbial load, one can not infer that the risk of infectious complications are minimal. Conclusion: The laparoscopic trocars used during gynecological laparoscopy showed microbial clean low (?10 a ?102 UFC)
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem
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Melo, Allana Agnes Pereira de. "Avaliação da incidência de micro trincas dentinárias após instrumentação reciprocante e rotatória /." São José dos Campos, 2019. http://hdl.handle.net/11449/190817.
Full textAbstract:
Orientador: Eduardo Galera da SilvaBanca: Claudio Hideki Kubo
Banca: Rodrigo Máximo de Araújo
Resumo: Para que o tratamento endodôntico tenha sucesso, buscam-se meios de realizar uma limpeza eficiente e modelagem adequada do canal radicular. No entanto, na prática clínica, alguns problemas podem ser encontrados durante a instrumentação, sendo um deles a formação de micro trincas e linhas de fratura, que podem evoluir após o estresse causado pelas forças oclusais e resultar em uma fratura completa da raiz. O presente estudo teve por objetivo avaliar a incidência de micro trincas dentinárias em 48 incisivos inferiores humanos extraídos, utilizando estereomicroscópio e Tomografia Computadorizada de Feixe Cônico (TCFC), após o preparo do canal radicular com o sistema ProDesign S (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brasil) em movimento rotatório e reciprocante, o sistema ProDesign R (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brasil) em movimento reciprocante e o sistema Reciproc (VDW, Munich, Germany) em movimento reciprocante. Além disso, buscouse analisar a superfície dos instrumentos quando sem uso, após o primeiro uso, e sucessivamente até o terceiro uso, através de estereomicroscópio e microscopia eletrônica de varredura. Os resultados foram submetidos à análise estatística por meio da Prova de Friedman. Houve formação de micro trincas dentinárias em todos os grupos avaliados em Estereomicroscópio após o preparo do canal radicular utilizando o sistema ProDesign S em movimento rotatório e reciprocante, o sistema ProDesign R em movimento reciprocant... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: So that the endodontic treatment is successful, means to achieve an efficient cleaning and proper modeling of root canal are sought. However, in clinical practice, some problems may be encountered during the instrumentation, one of them being the formation of micro cracks and lines of fracture, which may evolve after the stress caused by occlusal forces and result in a complete root fracture. The objective of this study is to evaluate the incidence of dentin micro cracks in 48 extracted human incisors using stereomicroscope and cone beam computed tomography (TCFC), after the root canal preparation with ProDesign S system (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil), in rotatory and reciprocating movement, ProDesign R system (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) in reciprocating movement and Reciproc system (VDW, Munich, Germany) in reciprocating movement. In addition, it was aimed to analyze the instruments surface when without use, after first use, and successively until the third use, through a stereomicroscope and scanning electron microscopy. The results will be subjected to statistical analysis by means of the Friedman test. Dentin micro cracks were formed in all groups evaluated in a stereomicroscope after root canal preparation using the ProDesign S system in rotating and reciprocating motion, the ProDesign R system in reciprocating motion and the Reciproc system in reciprocating motion; but without statistically significant dif... (Complete abstract click electronic access below)
Mestre
46
Johnstone, Patricia Lynne. "The process and organisational consequences of new artefact adoption in surgery." Thesis, Electronic version, 2001. http://hdl.handle.net/1959.14/3905.
Full textAbstract:
Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001.Bibliography: leaves 288-310.
Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion.
Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption.
Electronic reproduction.
xii, 347 leaves, bound :
Mode of access: World Wide Web.
Also available in print form
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Lima, Lonetá Lauro 1982. "Análise de falhas em instrumentais cirúrgicos metálicos." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/264587.
Full textAbstract:
Orientador:Cecilia Amélia de Carvalho ZavagliaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica
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Resumo: Este trabalho foi desenvolvido juntamente com a equipe de enfermagem do HC da Unicamp. O principal objetivo foi avaliar os modos de falhas presentes em pinças hemostáticas retas e curvas de fabricação nacional, que já haviam sido utilizadas pelo Hospital das Clínicas da Unicamp e que falharam prematuramente durante o uso. Os parâmetros avaliados estão relacionados com a qualidade da matéria-prima, propriedades mecânicas e com o processo de fabricação. As pinças foram avaliadas segundo as normas internacionais da ASTM, entre elas a ASTM F 899-09, a ASTM F 1744-96(2008) e a ASTM F 1026-86(2008). As fraturas ocorridas nas pinças falhadas foram analisadas por microscópio eletrônico de varredura-MEV, sendo possível visualizar que o mecanismo de fratura predominante foi o de corrosão sob tensão. Também foi realizado ensaio em pinças sem uso (nacionais e importadas) e os resultados obtidos foram diferentes para ambas, sendo que a pinça nacional sem uso apresentou itens reprovados pela norma. Os resultados obtidos permitiram concluir que existe diferença no processo de fabricação dos materiais nacionais e importados e isso reflete na durabilidade, qualidade e segurança no uso dos instrumentais nacionais. A inspeção por MEV das pinças nacionais indicou problemas no acabamento de superfície como: pontos de corrosão, trincas e rebarbas, reprovando essas pinças segundo os critérios de aceitação das normas ASTM. Através deste estudo foi possível criar um documento para auxiliar a equipe de enfermagem na avaliação da qualidade de instrumentais cirúrgicos metálicos
Abstract: This work was developed together with the team of nursing of the HC of the Unicamp. The objective went to evaluate the failure modes in national hemostatic forceps, that already had been used for the Hospital of the Clinics of the Unicamp and that failed prematurely during the use. The evaluated parameters are related with the quality of the raw material, mechanical properties and with the manufacture process. The hemostatic forceps went evaluated according to international norms of the ASTM, between them ASTM F 899-09, ASTM F 1744-96 (2008) and ASTM F 1026-86 (2008). The fracture occurred in the hemostatic forceps went analyzed by scanning electron microscope-SEM, being possible to visualize that the mechanism of predominant failure was stress corrosion crack. Also assay in hemostatic forceps without use (national and imported) and the results had different for both, being that the national forceps without use presented item disaccord to norm. Through the results went possible to conclude there are differences in the process of manufacture of the national and imported forceps, and this reflects in the durability, quality and security in the use of the national instruments. The inspection for SEM of the national fórceps indicated problems in the surface finishing as: points of corrosion, cracks and burrs, disapproving these forceps according to criteria of acceptance of norms ASTM. Through this study went possible to create a document to assist the nursing team to evaluate the quality of the metallic surgical instruments
Mestrado
Materiais e Processos de Fabricação
Mestre em Engenharia Mecânica
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Guatura, Gabrielle Meriche Galvão Bento da Silva. "Vigilância pós-alta em infecção de sítio cirúrgico: criação e validação de um instrumento." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-05112018-115921/.
Full textAbstract:
Introdução: A infecção de sítio cirúrgico representa a terceira causa de infecção relacionada à assistência à saúde, que mais acomete pacientes na Europa e no Brasil. Considerando as altas hospitalares cada vez mais precoces e que grande parte das infecções do sítio cirúrgico se manifestará até o sétimo dia após a cirurgia, a vigilância pós-alta se faz extremamente necessária, uma vez que sua não realização pode levar a subnotificação, dificultando as ações de prevenção e controle. Existe carência, até o momento, de ferramentas que tenham sido validadas para a identificação de potenciais casos de ISC durante a vigilância pós-alta. Objetivo: Criar e validar um instrumento para a detecção pós-alta de potenciais casos de ISC. Método: Estudo psicométrico para a criação e validação de um instrumento, empregando-se as etapas de validação de conteúdo, critério e constructo. Resultado: O instrumento, após validação de conteúdo com juízes especialistas, apresentou coeficiente de validade de conteúdo total igual a 0,87. Para a validação de critério e constructo o instrumento proposto foi aplicado em uma amostra de 100 pacientes e comparado ao exame físico por profissional de saúde, observando-se coeficiente alfa de Cronbach igual a 0,87; Kappa de Cohen igual a 0,83; sensibilidade igual a 76,4%; especificidade de 100%; valores preditivo negativo de 92,5%, e preditivo positivo igual a 100%; precisão de 94%. Conclusão: O instrumento proposto foi validado e demonstrou ser uma ferramenta útil para detecção de possíveis casos de infecção de sítio cirúrgico na vigilância pós-alta.Introduction: Surgical site infection (SSI) represents the third cause of healthcare-associated infections, which affects patients in Europe and Brazil. Considering hospital discharges that are becoming more precocious and that most SSI will manifest themselves up to the seventh postoperative day, postdischarge surveillance is extremely necessary, since its failure to perform can lead to underreporting, making it difficult to prevention and control actions. There is a lack, until now, of tools that have been validated for the identification of potential cases of SSI during postdischarge surveillance. Objective: To create and validate an instrument for the postdischarge surveillance of potential SSI cases. Method: a psychometric study for the creation and validation of an instrument, using content, criterion and construct validation. Result: The instrument, after validating content with expert judges, presented coefficient of total content validity equal to 0.87. For the validation of criterion and construct the instrument was applied in a sample of 100 patients. Comparing the instrument to the physical examination by the health professional, Cronbachs Alpha was equal to 0.87; Cohen\'s Kappa was equal to 0.83; sensitivity equal to 76.4%; specificity of 100%; negative predictive values of 92.5%, and, positive predictive equal to 100%. The accuracy of the instrument was 94%. Conclusion: The proposed instrument was validated and constitutes a useful tool to detect possible cases of Surgical Site Infection in postdischarge surveillance.
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Borges, Elsie Storch. "Instrumento para controle e prevenção de infecção de sítio cirúrgico em neurocirurgia." Universidade Federal Fluminense, 2016. https://app.uff.br/riuff/handle/1/3063.
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Mestrado Profissional em Enfermagem Assistencial
Estudo metodológico com abordagem quantitativa, com o objetivo de elaborar instrumento de checagem fundamentado no levantamento das ações para avaliação e acompanhamento dos pacientes submetidos à neurocirurgia, com vistas ao controle das Infecções do Sítio Cirúrgico (ISC), entendendo que o seu preenchimento se constitui em ação de vigilância realizada pelos profissionais da Comissão de Controle de Infecção Hospitalar (CCIH). Para tanto, este instrumento foi construído e validado de conforme cinco etapas metodológicas: 1- Levantamento bibliográfico; 2- Construção da primeira versão do instrumento com base na literatura; 3- Coleta de dados com a validação de conteúdo por juízes-especialistas; 4-Análise e discussão da validação realizada pelos juízes-especialistas; 5- Produção da versão final do instrumento. Na primeira etapa foi realizado levantamento bibliográfico por meio de revisão integrativa, com busca nas bases de dados LILACS, CINAHAL, PUBMED, LILACS e portal CAPES. Foram selecionados 23 artigos. Desta busca emergiram três categorias as quais deram origem à primeira versão do instrumento de checagem que foi subdividido em: ações pré operatória, intra operatória e pós operatória, com 24 itens a serem checados quanto à sua adequação. Para a etapa de validação, foram selecionados juízes especialistas com atuação no pré, intra ou pós operatório de neurocirurgia entre enfermeiros e médicos, cada profissional avaliando as questões pertinentes à sua prática. Para obtenção do consenso dos especialistas, foi utilizado um questionário com Escala do tipo Likert de quatro pontos, numeradas de 1 a 4, onde 1 corresponde à menor concordância, e 4, à maior concordância. Utilizou-se a análise com o cálculo de Índice de Validade de Conteúdo (IVC), onde foi encontrado 0,96. O instrumento demonstrou validade de conteúdo na opinião de especialistas. Conclui-se que este instrumento poderá facilitar os processos de trabalho dos profissionais da CCIH, possibilitando a vigilância de potenciais riscos ao paciente submetido à neurocirurgia
Methodological study with quantitative approach, with the aim of drawing up a reasoned check instrument in the assessment of actions for evaluation and follow-up of patients undergoing neurosurgery, with views to the control of surgical site infections (ISC), understand that your filling is performed by professional surveillance action of hospital infection control Committee (CCIH). For both, this instrument has been built and validated as five methodological steps: 1-bibliographic survey; 2-construction of the first version of the instrument based on literature; 3-data collection with content validation by judges-experts; 4-analysis and discussion of the validation performed by the judges-experts; 5-production of the final version of the instrument. In the first phase was carried out bibliographical through integrative review, with search in the databases LILACS, CINAHAL, PUBMED, LILACS and portal CAPES. 23 articles were selected. This search three categories emerged which gave rise to the first version of the instrument that was subdivided into checking: pre-operative actions, intra operative and post operative, with 24 items to be checked for appropriateness. For the validation step, judges were selected experts with expertise in pre, intra or post-operative neurosurgery between nurses and doctors, each professional assessing the issues pertinent to your practice. For obtaining the consensus of experts, it was used a questionnaire with Likert type scale of four points, numbered from 1 to 4, where 1 corresponds to the lowest agreement, and 4, the larger agreement. Analysis was used to calculate content Validity index (CVI), where he was found 0.96. The instrument demonstrated content validity in the opinion of experts. It is concluded that this instrument may facilitate work processes of the CCIH professionals, enabling the monitoring of potential risks to the patient submitted to Neurosurgery
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Moulton, Ethan David. "Influence of drill guide type and operator experience on accuracy of dental implant placement." Oklahoma City : [s.n.], 2006.
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