The bulk of this thesis will be devoted to the development of the new anastomotic technique and descriptions of the various experimental systems designed to test the anastomosis, together with the results obtained.

Surgical site infections (SSIs) are a leading cause of morbidity and mortality in the United States. Researchers have demonstrated the impact that SSIs have on the healthcare system and the need to improve patient outcomes. The purpose of this project was to develop an educational program for the 8-member nursing staff of an outpatient vascular surgical office to help reduce the occurrence of SSI rates for patients seen pre and postoperatively after a noted increase in SSI rates at this clinical setting. Guided by the Fitzpatrick model, a group of 6 health care providers comprising 3 surgeons and 3 nurse practitioners served as content experts to conduct formative evaluation during development of the educational program. Members of the surgical office nursing staff completed a questionnaire; results were analyzed using descriptive analysis. Findings indicated that 100% of nursing staff had no on-site work training on basic signs and symptoms of infection and infection control; 100% of staff were not confident in assessment of the surgical site and addressing patient issues; and at least 50% reported that they lacked knowledge of proper wound care including bathing, dressing changes, and expected symptoms for healing and/or complications postoperatively. Educational materials were designed to address these gaps. This project might benefit the surgical center nursing staff by providing education to help reduce surgical site infection in vascular patients, and bring about positive social change by improving quality of life and patient outcomes for the vascular surgery patient through a reduction in the occurrence of SSIs.

Minimally invasive surgery improves patient recovery time, minimizes surgical complications, and leaves smaller incisions on the patient skin. Yet drawbacks prevent the complete adoption of these methods, including the lack of sensor feedback which can lead to unintended tissue damage during surgery. Soft robots have been developed to minimize damage compared to rigid counterparts, yet control techniques can become complicated and computationally taxing due to the flexibility of polymeric materials and hyper-redundancy in the system. Additionally, sensor integration in soft systems at a miniature scale and sensor feedback for closed-loop control remains challenging. Presented in this thesis is a millimeter-scale continuum robot created from monolithically fabricated, origami-inspired, fluidically actuated programmable composite actuator modules with embedded ionic resistive self-sensing. The modules consist of inflatable Teflon bellows surrounded by a rigid arm structure with flexible joints. Constraints in the rigid structure mechanically program different types of motion---translation, bending, and rototranslation. An ionic resistive sensing mode is embedded, using biocompatible working fluid at low voltage for position tracking. Modules are stacked in series to form a continuum robot and a model is developed and analyzed using sensor data to track tip position, with the reduced number of degrees of freedom in the system allowing for ease of modeling using robot joint kinematics. / 2025-05-24T00:00:00Z

Background: In Hirschsprung's disease, the trend has been for earlier performance of definitive surgery. In our institution, primary Swenson pull- through has become the preferred procedure. Methods: Retrospective review of the patients treated for Hirschsprung's disease from January 1988 through March 1998 was performed. Sixty-five patients were identified. Median values, analysis of variance and χ2 were used for comparisons. Results: The multiple-stage group (M, n = 47) was similar to the primary group (P, n = 18) for gestational age (40 v 39 weeks), time to meconium passage (37.9 v 35.5 hours), and age at diagnosis (median, M 27 v P 3.5 days). Age (median, M 268 v P 5 days) and weight (mean, M 9.4 v P 3.7 kg; P < .001) at pull-through were lower in the primary group. Length of stay (LOS) was lower in the primary group (mean, M 40,8 v P 20.3 days; P < .05). Operating time for pull- through was decreased in P (mean, M 305.2 v P 272.2 minutes; P = .02). Total complications were lower in the primary group (P = .03), with no differences in mortality or enterocolitis rates. Conclusions: At our institution there were no increases in total complications or enterocolitis in the group undergoing primary Swenson. Primary pull-through is a viable option for the treatment of Hirschsprung's disease.

No description available.

In regions of the world that experience a deficit of surgical care, educational initiatives can foster the development of a skilled surgical workforce. Implicit in training these health workers is the mandate to retain them in the country in order build capacity. Eyal’s framework presents ways in which locally relevant training can improve retention and outlines the ethical and pragmatic concerns of such initiatives. In 2006, Guyana established it’s first surgical training program, an example of locally relevant training. The University of Guyana Diploma of Surgery (UGDS) program was selected for this case study research. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of the UGDS program. The purposes of this dissertation research were two-fold. Firstly, it sought to understand how the UGDS program influences retention and the ways in which the UGDS members contribute to capacity building and the program’s sustainability. Secondly, this program evaluation provides a useful context to inform Eyal’s framework. 8 graduates, 2 trainees, 4 faculty members and 2 persons identified as policy makers were interviewed. Interviews were conducted face to face, and then transcribed. Surveys were administered to graduates and trainees and reflective reports and presentations were coded and analyzed. Overall, the data mapped fairly well onto Eyal’s framework. The results of the study suggest that the benefits and concerns Eyal outlines would be better represented along a continuum rather than being classified as either advantageous or disadvantageous with respect to retention. While Eyal’s claims generalize across settings, he should acknowledge this limitation and consider the important role that context plays. Overall, the results suggest that the UGDS program has positively influenced retention and capacity building. Key recommendations were made to the UGDS program that aim to improve retention and capacity building. As regions continue to face challenges associated with providing adequate surgical care, fostering retention and capacity building is recommended so that a sustainable surgical workforce can meet surgical needs. / Thesis / Candidate in Philosophy

No description available.

No description available.

Purpose: Administration of a mechanical bowel preparation (MBP) has long been standard before colorectal surgery with the aim of preventing complications such as surgical site infection (SSI). Newer evidence suggests that MBP does not reduce the risk of infection and that oral antibiotic (OA) use may be important in reducing post-operative infectious complications, however, there is little evidence comparing MBP, OA, and combination preparations. Our goal was to determine the relationship between type of bowel preparation and SSI in patients undergoing elective colorectal resections Methods: All patients within the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database undergoing elective colorectal resections from 2012 to 2013 were identified. The primary outcomes of interest were: any post-operative SSI, wound SSI, and organ/space SSI. Secondary outcomes were anastomotic leak, post-operative ileus, cardiac complications, renal complications, death, unplanned readmission, and length of stay (LOS). Univariate models were used to compare frequencies of patient and surgical characteristics across types of bowel preparation, and propensity adjustment was used to study the relationship between type of bowel preparation and all outcomes of interest. Results: Among the study sample, 25.5% received no bowel preparation, 40.8% received MBP, 3.3% received OA, and 30.4% received OA+MBP. A total of 1,844 patients (9.5%) developed any type of post-operative SSI. 1,231 (6.4%) developed a wound SSI and 672 (3.5%) developed an organ/space SSI. MBP was not associated with a reduced risk of any type of SSI compared to no bowel preparation. Both OA and OA+MBP were significantly associated with a decreased risk of any SSI and wound SSI compared to both no preparation and compared to MBP. No differences were observed for any SSI or wound SSI between OA and OA+MBP. Compared to no preparation, OA+MBP was associated with a decreased risk of anastomotic leak and post-operative ileus. No differences were observed between MBP and OA, or between these preparation methods and no preparation, for these secondary outcomes. There were no significant associations between type of bowel preparation and cardiac or renal complications, mortality, or readmissions. Both OA and OA+MBP were associated with a reduction in LOS. Conclusion: These results suggest that a combination oral and mechanical bowel preparation may be most effective at preventing SSI after elective colorectal resection and that OA alone may also be effective. Future prospective studies comparing combination and OA preparations may be warranted to explore this relationship further. / Clinical Research and Translational Medicine

The transition from medical school to residency is often considered the most difficult year for both teachers and learners. Learners report feeling underprepared, and some researchers have identified a decrease in patient safety during the first month of residency. These factors suggest learners could be better supported during this transition period. Previous research demonstrates that boot camps (BCs) at the onset of residency can improve learners’ confidence, knowledge, and some technical skills. However, little information has been published on how those BCs were developed and implemented, why BCs only improve some skills and not others, or the long-term impacts of BC programs. We used a Context, Input, Process, and Product program evaluation framework to develop, implement, and evaluate a simulation-based BC for novice surgical trainees that was aligned with the recent shift towards competency-based models of medical education. Next, we used a Convergent Parallel Mixed Methods approach to explore the longer-term impacts of the BC program. Lastly, we explored how effectively the Objective Structured Clinical Examination (OSCE), a “gold standard” measure of learner competence that was used in the BC program, truly captures clinical performance of novice trainees. This work demonstrates that incorporating a BC at the onset of residency can improve residents’ confidence and skill for up to two years into training, although adherence to sound pedagogical principles is critical. The BC also provided residents with the opportunity to participate in role clarification, acculturation, and social integration. Finally, we demonstrate that OSCEs may not always be the best way to measure BC effectiveness. The data presented in this thesis will provide educators with new insights on how to create and evaluate successful BC programs to support learners through the transition to residency; highlight new approaches for evaluating educational initiatives; and prompt a conversation about how assessment is being used in medical education. / Dissertation / Doctor of Philosophy (PhD) / From day one, new doctors are expected to adapt to new training environments, manage increased workloads, and make decisions about patient care, while working longer hours, and with less support than they had as medical students. As such, research suggests that new doctors often feel underprepared and stressed when entering residency. Furthermore, the ‘July Effect’, which suggests that fatal medical errors rise by 10% in the first month of residency compared with all other months, suggests that something needs to change. In this thesis, we sought to improve the way that surgical training programs approach the transition into residency, and look at the long-term impacts of these changes. Through three interrelated studies, we provide educators with information on how to develop, implement, and evaluate a simulation-based boot camp for new doctors; highlight new approaches for evaluating educational initiatives; and revisit how assessment is being used in medical education.