MMed, Family Medicine, University of the Witwatersrand, 2011 / Background Informed consent is required for any surgical procedure. It is a demonstration of a patient‟s agreement to have surgery performed. Many studies have considered the quality of informed consent in clinical trials. However, only few studies have assessed patients‟ understanding of the process of informed consent in clinical practice. This descriptive cross-sectional study has looked at patients‟ perceptions and understanding of informed consent process for surgical procedures. Aim To explore patients‟ perceptions on informed consent and ascertain if those who have signed for surgical procedures have adequate understanding of the informed consent process. Objectives 1. To ascertain patients‟ perceptions of the process of informed consent; 2. To determine patients‟ recollection of elements of this process that were considered when they signed the consent. 5 3. To explore if patients understand the meaning and implications of the informed consent process; 4. To determine whether patients obtained information about procedures from sources other than the healthcare workers; Methods This was a descriptive cross-sectional study conducted among patients admitted at Leratong hospital for elective surgery. A sample of patients (n=98) selected from those booked for elective surgery at Leratong theatres between April 2008 and June 2008 were interviewed. Different aspects of information were analysed. Specifically: social and demographic profile, formal education, previous medical and surgical history, perceptions of informed consent, process of informed consent and knowledge of the procedure‟s indication, risks and alternatives. Equally considered were sources and value of external medical information. Results Patients interviewed represented 5.5% of the total of those booked for elective surgery. The median similar to the modal age was 38 years, 58.2% being females. Only 4.1% had tertiary education, 32% did not reach secondary school of which 11.2% had no formal education at all. Concerning their prior medical /surgical background, 26.5% were on chronic medical treatment and 48% had previous surgery. More than two third (91%) of them had stayed in the hospital for more than 12 hours prior to surgery. 6 Only 27% perceived the signing of consent form as a proof that they understood the procedure. It was demonstrated that the higher the education level the better the perceptions of informed consent process (P=0.0006). More than 2/3 of patients needed further explanation in their mother tongue to understand the information. Seventy-four per cent did not read the consent form. The understanding of information was more likely to be checked when the information was given by a doctor than by a nursing sister (P=0.014). Only 8% admitted to know some alternatives to the proposed procedure, 13% of patients knew the risks. Formal education was not linked to better understanding of the informed consent process (P=0.245). Patients claiming to have received further information on the procedure from sources other than the healthcare system did not show an added advantage on understanding (P=0.152). The study has demonstrated the low level of understanding of informed consent process in this provincial public hospital. It has shown the public perceptions of the consent form, and the advantage granted by the formal education in this regards. Based on these results, it is therefore recommended that an approved translation of the consent form be made available to patients as an alternative to those who are not English speakers. A proper guideline should be established for physicians to ensure disclosure of information in language of choice of patients to obtain better informed consent.

This report focuses on the use of Watson's theory of human caring for Do Not Resuscitate (DNR) patients in acute medical-surgical wards. It discusses the dilemmas facing DNR patients and their nurses and explores the solutions to these dilemmas offered by Watson's theory. Traditional nursing practice places the nurse in a difficult situation by focusing on physical health. The report discusses the philosophical assumptions underlying Watson's theory. These assumptions led Watson to focus on nursing holistically, and to emphasise an integrated approach to nursing, which promotes the comfort of the patient physically, spiritually and emotionally. Her focus is on the broader aspects of caring such as involving the care domain of nursing, instead of the narrower view of nursing which focuses on care for the 'cure' only. This appproach is particularly relevant to DNR situations because these situations involve patients for whom there is no physical cure. Watson's holistic approach to caring offers the nurses of DNR patients guidelines for their practice and meaning for their nursing actions. Because current DNR decisions are often made by medical officers but implemented by nurses, it is the nurse who may be legally liable for the patient's death. This can cause anxiety for the nurses involved. Another cause of anxiety can be the traditional focus in nursing on physical cure. In the care of DNR patients, no such cure is possible. This can leave the nurse feeling distressed and incompetent. DNR the patients, may lack of autonomy and suffer feelings of insecurity. It is in these areas that Watson's ten carative factors can offer support, for both patients and nurses. / Master of Nursing

ABSTRACT BACKGROUND. There have been few studies conducted in hospitalized patients in Viet nam on the epidemiology of surgical site infections (SSIs) and the impact of hand hygiene practices. This study aimed to assess the impact of a bedside hand sanitizer program on SSIs in orthopaedic and neurosurgical patients. DESIGN. A prospective quasi-experimental study was conducted with an untreated control group design in neurosurgical patients and before-after design in orthopaedic patients. A cost analysis based on data derived from the results of this study was also performed. SETTING. Cho Ray Hospital, a tertiary university hospital in Ho Chi Minh City, Viet nam. PATIENTS. All patients admitted for operation between 11 July and 15 August 2000 (Before), and 14 July and 18 August 2001 (After) were included, except those who had undergone another operation within one month prior to admission or were admitted because of SSIs. INTERVENTION. Bedside hand sanitizers were introduced into the Orthopaedic ward and one Neurosurgical ward (Ward A) from September 2000. Training on proper use was also provided to ward staff. Another Neurosurgical ward (Ward B) was used as a control group with no intervention conducted. RESULTS. A total of 1368 patients were recruited into the study. After intervention, in Ward A of the neurosurgical department, the SSI rate between the two periods was reduced by 54% (8.3% to 3.8%; p=0.09). Superficial SSIs were eliminated after the intervention (p=0.007). Comparison between Ward A (intervention) and Ward B (control) showed that, before the intervention, there was no difference in incidence of SSI between the two wards (Ward A: 8.3%, Ward B: 7.2%, p=0.7); however, after intervention, the incidence of SSI in Ward A was significantly lower than Ward B (3.8% and 9.2%, p=0.04). For orthopaedic patients, the SSI rate between the two periods was reduced by 34% (14.8% to 9.8%; p=0.07). SSI patients had a median post-operative length of stay of 19 days longer than patients without SSI (p&lt0.001). Costs were 2.5 times higher in patients with in-hospital SSI compared to uninfected patients (p&lt0.001). Mean SSI-attributable costs were conservatively estimated at US$368 in neurosurgical patients and US$207 in the orthopaedic patients in the before period. SSIs were responsible for at least 14 percent of the annual budget before intervention. The savings per SSI prevented were estimated at US$332 in neurosurgical patients and US$157 in orthopaedic patients. Annual cost savings arising from the intervention were estimated at US$11,112 in orthopaedic patients and US$19,320 in neurosurgical patients. CONCLUSIONS. The incidence of SSI in the hospital was high. The use of hand sanitizers reduced SSI rates, particularly impacting on the incidence of superficial SSIs. The hand sanitization program was found to be a dominant intervention being both more effective and cost saving as compared with no intervention in both study departments. The use of bedside hand sanitizers should be encouraged in the hospitals in Viet nam, where there often is a lack of other hand-washing facilities. / PhD Doctorate

Photocopy (Vol. 1) / 2v. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 1981

This study aimed to determine how CMs used by surgical patients are managed in the hospital system by doctors and pharmacists and what patient and practitioner influences affect this management. Research design and method Five systematic reviews were conducted to investigate the peer-reviewed literature for information about Australians use of CM; overseas and Australian doctors and CM; surgical patients use of CM and safety information about CMs in surgery as a basis to design and conduct three surveys. Surveys of hospital doctors, pharmacists and surgical patients were used to obtain measurement of people's attitudes, perceptions, behaviours and usage of CMs. For healthcare practitioners, knowledge of complementary medicines (CMs), past training, current practice and interest in future practice of complementary therapies (CTs) and education was also investigated. Approximately 50% of surgical patients reported taking CMs in the 2 weeks prior to surgery and approximately 50% of these patients intended to continue use in hospital. The most commonly used CMs were: fish oil supplements, multivitamins, vitamin C and glucosamine supplements as well as some CMs considered to potentially increase bleeding risk or induce drug interactions. It was not uncommon for CMs to be used at the same time as prescription medicines. Most surgical patients in general self-prescribe their CMs or have them recommended by family and friends whereas medical practitioners were the main prescribers to cardiac surgery patients. Nearly 60% of patients using CMs in the 2 weeks prior to admission did not tell hospital staff about use. The main reason for non-disclosure was not being asked about use whereas fear of a negative response was rarely a concern. The most common sources of information surgery patients refer to were GPs, pharmacists and health food stores. Hospital doctors and pharmacists did not routinely refer to information sources about CMs safety. The majority of doctors and pharmacists did not routinely ask patients about CMs, or record usage information. They had little training and knowledge of the evidence of commonly used CMs and lacked confidence in dealing with CMs-related issues. Their attitude to CMs is moderately negative and many are wary of safety, efficacy and cost-effectiveness issues. The majority of practitioners considered some CTs as potentially useful, particularly acupuncture, massage and meditation whereas the medicinal CTs and chiropractic were considered potentially harmful. Most practitioners were interested in future education about CMs and CTs and some would consider practising CTs. Personal usage of CTs was low although there was substantial interest in receiving future treatment. Despite many strategically orientated initiatives developed in Australia to promote evidence based medicine (EBM) and quality use of medicines (QUM), it appears that CMs have been largely ignored and overlooked in the practice of Medicine and Pharmacy within the hospital system. Furthermore, it appears that in regards to CMs a 'don't ask, don't tell, don't know' culture exists within hospitals and that evidence based patient-centred care and concordance is not being achieved and potentially patient safety and wellbeing is being compromised.

Abstract Objectives: To 1) develop an electronic Knowledge Model (e-KM) of a surgical procedure, and 2) investigate the efficacy of the model in knowledge acquisition. The main purpose of the study was to develop a knowledge model of a surgical procedure (cyst removal) in an electronic medium such that it would enhance knowledge acquisition of surgical skills and to then determine the efficacy of the model. This is based on the Fits-Posner stage theory of learning motor skills that has been adopted in many surgical teaching models. Methods: Two randomized experimental studies were conducted in three phases; the total student sample size was 118 (Study 1=56, Study 2=62). In both studies, one group received face-to-face instruction from a professor while the second group employed the e-KM. Both groups were administered a multiple choice test. Analysis of variance (ANOVA), regression analysis and Pearson’s correlation methods were employed to analyze data. Descriptive statistics were used to analyze the frequency of access and its impact on test scores. Reliability was determined with Cronbach’s alpha. Results: The results showed no significant difference (p> .05) between e-KM the computer model and the surgeon instructor. There was a significant correlation between access time to video and knowledge (significant r ranged from .68 to .86, p < .01); however, increased time on task increase test scores, thus having a positive impact on knowledge acquisition. Discussion: Research findings indicate that e-KM performs as well as the human instructor and provides the additional advantage of unlimited online access through the Web while addressing many of the pressures currently plaguing medical schools such as limited resources (staff and facilities), cost of administration, access to knowledge, academic regulations, policies and competing curricula. Furthermore, e-KM provides a standardized teaching model, eliminating instructor variability and functioning as a dependable learning tool. Conclusion: In this thesis, I addressed the efficacy of e-KM on knowledge acquisition. While there was no significant difference between e-KM and the surgeon instructor on knowledge acquisition overall, students who accessed the e- KM multiple times achieved higher scores. / Experimental Medicine

<p>To compare the use of a piezoelectric with a standard surgical handpiece in third molar surgery. Thirty patients requiring removal of third molars were included in the study. Panoramic radiographs were used to assess the third molars. The patients were randomly subdivided and the split-mouth technique applied. In split-mouth design, divisions of the mouth, such as right (upper and lower) and left (upper and lower) quadrants constitute the experimental units, which are randomly assigned to two treatment groups. Each patient serves as his or her own control, which increases statistical efficiency (Siddiqi et al. 2010). Each side was operated with either a piezoelectric or a conventional handpiece. All aspects of preoperative care, general anaesthesia, surgery and postoperative care were standardized for the groups.</p>

During surgery, both anesthesia and tissue damage cause physiological stress responses in the body. The hypothalamic-pituitary-adrenal (HPA) axis is activated with increased levels of glucocorticoids. After surgical procedures the stress response may be a cause of postoperative morbidity and pre-emptive analgesic treatment can attenuate the stress response during the postoperative period. In laboratory animals, buprenorphine is a commonly used analgesic. Subcutaneous (s.c.) administration of buprenorphine is most common, but oral administration would be preferable in many cases, enabling administration without any handling of the rat. In this thesis we studied the surgical stress response in laboratory rats during surgery and in the postoperative period, and its modulation by s.c. injection and oral voluntary ingestion (VI) of buprenorphine. Corticosterone levels and the clinical parameters body weight, water intake and behavior were observed. The concentration of buprenorphine in plasma was measured as well as stock-related differences in postoperative recovery. During surgery and anesthesia there was a higher corticosterone release during a more severe surgery and corticosterone levels were reduced more effectively after buprenorphine treatment than after lidocaine treatment. Buprenorphine treatment, independent of the route of administration, led to better postoperative recovery in body weight and water intake compared to local anesthetics. VI of buprenorphine resulted in a suppression of plasma corticosterone levels compared to s.c. buprenorphine treatment and treatment with local anesthetics during the first day after surgical catheterization. The corticosterone levels of all buprenorphine treated groups had, by the second postoperative day, reverted to the normal diurnal rhythm of corticosterone secretion. Buprenorphine treatment increased locomotor activity in non-operated rats only. The effect of buprenorphine in operated rats could not be detected via the monitoring of locomotor activity or the time spent resting in the present study. Treatment with buprenorphine by VI has similar effects on postoperative plasma corticosterone levels in both Wistar and Sprague-Dawley rats. VI of buprenorphine resulted in a buprenorphine concentration in plasma at least as high as by s.c. treatment. Thus, administration by VI of buprenorphine appears to be an effective stress-reducing method for administrating postoperative analgesia to laboratory rats.

No description available.

The purpose of this project was to compare the recurrence rates of dermatofibrsarcoma protuberans (DFSP) treated with surgical excision (SE) and Mohs surgery (MS) at Yale. Patients were identified through the dermatopathology laboratory database and stratified by treatment. The following information was collected: age at onset, sex, disease state (primary presentation versus recurrence), tumor site, preoperative tumor size, postoperative defect size, excisional margin, duration of follow-up, and recurrence after treatment. Of the 30 patients, 14 were in the SE group, and 16 were in the MS group. There were no recurrences in the SE group, and there was 1 recurrence (6%) in the MS group, which occurred 37 months post-operatively. The average area of the tumors were 12.1 cm[exponent]2 [plus-minus] 16.1 (SE) and 5.3 cm[exponent]2 [plus-minus] 5.9 (MS), and the mean excisional margins were 3.8 cm [plus-minus] 1.6 (SE) and 1.4 cm [plus-minus] 0.5 (MS). The mean duration of follow-up in the SE group was 33 months [plus-minus] 41 (range: 1-116 months), and the mean duration of follow-up in the MS group was 26 months [plus-minus] 25 (range: 2 to 69 months.) Although the MS group had a higher recurrence rate than the SE group, using the recurrence rates to make meaningful conclusions about the efficacy of the two treatment modalities is limited by the small n[italicized], lack of randomization to either procedure, and duration of follow-up. Once these issues are addressed, recurrence rates must also be adjusted for patient and tumor characteristics, that are associated with higher recurrence rates.