Made available in DSpace on 2016-05-02T13:55:15Z (GMT). No. of bitstreams: 1 Paulo Afonso da Silveira Ferreira.pdf: 81766 bytes, checksum: 29bb4f9fdb5b85f4aa4538727ae69dbe (MD5) Previous issue date: 2005-02-22 / Coordenacao de Aperfeicoamento de Pessoal de Nïvel Superior / Two surgical techniques were compared for yhe reparation of deep corneal lesions in dogs the flap from the upper bulbar conjunctiva and the superficial keratectomy (homologous transplant) Tem dog of both sexes with no defined breeds were used Considered healthy after a period of adaptation profylaxis and clinical evaluation the dogs were separated into two groups of five animal each They were clinically analized after the experiment through subjective observation with regard to blepharospasm opacities neovascularization adhesiveness and secretion (qualitavely and quantitatively) Both techniques were efficient for the reparation fo corneal lesions / Foi realizada a comparação de dois métodos cirúrgicos o flap a partir da conjuntiva bulbar superior e a ceratectomia superficial (transplante homólogo) para reparação de lesões corneanas profundas em cães Foram utilizados 10 cães de ambos os sexos sem raça definida considerados hígidos após um período de adaptação profilaxia e avaliação clínica Os animais foram divididos em dois grupos com 5 animais cada Foram analizados clinicamente após o experimento através de observação subjetiva em relação a blefaroespasmo opacidade neovascularização adesividade e secreção (qualitativamente e quantitativamente) Não houve diferença significativa em relação aos parâmetros mensurados Ambas as técnicas mostraram-se eficientes para a reparação de lesões corneanas

In recent years there has emerged a new trend focused on the body image in the Western countries. Our society is concerned with people's physical appearance and ideal body image. As consequence of this trend, two businesses emerge: fitness centers and plastic surgery clinics. Traditionally the consumers' expenditure in these services and goods has been considered a luxury especially during the economic slowdown. However, in the recent times, (at end of 2000s both service sectors are showing an increasing trend in terms of activity and business size). Thus, customers have seen the practice of fitness and plastic surgery procedures as a necessity rather than a luxury. The two kinds of products considered: fitness practice and plastic surgery procedures are of different nature; however they share several commonalities from the analysis point of view. In particular, referred to the fitness practice business, this involves a parallel increase of related economic sectors such as sports clothing, energy drinks and sports equipment. Related to the Spanish population who exercise regularly, this has evolved from 27% in 2005 to 35% in 2010, which shows a significant increase of the population sportive practices. A significant example of this trend is the fact that in 2009 the 74% of the Spanish public gyms had a fitness room for bodybuilding. On contrast, related to the market of plastic surgery measured by volume of activity, Spain occupies the level 13th position of the international ranking, which is headed by USA. The plastic surgery market embraces low invasive (non surgical) and high invasive (surgical) plastic surgery procedures; between both types, more than 300,000 thousands procedures are performed annually mainly by women in Spain. / Al-Kasadi, MSS. (2014). Modeling the propagation of the consumption of two emergent businesses: Fitness Practice and Plastic Surgery [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/39795 / TESIS

Surgeon expertise can be difficult to capture through direct robot programming. Deep imitation learning (DIL) is a popular method for teaching robots to autonomously execute tasks through learning from demonstrations. DIL approaches have been previously applied to surgical automation. However, previous approaches do not consider the full range of robot dexterous motion required in general surgical task, by leaving out tooltip rotation changes or modeling one robotic arm only. Hence, they are not directly applicable for tasks that require rotation and dual-arm collaboration such as debridement. We propose to address this limitation by formulating a DIL approach for the execution of dual-arm surgical tasks including changes in tooltip orientation, position and gripper actions.<br><br>In this thesis, a framework for multi-step surgical task automation is designed and implemented by leveraging deep imitation learning. The framework optimizes Recurrent Neural Networks (RNNs) for the execution of the whole surgical tasks while considering tooltip translations, rotations as well as gripper actions. The network architecture proposed implicitly optimizes for the interaction between two robotic arms as opposed to modeling each arm independently. The networks were trained directly from the human demonstrations and do not require to create task specific hand-crafted models or to manually segment the demonstrations.<br><br>The proposed framework was implemented and evaluated in simulation for two relevant surgical tasks, the peg transfer task and the surgical debridement. The tasks were tested under random initial conditions to challenge the robustness of the networks to generalize to variable settings. The performance of the framework was assessed using task and subtask success as well as a set of quantitative metrics. Experimental evaluation showed favorable results for automating surgical tasks under variable conditions for the surgical debridement, which obtained a task success rate comparable to the human task success. For the peg transfer task, the framework displayed moderate overall task success. Quantitative metrics indicate that the robot generated trajectories possess similar or better motion economy that the human demonstrations.

Bakgrund: Den svenska Försvarsmakten har en lång tradition av att rekrytera sjukvårdspersonal till fredsbevarande insatser från den civila arbetsmarknaden. Sjukvårdspersonalen består exempelvis av specialistsjuksköterskor inom anestesi- och operationssjukvård. Under insatserna så arbetar specialistsjuksköterskorna vid små rörliga enheter eller fasta baser. För att klara av de krav som ställs på dem så genomgår specialistsjuksköterskorna insatsspecifik utbildning inför insatsen.  Motiv: Inom den svenska sjukvården finns en grupp med specialistsjuksköterskor vars erfarenheter från fredsbevarande insatser ej anses väl utforskade enligt författarna. Genom att studera dessa erfarenheter kan specialistsjuksköterskornas kunnande om exempelvis traumaomhändertagande och deras ökade förmåga till självständighet tas till vara inom den civila sjukvården. Detta skulle sedermera kunna leda till ett förbättrat patientomhändertagande.   Syfte: Syftet var att beskriva anestesi- och operationssjuksköterskors erfarenheter av att arbeta inom svenska Försvarsmakten utomlands under pågående internationell insats.  Metod: Tolv semistrukturerade intervjuer av anestesi- och operationssjuksköterskor genomfördes. Intervjudeltagarna valdes ut genom ett bekvämlighetsurval och rekryteringen skedde digitalt över hela Sverige. Intervjuerna transkriberades och kvalitativ innehållsanalys med ett manifest förhållningssätt användes för att analysera resultatet.  Resultat: Analysen resulterade i fyra domäner: ”Att genomföra en insats”, ” Utbildning och utveckling”, ”Händelser under insats” och ”Mental och fysisk påfrestning”.  Konklusion: I studien framkommer det att specialistsjuksköterskorna valde att åka på en fredsbevarande insats för att utmana sig själva i en krävande miljö. De utbildningar de genomförde innan insatsen samt deras erfarenheter från insatserna ökade deras kompetens. Detta gjorde dem till bättre specialistsjuksköterskor i den civila sjukvården. Möjligheter till återhämtning fanns både under och efter insats. Dock så framhöll flertalet av specialistsjuksköterskorna den mentala påfrestning som det innebär att genomföra en fredsbevarande insats. / Background: The Swedish armed forces have a long tradition of recruiting medical personnel to peacekeeping missions from the civilian market. This personnel includes nurse anesthetists and surgical nurses. During the peace keeping missions the nurse specialists work in small moving units or at camps. To meet the military medical requirements, the nurse specialists undergo specific training prior to the peacekeeping mission.  Motive: In Swedish healthcare there is a group of specialist nurses whose experiences from peacekeeping missions are not considered well explored according to the authors. By studying these experiences, the specialist nurses’ knowledge of, for example, trauma care and their increased ability to work independently can be utilized by civilian healthcare. This could lead to improved patient care.    Aim: The aim of this study was to describe nurse anesthetists and surgical nurses’ experiences of working in the Swedish armed forces abroad during peacekeeping missions.  Methods: Twelve semi-structured interviews of nurse anesthetists and surgical nurses were conducted. The participants were selected through convenience selection and recruited digitally throughout Sweden. The interviews were transcribed, and qualitative content analysis with a manifest approach was used to analyze the results.  Results: The analysis resulted in four domains: "To carry out a mission", "Education and development", "Events during a mission" and "Mental and physical stress".   Conclusion: This study shows that nurse specialists chose to go on a peacekeeping mission to challenge themselves in a demanding environment. The training they completed before the peacekeeping mission and the experiences they acquired during the missions increased their competence. This made them better specialist nurses in civilian healthcare. Opportunities for recovery were available both during and after the peacekeeping mission. However, most specialist nurses emphasized the mental strain involved in carrying out peacekeeping missions.

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Background Force feedback is a critical element for performing and learning surgical suturing skill. Force feedback is impoverished or not present at all in non-open surgery (i.e., in simulation, laparoscopic, and robotic-assisted surgery), but it can be augmented using different modalities. This rapid, systematic review examines how the modality of delivering force feedback influences the performance and learning of surgical suturing skills. Methods An electronic search was performed on PubMed/MEDLINE, Web of Science, and Embase databases to identify relevant articles. The results were synthesized using vote counting based on direction of effect. Results A total of nine studies of medium-to-low quality were included. The synthesis of results suggests that the visual modality could be more beneficial than the tactile and auditory modalities in improving force control and that auditory and tactile modalities could be more beneficial than the visual modality in improving suturing performance. Results are mixed and unclear with regards to how modality affects the reduction of force magnitude and unclear when unimodal was compared to multimodal feedback. The studies have a general low level of evidence. Conclusion The low number of studies with low methodological quality and low level of evidence (most were proof of concept) prevents us from drawing any meaningful conclusion and as such it is currently unknown whether and how force feedback modality influences surgical suturing skill. Speculatively, the visual modality may be more beneficial for improving the control of exerted force, while auditory and tactile modalities may be more effective in improving the overall suturing performance. We consider the issue of feedback modality to be highly relevant in this field, and we encourage future research to conduct further investigation integrating principles from learning psychology and neuroscience: identify feedback goal, context, and skill level and then design and compare feedback modalities accordingly.

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<p>Training and ergonomics evaluation for laparoscopic surgery is an important tool for the assessment of trainees. Timely and objective assessment helps surgeons improve hand dexterity and movement precision, and perform surgery in an ergonomic manner. Traditionally, skill is evaluated by expert surgeons observing trainees, but this approach is both expensive and subjective. The approach proposed by this research employs an Ascension 3DGuidance trakSTAR system that captures the positions and orientations of hand and laparoscopic tool trajectories. Recorded trajectories are automatically analysed to extract meaningful feedback for training evaluation using statistical and machine learning methods.</p> <p>The data are acquired while a subject performs a standardized task such as peg transfer or suturing. The system records laproscopic instrument positions, hand, forearms, elbows trajectories, as well as wrist angles. We propose several metrics that attempt to objectively quantify the skill level or ergonomics of the procedure. The metrics for surgical skills are based on surgical instrument tip trajectories, whereas the ergonomics metric uses wrist angles. These metrics have been developed using statistical and machine learning methods.</p> <p>The metrics have been experimentally evaluated by using a population of seven first year postgraduate urology residents, one general surgery resident, and eight fourth year postgraduate urology residents and fellows. The machine learning approach discriminated correctly in 73% of cases between experts and novices. The machine learning approach applied to ergonomics data correctly discriminates between experts and novices in 88% of the cases for the peg transfer task and 75% for the suturing task. We also propose a method to derive a competency-based score using either statistical or machine learning derived metrics.</p> <p>Initial experimental data show that the proposed methods discriminate between the skills and ergonomics of expert and novice surgeons. The proposed system can be a valuable tool for research and training evaluation in laparoscopic surgery.</p> / Master of Applied Science (MASc)

Master of Science / Department of Clinical Sciences / James D. Lillich / Objective - To compare the biomechanical characteristics of the currently recommended (CR) technique and a less invasive (LI) surgical approach for arthrodesis of the proximal interphalangeal joint (PIPJ). Additionally, to describe a technique for cartilage removal and disruption of the subchondral bone. Study design - Randomized paired limb design for biomechanical comparison. Cartilage removal and subchondral bone disruption was accomplished using an orthopedic drill bit. Sample Population – 76 cadaver limbs. Methods - Cadaver PIPJs were drilled using a 3.5mm, 4.5mm or 5.5mm drill bit. Articular surfaces were digitally photographed and analyzed. Other paired PIPJs were arthrodesed using either the CR or the LI surgical technique. Implants consisted of a 3-hole DCP and two 5.5mm transarticular screws. Constructs were tested to failure in dorso-palmar/plantar and latero-medial in single cycle 3-point bending. The maximum load and yield load was measured and composite stiffness was calculated and statistically compared. Results - The LI technique had significantly greater mean yield load (11.3 ± 2.8 kN vs. 7.68 ± 1.1 kN, P=0.008) and mean maximum load (13.5 ± 3.1 kN vs. 10.1 ± 1.94 kN, P= 0.02) under latero-medial bending. Under dorso-palmar/plantar bending there was no statistical difference between the surgical approaches (P=0.5). The 4.5mm drill bit removed 42% ± 7.3 of the cartilage and disrupted subchondral bone. The LI technique had a decreased surgical time (19 ± 3 min.) when compared with the CR (31 ± 3 min.) technique. Conclusion – The LI technique results in a stronger composite as measured in 3-point bending, loaded to failure. Clinical Relevance – The LI surgical technique may be considered for clinical cases requiring arthrodesis of the PIPJ as there is no reduction in composite strength.

The shoulder joint is a multi-axis synovial ball and socket joint, by having a loose connection it provides a wide degree of freedom; however this means the joint lacks robustness and is prone to damage most commonly from shoulder dislocations. A rotator cuff tear causes major problems in allowing the arm to be lifted beyond a 90˚ abduction position. It is common that this insufficiency aggravates arthritis problems that may have occurred due the rotator cuff tear problem. The study focuses on investigating, describing and quantifying the implant geometric properties to evaluate the joint contact characteristics and use the outcome in redesign the implant. The investigation presents results of finite element analysis on a heavy loading condition on a Verso (reverse) shoulder implant which is validated using experimental data on the same prosthesis. The results are validated within a 5% error margin. A Verso implant is modelled using MIMICS (materialise) and imported into ABAQUS (Simulia, Providence, USA) to analyse the distribution of stress, strain and displacement across the Humerus and Scapula. Details of interaction, boundary conditions, loads and material properties are all obtained from research and applied to the model to portray realistic behaviour. The resulting stress, strain and displacement from this simulation are indicated to show the magnitude and distribution across the entire bone region. This validates the benefits of a Verso implant compared to conventional and long stemmed reverse shoulder implants, as well as provide a basis from which improved designs can be built upon and allow further accurate methods to be developed in analysing shoulder implants effectively.