No description available.

Modern image-guided surgery aids minimally-invasive, high-precision procedures that increase efficacy of treatment. This thesis investigates two research aims to improve precision and integration of intraoperative cone-beam CT (CBCT) imaging in guidance of head and neck (H&N) surgery. First, marker configurations were examined to identify arrangements that minimize target registration error (TRE). Best arrangements minimized the distance between the configuration centroid and surgical target while maximizing marker separation. Configurations of few markers could minimized TRE with more markers providing improved uniformity. Second, an algorithm for automatic registration of image and world reference frames was pursued to streamline integration of CBCT with real-time tracking and provide automatic updates per scan. Markers visible to the tracking and imaging systems are automatically co-localized and registered with equivalent accuracy and superior reproducibility compared to conventional registration. Such work helps the implementation of CBCT in H&N surgery to maximize surgical precision and exploit intraoperative image guidance.

Modern image-guided surgery aids minimally-invasive, high-precision procedures that increase efficacy of treatment. This thesis investigates two research aims to improve precision and integration of intraoperative cone-beam CT (CBCT) imaging in guidance of head and neck (H&N) surgery. First, marker configurations were examined to identify arrangements that minimize target registration error (TRE). Best arrangements minimized the distance between the configuration centroid and surgical target while maximizing marker separation. Configurations of few markers could minimized TRE with more markers providing improved uniformity. Second, an algorithm for automatic registration of image and world reference frames was pursued to streamline integration of CBCT with real-time tracking and provide automatic updates per scan. Markers visible to the tracking and imaging systems are automatically co-localized and registered with equivalent accuracy and superior reproducibility compared to conventional registration. Such work helps the implementation of CBCT in H&N surgery to maximize surgical precision and exploit intraoperative image guidance.

This thesis is an investigation of the use of various infection control practices, including hand hygiene, in companion animal veterinary clinics and a public petting zoo. Video observation of petting zoo visitors found overall hand hygiene compliance was 58% (340/583). Improved signage with offering hand sanitizer (odds ratio (OR) 3.38, p<0.001) and verbal hand hygiene reminders (OR 1.73, p=0.037) had a significant positive association with compliance. Video observation of preoperative preparation practices in ten veterinary clinics found contact times with preparatory solutions were often shorter than recommended: 10-462s for patients and 7-529s for surgeons using soap and water. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed. A survey of veterinary staff found that over 80% of respondents ranked hand hygiene as of high importance in all clinical situations queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Video observation of various infection control practices in 47 veterinary clinics found that poor sharps handling practices were common, yet only one needlestick injury was observed. Exam tables were cleaned following 76% (2015/2646) of appointments, and contact time with spray used to do so ranged from 0-4611s (mean 39s, median 9s). Appropriate personal protective clothing was worn for 72% (3518/4903) of staff-animal contacts. Video observation of hand hygiene practices in 38 veterinary clinics found overall hand hygiene compliance was 14% (1473/10894). Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4s (median 2s, range 1-49s). A hand hygiene poster campaign had no significant effect on compliance. There is clearly room for improvement with regard to many frequently used infection control measures in veterinary clinics in Ontario. Use of active interventions to improve practices such as hand hygiene should be investigated in clinics, as such measures have been effective in other settings. The video monitoring system used in this research may be a useful tool for conducting these and similar studies in the future. A better infection control culture needs to be established in veterinary medicine. Accompanying data files are located at: http://hdl.handle.net/10864/10445 / Canadian Institutes of Health Research (CIHR), Ontario Veterinary College Pet Trust, Canada Foundation for Innovation

Ovarian torsion is a rare children’s acute abdominal disease which is difficult to diagnose and there is no consensus among scientists how to treat it. This is the first scientific research in Lithuania which analyses causes, optimal diagnostic criteria, the strategy, methods of surgical treatment and follow-up results of ovarian torsion in children. This is the largest research of the follow-up results of the conservative surgical treatment in the world. It was identified during the research that as many as 54.7% of the causes of ovarian torsion were congenital anatomical. In the case of 45.3% of the patients ovarian torsion was caused by pathological derivatives. In patients before menarche there were statistically significantly more mature teratomas (p=0.03). No specific symptoms of ovarian torsion in children were identified. Prior to the surgery, ultrasonography showed that the twisted ovary was on average 21.48 (17.06) times larger than the healthy ovary. Leukocytosis and ovarian blood flow disorders were statistically significantly more common in the case of ovarectomy. None of the girls who underwent detorsion with the ovary left in the abdominal cavity had thromboembolism or peritonitis; no malignant tumour was detected in any girl. According to the histopathological findings, no necrosis was detected in 14 (82.35%) removed ovaries, therefore they could be salvaged. Normal ovarian anatomy and folliculogenesis were retained in 95.24% of girls and women who were... [to full text] / Kiaušidžių užsisukimas – reta ūminė vaikų pilvo organų liga, kurios diagnostika sudėtinga, o dėl gydymo mokslininkai vis dar nesutaria. Tai pirmasis Lietuvoje mokslinis tyrimas, analizuojantis vaikų kiaušidžių užsisukimo priežastis, optimalius diagnostikos kriterijus, chirurginio gydymo taktiką ir metodus bei atokiuosius rezultatus. Šis atokiųjų konservatyvaus chirurginio gydymo rezultatų tyrimas yra didžiausias pasaulyje. Darbe nustatyta, kad 54,7 % kiaušidės užsisukimo priežasčių buvo įgimtos anatominės; 45,3 % ligonių kiaušidė užsisuko dėl patologinių darinių. Ligonėms iki menarchės statistiškai patikimai dažniau rasta brandžių teratomų (p=0,03). Specifinių vaikų kiaušidės užsisukimo simptomų ir požymių nenustatyta. Iki operacijos, tiriant echoskopu, užsisukusi kiaušidė buvo didesnė nei sveikoji vidutiniškai 21,48 (17,06) karto. Leukocitozė ir kiaušidės kraujotakos sutrikimai statistiškai patikimai dažnesni mergaitėms, kurioms kiaušidė pašalinta. Nė vienai mergaitei, kuriai kiaušidė buvo atsukta ir palikta pilvo ertmėje, nebuvo trombembolijos ir peritonito, nė vienai nerasta piktybinio naviko. Remiantis patologijos histologijos tyrimais, nustatyta, kad 14-oje (82,35 %) pašalintų kiaušidžių nekrozės ir patologinių darinių nebuvo, todėl jos galėjo būti išsaugotos. Patikrintų 95,24 % mergaičių ir moterų atsuktos kiaušidės anatomija ir folikulogenezė išliko normali.

Kiaušidžių užsisukimas – reta ūminė vaikų pilvo organų liga, kurios diagnostika sudėtinga, o dėl gydymo mokslininkai vis dar nesutaria. Tai pirmasis Lietuvoje mokslinis tyrimas, analizuojantis vaikų kiaušidžių užsisukimo priežastis, optimalius diagnostikos kriterijus, chirurginio gydymo taktiką ir metodus bei atokiuosius rezultatus. Šis atokiųjų konservatyvaus chirurginio gydymo rezultatų tyrimas yra didžiausias pasaulyje. Darbe nustatyta, kad 54,7 % kiaušidės užsisukimo priežasčių buvo įgimtos anatominės; 45,3 % ligonių kiaušidė užsisuko dėl patologinių darinių. Ligonėms iki menarchės statistiškai patikimai dažniau rasta brandžių teratomų (p=0,03). Specifinių vaikų kiaušidės užsisukimo simptomų ir požymių nenustatyta. Iki operacijos, tiriant echoskopu, užsisukusi kiaušidė buvo didesnė nei sveikoji vidutiniškai 21,48 (17,06) karto. Leukocitozė ir kiaušidės kraujotakos sutrikimai statistiškai patikimai dažnesni mergaitėms, kurioms kiaušidė pašalinta. Nė vienai mergaitei, kuriai kiaušidė buvo atsukta ir palikta pilvo ertmėje, nebuvo trombembolijos ir peritonito, nė vienai nerasta piktybinio naviko. Remiantis patologijos histologijos tyrimais, nustatyta, kad 14-oje (82,35 %) pašalintų kiaušidžių nekrozės ir patologinių darinių nebuvo, todėl jos galėjo būti išsaugotos. Patikrintų 95,24 % mergaičių ir moterų atsuktos kiaušidės anatomija ir folikulogenezė išliko normali. / Ovarian torsion is a rare children’s acute abdominal disease which is difficult to diagnose and there is no consensus among scientists how to treat it. This is the first scientific research in Lithuania which analyses causes, optimal diagnostic criteria, the strategy, methods of surgical treatment and follow-up results of ovarian torsion in children. This is the largest research of the follow-up results of the conservative surgical treatment in the world. It was identified during the research that as many as 54.7% of the causes of ovarian torsion were congenital anatomical. In the case of 45.3% of the patients ovarian torsion was caused by pathological derivatives. In patients before menarche there were statistically significantly more mature teratomas (p=0.03). No specific symptoms of ovarian torsion in children were identified. Prior to the surgery, ultrasonography showed that the twisted ovary was on average 21.48 (17.06) times larger than the healthy ovary. Leukocytosis and ovarian blood flow disorders were statistically significantly more common in the case of ovarectomy. None of the girls who underwent detorsion with the ovary left in the abdominal cavity had thromboembolism or peritonitis; no malignant tumour was detected in any girl. According to the histopathological findings, no necrosis was detected in 14 (82.35%) removed ovaries, therefore they could be salvaged. Normal ovarian anatomy and folliculogenesis were retained in 95.24% of girls and women who were... [to full text]

Syftet för denna studie var att studera förekomsten av postoperativa sårinfektioner hos patienter som genomgått kärloperation med inguinal incision under åren 2008 till och med mars månad 2013. Undersöka skillnader gällande riskfaktorer inom studerad patientgrupp för förekomst av postoperativ sårinfektion samt studera om patienter som utfört endovaskulär metod under samma vårdtillfälle oftare drabbades av postoperativ sårinfektion än de patienter som inte genomgått endovaskulär metod under samma vårdtillfälle. Metoden som användes var granskning av patientjournaler efter utifrån studien utvalda specifika operationskoder. Granskningen av de 54 patientjournalerna skedde med hjälp av egenmodifierad tidigare använd granskningsmall. Studieresultatet visar att förekomsten av postoperativa sårinfektioner hos den studerade patientgruppen uppgår till 22,2 %. Skillnader mellan infektion och utförd endovaskulär metod kunde ses men inte påvisas med statistisk signifikans. Studien visade också att kvinnor oftare än män drabbas av postoperativ sårinfektion. Slutsatsen är att ungefär var femte patient i studien, som genomgått denna typ av kirurgi, ådrog sig en postoperativ sårinfektion och att många av dessa ledde till en kostsam postoperativ sårbehandling med Vacuum assisted closure, (VAC). / The purpose of this study was to investigate the incidence of postoperative wound infections in patients undergoing vascular surgery with inguinal incision in the years 2008 until March 2013. Examining differences in the risk factors in the studied group of patients occurrence of postoperative wound infection and to study whether patients who performed endovascular method during the same hospitalization more often suffered postoperative wound infection than patients who did not undergo endovascular method during the same hospitalization. The method used was the examination of patient records for the study, based on selected specific audit template. Study results show that the incidence of postoperative wound infections in the studied patient population amounts to 22,2 %. Differences between infection and performed endovascular method could be seen but not detected with statistical significance. The study also showed that women more often than men suffer from postoperative wound infection. The conclusion is that approximately one in five patients in the study who have undergone this type of surgery, suffered a postoperative wound infection and that many of these led to a costly postoperative wound Vacuum Assisted Closure (VAC).

No description available.

This research has been defined in response to the Winnipeg children's hospital (WCH) challenges such as long waiting times, delays and cancellations in surgical flow. Preliminary studies on the surgical flow revealed that definition and implementation of successful process improvement projects (PIPs) along with application of an efficient master surgical schedule (MSS) are efficient solutions to the critical problems in WCH. In the first phase of this work, a process improvement program including three major PIPs, is defined and implemented in WCH in order to improve the efficiency of the processes providing surgical service for patients. In the second phase, two new multi-objective mathematical models are presented to develop efficient MSSs for operating room department (OR) in WCH.

Consolidation of Acute Care Surgical Services (ACSS) as a response to multiple challenges in providing timely and high-quality emergency services is a growing interest among healthcare policymakers. However, very little is known about patient experiences within this system. This study explores patient perceptions of their acute care surgical experiences within a consolidated ACSS program. A qualitative study guided by the tenets of Appreciative Inquiry was conducted. Data were collected by means of semi-structured interviews and personal stories. Thirteen participants were involved, seven females and six males of varying ages; all underwent emergency surgeries including appendectomy, cholecystectomy, and small bowel obstruction surgery. Findings suggest that clear and effective communication, excellent nursing care, timely access to surgical services, continuity of care, patient safety, transfer to an Acute Care Surgical (ACS) site, communication regarding transportation, and process of admission to an ACS site play important roles in patient experiences within a consolidated ACSS.