The surgical robot experienced rapid uptake throughout hospitals in the US despite lack of clinical evidence that it is superior to existing methods and undeterred by its high cost. This type of technology may be a “weapon” in the medical arms race hypothesis which asserts that competition among hospitals may be welfare reducing wherein it encourages resource use that is not commensurate with beneficial health outcomes. This paper is a case-study of the diffusion of the surgical robot among hospitals in Florida. We address the medical arms race hypothesis directly by investigating whether a hospital’s decision to adopt a robot is a function of the neighboring, competing hospitals’ decisions to do so. Using a spatial autoregressive probit model, we find that the spatial coefficient is significant and negative. That is, when neighboring hospitals operate a robot, a given hospital is less likely to operate one. Indeed, hospitals appear to consider the behavior of rival hospitals, but not in a way that would be consistent with a medical arms race. Support is lent to the hypothesis that as more hospitals become providers of robotic-assisted surgery, the less profitable it becomes to enter the market.

Magister Curationis - MCur / Academic hospitals do recognise that all patients have basic human needs. Nurses have been obliged to pay attention to conditions that destabilise patient's health. An academic hospital in the Western Cape is dedicated to living up to its vision to deliver excellent nursing services, which include the fulfilment of the basic needs of patients who are making use of surgical emergency department. Emergency surgical departments should be created in a manner that provides safety and comfort to patients. Patient satisfaction is influenced by the manner in which their expectations about the successful addressing of their basic needs are met. At the moment, the extent of meeting these basic needs during the delivery of nursing care in the surgical emergency department of the academic hospital is unclear. The purpose of this study was to explore and describe the perceptions of patients about the fulfilment of their basic needs during nursing care in a surgical emergency department at an academic hospital in the Western Cape. The study was conducted according to a quantitative non-experimental descriptive survey design. A convenience sampling method was used to select patients (n = 150) after they were discharged from a surgical emergency department. A self-administered questionnaire was compiled within the framework of Alderfer's theory, with closed and a few open questions, that was for distribution to respondents. Descriptive statistics were extracted. The responses to items were indicated on a continuum starting at 1 (never) to 7 (always) on a 5-point Likert scale. Respondents signed informed consent before they completed the instrument in a private room that took around 30 minutes. In this study, validity and reliability were maintained during the research process, and ethical principles were adhered to. Descriptive data was presented through mean values and standard deviations and a factor analysis performed. The findings were presented according to six factors that indicated that the responses varied on the basic existence, relatedness and growth needs of patients in a surgical emergency unit. From the findings, recommendation was described for the operational nursing managers in the surgical emergency department to take action during addressing patients' basic needs in the delivery of nursing care. It can be concluded that patients perceive that many of their basic needs are not being met while receiving surgical emergency care.

M.Cur. / Refined equipment, heightened technology and improved surgical techniques in the field of ophthalmology have all resulted in a marked shift towards ambulatory, outpatient surgical treatment and day surgery and therefore shortened hospital stay for patients. This leaves patients and their next-of-kin with the responsibility for own care after treatment. To be able to accomplish this, they need adequate and relevant health education. Nurses are faced with the responsibility of imparting this information in order to enable patients to make decisions or choices that will address their health behaviour and thus influence their lifestyle. It is therefore necessary to use strategies of health education that will bring about this change of behaviour. One such strategy is values clarification. The aim of this study was to explore and describe the health education experience of patients undergoing ophthalmic day surgery before and after the health educator attends a workshop in values clarification. The study was conducted in two phases, with a workshop in values clarification as intervention between the phases. During Phase 1, phenomenological interviews were held with patients before the health educator attended the workshop in values clarification. The health educator then attended a workshop in values clarification. Thereafter, phenomenological interviews were again held with patients. Data analysis was done and findings were compared and discussed together with a literature control. The trustworthiness of the study was determined according to Lincoln and Guba's model. Conclusions and recommendations were made and guidelines, based on findings, were set for preoperative health education of patients undergoing ophthalmic surgery.

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Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

Surgery precipitates a hypercoagulable state and has been shown to increase the development of cancer metastases in animal models, however mechanism(s) responsible for this are largely unknown. We hypothesize that the prometastatic effect of surgery may be secondary to postoperative hypercoagulable state. Surgical stress was induced in mice by partial hepatectomy or nephrectomy, preceded by intravenous injection of CT26-LacZ or B16F10-LacZ cells to establish pulmonary metastases with or without perioperative anticoagulation and their lung tumor cell emboli (TCE) were quantified. Fibrinogen and platelets were fluorescently labeled prior to surgical stress to evaluate TCE-associated fibrin and platelet clots. Surgery significantly increased metastases while anticoagulation with five different agents attenuated this effect. Fibrin and platelet clots were associated with TCE significantly more frequently in surgically stressed mice. Surgery promotes the formation of fibrin and platelet clots around TCE and this appears to be the mechanism for the increase in metastases seen following surgery.

The thesis focuses on a model that seeks to address patient scheduling step of the surgical scheduling process to determine the number of surgeries to perform in a given day. Specifically, provided a master schedule that provides a cyclic breakdown of total OR availability into specific daily allocations to each surgical specialty, we look to provide a scheduling policy for all surgeries that minimizes a combination of the lead time between patient request and surgery date, overtime in the ORs and congestion in the wards. We cast the problem of generating optimal control strategies into the framework of Markov Decision Process (MDP). The Approximate Dynamic Programming (ADP) approach has been employed to solving the model which would otherwise be intractable due to the size of the state space. We assess performance of resulting policy and quality of the driven policy through simulation and we provide our policy insights and conclusions.

Solid malignancies in cancer patients require surgical intervention; however, surgery has been shown to promote the metastatic potential of tumour cells. Surgery-induced impairment of adaptive immunity is poorly understood, thus, our aim is to characterize the impact of surgery on tumour antigen-specific cytotoxic T lymphocyte function. To generate anti-tumour immunity, we adopted a C57/B6 model of B16 melanoma immunized with intramuscular (IM) AdhDCT, an adenovirus expressing the melanoma-associated antigen human dopachrome tautomerase (hDCT). Surgical stress was induced by left abdominal nephrectomy. We found that surgery reduces overall survival in AdhDCT-immunized mice, whereas those that did not undergo surgery were cured of their tumours. Surgical stress also decreases both the proportion and absolute spleen numbers of DCT-specific IFN-gamma+ CD8+ T-cells by over 2-fold. We have shown that perioperative suppression of antigen-specific T-cells can lead to increased tumour burden in a murine melanoma model.

This experimental study was designed to determine the effectiveness of a structured preoperative teaching programme for the adult surgical patient as measured by several indicators. The major questions asked in this study were: What are the effects of a structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, recall of knowledge explained preoperatively, and satisfaction with his preoperative teaching. This study was conducted over a four month period, on one surgical ward of a large general hospital. A total of forty subjects met the criteria of the study, and their informed consent was obtained. The first twenty subjects were assigned to the control group, and received the unstructured, pre-existing preoperative instruction from the staff nurses. The second twenty subjects made up the experimental group and received structured preoperative teaching in small groups conducted by the investigator, with the aid of a slide-taped programme developed specifically for the study. Prior to discharge, each subject was given two questionnaires to complete, and data were collected by means of a patient profile sheet. The two groups of subjects were found to be similar when compared on selected characteristics. The alternative hypotheses of the study were analyzed by means of a t-test, and chi square test at the .05 level of significance. The results revealed no significant effect of the structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, or the degree of satisfaction attained from the preoperative teaching he received. However, statistical significance was found for the patient's ability to recall knowledge explained preoperatively. Implications of this study and recommendations for future research were also suggested. / Applied Science, Faculty of / Nursing, School of / Graduate

The aim of this thesis was to evaluate the benefits and complications of surgical treatment of refractory epilepsy. The criterion for the selection of patients was undergoing preoperative long-term monitoring. Information were obtained from six patients after 2-3 years r of surgery using the narrative interview and questionnaire QOLIE 89, which evaluates the quality of life. The interview was analyzed using grounded theory while the information obtained from questionnaire were used only as supplement and comparison of the results. Overall evaluation of questionnaire QOLIE 89 was in standard in five of six patients which is against the results obtained in interviews. Comparing risks and complications with benefits of surgical treatment of refractory epilepsy in the observed group was evaluate as problematic. Patients expected more positive benefit of the treatment and improving the quality of life. Keyword: epilepsy, surgical treatment, nursing care, quality of live