BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future.

M.Cur. (Intensive General Nursing) / The intensive care unit, as experienced by the patients undergoing coronary artery bypass graft surgery, may have a positive or negative effect on the facilitation of health. This study is an attempt to identify the obstacles as experienced by the patients, in order to help the professional nurse to facilitate health. The objectives of this study: • • to explore and describe the experience of the coronary artery bypass patient in the intensive care unit, to be able to identify obstacles which may impair their health; and to set guidelines for improving the environment. in order to help facilitate health. The phenomenological method of interviewing was used. Interviews were conducted with seven participants. Conclusions were made after analysing the interviews, and theoretical justifications of tho conclusions were found in the literature. The results showed that the lack of guidance was the most important obstacle. and therefore guidelines for the professional nurse in the cardic-thoracic unit were proposed. The goal of these guidelines is to improve the health of the coronary artery bypass patient by improving the intensive care unit environment. Recommendations for practice, nursing education and further research were made.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

While the number of techniques and procedures that surgical trainees must learn is increasing, opportunities for trainees to practice the necessary skills on patients is decreasing; the COVID-19 pandemic further limited these learning opportunities. There is a need to explore additional ways for trainees to practice and improve their performance on surgical tasks. Observing others perform tasks can improve a learner’s own performance of a task, but it is unclear how well current evidence applies to improving surgical task performance as much of the existing evidence supporting the use of observation is for non-surgical tasks. This thesis explores the influence of observing someone else demonstrate tasks on learner’s own performance of tasks relevant to surgical training. Through three experiments, we explored the influence of the type of demonstrator that a learner observes (e.g., someone who is experienced or inexperienced), and whether or not tasks that encourage the learner to think more about the quality of a demonstrator’s performance further influences the learner’s performance. The findings suggest that for learners who are new to a task, observing an experienced demonstrator is more helpful for improving performance than observing an inexperienced demonstrator. Prompting learners to think more about the quality of the demonstrator’s performance, either by requiring them to judge the demonstrator’s performance or by providing them with an expert’s judgment of the demonstrator’s performance, does not further influence the learner’s performance. The findings from this thesis provide insights into how surgical educators can optimize learner’s performance improvements on surgical tasks using observation. This thesis also provides evidence for an effective way for learners to practice surgical tasks, either in-person or remotely, before performing those tasks on patients. / Thesis / Doctor of Philosophy (PhD) / People who are training to become surgeons have a lot to learn. It is important to find ways that they can get better at tasks. We explored whether having learners watch someone else can help them get better at tasks relevant to surgery. We explored if it is better for a learner to watch someone who knows the task well or someone who is new at the task. We also explored if it is helpful for learners to think about how well the person they are watching did. We found that for learners to get better at a task, it is generally more helpful to watch someone who knows the task well. It did not help learners to think about how the person they are watching did. This helps us better understand how to help surgical learners get better at tasks from observing others before performing those tasks on patients.

research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine. Johannesburg, 2018. / Objectives Present on arrival infection is a common indication for admission in surgical patients initially managed at primary care level. We aimed to describe the demographic and disease profile of patients with infection requiring surgical management, describe determinants of patients’ health seeking behaviour and identify barriers to care. Methods A prospective descriptive questionnaire based study was conducted at Edenvale General Hospital between February 2014 and October 2016. Minors were excluded. Results Eighty nine patients participated. Abscesses (26%, 23/89), diabetic foot (22%, 20/89), and cellulitis (16%, 14/89) were the largest categories of infection necessitating admission. The majority of patients were South African (88%, 78/89), Black African (82%, 73/89), males (58%, 52/89), without medical aid (99%, 88/89), who were not formally employed (58%, 52/89), were from poor households (74%, 73/89), inhabited some form of formal housing (90%, 80/89), were in charge of decisions regarding personal health (80%, 71/89), and first sought help at the primary care level (71%, 62/89). Delay from onset of symptoms to presentation was noted in 69% (61/89) of patients, and delay from presentation to referral to specialist care in 46% (41/89) of patients. Age, race, history of diabetes, and main source of monthly income were significant variables in delayed presentation (p<0.05), and age and level of care on first contact in delayed referral (p<0.05). The most common reason for delay to presentation (84%, 51/61) and referral (61%, 25/41) was patients’ own belief that the problem would get better spontaneously. Conclusions Patients’ socio-economic status, past medical history, demographics, level of first contact with the health care system, and perceptions of their own health contributed to delays in seeking and receiving care. Barriers to care may be addressed by improvements targeting issues of availability, accessibility, acceptability and affordability of health care services. / E.K. 2019

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree Of Masters of Science in Nursing Johannesburg 2018 / Background: Despite the availability of policies, procedures and clinical guidelines developed to improve patient safety in correctly completing the pre-operative assessment records, there is poor adherence to compliance. Therefore the aim of this study was to determine if the introduction of an in-service education programme will improve the completion of the pre-operative assessment records. Objective: The objective of the study was to improve the completion of the pre-operative assessment records in two private hospitals in Gauteng. Method: The setting for this study was two private hospitals in the Gauteng Province; each hospital conducting approximately 900 surgical procedures over a three monthly period. A one group pre-test-post-test design and a survey were conducted in this study. A retrospective chart review was conducted using a simple random sampling method in the pre-and post-test selection of the pre-operative assessment records. The pre-test was conducted between September and October 2016 and the post-test between May and June 2017. The researcher audited (n=187) pre-operative assessment records in the pre-and post-test. The data were collected using an approved audit tool currently in use at both Private Hospitals included in the current study. The data obtained in the first chart review (pre-test audit) was used to develop and implement the in-service education programme for the nursing staff at the two private hospitals where the study was conducted. The in-service education programme was conducted in February 2017 following the gaps identified in the incompleteness of the pre-operative assessment records in the first chart review. The second chart review (post-test audit) was conducted after the introduction of the in-service education programme to evaluate if the education programme had positively influenced the improvement of the completion of the pre-operative assessment records. A survey was designed by the researcher and was completed by the respondents that had attended the in-service education programme. The aim of the survey was to explore the respondents’ satisfaction of the training programme. The data obtained from the questionnaire was captured on an excel spread sheet and analysed by descriptive statistics and presented on frequency tables. Results: Eleven of the 16 discrete variables tested in the course of the pre-and post-test analysis in Hospital A and B, demonstrated significant (p<0.05) change following the in-service education programme. In each instance the change represented improved recording of the pre-operative assessment records, which is an important finding and one in which evidences the need for and value continued in-service education. The criteria that showed recording improvement post-education programme were: patient received in theatre noted (44.9%); booked procedure same as patients’ description (12.8%); premedication administered (41.2%); patient kept nil per mouth (23%); identity band applied (20.3%); signatures with handover (10.2%); fluid start and end times (11.7%); fluid volumes start and completion (20.9%); fluid running total (18.7%); intravenous site checked (25.6%).The results provide evidence that the education programme did influence the compliance in some of the criterion in completing the pre-operative assessment records correctly. Of the completed feedback questionnaires received (n=45: an overall response rate of 96.1%), 14 discrete answers were collated and 28% of the respondents answered the questions, including the respondents who indicated “nothing” as an answer. All respondents indicated the nurses who attended the training felt it was beneficial, with 35.7% indicating that the training should be repeated and held frequently; ensuring that the Doctors and agency nursing staff attended alongside the nurses was deemed important by 28.6% of the respondents. Additional training on the pre-operative assessment process and care was requested by 14.3% of the nurses and post-operative care was specifically noted by 21.4% of those respondents. Conclusion: This study provided evidence that after the introduction of the education programme to the nurses there was an overall improvement in the completion of the pre-operative assessment records. Although there was a disappointing note of compliance in completing the fluid balance record, the results indicated and overall improvement of the compliance in completion in most of the criterion of the pre-operative assessment records partially fulfilling the aims of this study. However it is strongly indicated that there is a need for further improvement in completing the pre-operative assessment records. Keywords: Pre-operative Assessment; Patient Safety; Patient Records; In-Service Educational Programme; Improving Quality. / E.K. 2019

Thesis (M.S.)--Boston University

No description available.

Thesis (PhD (Surgical Sciences))—University of Stellenbosch, 2007. / Aims: The goal of this study was to identify arterial variations by cadaveric dissection, in the forehead, in order to validate the practicality and implementation of planned forehead flaps and to increase the safety of forehead flaps in plastic and reconstructive surgery. Hypothesis tested: Unique frontal forehead flaps can be safely based on anatomical dissection and on the presence of the central vein and the anastomosing branches of the frontal ramifications of the angular artery (AA). Materials & methods: The study had two strategic components: an anatomical cadaveric study and a clinical study, based on the newly described forehead vasculature. The anatomical study consisted of a) dissection of 30 latex infused cadavers and 20 non-latexed cadavers; b) histological assessment of forehead vasculature of 20 cadavers. The clinical applicability study consisted of a cohort of 12 plastic and reconstructive surgery cases, undergoing nasal rhinoplasty, based on the cadaveric study and anatomical vasculature. The research was conducted within an ethical protocol and all patients gave informed consent. The follow-up period is 2 years. Results: In the cadaveric dissection, the following vessels, relevant to forehead flaps and nasal reconstruction, were consistently identified: DNA, FBSTA, STrA, TFA, AA, CA, CV, PCA, SOA and OV. Side branch analysis of STrA (N = 43) showed: MCB (60%), LCB (23%), SPA (26%), OB (19%), single VB (47%), medial and lateral VB (53%). Side branches of the supra-orbital artery (SOA) were: LRB (91%), OB (91%), VB (100%), MB (44%), BB (5%) and SVB (9%). Side branch profile of the angular artery (AA) was: DNA (96%), CB (67%) and PCA (47%). In 71% of cases the origin of the PCA was from the angular artery (AA). Individual artery side branches of the forehead were as follows: STrA (9), SOA (6), FBSTA (4), DNA (4), AA (3/4), CA (2) and PCA (2). Average diameter of the small arteries at point of entry ranged from 1 – 2mm (CA < 1mm, PCA < 1mm). The central vein was a constant finding in all dissections and an important landmark. Other constant veins detected included the nasofrontal, ophthalmic, angular, supra-trochlear and facial veins. Twelve prospective randomized patients met inclusion criteria for nasal flap reconstruction, based on the cadaveric vascular study. Race profile was white (6), mixed (4) and black (2). There were 8 males and 4 females. Disease demographics included cancer (6; melanoma 2, basal cell cancer 5), trauma (3), infections (1) and congenital (1). Post-operative grading was as follows: defects corrected (12/12), subjective improvement (12/12), objective improvement (12/12), partial flap necrosis (1/12) and secondary interventions (debulking or revision 2/12). Doppler assessment for pedicle vasculature showed identification of the following arteries: TFA (85%), STrA (65%), PCA (20%) and AA (25%). Doppler studies further indicated the following small side branches: TFA (49%), STrA (30%), PCA (9%), AA (12%). The central vein was identified in 9/12 (75%) by macroscopic examination. In one female with a basal cell carcinoma (BCC), modest dermal stock loss was demonstrated by the application of high frequency dermal ultrasound (Dermascan®). The results of the cadaveric anatomy study show the existence of various important subtle arterial variations in the forehead that are not described in the literature. Many arterial side branches not clearly named and others not described before, were highlighted in this anatomical study. Other observations regarding the anatomical relationships of the forehead nerves were of practical surgical value, the most important being to reduce sensory neuropraxia. The histological study endorsed the cadaver dissection observations and showed the importance of the flap vasculature at the proximal level of the pedicle. The clinical study with follow-up period of 24 months, illustrates an evolving refinement in surgical technique based on the findings of the anatomic vasculature study. A new method of planning a “2500-year-old operation” was confidently developed based on the anatomical vasculature observations detected during the cadaver study. The Doppler study suggests that crude arterial variations of the central forehead, in the region of the intended flap pedicle, can not be diagnosed and highlighted accurately pre-operatively. The macroscopic anatomy of the central vein (clinical landmark) is an accurate predictor of underlying arterial variations and may be more valuable clinically than the hand-held Doppler examination. Conclusion: Comprehensive vascular anatomical detail of the forehead was not described accurately or completely by clinical anatomists in the past and does not appear in classic text books of anatomy and morphology. This has led to one-dimensional (arterial) application of the midline forehead flap planning and eventually the introduction of the para-median forehead flap, which has become the modern “work horse” of forehead flaps for nasal reconstruction. Now that in a definitive cadaveric study of the forehead blood supply has been demonstrated, the results show that surgeons will once again be able to embrace the midline forehead flap, only this time there will be possibly no inconsistent descriptions of unnamed blood vessels or ill-defined landmarks for flap planning. New flaps and reconstructive options in or around the forehead will be hopefully planned and executed more effectively and safer based on a more comprehensive understanding of the forehead anatomy and vasculature. The subjective and objective end-point analysis of the clinical study show favourable measured outcomes in the interim follow-up period (24 months) and benefit to the patients, in the presence of a low percentage of flap loss (1/12; 8.3%). The use of pre-operative Doppler assessment helped with flap planning. In one patient, the application of high frequency ultrasound facilitated long term follow-up regarding recurrent tumour formation and enhancement of dermal consistency with anti-aging creams, vitamin A derivations and sunscreens. Recommendations: The classic anatomy text books and clinical plastic surgery works with their inconsistent descriptions of the central forehead blood supply (arterial and venous) need to be updated. The evolution of the midline forehead flap method is far from complete. The refinement of the one-stage midline forehead flap method without an island is in progress and can clinically be implemented, based on a sound anatomical dissection study.

In the first study, a literature review and semi-structured interviews with experienced scrub nurses (n=25) and consultant surgeons (n=9), identified ‘communication’, ‘teamwork’, ‘situation awareness’ and ‘coping with stress’ skills as important skills for scrub practitioners. The second study used focus groups (n=4 groups) of experienced scrub nurses (total n=16 participants) to sort and label the extracted non-technical skill data, from study 1, into skill categories and underlying elements. The focus groups also generated ‘behavioural markers’ describing good and poor performance of those elements. This preliminary taxonomy contained eight categories with 28 underlying elements. An expert panel, comprising two psychologists and a subject matter expert used an iterative process, with reference to the system design guidelines, to refine the taxonomy. The resulting prototype was called the Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS) system which had three skill categories – ‘Situation awareness’; ‘Communication and teamwork’; ‘Task management’, each of which had three underlying elements. The third study tested the psychometric properties of the prototype SPLINTS system. Scrub practitioners (n=34) attended a single-day evaluation session where they received training (5 hours) and practice (1 hour) using the SPLINTS system before rating the scrub practitioner’s behaviour seen in standardized surgical video scenarios (n=7) (1 hour). Within-group agreement was acceptable (<i>r</i>_wg &gt;.7) for the three skill categories and for six of the nine elements. Future work will assess the usability of SPLINTS system in the operating theatre environment. This project has provided scrub practitioners with a structured method for training and assessing an important aspect of performance, which could help to reduce adverse events in the operating theatre.