Source: Masters Abstracts International, Volume: 46-03, page: 1492. Adviser: Robert E. Roberts. Includes bibliographical references.

Surgical site infection not only brings morbidity and mortality to patients, but it also bring substantial financial burden to the hospital and the healthcare system. To minimize the clinical consequences of surgical site infection, it is crucial that all appropriate measures for reduction of surgical site infection should be implemented. Since patient’s skin is a potential source of pathogens, normal skin flora is a common cause of surgical site infections. Preoperative skin disinfection of the surgical site with an antiseptic agent is an effective method to remove the soil and transient organisms from the skin. Currently, there are different skin antiseptics available and the most commonly used agents are povidone iodine and chlorhexidine gluconate. Although povidone iodine has a long-standing recommendation and it is widely used in various surgical procedures, it has several limitations. On the other hand, there is an increasing interest of the use of chlorhexidine in indwelling catheter placement and care, surgical hand scrubbing, as well as wound dressing. In view of this, there is a potential of replacing povidone iodine by chlorhexidine as preoperative skin antiseptic agent. As there is no existing guideline supportingthis innovative movement, this dissertation aimed to review the currently available evidence on preoperative skin preparation and to develop an evidence-based guideline of using chlorhexidine in preoperative skin preparation for reducing surgical site infection in patients undergoing general surgery. Five randomized controlled studies were identified from MEDLINE, CINAHL and PUBMED and evaluated by a critical appraisal tool, the Scottish Intercollegiate Guidelines Network. All studies reported that preoperative skin preparation with chlorhexidine is more effective than the use of povidone iodine in reducing surgical site infection. An evidence-based guideline is developed according to the guideline development process from the Scottish Intercollegiate Guideline Network. Patient characteristics, local clinical setting, organizational infrastructure and staff competency is congruent with the proposed innovation. The new protocol not only can minimize the risk of postoperative surgical site infection but also save costs. The cost-benefit analysis showed that the new protocol can help to save $675,552 to $1,097,772 (HK dollars) in six-month period after implementation. To facilitate a more comprehensive plan in actual implementation of the proposed guideline, stakeholders at administrative, managerial, and operational levels would be invited to take part in the 12-week pilot test. Surgical site infection, staff satisfaction and compliance, as well as cost and benefit ratio of the guideline would be measured in the evaluation plan. The refined guidelines would then be implemented for one year. The effectiveness of the guideline would be determined by reduction in postoperative surgical site infection, increase in staff knowledge and satisfaction, and the overall expenditure. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The phenomenon of 'slowing down' in response to important cues in the operative field is proposed as a hallmark of expert surgical judgment. As part of a larger program of research, the purpose of this study was to explore a methodology for capturing 'slowing down' moments using a standardised task. Edited videos of 6 laparoscopic cholecystectomies were shown to 10 expert surgeons (>250 laparoscopic cholecystectomies completed). Participants were asked to think aloud while watching them as if observing each procedure in the operating room. Each session was audiotaped and transcribed. Many examples of 'slowing down' moments were identified in the transcripts, including several categories that were previously uncharacterised or undescribed. A subset of 'slowing down' moments was compared between participants. Many appeared to be inconsistent between expert surgeons, suggesting that with this methodology alone, formal teaching and assessment of the 'slowing down' phenomenon will be challenging.

The phenomenon of 'slowing down' in response to important cues in the operative field is proposed as a hallmark of expert surgical judgment. As part of a larger program of research, the purpose of this study was to explore a methodology for capturing 'slowing down' moments using a standardised task. Edited videos of 6 laparoscopic cholecystectomies were shown to 10 expert surgeons (>250 laparoscopic cholecystectomies completed). Participants were asked to think aloud while watching them as if observing each procedure in the operating room. Each session was audiotaped and transcribed. Many examples of 'slowing down' moments were identified in the transcripts, including several categories that were previously uncharacterised or undescribed. A subset of 'slowing down' moments was compared between participants. Many appeared to be inconsistent between expert surgeons, suggesting that with this methodology alone, formal teaching and assessment of the 'slowing down' phenomenon will be challenging.

Surgical site infections (SSIs) are an emerging cause of increased morbidity, mortality, and treatment cost, in veterinary medicine. Medical records were searched to evaluate for associations that could increase the risk of developing SSIs. Logistic regression was used to analyze the risk factors statistically, to determine their influence on SSI risk. An SSI incidence rate of 3.0% was found in this study for all small animal surgical procedures performed from September 2010 to July 2011, with implants, hypotension and surgical classification associated with increased likelihood of SSI. Active surveillance is crucial for the development of methods to prevent SSI’s. Biofilms contribute to the antimicrobial resistance properties commonly found in bacteria such as methicillin-resistant Staphylococcus pseudintermedius, which is found in canines. An enzyme known as DispersinB was studied to assess its effect on biofilm formation and degradation. DispersinB prevented the formation and eradicated biofilm in vitro. In vivo testing is required to further assess the effects of DispersinB. / Ontario Veterinary College Pet Trust, Canadian Institutes of Health Research, Kane Biotchech

Suturing in laparoscopic surgery is a challenging and time-consuming task that presents haptic, motor and spatial constraints for the surgeon. As a result, there is variability in surgical outcome when performing basic suturing tasks such as knot tying, stitching and tissue dissection (as large as 50\%). This goal of this thesis is to develop a standardized, proof-of-concept, automated robotic suturing system that performs a side-to-side anastomosis with image guidance and dynamic trajectory control. A passive alignment tool is created for rigidly constraining needle pose, and robust computer vision algorithms are used to track surface features and the suture needle. A robotic system integrates these components to autonomously pass a curved suture needle through sequential loops in a tissue pad phantom.

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<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>

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