Bakgrund Postoperativa sårinfektioner orsakar stora kostnader för samhället och orsakar patienterna stort lidande. För att förhindra uppkomsten av infektioner behövs förutom operationssjuksköterskans övergripande ansvar för hygien och sterilitet under operation även att operatören har följsamhet till hygienrutinerna för att förhindra att smittspridning sker. Syfte Att undersöka operationssjuksköterskornas upplevelser av operatörernas följsamhet avseende sterilitet och hygien i samband med kirurgiska ingrepp. Samt att identifiera faktorer som enligt operationssjuksköterskorna kan påverka operatörernas följsamhet och förslag på åtgärder. Metod Kvalitativ design, med semistrukturerade intervjuer med åtta operationssjuksköterskor på två sjukhus i norra Sverige. Induktiv innehållsanalys av Lundman & Hällgren Graneheim (2012) användes för analys av data. Resultat Alla operationssjuksköterskor upplevde att operatörerna brast i sin följsamhet och operationssjuksköterskornas uppfattning var att detta dels berodde på kunskapsluckor hos operatörerna men även kunde härledas till dåligt teamsamarbete och bristande ledning. Operationssjuksköterskorna ansåg att stärkande av operatörernas kompetens, ett stärkt samarbete och en tydligare styrning skulle kunna förbättra följsamheten hos operatörerna. Slutsats Inte endast genom att fylla operatörernas kunskapsluckor kan följsamheten till hygienrutiner förbättras utan det är även av betydande vikt att teamsamarbetet förbättras. / Background Postoperative wound infections cause major costs to society and causes patients great suffering. To prevent the occurrence of infections surgeon adherence to hygiene routines, in addition to the operating room nurse overall responsibility for hygiene and sterility during surgery, is needed. Aim To investigate surgical nurses experiences of surgeons adherence regarding sterility and hygiene during surgical procedures. And identify factors that according to surgical nurses can affect surgeons' adherence and proposed actions. Method Qualitative design, with semi-structured interviews with eight surgical nurses at two hospitals in northern Sweden. Inductive content analysis of Lundman & Hällgren Graneheim (2012) was used for analysis of data. Result All surgical nurses experienced surgeons to fail in adherence and the surgical nurses opinion was that this is partly due to knowledge gaps among surgeons, but that it could also be attributed to poor team cooperation and lack of leadership. The surgical nurses felt that strengthening of the surgeon's skills, strengthened cooperation and a more distinct leadership could improve adherence among surgeons. Conclusion Not only by addressing the surgeon's knowledge gaps can adherence to hygiene be improved but it is also of significant importance to improve team collaboration.

Various silicone elastomers have been evaluated for use in the prosthetic reconstruction of facial defects. Their strength, texture, flexibility, hardness, ease of preparation, pigment receptivity and retention, and their resistance to cleaning were compared and the data consulted when an elastomer was chosen to restore defects, improve aesthetics and reestablish the confidence of a selection of patients. Detailed case reports are provided, together with information on the adhesives or mechanical methods available for retaining the facial prosetheses. Cyanoacrylate adhesives for use on skin surfaces and as tissue adhesives have been studied in detail. A novel n-butyl 413 cyanoacrylate has been developed with a viscosity, haemostatic property and stability to make it particularly suitable for use in skin grafting and tissue repair. It has already been used with good results on patients with severe burns. An improved formulation, containing a fluorescent dye, can be precisely applied through a specially constructed foot-controlled dispenser illuminated by a fibre-optic supplying UV-light. Cyanoacrylates are already being used as tissue adhesives in place of the conventional but potentially disfiguring suture. The availability of improved, imperceptible adhesives and a precision applicator, which can be used in a modern operating theatre, will extend their effectiveness and satisfy some of the needs of Plastic, and Oral and Maxillo-Facial Surgeons. Portable applicators have potential use in battlefield and in veterinary surgery and overcome the imprecision characteristic of earlier methods.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2017-01-24T19:04:27Z No. of bitstreams: 1 Aglae Regina Pessoa Giansanti Tavares.pdf: 1881514 bytes, checksum: c8f72a5c531f6a42ee561b059cf17cc8 (MD5) / Made available in DSpace on 2017-01-24T19:04:27Z (GMT). No. of bitstreams: 1 Aglae Regina Pessoa Giansanti Tavares.pdf: 1881514 bytes, checksum: c8f72a5c531f6a42ee561b059cf17cc8 (MD5) Previous issue date: 2016-12-05 / The Dental Record collects all necessary documentation so that the dental surgeon can adequately perform his work, as well as its importance in eventual judicial demands and cases of human identification. Once it is a complex document, not all dental surgeons dare to carry out the correct recording and filing of this information. On the other hand, there is a number of apps on market directed to the health area for several purposes, among them professional support is highlighted. Therefore, the objective of this research was to show how the dental-surgeons perceived the technology of the mobile devices (smartphones or tablets) and how it would aid in their work routine by analyzing an application for the registry of information of patients Because it was still an unexplored topic, 10 dentists, using a semi-structured questionnaire, conducted an in-depth interview, with the objective of understanding how this type of technology could contribute, taking into account its possibilities and current limits. It was, therefore, a qualitative, exploratory and descriptive research; and they analyzed responses using the Content Analysis technique. The results showed that according to the view of dentists, this technology could be useful in archiving and storing information. The conclusion was that 90% of the dental-surgeons interviewed said that the application helps in clinical practice and 10% consider this technology still limited to this function. / O Prontuário Odontológico reúne toda a documentação necessária para que o cirurgião-dentista desempenhe de forma adequada o seu trabalho, além da sua importância em eventuais demandas judiciais e em casos de identificação humana. Por ser um documento complexo, nem todos os cirurgiões-dentistas se propõem a realizar o correto registro dessas informações. Por outro lado, nota-se um mercado de aplicativos direcionado à área da saúde para diversas finalidades, dentre elas o apoio profissional. Portanto, o objetivo desta pesquisa foi apresentar como os cirurgiões-dentistas perceberam a tecnologia dos dispositivos móveis (smartphones ou tablets) e como seria o seu auxílio na rotina de trabalho pela análise de um aplicativo para o registro de informações de pacientes Por se tratar ainda de um tema pouco explorado, para esta pesquisa foi realizada uma entrevista em profundidade com dez cirurgiões-dentistas, utilizando um questionário semiestruturado, com o objetivo de compreender como este tipo de tecnologia poderia contribuir, levando-se em conta suas possibilidades e limites atuais. Tratou-se, portanto, de uma pesquisa qualitativa, exploratória e descritiva; as respostas foram analisadas pela técnica de análise do conteúdo. Os resultados apontaram que, segundo a visão dos cirurgiões-dentistas, esta tecnologia pode ser útil no registro de informações. Concluiu-se, enfim, que 90% dos cirurgiões-dentistas entrevistados afirmaram que o aplicativo auxilia na prática clínica e 10% considera esta tecnologia ainda limitada para essa função.

This final thesis covers the basics of artificial neural networks, with focus on supervised learning, pruning and the problem of achieving good generalization ability. An empirical investigation is conducted on twelve dierent problems originating from the Proben1 benchmark collection.The results indicate that pruning is more likely to improve generalization if the data is sensitive to overtting or if the networks are likely to be trapped in local minima.

Orthopedic surgery is dangerous, especially for the surgeon! Tool failures belong to the ten most frequent causes of operation delays. Nowadays, hospitals are pressured to optimize procedures and lower costs. Especially, orthopedic surgery is physically demanding for the ergonomics of the surgeon and tools wear out more quickly. Could the evolution of a surgical power tool be used in these scenarios to ease and support the surgeons work, increase the efficiency and flexibility of usage and at the same time offer more control and knowledge about the condition of the tools?

Abstract The perioperative operating room (OR) is a highly complex, fast-paced environment where countless transactions must be executed with efficiency, speed, and accuracy, and where mistakes of any kind could lead to adverse patient outcome, injury, or death. The surgeon, as leader of the procedure and the OR team, sets the overall climate of the OR and determines how willing (or unwilling) team members are to speak up about potential errors or unsafe patient conditions. This exploration of the relationship between perioperative surgeon leadership style and OR team member job satisfaction fills a gap unaddressed in the literature using items from The Multifactor Leadership Questionnaire (MLQ) and the Safety Attitudes Questionnaire- OR version (SAQ-OR). The MLQ has been used to confirm the intersection of transformational leadership style and positive team behavior in the perioperative surgical OR. The SAQ has proven reliable and valid in the OR for the domain of job satisfaction as measured by OR team members. In this study, 227 OR team members were recruited from LinkedIn professional groups and Facebook groups and completed an electronic survey. Data were analyzed using multifactor regression analyses. Results indicated that passive avoidant surgeon leadership style had the only significant relationship to OR team member job satisfaction. The importance of this study is apparent in findings suggesting that when leaders work to improve their interactions in ways that increase team members' job satisfaction, they improve team members' health, well-being, and overall life satisfaction.

With an increasing prevalence of osteoarthritis, total knee (TKA) and hip (THA) arthroplasty are the second-and third-most common surgeries in Canada. Although these procedures improve pain and function for a majority of patients, some patients report persistent postoperative pain. Opioids are conventionally used for these patients even though they are associated with addiction, falls, overdose, and death. Recently, many strategies have been proposed to decrease reliance on opioids after TKA and THA, including opioid-free and opioid-reduced multimodal protocols for pain management. Our findings demonstrate that Canadian patients’ receptivity to opioid-free or reduced postoperative protocols is associated with their perception of the efficacy and safety of opioids compared to non-opioid alternatives, and current opioid use. More patients are open to opioid-reduced postoperative care as they perceive that pain will be intolerable without opioids. This overlaps with many Canadian surgeons’ perception that opioids cannot be completely eliminated from postoperative pain management regimens and that patients expect an intolerable level of pain after surgery, warranting opioid use. This highlights a need for enhanced patient education on the safety and efficacy of opioids and alternatives, while managing patients’ expectations of postoperative pain control. Most Canadian and Dutch surgeons reported that they prescribe opioids to nearly all of their patients postoperatively. However, our cross-sectional study indicates that 40% of Canadian patients would be open to receiving no opioids postoperatively. In contrast, Japanese surgeons believed that opioids are unnecessary for managing postoperative pain. Variations observed among orthopaedic surgeons in Canada, the Netherlands, and Japan can be attributed to differences at the surgeon-level (individual practices and beliefs), patient-level (patient characteristics and preferences), and system-level (regulatory frameworks and healthcare systems). Further research is required on surgeon-centered approaches to mitigating opioid use, focusing on education and guidelines/policies for opioid prescribing. / Thesis / Master of Science (MSc) / Opioid analgesics are routinely prescribed to manage pain after total knee and hip replacement surgery. However, opioids are not typically more effective than alternatives and are associated with addiction, overdose, and death. This thesis aims to understand the perceptions of patients and orthopaedic surgeons on opioid use after total knee and hip replacement surgery. The findings demonstrate that more patients are open to receiving opioid-reduced surgery compared to opioid-free surgery, with receptivity being associated with patients’ perceptions of opioid efficacy and safety and current opioid use, highlighting a need for improved patient education. Additionally, orthopaedic surgeons identified challenges and facilitators to postoperative opioid reduction in six key areas: opioid prescribing practices, patient factors, collaborative care, policies/guidelines, surgeon education and training, and personal perceptions/beliefs. Compared to Canadian and Dutch surgeons, Japanese surgeons heavily relied on non-opioid medications as they believed that opioids are unnecessary for managing postoperative pain.

Bakgrund: Postoperativ sårinfektion är en av de vanligaste vårdrelaterade infektionerna i Sverige och kostar samhället enorma summor varje år. Operationer på rörelseapparaten är förutom mindre kirurgiska ingrepp den vanligaste operationskategorin inom sluten vård. Som operationssjuksköterska har man ansvar över hygien i operationsteamet för att förebygga smittspridning och infektion. En del i detta arbete är att ge direktiv till operatören gällande hygien för att förebygga infektion. Huruvida operatören är följsam till dessa direktiv eller ej är därför centralt i det infektionspreventiva arbetet under ortopedkirurgiska ingrepp.  Motiv: Genom att belysa vikten av följsamhet gällande god hygien och sterilitet under kirurgiska ingrepp är målet att studien ska ge en ökad kunskap i ämnet samt göra att operationssjuksköterskor känner sig stärkta i sitt infektionspreventiva arbete. En ökad kunskap i ämnet kan bidra till färre postoperativa infektioner som både minskar det onödiga lidande och död som drabbar patienten samtidigt som det minskar de enorma kostnader som det medför. Syfte: Att belysa operationssjuksköterskans upplevelse av operatörens följsamhet till direktiv från operationssjuksköterskan gällande hygien under ortopedkirurgiska ingrepp.  Metod: Kvalitativ design där semistrukturerade intervjuer utfördes med tio operationssjuksköterskor som jobbade kliniskt på en ortopedisk operationsavdelning på ett universitetssjukhus i Sverige. Data analyserades med en deduktiv innehållsanalys. Resultat: Operationssjuksköterskorna hade varierande erfarenheter av operatörernas följsamhet till direktiv under ortopedkirurgiska ingrepp. Fyra huvudkategorier identifierades;`När följsamhet fungerar´, `När följsamhet brister´, `Kritiska situationer´ och `Förändring över tid´.  Konklusion: De hygienområden där följsamheten upplevdes som fungerande var vid byte av sterila handskar, byte av lamphandtag och när instrument blivit osterila. Förbättringsområden som identifierades var bristande kunskap hos operatörerna iiinom hygien, ett hierarkiskt synsätt hos operatören samt bristande följsamhet vid begränsning av antal personer på sal och dörröppningar. / Background: Postoperative infection is one of the most common healthcare-related infections in Sweden and causes major costs to society. Operations on the musculoskeletal are apart from minor surgical interventions the most common category of operations in inpatient care. As a surgical nurse, you are responsible for hygiene and asepsis in the operating team to prevent infection. Part of this work is to give directives to the surgeons regarding hygiene. Whether or not the surgeon complies with these directives is therefore central to the infection prevention work during orthopedic surgery.  Motive: By highlighting the importance of compliance regarding good hygiene and sterility during surgical procedures this study can provide increased knowledge on the subject and make surgical nurses feel empowered in their infection prevention work. Increased knowledge on the subject can contribute to fewer postoperative infections, reducing both the unnecessary suffering that affects the patient and the major cost that this entails. Aim: To investigate surgical nurses’ experiences of surgeons’ compliance to directives from the surgical nurse regarding hygiene during orthopedic surgery. Methods: Qualitative design with semi-structured interviews conducted with 10 surgical nurses who worked clinically in an orthopedic surgery department at a university hospital in Sweden. The data was analyzed with a deductive content analysis. Result: The surgical nurses had varying experiences of the surgeon's compliance to directives during orthopedic surgery. Four main categories could be identified; `When compliance works´, `When compliance fails´, `Critical situations´ and `Change over time´.  Conclusion: The hygiene areas where compliance was working were when changing sterile gloves, changing lamp handles and unsterile instruments. Improvement areas that were identified were the surgeon´s lack of knowledge about hygiene, a ivhierarchical approach and a lack of compliance when limiting the number of people in the operating room and door openings.

Syfte. Att belysa attityder hos operationspersonal samt risken för intraoperativa stick- och skärskador. Bakgrund. Det finns flera olika tekniker för att hantera stickande och skärande instrument och olika säkerhetsprodukter som kan användas för att minimera risken för stick- och skärskador. Det finns många studier som handlar om lämpliga arbetssätt för att minimera risken för stick- och skärskador, men bara ett fåtal studier som belyser betydelsen av användarnas attityder och inställning till användande av tekniker och säkerhetsprodukter samt uppföljning och rapportering av tillbud. Metod. Studiens design är en empirisk intervjustudie med kvalitativ ansats. Semistrukturerade intervjuer utfördes med sju operationssjuksköterskor och fyra operatörer på två sjukhus i Sverige. Data insamlades oktober-december 2015. Resultat. Resultatet visar på att det finns olika attityder hos operationspersonal som kan påverka risken för stick- och skärskador, vilka redovisas under fyra olika teman: Att ha ett säkert arbetsklimat; Att skydda sig själv, medarbetare och patient; Att vara följsam till riktlinjer och arbetsrutiner samt Att vara oföljsam riktlinjer och arbetsrutiner. Slutsats. Risken för stick- och skärskador går inte att eliminera då det alltid finns riskområden som man som operationspersonal måste ta hänsyn till. Det finns mycket kunskap kring säkerhetsprodukter och tekniker som syftar till att minimera risken för stick- och skärskador men om användarens attityd får styra kanske inte dessa används på rätt sätt om ens alls. I denna studie framkommer det en antydan till att attityder hos operationspersonal kan påverka risken intraoperativa stick- och skärskador. / Aim. To illustrate the attitudes of the operating theatre personnel and the risk of intraoperative sharp injuries. Background. There are several ways to manage sharp instruments such as various techniques and safety products to minimize the risk of sharps injuries. There are many studies about working practices to minimize the risk of sharps injuries but only a few that illustrate the importance of attitudes towards techniques and safety products as well as follow up and reporting incidents. Method. The design of the study is an empirical interview study with a qualitative approach. Semi-structured interviews were conducted with seven theatre nurses and four surgeons at two hospitals in Sweden. Data collected October-December 2015. Findings. The findings show that there exists different attitudes of the operating theatre personnel that could affect the risk of sharps injuries. The finding is presented in four themes: To have a safe working environment; To protect oneself, co-worker and patient; To be compliant to guidelines and working practices and To be non-compliant to guidelines and working practices. Conclusions. The risk of sharp injuries can’t be eliminated since there is always a risk of sharp injuries which the operating theatre personnel must pay attention to. There are a lot of knowledge about safety products and techniques for minimizing the risk of sharps injuries but when the attitude of the user come into play the safety product may not be used correctly, if used at all. In this study a indication appears that the attitudes of the operating theatre personnel may be affecting the risk of intraoperative sharp injuries.

O instituto jurídico da responsabilidade civil é um dos instrumentos previstos em lei, do qual qualquer paciente pode se valer para promover uma ação de reparação de danos contra o cirurgião-dentista, pelos prejuízos causados. Com o incremento do número de processos, aumenta proporcionalmente a importância do conhecimento das características dessas demandas, no intuito de estabelecer uma orientação fundamentada para que o profissional possa se resguardar e, na ocorrência de lides, encontrar-se municiado para produzir sua competente defesa. Ante tal fato, torna-se fundamental a verificação dos entendimentos dos Tribunais sobre a responsabilidade civil dos cirurgiões-dentistas, sendo que não existem pesquisas que se preocupam em analisar o tema em âmbito nacional. O objetivo deste trabalho foi realizar o levantamento das jurisprudências a respeito das ações de responsabilidade civil promovidas contra o cirurgião-dentista, utilizando a Internet, bem como apresentar o panorama e o entendimento dos principais temas perante os Tribunais do Brasil. Foram obtidos, quando possível, dados relativos à origem, à obrigação assumida, ao seu fundamento, ao agente, à inversão do ônus da prova e às especialidades mais demandadas. Para facilitar a comparação entre os vários entes da Federação, foi proposto um coeficiente de experiência processual que relaciona o número de processos e a quantidade de cirurgiões-dentistas. Foram levantadas 482 jurisprudências, sendo 1 no Supremo Tribunal Federal, 3 no Superior Tribunal de Justiça e 478 nos Tribunais Estaduais e Distrito Federal. Dessas 478, foi possível verificar uma tendência de aumento no número e na quantidade de Estados que tiveram experiências com processos judiciais. Em relação à origem, 18,6% foram consideradas como Contratual, enquanto 6% relacionavam-na como Extracontratual. Foram encontradas 10,6% como obrigação de resultado e, 4,1% como obrigação de meio. Como fundamento, 58,15% tiveram a Teoria Subjetiva, enquanto que 8,15% a Teoria Objetiva. A responsabilidade do agente foi observada como direta em 99,3% e, em 0,6%, como indireta. Houve o deferimento da inversão do ônus da prova em 2,7% dos casos. Em 48,3%, foi possível identificar as especialidades odontológicas, das quais as mais citadas foram: cirurgia (32,9%); prótese (26,4%); ortodontia (15,6%); implantodontia (13%); endodontia (6,5%), periodontia (2,6%); pediatria (1,7%); patologia (0,9%) e, por último, disfunção têmporo-mandibular e dor oro-facial (0,4%). Os Estados que apresentaram maior quantidade de processos foram: Rio de Janeiro, com 107; Minas Gerais, com 101; São Paulo, com 94; Rio Grande do Sul, com 75; o Distrito Federal, com 32. Quanto ao coeficiente de experiência processual, a cada 1.000 profissionais, no Brasil, 2,23 já tiveram experiência com processos. A Região mais exposta a processos foi a Região Sul, seguida das Regiões Centro-Oeste, Sudeste, Norte e Nordeste. Em relação aos Estados e Distrito Federal, verificou-se que o Distrito Federal apresenta 6,22 profissionais processados civilmente a cada 1.000. No Rio Grande do Sul são 5,95; no Rio de Janeiro, 4,22; Minas Gerais, 3,82; Rondônia, 2,15; Paraná, 1,91; Mato Grosso do Sul, 1,81; Espírito Santo, 1,75; Santa Catarina, 1,36; São Paulo, 1,31; Bahia, 1,13; Goiás, 1,06; Tocantins, 0,89; Alagoas, 0,54; Rio Grande do Norte, 0,43; e, por último, no Estado de Pernambuco, 0,18. / The civil liability act is one of the resources provided by law, which can be used by any patient in order to bring a legal action for damages against dentists. With the increase in the number of cases, the necessity of a sound knowledge on the features of these lawsuits has proportionally augmented, so that the professionals may have a solid orientation to protect themselves, and in case of a legal process, be able to produce their competent defense. In view of this fact, the checking of the jurisprudences concerning dentists\' civil liability becomes of paramount importance, since in Brazil there are no studies analyzing this matter. The objective of this study has been to survey the jurisprudences of civil liability lawsuits against dentists, by using the Internet, as well as to present an outlook on jurisprudences related to the main topics in Brazilian Courts. When possible, data have been obtained regarding the origin, professional obligation, legal basis, defendant, inversion of the burden of proof, and more demanded dental specialties. In order to facilitate the comparison between the Brazilian states, a coefficient of procedural experience has been proposed. This coefficient correlates the number of legal processes and the quantity of dentists. 482 jurisprudences have been studied: 01, in the Federal Supreme Court; 03, in the Supreme Court of Justice, and 478, in the State Courts and the Federal District. From these 478, it has been possible to verify an increasing trend in the number and quantity of the states which have experienced lawsuits. As to the origin, 18.6% have been considered contractual, while 6%, extracontractual. 10.6% have been regarded as obligation de résultat (obligation of result), and 4.1%, as obligation de moyens (obligation of means). 58.15% have been legally based on the Subjective Theory, whereas 8.15%, on the Objective Theory. The liability of the defendant has been evaluated as direct in 99.3%, and indirect in 0.6%. The granting of the inversion of the burden of proof has occurred in 2.7% of the cases. It has been possible to identify the dental specialties in 48.3%, from which the most cited ones have been: dental surgery (32.9%), prosthodontics (26.4%), orthodontics (15.6%), implantology (13%), endodontics (6.5%), periodontics (2.6%), pediatrics (1.7%), pathology (0.9%), and finally, temporomandibular joint dysfunction and orofacial pain (0.4%). The states presenting the largest quantity of legal processes have been: Rio de Janeiro, with 107, Minas Gerais with 101, São Paulo with 94, Rio Grande do Sul with 75, the Federal District with 32. Concerning the coefficient of procedural experience, in Brazil, 2.23 professionals have already experienced lawsuits out of 1,000. The Southern Region has had more lawsuits, followed by the Central-Western, Southeastern, Northern, and Northeastern ones. In relation to the states and the Federal District, it has been noted that the Federal District have presented 6.22 professionals who have faced civil lawsuit out of 1,000; Rio Grande do Sul, 5.95; Rio de Janeiro, 4.22; Minas Gerais, 3.82; Rondônia, 2.15; Paraná, 1.91; Mato Gosso do Sul, 1.81; Espírito Santo, 1.75; Santa Catarina, 1.36; São Paulo, 1.31; Bahia, 1.13; Goiás, 1.06; Tocantins, 0.89; Alagoas, 0.54; Rio Grande do Norte, 0.43; and Pernambuco, 0,18.