Thesis - College of Physicians and Surgeons, New York. / Film 633 reel 13 is part of Research Publications Early American Medical Imprints collection (RP reel 13, no. 211). DNLM Includes bibliographical references.

This paper deals with the development of the trade surgery in Sweden, mainly in Stockholm, from the 16th century until training for surgeons was incorporated in the university education for physicians in 1861. Surgeons long claimed to be able to continue their practice, not only with injuries and external illness, but also with internal illness. Surgeons were organized in guilds as craftsmen. For many years, when Sweden was a Great Power, there was a great demand for surgeons for active service in the wars, often going on for long periods. But soon surgeons lost the rights to deal with internal illness after struggle with the organization of university educated physicians. Physicians considered surgeons to be uncultured and ill-bred. However, at the end of the 18th century these two groups came together in the same organization, the one of the university educated. Until 1861 the surgeons kept much of their old education. In the first half of the 19th century the discovery of narcosis and antiseptic revolutionized surgery. Now it became possible for surgeons to treat both external and internal illness. Their social position increased radically. The 19th century has been called “the century of surgery”. In addition, the paper also deals with the causes of this transformation based on the documents used, however without being able to establish one cause as the inevitable one.

The goal of this research was to establish a methodology for quantifying performance of surgeons and distinguishing skill levels during live surgeries. We integrated three physical measures (kinematics, time and movement transitions) into a modeling technique for quantifying performance of surgical trainees. We first defined a new hierarchical representation called Motor and Cognitive Modeling Diagram for laparoscopic procedures, which: (1) decomposes ‘tasks’ into ‘subtasks’ and at the very detailed level into individual movements ‘actions’; and (2) includes an explicit cognitive/motor diagrammatic representation that enables to take account of the operative variability as most intraoperative assessments are conducted at the ‘whole procedure’ level and do not distinguish between performance of trivial and complicated aspects of the procedure. Then, at each level of surgical complexity, we implemented specific mathematical techniques for providing a quantitative sense of how far a performance is located from a reference level: (1) The Kolgomorov-Smirnov statistic to describe the similarity between two empirical cumulative distribution functions (e.g., speed profiles) (2) The symmetric normalized Jensen-Shannon Divergence to compare transition probability matrices (3) The Principal Component Analysis to identify the directions of greatest variability in a multidimensional space and to reduce the dimensionality of the data using a weight space. Two experimental studies were completed in order to show feasibility of our proposed assessment methodology by monitoring movements of surgical tools while: (1) dissecting mandarin oranges, and (2) performing laparoscopic cholecystectomy procedures at the operating room to compare residents and expert surgeons when executing two surgical tasks: exposing Calot’s Triangle and dissecting the cystic duct and artery. Results demonstrated the ability of our methodology to represent selected tasks using the Motor and Cognitive Modeling Diagram and to differentiate skill levels. We aim to use our approach in future studies to establish correspondences between specific surgical tasks and the corresponding simulations of these tasks, which may ultimately enable us to do validated assessments in a simulated setting, and to test its reliability in differentiating skill levels at the operating room as the number of subjects and procedures increase. / Applied Science, Faculty of / Mechanical Engineering, Department of / Graduate

Magister Scientiae (Physiotherapy) - MSc(Physio) / An increase of cardiac surgeries globally has been associated with an increasing number of people with cardiovascular disease in both developed and developing countries. Following cardiac surgery, pulmonary complications are an important cause of morbidity leading to significant prolonged hospitalisation, mortality and overall hospital costs. Physiotherapists have been part of cardiac multidisciplinary team playing a role in prevention and managing respiratory complications post-operatively. Numbers of studies have investigated on the efficacy of physiotherapy interventions in managing patients following cardiac surgery. However, there is no consensus in the literature with regards to intensity, duration of the session and content of therapy in this specialised area of cardio-pulmonary. These variations of physiotherapy intervention have made difficult to find agreement on the necessity of physiotherapy care in the post-operative management of patients following cardiac surgery. To date, however, there have been limited or no studies done on the role of physiotherapy in the Cardiac Unit setting. Thus, the aim of the study was to investigate the role of physiotherapy in the post-operative management of patients following cardiac surgery at Muhimbili National Hospital (MNH), Tanzania. An explanatory sequential mixed method study design was used. A descriptive retrospective study design was chosen for the quantitative phase using a convenient sample of all 105 patients’ records operated from January 2010 to 31st December 2013. With regards to the qualitative phase, 2 Cardiac Surgeons and 10 Physiotherapists working at MNH were conveniently sampled to explore their perceptions on the post-operative role of physiotherapy in the management of patients following cardiac surgery at MNH. Ethical clearance was obtained from the University of the Western Cape and Muhimbili National Hospital to conduct the study. Anonymity and confidentiality was ensured for all participants and their participation was voluntary. They were allowed to withdraw from the study anytime without any negative consequences. Following ethical issues; quantitative data (i.e. profile and process of care of patients) was collected by means of a data extraction sheet while the two separate semi-structured interview guides were used for qualitative data. A total of 105 patients’ records were obtained. Quantitative data was analysed using SPSS 22.0 version. A descriptive statistics was used. The mean age of the study sample was 30.6 (SD=10.5). More than half (54.3%) were females and males 45.7% of the sample. The results show that Rheumatic Heart Disease (RHD) accounted for the majority (74.3%) of cardiac diseases. Double valve repair accounted for 71.4%. A decline in the number of surgeries performed were noted from 2010 (48.6%) to 2013 (10.5%). The mean number of days spent in Intensive Care Unit (ICU) were 6.4 (SD=5.3) and in the ward 12.2 (SD=7.8). A total of 21.4% of the sample developed post-operative complications and 10.5% of the total sample died. A substantial number of patients (77.7%) were referred for physiotherapy treatment post-operatively, with most of these referrals (70.0%) on the first day post-operatively. The majority (37.8%) of the patients received 3 physiotherapy sessions in the ICU with most of these patients (79.3%) being seen once a day in the ICU and (65.8%) in the ward. Physiotherapists prescribed (53.7%) a combination of breathing exercises, active limb mobilisation, incentive spirometry and progressive ambulation in the ICU. A combination of breathing exercises, active limb mobilisations, endurance training and posture correction was frequently (89.5%) prescribed in the ward. Content analysis was used to analyse qualitative data. Cardiac Surgeons were aware of the role of Physiotherapists on the post-operative management of patients following cardiac surgery. They also identified shortcomings on the side of Physiotherapists’ in terms of poor co-operation, inadequate skills and a lack of motivation to work in the Cardiac Unit. On the other hand, Physiotherapists revealed that there was communication breakdown between them and Cardiac Surgeons. They added that they were not motivated to work in the Cardiac Unit due to their inadequate skills in the area of investigation, training and lack of working facilities. Although they had consensus on different techniques, they had variations on the application procedure, intensity and frequency. Cardiac Surgeons and Physiotherapists agreed that hospital management should motivate Physiotherapists by opening a Physiotherapy Unit within the Cardiac Complex and train Physiotherapists in the area of cardio-pulmonary. From these findings it can be concluded that, poor communication and lack of trained Physiotherapists in the field of cardio-pulmonary is a setback which need to be addressed. Also, lack of standard treatment procedure among Physiotherapists brings variations in this world of evidence based practice.

Thesis (MA)--University of Stellenbosch, 2007. / Bibliography. Also available via the Internet.

Surgeons’ satisfaction with their work Nomeda Adamonienė Scientific advisor Assoc. Prof. Dr. Ilona Bučiūnienė, ISM University of Management and Economics. Kaunas University of Medicine, Faculty of Public Health, Department of Social Medicine – Kaunas, 2005.- 83p. The aim of the study was to investigate the approach of the surgeons working in the Hospital of Kaunas University of Medicine (HKUM) towards their profession, and to identify the factors that stipulate their satisfaction with their work. The objectives of the study were the following: 1. To evaluate surgeons’ attitude to their profession; 2. To identify the factors that condition satisfaction at work; 3. To evaluate the influence of satisfaction at work on the surgeons’ health and personal life. The methods of the study: The subject of research: An inquiry of the surgeons working in the Hospital of Kaunas University of Medicine was performed. The methods and span of the study: Of 250 distributed questionnaires, 187 were filled and returned. The response rate was 75%. Methods of the statistical analysis: The study used 7-point Likert scale, where 1 point stood for “totally disagree”, and 7 points – to “totally agree”. The obtained data were processed using SPSS 9.0. statistical software package. Hypotheses about the absence of interdependence between two indicators (e.g. sex and the length of service) were verified using the chi-square (χ2) criterion. Results: The results of the study showed that surgeons’... [to full text]

Dedicated to the Rev. John B. Romeyn, D.D., David Hosack, Theoderick Romeyn Beck, M.D., and John W. Francis, M.D. / "Printed under the authority of the College of Physicians and Surgeons as the statute directs."--p. [2]. "Errata."--p. [96]. Includes bibliographical references.

Thesis (Ph.D.)--University of Tennessee Health Science Center, 2008. / Title from title page screen (viewed on Sept. 17, 2008). Research advisor: Clinton Stewart, Pharm.D. Document formatted into pages (xiii, 105 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 80-102).

Dedicated to the Rev. John B. Romeyn, D.D., David Hosack, Theoderick Romeyn Beck, M.D., and John W. Francis, M.D. / "Printed under the authority of the College of Physicians and Surgeons as the statute directs."--p. [2]. "Errata."--p. [96]. Includes bibliographical references. Microform version available in the Readex Early American Imprints series.

Orientadores: Heloisa Amelia de Lima Castro, Fausto Berzin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-06T02:20:08Z (GMT). No. of bitstreams: 1 Fortinguerra_EduardoBaumgartner_M.pdf: 889404 bytes, checksum: d79294d68817b4d64a47192f78c9330e (MD5) Previous issue date: 2006 / Resumo: O posicionamento e a postura do cirurgião-dentista no ambiente de trabalho apresentam riscos de dores e desconfortos músculo-esqueléticos na região da cintura escapular. À avaliação da repercussão da postura ocupacional, sobre a atividade muscular pela eletromiografia, tem sido utilizada em estudos ergonômicos. O objetivo desta pesquisa foi analisar a atividade elétrica dos músculos Deltóide (porção média) e Trapézio (porção superior) em abdução do braço e em 50% da sua contração máxima voluntária que foi obtida através da utilização de uma célula de carga da marca krattos por meio de eletromiografia de superfície em cirurgiões-dentistas com mais de 50 anos, que ainda estão trabalhando, relacionando esta análise eletromiográfica com os dados coletados de outro grupo que seriam cirurgiões-dentistas que estão trabalhando entre um período de 5 a 10 anos. Participaram das análises eletromiográficas 14 cirurgiões-dentistas com mais de 50 anos sendo 9 homens e 5 mulheres com média de idade entre 54,64 anos e média de tempo de trabalho de 30,78 anos e 14 cirurgiões-dentistas com tempo de trabalho de 5 a 10 anos, sendo 11 homens e 3 mulheres com média de idade de 30,64 anos e média de tempo de trabalho de 6,42 anos. Os dados eletromiográficos foram normalizados pelo pico da CVM. A análise final foi à comparação do RMS bruto encontrado nos dois grupos, sendo encontrado o RMS significantemente mais baixo (p<0,01) no grupo de CDs com mais de 50 anos para ambos os músculos, e apesar do teste do qui-quadrado não significativo, provavelmente pelo tamanho da amostra, há fortes indícios que a pratica de atividade física regularmente e tempo de trabalho (horas/dia) mais reduzido no ambiente de trabalho podem diminuir os riscos de dores e desconfortos músculo-esqueléticos na região dos ombros / Abstract: The posture of the Surgeon Dentist, in the work environment, may cause the risk of skeletal muscle pain and discomfort in the scapular region. The recognition of the value of the repercussion of the occupational posture, regarding the use of electromyography, has been practiced in ergonomic studies. The objective of this search was to analyze the electric activity of the muscle deltoid (medium portion) and trapeze (upper portion). To reach such objective a selection of Surgeon Dentists older than 50 and still practicing, abducted their arms in 50% of the maximum voluntary contraction obtained through the utilization of a Krattos charging cell and surface electromyography. A comparison was done, of this analysis, with the data obtained from another group composed of Surgeon Dentists who are still working for 5 to 10 years. This comparison provided an interesting information. 14 Surgeons Dentists with more than 50 years old participate in these analyses, 9 men and 5 women with an average age of 54,64 years and work time average 30,78 years and 14 Surgeons Dentists with work time 5 to 10 years, being 11 men and 3 women with an age average of 30,64 and work time 6,42 years. The electromyographic data was normalized with the high point of CVM. The final analysis was a comparison of the gross RMS found in both groups. However, the lowest gross RMS (p<0,01) was found in the SDs group older than 50 years for both muscles, even thought, the test Chi-Square was found nonmeaningful, probably because the size of the evidence. There are indications that the practice of regular physical activity and work time (hours/days) when reduced in the work environment can diminish the risks of skeletal muscle pain and discomfort in the shoulder region / Mestrado / Anatomia / Mestre em Biologia Buco-Dental