Dissertations / Theses on the topic 'Surgical equipment'

FINANCIADORA DE ESTUDOS E PROJETOS
MINISTÉRIO DA CIÊNCIA E TECNOLOGIA
A garantia da confiabilidade metrológica de equipamentos médicohospitalares, apesar de essencial para garantir a obtenção do efeito desejado e evitar efeitos adversos, em geral não é realizada durante o período de uso (pós-comercialização). Dentre as principais causas possíveis desta realidade se encontra a falta de informação por parte dos profissionais usuários quanto aos riscos, ou seja, a reduzida cultura metrológica no ambiente da saúde. A partir da identificação de alguns pontos vulneráveis e de graves repercussões na utilização inadequada de bisturis eletrônicos, esta dissertação avaliou parâmetros para a confiabilidade metrológica destes equipamentos, tanto em nível técnico e normativo, quanto em termos da utilização em ambientes hospitalar.Foi realizada uma busca e identificação da normalização nacional, e avaliada a abrangência das normas para garantir de forma completa a utilização dos equipamentos. Os trabalhos práticos para a avaliação metrológica das unidades eletrocirúrgicas foram realizados em três hospitais. Os resultados obtidos auxiliaram na avaliação da confiabilidade metrológica das unidades eletrocirúrgicas em uso, apontando para a necessidade não só de um controle metrológico periódico, como também da inserção de parâmetros de avaliação que não constam na norma aplicável ao equipamento em estudo. Parte desta dissertação foi financiada, através do Convênio referência FINEP n° 22.01.0692.00, pelo Programa Tecnologia Industrial Básica e Serviços Tecnológicos para a Inovação e Competitividade MCT/FINEP/FNDCT/Fundo Verde Amarelo, um programa cooperativo universidade-empresa.
The metrological reliability of electromedical equipment, although essential in order to guarantee the desired effects and to avoid adverse effects, is often not verified after the equipment is sold and being used (post-sale period). This is partially due to the fact that, usually, health-care takers that use the equipment are unaware of the risks involved, in other words, there is a low metrological culture in the healthcare environment. In this dissertation, vulnerable aspects regarding the inadequate use of high frequency surgical equipment, also known as electrosurgical unit (ESU), were identified, and their consequences evaluated. Based on these results, technical and standard parameters important for the metrological reliability of ESUs, were evaluated. This dissertation also includes a detailed bibliographical research of basic principles, technical specifications, and international procedures that guarantee the metrological reliability of electrosurgical units. The scope of national standards was evaluated in order to guarantee the correct use of all of the ESU´s functions and modes. Experimental data for the metrological evaluation of the EUSs were collected in three (3) hospitals, one (1) private and two (2) public. The results are helpful for evaluating their metrological reliability, and indicate that not only that there is a need for a periodical metrological evaluation, but also that other parameters should be included in existing standards. Part of this dissertation was financed by the Convênio referência FINEP n° 22.01.0692.00 of the Programa Tecnologia Industrial Básica e Serviços Tecnológicos para a Inovação e Competitividade MCT/FINEP/FNDCT/Fundo Verde Amarelo, a universitycompany cooperative program.

Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2019, In conjunction with the Leaders for Global Operations Program at MIT
Thesis: S.M., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2019, In conjunction with the Leaders for Global Operations Program at MIT
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 73-76).
Massachusetts General Hospital (MGH) manages a large inventory of surgical equipment which must be delivered to operating rooms on-time, efficiently, and according to a set of quality standards. In recent years, flexible scope management has become a topic of interest for many hospitals, as they face pressure to both reduce costs and prevent infections that can result from mismanagement. This thesis proposes a novel method for surgical equipment management in a hospital. The proposed solution uses a real-time locating system to track flexible scopes, a semantic reasoning engine to determine the state of each scope, and a dashboard to inform staff about necessary interventions to avoid scope expirations while maximizing efficiency. This project aims to accomplish three primary goals. First, the project seeks to improve the hospital's compliance to quality standards in order to reduce risks of infection due to expired scopes. Second, the project aims to improve the cost-efficiency of scope disinfecting processes through more efficient inventory management. Finally, the project serves as an opportunity for the hospital to establish best practices for working with the newly installed real-time locating system. The system proposed in this work is piloted at MGH on a subset of the hospital's flexible scopes. The pilot results demonstrated a quality compliance increase from 88.9% to 94.5%. The implementation also resulted in an estimated $17,350 annual cost savings due to more efficient management of scopes.
by Jason Troutner.
M.B.A.
S.M.
M.B.A. Massachusetts Institute of Technology, Sloan School of Management
S.M. Massachusetts Institute of Technology, Department of Mechanical Engineering

The study aimed to identify leading practices to promote environmentally friendly and efficient efforts in surgical healthcare. Despite widespread enthusiasm for going green in the U.S. economy, little information is available to inform the medical community on the effort. We explore safe and efficient strategies for hospitals and healthcare providers to protect the environment while delivering high-quality care. As part of the study design, we performed a systematic review of the literature using relevant Pubmed search terms and surveyed a panel of hospital managers and CEOs of healthcare organizations pursuing green initiatives. Recommendations were itemized and reviewed with each panelist for a consensus agreement. At the end, we identified forty-three published articles and obtained interview data from the 7-member expert panel. Five green recommendations for surgical practices were identified: (1) OR Waste Reduction and Segregation; (2) Environmentally Preferable Purchasing; (3) Energy Consumption Management; (4) Pharmaceutical Waste Management; (5) Reprocessing of Single Use Medical Devices. We concluded that the medical community has a large opportunity to implement green practices in surgical units. These practices can have significant benefits to both the healthcare community and the environment.

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-08-17T19:44:43Z No. of bitstreams: 2 Dissertação - Júnnia Pires de Amorim Trindade - 2016.pdf: 4029550 bytes, checksum: 8273cd9d0a5907d8dd17702921026096 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-18T12:56:44Z (GMT) No. of bitstreams: 2 Dissertação - Júnnia Pires de Amorim Trindade - 2016.pdf: 4029550 bytes, checksum: 8273cd9d0a5907d8dd17702921026096 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2016-08-18T12:56:44Z (GMT). No. of bitstreams: 2 Dissertação - Júnnia Pires de Amorim Trindade - 2016.pdf: 4029550 bytes, checksum: 8273cd9d0a5907d8dd17702921026096 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-12
Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
This experimental study examined silicone tubes coming from care to surgical patients in the perioperative period, chosen randomly. The study was conducted from September to November 2015 and the tubes were derived from the Central Sterile Supply Departments (CSSD) of a large general hospital in the Midwest region of Brazil. The objectives were to validate a method for extraction and quantification of microbial contamination in silicon tubes, checking the microbial charge of silicone tubes immediately after cleaning, and in different storage intervals identify the presence of biofilms on silicone tubing.The study was approved by the Ethics Committee under the protocols No. 1,277,077 and 1,000,946. To validate the method, two new sterile silicone tubing were used, pipe 01 and pipe 02 to 106 were artificially contaminated with bacterial spores of Geobacillus stearothermophilus. The contaminated pipes were filled with sterile water and sealed at the extremities. The tube 02 was submitted to five minutes sonication. The tube 01 has not submitted to this process. Subsequently, the seals were removed and the water collected in 60- mL syringe and filtered through 0.45 Millipore membrane μm in holder for syringe device. Membranes were incubated at 35 ° C for 24 hours in petri dishes containing nutrient agar. After the incubation period, the membranes were removed and placed in test tubes containing 1mL of saline that were submitted to vortexing for five minutes and subjected to handle calibrated technique for quantification of the colony. The sonication proved to be more effective for recovery of micro-organisms. The validated methodology was used for the tubes of the experimental groups (consisting of 10 silicon tubes used in hospital care after the cleaning process), negative control (three new silicone tubes) and positive control (tubes used in assisting during surgery with organic matter visible). The tubes were initially segmented into three fragments: end 01, 02 and a half later and were again targeted to pre-established time intervals zero, 12 and 24 hours in conditions similar to those offered by the study institution. In addition to the groups submitted to microbiological analysis by this method, similar tubes to the experimental group were collected for analysis by scanning electron microscopy (SEM). Among the tubes that were subjected to analysis by SEM, experimental groups were formed (three tubes used in hospital care after the cleaning process), positive control (tubes used without cleaning) and negative (new tubes). There was no statistically significant difference when comparing the means and the ends of the silicone tubing used in hospital care (p> 0.05) in zero periods, 12 and 24 hours. There was an increase of microbial load of the order of a magnitude on the logarithmic scale every 12 hours (p <0.05) in cleaning and storage conditions provided by the institution in experimental and positive control. There was no microbial growth in the negative control group. SEM showed the presence of organic matter that can support microbial growth.
Estudo experimental que analisou tubos de silicone oriundos da assistência ao paciente cirúrgico no período transoperatório, escolhidos aleatoriamente. O estudo foi realizado no período de setembro a novembro de 2015 e os tubos foram oriundos do Centro de Material e Esterilização (CME) de um hospital geral de grande porte da região Centro-Oeste do Brasil. Os objetivos foram validar um método para extração e quantificação da carga microbiana em tubos de silicone, determinar a carga microbiana de tubos de silicone imediatamente após a limpeza e em diferentes intervalos de armazenamento e avaliar a presença de biofilme em tubos de silicone. O estudo foi aprovado pelo Comitê de Ética sob os protocolos nº 1.277.077 e 1.000.946. Para a validação do método foram utilizados dois tubos de silicone novos esterilizados, tubo 01 e tubo 02 que foram artificialmente contaminados com 106 esporos bacterianos de Geobacillus stearothermophilus e em seguida. Os tubos contaminados foram preenchidos com água estéril e vedados nas extremidades. O tubo 02 foi submetido a cinco minutos de sonicação, já o tubo 01 não passou por este processo. Posteriormente, os lacres foram removidos e a água coletada em seringa de 60 mL e filtradas em membrana Millipore 0,45 µm em dispositivo holder para seringa. As membranas foram incubadas em estufa a 35ºC por 24 horas em placas de petri contendo ágar nutriente. Após o período de incubação, as membranas foram removidas e dispostas em tubos de ensaio contendo 1mL de solução salina que foram submetidas a agitação em vórtex por cinco minutos e submetidos a técnica de alça calibrada para quantificação das colônias. A sonicação demonstrou-se mais eficaz para a recuperação dos micro-organismos. A metodologia validada foi utilizada para os tubos dos grupos experimental (composto por 10 tubos de silicone utilizados na assistência hospitalar após o processo de limpeza), controle negativo (três tubos de silicone novos) e controle positivo (tubos usados na assistência transoperatória com matéria orgânica visível). Os tubos foram segmentados inicialmente em três fragmentos: extremidade 01, 02 e meio e posteriormente foram novamente segmentados conforme intervalos de tempo pré- estabelecidos zero, 12 e 24 horas em condições semelhantes às oferecidas pela instituição, local do estudo. Além dos grupos submetidos a análise microbiológica pelo método descrito, Novos tubos em condições semelhantes ao do grupo experimental foram coletados tubos semelhantes ao grupo experimental para análise por microscopia eletrônica de varredura (MEV). Dos tubos submetidos a análise pelo MEV, foram formados grupo experimental (três tubos utilizados na assistência hospitalar após o processo de limpeza), grupos controle positivo (tubos utilizados sem limpeza prévia) e negativo (tubos novos). Não houve diferença estatisticamente significativa quando comparados o meio e as extremidades dos tubos de silicone utilizados na assistência hospitalar (p>0,05) nos períodos zero, 12 e 24 horas. Houve aumento da carga microbiana na ordem de uma grandeza na escala logarítmica a cada 12 horas (p<0,05), nas condições de limpeza e armazenamento proporcionados pela instituição nos grupos experimental e controle positivo. Não houve crescimento microbiano no grupo controle negativo. A MEV mostrou presença de matéria orgânica que pode favorecer o crescimento microbiano.

Abstract The purpose of this study was to investigate the clinical implications of a combination of a peripheral opioid, paracetamol (APAP) and ketoprofen (KTP) on the intensity of acute postoperative pain by focusing on tonsillectomy (TE) and third molar extraction. A second focus in the study was to assess the utility of the surgical ultrasonically activated scalpel (HS) technique for TE. In Study I, TE was performed on one side using the HS and on the contralateral side using a “blunt dissection technique”. The first TE study (I) demonstrated that - based on NRS pain scores during the first 10 postoperative hours - intra-operative blood loss and need for haemostasis were greater on the blunt dissection side than on the HS side. Pain scores were higher on the HS side than on the cold dissection side during the second postoperative week. Study III assessed the analgesic effect of a peripheral dose of 4 mg morphine. The peritonsillar infiltration of morphine locally did not significantly decrease pain compared to the control side. Studies (II and IV) included patients who were scheduled for third molar extraction. In Study II, patients received 1000 mg APAP or 100 mg KTP or both or a placebo to evaluate pain relief after third molar extraction. This study demonstrated that the mean sum of pain intensity differences scores up to the 1.5 h mark and the mean time to onset of pain relief at rest and on swallowing were favoured in the combination group more than in the APAP, KTP, and placebo groups. In Study IV, patients were assigned for a submucosal injection of 2 mg morphine or NaCl into either the non-inflamed (Trial I) or the inflamed (Trial II) peridental tissue, while the active control group received the same drugs in reverse order intramuscular (IM). Postoperative pain intensity at rest and on swallowing was assessed in all studies using the numerical rating scale (NRS). Pain scores in the peripheral morphine group at rest (Trials I and II) and on swallowing (Trial I) were not associated with any further pain reduction. Pain scores on swallowing during the 2–6 hours postoperative period (Trial II) were greater in the IM morphine group. HS TE was associated with decreased pain in the early postoperative period, but there was increased pain and otalgia during the second postoperative week. Locally administered peripheral morphine was not associated with any benefit during the postoperative period after TE. The multimodal analgesia combination of a single dose of KTP and APAP demonstrated the same benefit during the early postoperative period without an increase in side effects. Locally administered peripheral morphine produced significant analgesia on swallowing during the early postoperative stage in inflamed tissue after third molar extraction
Tiivistelmä Hyvä leikkauksen jälkeinen kivunhoito on yksilöllisesti suunniteltua, turvallista, helppokäyttöistä ja taloudellista. Nykyään pyritään kivunlievityksessä hyödyn-tämään eri vaikutuspaikkoihin kohdistuvia hoitoja eli multimodaalista kivun¬hoitoa. Tämän työn tarkoituksena oli selvittää eri kivunlievitysmenetelmien tehoa ja turvallisuutta kahdessa eri toimenpiteessä: nielurisojen poistoleikkauksen (TE) tai viisaudenhampaan poistoleikkauksen jälkeen. Tutkimuskokonaisuus käsittelee leikkaustekniikan (Ultraääniveitsi), lääke-ainekombinaatioiden ja perifeerisesti annostellun morfiinin vaikutusta post-operatiiviseen kipuun. Tutkimusaineisto koostuu neljästä tutkimuksesta. Kaikki työt olivat satunnaistettuja ja kaksoissokkoutettuja. Kipu mitattiin numeerista asteikolla (Numerical Rating Scale, NRS) sekä levossa että nielemisen aikana enintään 2 viikon ajan. Ultraääniveitsen käytön vaikutusta postoperatiiviseen kipuun verrattiin perinteiseen leikkaustekniikkaan. Potilailta toinen nielurisa poistettiin ultraääni¬veistä käyttäen ja toinen tylpästi irrotellen kylmiä instrumentteja käyttäen. Kipu oli perinteisellä tekniikalla leikatulla puolella voimakkaampi kuin ultraääni¬veitsellä leikatulla puolella leikkauspäivänä. Toisen leikkauksen jälkeisen viikon aikana kipu oli kuitenkin voimakkaampaa ultraääniveitsillä leikatulla puolella. Parasetamolin (APAP), ketoprofeenin (KTP) tuottamaa kivunlievitystä ja näiden yhteisvaikutusta verrattiin viisaudenhampaan poistoleikkauksen jälkeen. KTP ja APAP kombinaatio antoi tehokkaamman kivunlievityksen ja nopeamman hoitovasteen kuin kumpikaan lääke yksin annettuna. Perifeerisesti infiltroidun morfiinin vaikutusta kipuun tutkittiin TE sekä viisaudenhampaan poistoleikkauksen jälkeen. TE jälkeen toiselle puolelle infiltroitiin nielurisan taakse 4 mg morfiinia ja toiselle puolelle fysiologista suolaliuosta. Viisaudenhampaan poistoleikkauksessa paikallisesti infiltroitua 2 mg morfiinia verrattiin lihakseen annettuun samaa lääkkeeseen kahdessa eri tilanteessa, joko tulehtuneeseen tai tulehtumattomaan kudokseen annosteltuna. Paikallisesti infiltroidulla morfiinilla ei todettu kipua lievittävää vaikutusta TE jälkeen. Tulehtuneeseen kudokseen infiltroitu morfiini lievensi leikkauksen jälkeistä nielemiskipua 2–6 tuntia leikkauksesta. Tulehtumattomaan kudokseen infiltroidulla morfiinilla ei saatu lisäetua. Yhteenvetona voidaan todeta, että TE ja viisaudenhampaanpoistoleikkauksen jälkeen kivunhoitoa voidaan optimoida multimodaalisin kivunhoidon keinoin. Tutkimustulokset auttavat potilaskohtaisen yksilöllisen kivunhoidon suunnittelussa

Stroke is the third most common cause of death and a leading cause of disability in the United States. The existing treatments of acute ischemic stroke (AIS) involve pharmaceutical thrombolytic therapy and/or mechanical thrombectomy. The Food and Drug Administration (FDA)-approved recombinant tissue plasminogen activator (tPA) administration for treatment of stroke is efficacious, but has a short treatment time window and is associated with a risk of symptomatic hemorrhage. Other than tPA, the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever system and the Penumbra Aspiration system are both approved by the FDA for retrieval of thromboemboli in AIS patients. However, the previous clinical studies have shown that the recanalization rate of the MERCI system and the clinical outcome of the Penumbra system are not optimal. To identify the variables which could affect the performance of the thrombectomy devices, much effort has been devoted to evaluate thrombectomy devices in model systems, both in vivo and in vitro, of vascular occlusion. The goal of this study is to establish a physiologically realistic, in vitro model system for the preclinical assessment of mechanical thrombectomy devices. In this study, the model system of cerebrovascular occlusion was mainly composed of a human vascular replica, an embolus analogue (EA), and a simulated physiologic mock circulation system. The human vascular replica represents the geometry of the internal carotid artery (ICA)/middle cerebral artery (MCA) that is derived from image data in a population of patients. The features of the vasculature were characterized in terms of average curvature (AC), diameter, and length, and were used to determine the representative model. A batch manufacturing was developed to prepare the silicone replica. The EA is a much neglected component of model systems currently. To address this limitation, extensive mechanical characterization of commonly used EAs was performed. Importantly, the properties of the EAs were compared to specimens extracted from patients. In the preliminary tests of our model system, we selected a bovine EA with stiffness similar to the thrombi retrieved from the atherosclerotic plaques. This EA was used to create an occlusion in the aforesaid replica. The thrombectomy devices tested included the MERCI L5 Retriever, Penumbra system 054, Enterprise stent, and an ultrasound waveguide device. The primary efficacy endpoint was the amount of blood flow restored, and the primary safety endpoint was an analysis of clot fragments generated and their size distribution. A physiologically realistic model system of cerebrovascular occlusion was successfully built and applied for preclinical evaluation of thrombectomy devices. The recanalization rate of the thrombectomy device was related to the ability of the device to capture the EA during the removal of the device and the geometry of the cerebrovasculature. The risk of the embolic shower was influenced by the mechanical properties of the EA and the design of the thrombectomy device.

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase the use of disposable blades will be determined. Once Institutional Review Board (IRB) approval and written consent were obtained, anesthesia providers were asked to complete an anonymous one page questionnaire on their knowledge and practice regarding disposable laryngoscope blades. Immediately following the completion of the questionnaire, participants were given an investigator developed article to read. Participants completed the same anonymous questionnaire 3 months following the pre-intervention questionnaire. Inventory of the disposable laryngoscope blades were collected at the start of the project, at one month, and then again at three months. A total of 12 anesthesia providers participated in the evidence based practice project. An increased number of providers stated that they felt disposable laryngoscope blades were easy to use at the completion of the project and there was an increased use of disposable laryngoscope blades. At post-intervention, anesthesia providers described performance (25%) as their reason for not using the disposable laryngoscope blade which was down from the start of the project (60%). A single proportion Z-Test showed that the 23% increase in use of disposable laryngoscope blades after the intervention was statistically significant (Z=2.046, p=0.041). This evidence based project has shown that despite initial apprehension, a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades which should translate to improved patient outcomes.

I december 2019 rapporterades de första fallen av ett virus benämnt som covid-19 i Wuhan, Kina. Viruset sprider sig snabbt och i takt med den okontrollerade spridningen blir också trycket på sjukvården allt högre. Samtidigt som vården gör allt i sin makt för att räcka till så rapporteras det om global brist på skyddsutrustning. Tillverkningen av ett kirurgiskt munskydd, från fiber till färdig produkt, består av ett omfattande system och kräver material av specifika fibrer som framställs i avancerade processer. Att skapa ett munskydd som besitter möjligheten för återanvändning hade varit ett alternativ i syfte att minska risk för att munskydd tar slut samtidigt som engångsförbrukning minimeras. Syftet med denna studie är att studera och analysera materialval, framställning, konstruktion och krav för kirurgiska munskydd. Studien syftar också till att undersöka alternativa möjligheter till att skapa ett återanvändbart munskydd. Val av metod för insamling av material har haft sin utgångspunkt i litteraturstudier av främst vetenskaplig karaktär. Då ämnet är högaktuellt har nyhetsartiklar från betrodda dagstidningar varit av värde. Intervjuer av kvalitativ läggning genomfördes i syfte att skapa en överskådlig inblick i vårdarbetet. Ett kirurgiskt munskydd fungerar som en skyddande barriär mot överföring av smittämnen mellan personal och patient och är generellt uppbyggt i tre olika lager. Det inre lagret, mittenlagret, är tillverkat genom en process kallad nonwoven meltblown medan de två yttre lagren, det övre och det undre, tillverkas genom en process kallad nonwoven spunbond. Dessa tre lager kalendreras sedan samman och bildar själva filtermediet som därefter veckas och sys i en konverteringslinje. Munskydd är en engångsvara och slängs direkt efter användning. Nawar Kadi, som är professor på Textilhögskolan i Borås, arbetar för tillfället med ett projekt som syftar till att utveckla ett delvis tvättbart munskydd som fungerar att återanvända. I dagsläget finns många aspekter att beakta och frågor att besvara innan projektet går att förverkliga i praktiken men med rätt förutsättningar, ekonomisk stöttning och framförallt beprövade metoder med bakomliggande forskning är möjligheten till att skapa ett återanvändbart munskydd inte långt borta.
In December 2019, the first cases of a virus called covid-19 were reported in Wuhan, China. The virus is spreading rapidly and in connection with the uncontrolled spread, the pressure on healthcare is also increasing. At the same time as healthcare is doing everything in its power to suffice, a global lack of protective equipment is reported. The manufacture of a surgical face mask, from fiber to finished product, consists of a comprehensive system and requires materials of specific fibers produced in advanced processes. Creating a face mask that possesses the possibility of reuse would have been an alternative with the aim of reducing the risk of face mask ending while minimizing disposable consumption. The purpose of this study is to analyze material selection, manufacture, construction and requirements for surgical face masks. The study also aims to explore alternative ways of creating a reusable face mask. The choice of method for collecting material has been based on literature studies of a primarily scientific nature. As the topic is highly current, news articles from trusted newspapers have been of value. Qualitative interviews were conducted with the aim of providing a clear insight into the healthcare work. A surgical face mask serves as a protective barrier against the transmission of infectious agents between staff and patients and is generally constructed in three different layers. The inner layer is made by a process called nonwoven meltblown, while the two outer layers, the upper and the lower, are made by a process called nonwoven spunbond. These three layers are then calendered together to form the filter media, which is then pleated and seamed in a converting line. The surgical face mask is a disposable item and is discarded immediately after use. Nawar Kadi, who is a professor at Textilhögskolan in Borås, is currently working on a project aimed at developing a partially washable face mask that thus functions to reuse. At present, there are many aspects to consider and questions to answer before the project can be realized in practice but with the right conditions, financial support and proven methods with underlying research, the possibility of creating a reusable face mask is not far away.

Magnesium alloys have been widely explored as potential biomaterials, but several limitations to using these materials have prevented their widespread use, such as uncontrollable degradation kinetics which alter their mechanical properties. In an attempt to further the applicability of magnesium and its alloys for biomedical purposes, two novel magnesium alloys Mg-Zn-Cu and Mg-Zn-Se were developed with the expectation of improving upon the unfavorable qualities shown by similar magnesium based materials that have previously been explored. The overall performance of these novel magnesium alloys has been assessesed in three distinct phases of research: 1) analysing the mechanical properties of the as-cast magnesium alloys, 2) evaluating the biocompatibility of the as-cast magnesium alloys through the use of in-vitro cellular studies, and 3) profiling the degradation kinetics of the as-cast magnesium alloys through the use of electrochemical potentiodynamic polarization techqnique as well as gravimetric weight-loss methods. As compared to currently available shape memory alloys and degradable as-cast alloys, these experimental alloys possess superior as-cast mechanical properties with elongation at failure values of 12% and 13% for the Mg-Zn-Se and Mg-Zn-Se alloys, respectively. This is substantially higher than other as-cast magnesium alloys that have elongation at failure values that range from 7-10%. Biocompatibility tests revealed that both the Mg-Zn-Se and Mg-Zn-Cu alloys exhibit low cytotoxicity levels which are suitable for biomaterial applications. Gravimetric and electrochemical testing was indicative of the weight loss and initial corrosion behavior of the alloys once immersed within a simulated body fluid. The development of these novel as-cast magnesium alloys provide an advancement to the field of degradable metallic materials, while experimental results indicate their potential as cost-effective medical devices.

La present tesi doctoral s’ha centrat en el repte d’aconseguir, mitjançant Fabricació Additiva (FA), models per a assaig quirúrgic, sota la premissa que els equips per fer-los haurien de ser accessibles a l’àmbit hospitalari. L’objectiu és facilitar l’extensió de l’ús dels prototips com a eina de preparació d’operacions quirúrgiques, transformant la pràctica mèdica actual de la mateixa manera que en el seu moment ho van fer tecnologies com les que van facilitar l’ús de radiografies. El motiu d’utilitzar FA, en lloc de tecnologies més tradicionals, és la seva capacitat de materialitzar de forma directa les dades digitals obtingudes de l’anatomia del pacient mitjançant sistemes d’escanejat tridimensional, fent possible l’obtenció de models personalitzats. Els resultats es centren en la generació de nou coneixement sobre com aconseguir equipaments d’impressió 3D multimaterials accessibles que permetin l’obtenció de models mimètics respecte als teixits vius. Per facilitar aquesta buscada extensió de la tecnologia, s’ha focalitzat en les tecnologies de codi obert com la Fabricació per Filament Fos (FFF) i similars basades en líquids catalitzables. La recerca s’alinea dins l’activitat de desenvolupament de la FA al CIM UPC, i en aquest àmbit concret amb la col·laboració amb l’Hospital Sant Joan de Déu de Barcelona (HSJD). El primer bloc de la tesi inclou la descripció de l’estat de l’art, detallant les tecnologies existents i la seva aplicació a l’entorn mèdic. S’han establert per primer cop unes bases de caracterització dels teixits vius -sobretot tous- per donar suport a la selecció de materials que els puguin mimetitzar en un procés de FA, a efectes de millorar l’experiència d’assaig dels cirurgians. El caràcter rígid dels materials majoritàriament usats en impressió 3D els fa poc útils per simular tumors i altres referències anatòmiques. De forma successiva, es tracten paràmetres com la densitat, la viscoelasticitat, la caracterització dels materials tous a la indústria, l’estudi del mòdul elàstic de teixits tous i vasos, la duresa d’aquests, i requeriments com l’esterilització dels models. El segon bloc comença explorant la impressió 3D mitjançant FFF. Es classifiquen les variants del procés des del punt de vista de la multimaterialitat, essencial per fer models d’assaig quirúrgic, diferenciant entre solucions multibroquet i de barreja al capçal. S’ha inclòs l’estudi de materials (filaments i líquids) que serien més útils per mimetitzar teixits tous. Es constata com en els líquids, en comparació amb els filaments, la complexitat del treball en processos de FA és més elevada, i es determinen formes d’imprimir materials molt tous. Per acabar, s’exposen sis casos reals de col·laboració amb l’HJSD, una selecció d’aquells en els que el doctorand ha intervingut en els darrers anys. L’origen es troba en la dificultat de l’abordatge d’operacions de resecció de tumors infantils com el neuroblastoma, i a la iniciativa del Dr. Lucas Krauel. Finalment, el Bloc 3 té per objecte explorar nombrosos conceptes (fins a 8), activitat completada al llarg dels darrers cinc anys amb el suport dels mitjans del CIM UPC i de l’activitat associada a treballs finals d’estudis d’estudiants de la UPC, arribant-se a materialitzar equipaments experimentals per validar-los. La recerca ampla i sistemàtica al respecte fa que s’estigui més a prop de disposar d’una solució d’impressió 3D multimaterial de sobretaula. Es determina que la millor via de progrés és la de disposar d’una pluralitat de capçals independents a fi de capacitar la impressora 3D per integrar diversos conceptes estudiats, materialitzant-se una possible solució. Cloent la tesi, es planteja com seria un equipament d’impressió 3D per a models d’assaig quirúrgic, a fi de servir de base per a futurs desenvolupaments.
La presente tesis doctoral se ha centrado en el reto de conseguir, mediante Fabricación Aditiva (FA), modelos para ensayo quirúrgico, bajo la premisa que los equipos para obtenerlos tendrían que ser accesibles al ámbito hospitalario. El objetivo es facilitar la extensión del uso de modelos como herramienta de preparación de operaciones quirúrgicas, transformando la práctica médica actual de la misma manera que, en su momento, lo hicieron tecnologías como las que facilitaron el uso de radiografías. El motivo de utilizar FA, en lugar de tecnologías más tradicionales, es su capacidad de materializar de forma directa los datos digitales obtenidos de la anatomía del paciente mediante sistemas de escaneado tridimensional, haciendo posible la obtención de modelos personalizados. Los resultados se centran en la generación de nuevo conocimiento para conseguir equipamientos de impresión 3D multimateriales accesibles que permitan la obtención de modelos miméticos respecto a los tejidos vivos. Para facilitar la buscada extensión de la tecnología, se ha focalizado en las tecnologías de código abierto como la Fabricación por Hilo Fundido (FFF) y similares basadas en líquidos catalizables. Esta investigación se alinea dentro de la actividad de desarrollo de la FA en el CIM UPC, y en este ámbito concreto con la colaboración con el Hospital Sant Joan de Déu de Barcelona (HSJD). El primer bloque de la tesis incluye la descripción del estado del arte, detallando las tecnologías existentes y su aplicación al entorno médico. Se han establecido por primera vez unas bases de caracterización de los tejidos vivos – principalmente blandos – para dar apoyo a la selección de materiales que los puedan mimetizar en un proceso de FA, a efectos de mejorar la experiencia de ensayo de los cirujanos. El carácter rígido de los materiales mayoritariamente usados en impresión 3D los hace poco útiles para simular tumores y otras referencias anatómicas. De forma sucesiva, se tratan parámetros como la densidad, la viscoelasticidad, la caracterización de materiales blandos en la industria, el estudio del módulo elástico de tejidos blandos y vasos, la dureza de los mismos, y requerimientos como la esterilización de los modelos. El segundo bloque empieza explorando la impresión 3D mediante FFF. Se clasifican las variantes del proceso desde el punto de vista de la multimaterialidad, esencial para hacer modelos de ensayo quirúrgico, diferenciando entre soluciones multiboquilla y de mezcla en el cabezal. Se ha incluido el estudio de materiales (filamentos y líquidos) que serían más útiles para mimetizar tejidos blandos. Se constata como en los líquidos, en comparación con los filamentos, la complejidad del trabajo en procesos de FA es más elevada, y se determinan formas de imprimir materiales muy blandos. Para acabar, se exponen seis casos reales de colaboración con el HJSD, una selección de aquellos en los que el doctorando ha intervenido en los últimos años. El origen se encuentra en la dificultad del abordaje de operaciones de resección de tumores infantiles como el neuroblastoma, y en la iniciativa del Dr. Lucas Krauel. Finalmente, el Bloque 3 desarrolla numerosos conceptos (hasta 8), actividad completada a lo largo de los últimos cinco años con el apoyo de los medios del CIM UPC y de la actividad asociada a trabajos finales de estudios de estudiantes de la UPC, llegándose a materializar equipamientos experimentales para validarlos. La investigación amplia y sistemática al respecto hace que se esté más cerca de disponer de una solución de impresión 3D multimaterial de sobremesa. Se determina que la mejor vía de progreso es la de disponer de una pluralidad de cabezales independientes, a fin de capacitar la impresora 3D para integrar diversos conceptos estudiados, materializándose una posible solución. Para cerrar la tesis, se plantea cómo sería un equipamiento de impresión 3D para modelos de ensayo quirúrgico, a fin de servir de base para futuros desarrollos.

碩士
中原大學
資訊工程研究所
103
In medicine, surgical operations are important clinical procedure for patient treatment. Although robots and/or robot arms have been widely used in industry, they are not yet seen in surgical operations at present. This is partly because the technical challenge of implementing such a medical robot remains in resolving the vision problems. In this study, our objective is to develop a vision-based system for the automatic recognition and localization of surgical equipment. The technical approaches include: (1) image preprocessing; (2) region segmentation; and (3) object recognition. Using a set of surgical equipment, i.e., scalpels, acutenaculums, and haemostats, preliminary results showed that our system could achieve the recognition rate of over 83.8%. In conclusion, our system has the potentials to be incorporated in a robot and/or a robot arm to play the role of a surgical assistant, despite that this is beyond the scope of this study.

碩士
長庚大學
機械工程學系
105
In our research, we developed a registration procedure and a bone drilling system for robot arm. Improve surgery accuracy and security with robot arm assistant. Our system includes an optical tracking system, a six-axis robot arm, and a bone-drilling instrument on robot end-effector. For obtain coordinate relationship between robot arm base and tracking system, and between robot end-effector and bone-drilling instrument, we solved coordinate relationship equation by optimization method. For the requirement of measurement, we made a calibration tool, using tracking system, we can measure the location of bone-drilling instrument tip in real world with calibration tool. We can obtain the rotation relationship between robot arm base and tracking system with numbers of passive markers on bone-drilling instrument, and fix the robot base coordinate origin by the location of bone-drilling instrument tip in real world. After verify, the registration average error in our system is 1.64 mm. In addition, we detected drilling reaction force signal in real-time by load cell, let bone-drilling instrument stop at appropriate step, keep enough margin.

碩士
逢甲大學
經營管理碩士在職專班
99
Taiwan’s market of medical device is growing with the aging of population, and most of the major international medical device’s companies sell the most advanced product directly or indirectly. With it, Taiwan’s market of medical device is very competitive and the companies which sell the medical devices/ equipments take rigorous competitions. How to cater for the hospital’s requirements or create the requirements from doctors hold the rights to choice straightly are the key points to drive a successful sales or not for the suppliers of medical device/ equipment. Technology Acceptance Model (TAM) is the theory’s base of this study. This study explores the points to influence the surgeon’s willing on purchasing medical and then bring up a theory model which can be applied on the purchase’s selection intents of surgery department in hospitals. The research objects are focused on Taiwan’ s surgeons, and the total of 277 valid questionnaires were delivered & retrieved by sales in person. All the data were analyzed by AMOS 16.0 Structure Equation Modeling (SEM). This study found endorsement from expert has positive effects on Perceived Usefulness (PU), but quality of export & enhancement of development don’t have significant relation. On the other hand, both procedures of operation and higher convenience have positive effects on Perceived Ease of Use (PEoU), and the effects from the former are more than the latter. Development’s trend in social norms has positive effects on surgeon’s intention to use, but requirements of hospital evaluations don’t.

Orientação : Pedro Faísca
Introdução: A utilização do tubo endotraqueal (TE) e da traqueia respiratória (TR) é fundamental na prática cirúrgica veterinária e a reutilização dos mesmos é também uma prática recorrente de forma a obter uma diminuição de custos. A avaliação da contaminação microbiológica dos mesmos está amplamente documentada em Medicina Humana. O mesmo não se sucede em Medicina Veterinária, pois devido aos altos custos de manutenção, torna-se impraticável realizar estudos microbiológicos de rotina. Material e Métodos: O presente estudo foi realizado num Hospital de Medicina Veterinária na zona de Lisboa, com o objectivo de determinar a contaminação bacteriana e fúngica nestes equipamentos. Procedeu-se à avaliação clínica e radiográfica de todos os pacientes. Foram recolhidas amostras microbiológicas a partir de 30 TEs e 30 TRs reutilizados, escolhidos aleatoriamente, antes do procedimento cirúrgico e cultivadas em meios de cultura para bactérias e fungos. Este procedimento foi realizado independentemente do sexo, raça e idade do animal, tipo e tempo de cirurgia. Seguido de determinação, caracterização e identificação microbiológica. Resultados: Verificou-se crescimento bacteriano e/ou fúngico total de 73% (44 amostras positivas em 60 amostras). Por fim, correlacionaram-se os resultados com o aparecimento de afecções respiratórias. Conclusão: O estudo de fontes de contaminação em ambientes hospitalares veterinários é uma actividade em crescimento, sendo necessário o desenvolvimento de programas de controlo mais específicos e eficazes, que tenham como pilares básicos um sistema de vigilância efectivo combinado com uma rotina de análises microbiológicas.
Background: The use of the endotracheal tube (ET) and the tubing of breathing circuit systems (tBCS) is fundamental for the practice of the veterinary surgery and reusing them is also a recurring way of reducing costs. The evaluation of the microbiological contamination is widely documented in Human Medicine. In Veterinary Medicine however, due to high maintenance costs, it is impossible to perform routine microbiological studies. Materials and methods: The current study was done in a Veterinary Medicine Hospital in the Lisbon area, with the objective of defining the bacteriological and fungi contamination of these medical devices. All patients underwent a clinical and radiographic evaluation. Microbiological samples were taken from 30 ET and 30 tBCS reused randomly chosen and were collected before initiating the surgical procedure and cultured for bacteria and fungi. This procedure was performed regardless of the sex, race and age of the animal, type and time of surgery. Followed by determination, characterization and microbiological identification. Results: Bacterial and/or fungal growth was found to be 73% (44 positive samples in 60 samples). In the end the results were correlated with the appearance of respiratory disorders. Conclusion: The study of the sources of contamination in veterinary hospital environments is a growing activity, creating the need to develop more specific and efficient control programs, which will be supported by a basis of a surveillance system combined with a routine of microbiological analysis.