Search results for: surgical errors

Authors: Z. Karakus, Z. Ozer

Abstract:

Nurses are responsible for the care and treatment of individuals, as well as health maintenance and education. Medication administration is an important part of health promotion. The administration of a medicine is a common but important clinical procedure for nurses because of its complex structure. Therefore, medication errors are inevitable for nurses or nursing students. Medication errors can cause ineffective treatment, patient’s prolonged hospital stay, disablement, or death. Additionally, medication errors affect the global economy adversely by increasing health costs. Hence, preventing or decreasing of medication errors is a critical and essential issue in nursing. Nurse educators are in pursuit of new teaching methods to teach students significance of medication application. In the light of technological developments of this age, e-learning has started to be accepted as an important teaching method. E-learning is the use of electronic media and information and communication technologies in education. It has advantages such as flexibility of time and place, lower costs, faster delivery, and lower environmental impact. Students can make their own schedule and decide the learning method. This study is conducted to determine the impact of e-learning on medication administration of nursing students.

Keywords: e-learning, medication administration, nursing, nursing students

Procedia PDF Downloads 228

Authors: Hakim Derradji, Abdelkader Yahi, Abdelmalek Sabrou, Nacer Tabet

Abstract:

Introduction: Cystic lesions located in the sellar and suprasellar region cause a diagnostic and therapeutic problem, given their location and their impact on neighboring structures. The patient's symptomatology varies from a simple headache to serious visual and endocrine disorders, involving the functional prognosis, sometimes even the vital prognosis. Surgery in this region remains a therapeutic challenge, and several surgical techniques have been described and used. Material and Methods: We treated 15 patients during the period from 2015 to 2022, whose clinical, biological, radiological, and therapeutic characteristics will be presented in detail in this work, and in whom the surgical technique differs from one case to another. Conclusion: We will discuss in this work the different techniques used to treat these lesions and the different objectives to be achieved for each case, as well as the complications and our conduct to be taken per and post-operative.

Keywords: cystic lesions, adenomas, sellar and suprasellar region, neuroendoscopy

Procedia PDF Downloads 65

Authors: Anish Desai, Reshmi Pillai, Nilesh Mahajan, Hitesh Chopra, Vishal Mahajan, Ajay Grover, Ashish Kohli

Abstract:

Surgical Site Infection (SSI) is hospital acquired infection of growing concern. This study presents the efficacy and cost-effectiveness of triclosan-coated suture, in reducing the burden of SSI in India. Methodology: A systematic literature search was conducted for economic burden (1998-2018) of SSI and efficacy of triclosan-coated sutures (TCS) vs. non-coated sutures (NCS) (2000-2018). PubMed Medline and EMBASE indexed articles were searched using Mesh terms or Emtree. Decision tree analysis was used to calculate, the cost difference between TCS and NCS at private and public hospitals, respectively for 7 surgical procedures. Results: The SSI range from low to high for Caesarean section (C-section), Laparoscopic hysterectomy (L-hysterectomy), Open Hernia (O-Hernia), Laparoscopic Cholecystectomy (L-Cholecystectomy), Coronary artery bypass graft (CABG), Total knee replacement (TKR), and Mastectomy were (3.77 to 24.2%), (2.28 to 11.7%), (1.75 to 60%), (1.71 to 25.58%), (1.6 to 18.86%), (1.74 to 12.5%), and (5.56 to 25%), respectively. The incremental cost (%) of TCS ranged 0.1%-0.01% in private and from 0.9%-0.09% at public hospitals across all surgical procedures. Cost savings at median efficacy & SSI risk was 6.52%, 5.07 %, 11.39%, 9.63%, 3.62%, 2.71%, 9.41% for C-section, L-hysterectomy, O-Hernia, L-Cholecystectomy, CABG, TKR, and Mastectomy in private and 8.79%, 4.99%, 12.67%, 10.58%, 3.32%, 2.35%, 11.83% in public hospital, respectively. Efficacy of TCS and SSI incidence in a particular surgical procedure were important determinants of cost savings using one-way sensitivity analysis. Conclusion: TCS suture led to cost savings across all 7 surgeries in both private and public hospitals in India.

Keywords: cost Savings, non-coated sutures, surgical site infection, triclosan-coated sutures

Procedia PDF Downloads 368

Authors: Aimen Mohamed Almaloul

Abstract:

The main focus of this study is investigating the interference of Arabic in the use of English prepositions by Libyan university students. Prepositions in the tests used in the study were categorized, according to their relation to Arabic, into similar Arabic and English prepositions (SAEP), dissimilar Arabic and English prepositions (DAEP), Arabic prepositions with no English counterparts (APEC), and English prepositions with no Arabic counterparts (EPAC). The subjects of the study were the first year university students of the English department, Sabrata Faculty of Arts, Azzawia University; both males and females, and they were 100 students. The basic tool for data collection was a test of English prepositions; students are instructed to fill in the blanks with the correct prepositions and to put a zero (0) if no preposition was needed. The test was then handed to the subjects of the study. The test was then scored and quantitative as well as qualitative results were obtained. Quantitative results indicated the number, percentages and rank order of errors in each of the categories and qualitative results indicated the nature and significance of those errors and their possible sources. Based on the obtained results the researcher could detect that students made more errors in the EPAC category than the other three categories and these errors could be attributed to the lack of knowledge of the different meanings of English prepositions. This lack of knowledge forced the students to adopt what is called the strategy of transfer.

Keywords: foreign language acquisition, foreign language learning, interference system, interlanguage system, mother tongue interference

Procedia PDF Downloads 350

Authors: Chaiwat Tantarangsee

Abstract:

The purposes of this study are 1) to study the frequent English writing errors of students registering the course: Reading and Writing English for Academic Purposes II, and 2) to find out the results of writing error correction by using coded indirect corrective feedback and writing error treatments. Samples include 28 2nd year English Major students, Faculty of Education, Suan Sunandha Rajabhat University. Tool for experimental study includes the lesson plan of the course; Reading and Writing English for Academic Purposes II, and tool for data collection includes 4 writing tests of short texts. The research findings disclose that frequent English writing errors found in this course comprise 7 types of grammatical errors, namely Fragment sentence, Subject-verb agreement, Wrong form of verb tense, Singular or plural noun endings, Run-ons sentence, Wrong form of verb pattern and Lack of parallel structure. Moreover, it is found that the results of writing error correction by using coded indirect corrective feedback and error treatment reveal the overall reduction of the frequent English writing errors and the increase of students’ achievement in the writing of short texts with the significance at .05.

Keywords: coded indirect corrective feedback, error correction, error treatment, English writing

Procedia PDF Downloads 277

Authors: Chandeera Gunawardena

Abstract:

The present research analyzes the pronunciation errors encountered by thirty Sinhala speaking learners of French on the assumption that the pronunciation errors were systematic and they reflect the interference of the native language of the learners. The thirty participants were selected using random sampling method. By the time of the study, the subjects were studying French as a foreign language for their Bachelor of Arts Degree at University of Kelaniya, Sri Lanka. The participants were from a homogenous linguistics background. All participants speak the same native language (Sinhala) thus they had completed their secondary education in Sinhala medium and during which they had also learnt French as a foreign language. A battery operated audio tape recorder and a 120-minute blank cassettes were used for recording. A list comprised of 60 words representing all French phonemes was used to diagnose pronunciation difficulties. Before the recording process commenced, the subjects were requested to familiarize themselves with the words through reading them several times. The recording was conducted individually in a quiet classroom and each recording approximately took fifteen minutes. Each subject was required to read at a normal speed. After the completion of recording, the recordings were replayed to identify common errors which were immediately transcribed using the International Phonetic Alphabet. Results show that Sinhala speaking learners face problems with French nasal vowels and French initial consonants clusters. The learners also exhibit errors which occur because of their second language (English) interference.

Keywords: error analysis, pronunciation difficulties, pronunciation errors, Sinhala speaking learners of French

Procedia PDF Downloads 180

Authors: Yu Menshikov

Abstract:

In this paper the influence of errors of function derivatives in initial time which have been obtained by experiment (uncontrollable inaccuracy) to the results of inverse problem solution was investigated. It was shown that these errors distort the inverse problem solution as a rule near the beginning of interval where the solution are analyzed. Several methods for remove the influence of uncontrollable inaccuracy have been suggested.

Keywords: inverse problems, filtration, uncontrollable inaccuracy

Procedia PDF Downloads 481

Authors: M. A. Sedghamiz, S. Raeissi

Abstract:

This study presents three different approaches to estimate bubble point pressures for the binary system of CO2 and ethyl palmitate fatty acid ethyl ester. The first method involves the Peng-Robinson (PR) Equation of State (EoS) with the conventional mixing rule of Van der Waals. The second approach involves the PR EOS together with the Wong Sandler (WS) mixing rule, coupled with the Uniquac Ge model. In order to model the bubble point pressures with this approach, the volume and area parameter for ethyl palmitate were estimated by the Hansen group contribution method. The last method involved the Peng-Robinson, combined with the Wong-Sandler Method, but using NRTL as the GE model. Results using the Van der Waals mixing rule clearly indicated that this method has the largest errors among all three methods, with errors in the range of 3.96–6.22 %. The Pr-Ws-Uniquac method exhibited small errors, with average absolute deviations between 0.95 to 1.97 percent. The Pr-Ws-Nrtl method led to the least errors where average absolute deviations ranged between 0.65-1.7%.

Keywords: bubble pressure, Gibbs excess energy model, mixing rule, CO2 solubility, ethyl palmitate

Procedia PDF Downloads 434

Authors: Xiuguo Zhao, He Li, Alireza Yazdani, Xiaoning Zheng, Xinxi Xu

Abstract:

Wound infected poses a serious threat to the surgery on the patient during the process of surgery. Understanding the bacteria-carrying particles (BCPs) transportation and deposition in the open surgical wound model play essential role in protecting wound against being infected. Therefore BCPs transportation and deposition in the surgical wound model were investigated using force-coupling method (FCM) based computational fluid dynamics. The BCPs deposition in the wound was strongly associated with BCPs diameter and concentration. The results showed that the rise on the BCPs deposition was increasing not only with the increase of BCPs diameters but also with the increase of the BCPs concentration. BCPs deposition morphology was impacted by the combination of size distribution, airflow patterns and model geometry. The deposition morphology exhibited the characteristic with BCPs deposition on the sidewall in wound model and no BCPs deposition on the bottom of the wound model mainly because the airflow movement in one direction from up to down and then side created by laminar system constructing airflow patterns and then made BCPs hard deposit in the bottom of the wound model due to wound geometry limit. It was also observed that inertial impact becomes a main mechanism of the BCPs deposition. This work may contribute to next study in BCPs deposition limit, as well as wound infected estimation in surgical-site infections.

Keywords: BCPs deposition, computational fluid dynamics, force-coupling method (FCM), numerical simulation, open surgical wound model

Procedia PDF Downloads 264

Authors: Robnier Reyes, Andrew J. P. Marques, Joel Ramjist, Chris R. Pasarikovski, Victor X. D. Yang

Abstract:

Over the past three decades, surgical robotic systems have demonstrated their ability to improve surgical outcomes. The LBR Med is a collaborative robotic arm that is meant to work with a surgeon to streamline surgical workflow. It has 7 degrees of freedom and thus can be easily oriented. Position and torque sensors at each joint allow it to maintain a position accuracy of 150 µm with real-time force and torque feedback, making it ideal for complex surgical procedures. Spinal fusion procedures involve the placement of as many as 20 pedicle screws, requiring a great deal of accuracy due to proximity to the spinal canal and surrounding vessels. Any deviation from intended path can lead to major surgical complications. Assistive surgical robotic systems are meant to serve as collaborative devices easing the workload of the surgeon, thereby improving pedicle screw placement by mitigating fatigue related inaccuracies. Moreover, robotic spinal systems have shown marked improvements over conventional freehanded techniques in both screw placement accuracy and fusion quality and have greatly reduced the need for screw revision, intraoperatively and post-operatively. However, current assistive spinal fusion robots, such as the ROSA Spine, are limited in functionality to positioning surgical instruments. While they offer a small degree of improvement in pedicle screw placement accuracy, they do not alleviate surgeon fatigue, nor do they provide real-time force and torque feedback during screw insertion. We propose a semi-autonomous surgical robot workflow for spinal fusion where the surgeon guides the robot to its initial position and orientation, and the robot drives the pedicle screw accurately into the vertebra. Here, we demonstrate feasibility by inserting pedicle screws into ex-vivo bovine rib bone. The robot monitors position, force and torque with respect to predefined values selected by the surgeon to ensure the highest possible spinal fusion quality. The workflow alleviates the strain on the surgeon by having the robot perform the screw placement while the ability to monitor the process in real-time keeps the surgeon in the system loop. The approach we have taken in terms of level autonomy for the robot reflects its ability to safely collaborate with the surgeon in the operating room without external navigation systems.

Keywords: ex vivo bovine bone, pedicle screw, surgical robot, surgical workflow

Procedia PDF Downloads 128

Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

Abstract:

Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

Procedia PDF Downloads 96

Authors: Rim Chang Hyon, Song Hak Jin, Song Kwang Hyok, Jong Ki Hun

Abstract:

The calibration of the articulated arm coordinate measuring machine (AACMM) is key to improving calibration accuracy and saving calibration time. To reduce the time consumed for calibration, we should choose the proper calibration gauges and develop a reasonable calibration method. In addition, we should get the exact optimal solution by accurately removing the rough errors within the experimental data. In this paper, we present a calibration method of the portable coordinate measuring arm (PCMA) using the 1.2m long bar guage with cone-holes. First, we determine the locations of the bar gauge and establish an optimal objective function for identifying the structural parameter errors. Next, we make a mathematical model of the calibration algorithm and present a new mathematical method to remove the rough errors within calibration data. Finally, we find the optimal solution to identify the kinematic parameter errors by using Levenberg-Marquardt algorithm. The experimental results show that our calibration method is very effective in saving the calibration time and improving the calibration accuracy.

Keywords: AACMM, kinematic model, parameter identify, measurement accuracy, calibration

Procedia PDF Downloads 37

Authors: Orit Zeevy-Solovey

Abstract:

Grammar has traditionally been taught for its own sake, emphasizing rules and drills. However, in recent years, more emphasis is given to communicative competence. Current research suggests that form-focused instruction is notably efficient when incorporated in a meaningful communicative context. It is maintained that writing tasks related to the students’ academic fields will encourage them to express themselves openly in topics that are close to their hearts, without feeling too uneasy about grammatical forms. The teacher can further reduce students’ apprehension of grammar by announcing that credit will be given for merely doing the task and that grammar mistakes will not affect the grade. Students’ linguistic errors can then be corrected by giving metalinguistic feedback which involves providing learners with some kind of explicit remark about the nature of the errors they have made. Research has also shown that learners’ developmental readiness is an important factor influencing the effectiveness of written corrective feedback. Larger effect sizes appear as the proficiency level is higher. The purposes of this paper are to demonstrate how grammar can be taught indirectly through writing tasks, and more specifically, how the use of metalinguistic written corrective feedback given to advanced English as a Foreign Language (EFL) students can raise their linguistic awareness. Since errors are not directly corrected, the students have to work out the corrections needed through exploring grammar books and websites. Longitudinal studies of metalinguistic written corrective feedback comparing the number of errors in students’ first and fourth compositions have shown a decrease in errors.

Keywords: EFL, linguistic awareness, metalinguistic corrective feedback, teaching grammar through writing

Procedia PDF Downloads 105

Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy

Abstract:

The improvement of surgical techniques in recent years has reduced the frequency of postoperative complications in kidney transplant recipients. Novel immunosuppressive agents have reduced rates of graft loss due to acute rejection to less than 1%. However, surgical complications may still lead graft loss and morbidity in recipients. Because of potent immunosuppression, impaired wound healing and complications are frequent after transplantation. We compared the frequency of post-operative surgical complications in diabetic and non-diabetic patients after kidney transplantation. Materials and Methods: This retrospective study conducted in consecutive patients (213 females, 285 males, median age 39 years) who underwent kidney transplant surgery at our center between December 2005 and October 2015. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). Characteristics of both groups were obtained from medical records. Results: We performed 225 living and 273 deceased donor transplantations. Renal replacement type was hemodialysis in 60.8%, peritoneal dialysis in 17.3% and preemptive in 12%. The mean body mass indexes of the recipients were 24 ± 4.6 kg/m², donor age was 48.6 ± 14.3 years, cold ischemic time was 11.3 ± 6.1 hours, surgery time was 4.9 ± 1.2 hours, and recovery time was 54±31 min. The mean hospitalization duration was 19.1 ± 13.5 days. The frequency of postoperative surgical complications was 43.8%. There was no significant difference between the ratios of post-operative surgical complications in non-diabetic (43.5%) and diabetic (47.4%) groups (p=0.648). Post-operative surgical complications were lymphocele (24.6% vs. 23.7%), delayed wound healing (13.2% vs. 7.6%), hematoma (7.8% vs.15.8 %), urinary leak (4.6% vs. 5.3%), hemorrhage (5.1% vs. 0%), hydronephrosis (2.2% vs. 0%), renal artery thrombosis (1.5% vs. 0%), renal vein thrombosis (1% vs. 2.6%), urinoma (0.7% vs. 0%), urinary obstruction (0.5% vs. 0%), ureteral stenosis (0.5% vs. 0%) and ureteral reflux (0.2% vs. 0%) in non-diabetic and diabetic groups, respectively (p > 0.05). Mean serum creatinine levels in non-diabetics and diabetics were 1.43 ± 0.81 and 1.61 ± 0.96 mg/dL at 1st month (p=0.198). At the 6th month, the mean graft and patient survival times in patients with post-operative surgical complications were significantly lower than in those who did not (162.9 ± 3.4 vs. 175.6 ± 1.5 days, p=0.008, and 171 ± 2.9 vs. 176.1 ± 1.6 days, p=0.047, respectively). However, patient survival durations of non-diabetic (173 ± 27) and diabetic (177 ± 13 day) groups were comparable (p=0.396). Conclusion: As a result, we concluded that surgical complications such as lymphocele and delayed wound healing were common and that frequency of these complications in diabetic recipients did not differ from non-diabetic one. All persons involved in the postoperative care of kidney transplant recipients be aware of the potential surgical complications for rapid diagnosis and treatment.

Keywords: kidney transplantation, diabetes mellitus, surgery, complication

Procedia PDF Downloads 155

Authors: Anupam Sibal

Abstract:

Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

Procedia PDF Downloads 235

Authors: Dalvinder Kaur Mangal

Abstract:

For the past decade, noise corrupted output measurements have been a fundamental research problem to be investigated. On the other hand, the estimation of the parameters for linear dynamic systems when also the input is affected by noise is recognized as more difficult problem which only recently has received increasing attention. Representations where errors or measurement noises/disturbances are present on both the inputs and outputs are usually called errors-in-variables (EIV) models. These disturbances may also have additive effects which are also considered in this paper. Parameter estimation of false EIV problem using equation error, output error and iterative prefiltering identification schemes with and without additive uncertainty, when only the output observation is corrupted by noise has been dealt in this paper. The comparative study of these three schemes has also been carried out.

Keywords: errors-in-variable (EIV), false EIV, equation error, output error, iterative prefiltering, Gaussian noise

Procedia PDF Downloads 458

Authors: Bimrisha Mali

Abstract:

The present study investigates the type of errors English as a second language (ESL) learners produce using the definite article ‘the’. The participants were provided a questionnaire on the learner's ability test. The questionnaire consists of three cloze tests and two free composition tests. Each participant's response was received in the form of written data. A total of 78 participants from three government schools participated in the study. The participants are high-school students from Rural Assam. Assam is a north-eastern state of India. Their age ranged between 14-15. The medium of instruction and the communication among the students take place in the local language, i.e., Assamese. Pit Corder’s steps for conducting error analysis have been followed for the analysis procedure. Four types of errors were found (1) deletion of the definite article, (2) use of the definite article as modifiers as adjectives, (3) incorrect use of the definite article with singular proper nouns, (4) substitution of the definite article by the indefinite article ‘a’. Classifiers in Assamese that express definiteness is used with nouns, adjectives, and numerals. It is found that native language (L1) transfer plays a pivotal role in the learners’ errors. The analysis reveals the learners' inability to acquire the semantic connotation of definiteness in English due to native language (L1) interference.

Keywords: definite article error, l1 transfer, error analysis, ESL

Procedia PDF Downloads 102

Authors: F. Viprey, H. Nouira, S. Lavernhe, C. Tournier

Abstract:

Manufacturing of freeform parts may be achieved on 5-axis machine tools currently considered as a common means of production. In particular, the geometrical quality of the freeform parts depends on the accuracy of the multi-axis structural loop, which is composed of several component assemblies maintaining the relative positioning between the tool and the workpiece. Therefore, to reach high quality of the geometries of the freeform parts the geometric errors of the 5 axis machine should be evaluated and compensated, which leads one to master the deviations between the tool and the workpiece (volumetric accuracy). In this study, a novel hole-bar design was developed and used for the characterization of the geometric errors of a RRTTT 5-axis machine tool. The hole-bar standard design is made of Invar material, selected since it is less sensitive to thermal drift. The proposed design allows once to extract 3 intrinsic parameters: one linear positioning and two straightnesses. These parameters can be obtained by measuring the cylindricity of 12 holes (bores) and 11 cylinders located on a perpendicular plane. By mathematical analysis, twelve 3D points coordinates can be identified and correspond to the intersection of each hole axis with the least square plane passing through two perpendicular neighbour cylinders axes. The hole-bar was calibrated using a precision CMM at LNE traceable the SI meter definition. The reversal technique was applied in order to separate the error forms of the hole bar from the motion errors of the mechanical guiding systems. An inter-comparison was additionally conducted between four NMIs (National Metrology Institutes) within the EMRP IND62: JRP-TIM project. Afterwards, the hole-bar was integrated in RRTTT 5-axis machine tool to identify its volumetric errors. Measurements were carried out in real time and combine raw data acquired by the Renishaw RMP600 touch probe and the linear and rotary encoders. The geometric errors of the 5 axis machine were also evaluated by an accurate laser tracer interferometer system. The results were compared to those obtained with the hole bar.

Keywords: volumetric errors, CMM, 3D hole-bar, inter-comparison

Procedia PDF Downloads 359

Authors: Kamal Kaushik, Trisha, Dandapni, Sambit Nanda, A. Mukherjee, S. Pradhan

Abstract:

INTRODUCTION: As complexity in radiotherapy practice and processes are increasing, there is a need to assure quality control to a greater extent. At present, no international literature available with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The primary aim is to improve the processes that directly impact clinical outcomes for patients in terms of patient safety and quality of care. PROCEDURE: A team of an Oncologist, a Medical Physicist and a Radiation Therapist was formed for weekly clinical audits of patient’s undergoing radiotherapy audits The stages for audits include Pre planning audits, Simulation, Planning, Daily QA, Implementation and Execution (with image guidance). Errors in all the parts of the chain were evaluated and recorded for the development of further departmental protocols for radiotherapy. EVALUATION: The errors at various stages of radiotherapy chain were evaluated and recorded for comparison before starting the clinical audits in the department of radiotherapy and after starting the audits. It was also evaluated to find the stage in which maximum errors were recorded. The clinical audits were used to structure standard protocols (in the form of checklist) in department of Radiotherapy, which may lead to further reduce the occurrences of clinical errors in the chain of radiotherapy. RESULTS: The aim of this study is to perform a comparison between number of errors in different part of RT chain in two groups (A- Before Audit and B-After Audit). Group A: 94 pts. (48 males,46 female), Total no. of errors in RT chain:19 (9 needed Resimulation) Group B: 94 pts. (61 males,33 females), Total no. of errors in RT chain: 8 (4 needed Resimulation) CONCLUSION: After systematic periodic clinical audits percentage of error in radiotherapy process reduced more than 50% within 2 months. There is a great need in improving quality control in radiotherapy, and the role of clinical audits can only grow. Although clinical audits are time-consuming and complex undertakings, the potential benefits in terms of identifying and rectifying errors in quality control procedures are potentially enormous. Radiotherapy being a chain of various process. There is always a probability of occurrence of error in any part of the chain which may further propagate in the chain till execution of treatment. Structuring departmental protocols and policies helps in reducing, if not completely eradicating occurrence of such incidents.

Keywords: audit, clinical, radiotherapy, improving functionality

Procedia PDF Downloads 48

Authors: Hirokatsu Kawashima

Abstract:

One important element of teaching/learning listening is intensive listening such as listening for precise sounds, words, grammatical, and semantic units. Several classroom-based investigations have been conducted to explore the usefulness of auditory recognition of phonological, grammatical and semantic errors in such a context. The current study reports the results of one such investigation, which targeted auditory recognition of phonological, grammatical, and semantic errors at the sentence level. 56 Japanese EFL learners participated in this investigation, in which their recognition performance of phonological, grammatical and semantic errors was measured on a 9-point scale by learners’ self-evaluation from the perspective of 1) two types of similar English sound (vowel and consonant minimal pair words), 2) two types of sentence word order (verb phrase-based and noun phrase-based word orders), and 3) two types of semantic consistency (verb-purpose and verb-place agreements), respectively, and their general listening proficiency was examined using standardized tests. A number of findings have been made about the interactive relationships between the three types of auditory error recognition and general listening proficiency. Analyses based on the OPLS (Orthogonal Projections to Latent Structure) regression model have disclosed, for example, that the three types of auditory error recognition are linked in a non-linear way: the highest explanatory power for general listening proficiency may be attained when quadratic interactions between auditory recognition of errors related to vowel minimal pair words and that of errors related to noun phrase-based word order are embraced (R2=.33, p=.01).

Keywords: auditory error recognition, intensive listening, interaction, investigation

Procedia PDF Downloads 487

Authors: Joana Gato, Ahmed Abotabekh, Panayoti Bachkangi

Abstract:

Introduction: Oestrogen is an essential gonadal hormone that plays a vital role in the reproductive system of women1. The average age of menopause in the UK is 512. Women who go through premature menopause should be offered Hormone replacement therapy (HRT). Similarly, women who undergo surgical menopause should be offered HRT, unless contraindicated, depending on the indication of their surgery2,3. Aim: To assess if the patients in our department are counselled regarding HRT after surgical treatment and if HRT was prescribed. Methodology: A retrospective audit in a busy district hospital, examining all the patients who had a hysterectomy. The audit examined if HRT was discussed pre-operatively, prescribed on discharge and if a follow up was arranged. For women with contraindication to HRT, the audit assessed if the reasons were discussed pre-operatively and communicated to the Inclusion criteria: woman having a total or subtotal hysterectomy, with or without bilateral salpingo-ophorectomy (BSO), between April and September 2022. Exclusion criteria: woman having a vaginal hysterectomy. Results: 40 patients in total had hysterectomy; 27 (68%) were under the age of 51. 15 out of 27 patients bad BSO. 9 women were prescribed HRT, but 8 were offered HRT immediately, and 1 of them were offered a follow up. Of women who underwent surgical menopause, 7 were not given any HRT. The HRT choice was diverse, however, the majority was prescribed oral HRT. 40% of women undergoing surgical menopause did not have a discussion about HRT prior to their surgery. In postmenopausal women (n=13; 33%), still two were given HRT for preexisting menopausal symptoms. Discussion: Only 59% of the pre-menopausal patients had oophorectomy, therefore undergoing surgical menopause. Of these, 44% were not given any HRT, and 40% had no discussion about HRT prior to surgery. Interestingly, the majority of these women have no obvious contraindication to HRT. The choice of HRT was diverse, but the majority was commenced on oral HRT. Our unit is still working towards meeting all the NICE guidance standards of offering HRT and information prior to surgery to women planning to undergo surgical menopause. Conclusion: Starting HRT at the onset of menopause has been shown to improve quality of life and reduce the risk of cardiovascular disease and osteoporotic fractures4. Our unit still has scope for improvement to comply with the current NICE guidance. All pre-menopausal women undergoing surgical menopause should have a discussion regarding HRT prior to surgery and be offered it if there are no contraindications. This discussion should be clearly documented in the notes. At the time of this report, some of the patients have not yet had a follow up, which we recognize as a limitation to our audit.

Keywords: hormone replacement therapy, menopause, premature ovarian insufficiency, surgical management

Procedia PDF Downloads 66

Authors: Alex Knighton, Roba Khundkar, Michael Dunn

Abstract:

Neo-colonialism is defined as the use of economic, political, cultural, or other pressures to control or influence other countries, especially former dependencies, and concerns have been raised about its presence in surgical missions. Surgical missions aim to rectify the huge disparity in surgical access worldwide, but their ethics must be carefully considered. This is especially in light of colonial history which affects international relations and global health today, to ensure that colonial attitudes are not influencing efforts to promote equity. This review examines the history of colonial global health, demonstrating that global health initiatives have consistently been used to benefit those providing them, and then asks whether elements of colonialism are still pervasive in surgical missions today. Data was collected from the literature using specified search terms and snowball searching, as well as from international expert web-based conferences on global surgery ethics. A thematic analysis was then conducted on this data, resulting in the identification of six themes which are identifiable in both past and present global health initiatives. These six themes are power, lack of understanding or respect, feelings of superiority, exploitation, enabling of dependency, and acceptance of poorer standards of care. An ethical analysis follows, concluding that the concerns of power and neo-colonialism in global surgery would be addressed by adopting a framework of procedural justice that promotes a refined governance process in which stakeholders are able to propose and reject decisions that affect them. The paper argues that adopting this model would address concerns of the power disparity in the field directly, as well as promoting an ethical framework to enable the other concerns of power disparity and neo-colonialism identified in the present analysis to be addressed.

Keywords: medical ethics, global surgery, global health, neocolonialism, surgical missions

Procedia PDF Downloads 68

Authors: Freddy Patricio Moncayo-Matute, Pablo Gerardo Peña-Tapia, Vázquez-Silva Efrén, Paúl Bolívar Torres-Jara, Diana Patricia Moya-Loaiza, Gabriela Abad-Farfán

Abstract:

This study describes a clinical case and the results on the application of additive manufacturing for the surgical planning in the removal of a cranial spheno-orbital meningioma. It is verified that the use of personalized anatomical models and cutting guides helps to manage the cranial anomalies approach. The application of additive manufacturing technology: Fused Deposition Modeling (FDM), as a low-cost alternative, enables the printing of the test anatomical model, which in turn favors the reduction of surgery time, as well the morbidity rate reduction too. And the printing of the personalized cutting guide, which constitutes a valuable aid to the surgeon in terms of improving the intervention precision and reducing the invasive effect during the craniotomy. As part of the results, post-surgical follow-up is included as an instrument to verify the patient's recovery and the validity of the procedure.

Keywords: surgical planning, additive manufacturing, rapid prototyping, fused deposition modeling, custom anatomical model

Procedia PDF Downloads 65

Authors: Nick Toossi, Joseph Hartland

Abstract:

Background: Malawi is an example of a low resource setting which faces a chronic shortage of doctors and other medical staff. This shortfall is made up for by clinical officers (COs), who are para-medicals trained for 4 years. The literature suggests to improve outcomes surgical skills training specifically should be promoted for COs in district and mission hospitals. Accordingly, the primary author was tasked with developing a basic surgical skills teaching package for COs of Mulanje Mission Hospital (MMH), Malawi, as part of a 4th year medical student External Student Selected Component field trip. MMH is a hospital based in the South of Malawi near the base of Mulanje Mountain and works in an extremely isolated environment with some of the poorest communities in the country. Traveling to Malawi the medical student author performed an educational needs assessment to develop and deliver a bespoke basic surgical skills teaching package. Methodology: An initial needs assessment identified the following domains: basic surgical skills (instrument naming & handling, knot tying, suturing principles and suturing techniques) and perineal repair. Five COs took part in a teaching package involving an interactive group simulation session, overseen by senior clinical officers and surgical trainees from the UK. Non-organic and animal models were used for simulation practice. This included the use of surgical skills boards to practice knot tying and ox tongue to simulate perineal repair. All participants spoke and read English. The impact of the session was analysed in two different ways. The first was via a pre and post Single Best Answer test and the second a questionnaire including likert’s scales and free text response questions. Results: There was a positive trend in pre and post test scores on competition of the course. There was increase in the mean confidence of learners before and after the delivery of teaching in basic surgical skills and simulated perineal repair, especially in ‘instrument naming and handling’. Whilst positively received it was discovered that learners desire more frequent surgical skills teaching sessions in order to improve and revise skills. Feedback suggests that the learners were not confident in retaining the skills without regular input. Discussion: Skills and confidence were improved as a result of the teaching provided. Learner's written feedback suggested there was an overall appetite for regular surgical skills teaching in the clinical environment and further opportunities to allow for deliberate self-practice. Surgical mentorship schemes facilitating supervised theatre time among trainees and lead surgeons along with improving access to surgical models/textbooks were some of the simple suggestions to improve surgical skills and confidence among COs. Although, this study is limited by population size it is reflective of the small, isolated and low resource environment in which this healthcare is delivered. This project does suggest that current surgical skills packages used in the UK could be adapted for employment in low resource settings, but it is consistency and sustainability that staff seek above all in their on-going education.

Keywords: clinical officers, education, Malawi, surgical skills

Procedia PDF Downloads 157

Authors: Naglaa A. Abd Elkader, Haithem A. Farghali

Abstract:

The present study carried out on fifteen clinical cases of different species of dogs which admitted to surgical clinic of veterinary medicine with different symptoms (Acute vomiting, hematemesis and anorexia). There was diagnostic march which including plain radiograph and endoscopic examination. Treatment was including surgical interference and endoscopic retrieval followed by medicinal treatment. This study was aimed the detection of different foreign bodies by the most suitable method according to the type of the foreign bodies.

Keywords: stomach, endoscopy, foreign bodies, dogs

Procedia PDF Downloads 384

Authors: Samir Hessas

Abstract:

Modern medicine is witnessing a profound transformation as advanced technology reshapes surgical environments. Hybrid operating rooms, where state-of-the-art medical equipment, advanced imaging solutions, and Artificial Intelligence (AI) converge, are at the forefront of this revolution. In this comprehensive exploration, we scrutinize the multifaceted facets of AI and delve into an array of groundbreaking technologies. We also discuss visionary concepts that hold the potential to revolutionize hybrid operating rooms, making them more efficient and patient-centered. These innovations encompass real-time imaging, surgical simulation, IoT and remote monitoring, 3D printing, telemedicine, quantum computing, and nanotechnology. The outcome of this fusion of technology and imagination is a promising future of surgical precision, individualized patient care, and unprecedented medical advances in hybrid operating rooms.

Keywords: artificial intelligence, hybrid operating rooms, telemedicine, monitoring

Procedia PDF Downloads 43

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

Abstract:

Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

Procedia PDF Downloads 107

Authors: S. Saeed, T. Butt, M. Rehan, S. Khaliq

Abstract:

Objective: To determine the frequency of pre-analytical errors in samples taken from patients for various lab tests at Fauji Foundation Hospital, Rawalpindi. Material and Methods: All the lab specimens for diagnostic purposes received at the lab from Fauji Foundation hospital, Rawalpindi indoor and outdoor patients were included. Total number of samples received in the lab is recorded in the computerized program made for the hospital. All the errors observed for pre-analytical process including patient identification, sampling techniques, test collection procedures, specimen transport/processing and storage were recorded in the log book kept for the purpose. Results: A total of 476616 specimens were received in the lab during the period of study including 237931 and 238685 from outdoor and indoor patients respectively. Forty-one percent of the samples (n=197976) revealed pre-analytical discrepancies. The discrepancies included Hemolyzed samples (34.8%), Clotted blood (27.8%), Incorrect samples (17.4%), Unlabeled samples (8.9%), Insufficient specimens (3.9%), Request forms without authorized signature (2.9%), Empty containers (3.9%) and tube breakage during centrifugation (0.8%). Most of these pre-analytical discrepancies were observed in samples received from the wards revealing that inappropriate sample collection by the medical staff of the ward, as most of the outdoor samples are collected by the lab staff who are properly trained for sample collection. Conclusion: It is mandatory to educate phlebotomists and paramedical staff particularly performing duties in the wards regarding timing and techniques of sampling/appropriate container to use/early delivery of the samples to the lab to reduce pre-analytical errors.

Keywords: pre analytical lab errors, tertiary care hospital, hemolyzed, paramedical staff

Procedia PDF Downloads 183

Authors: Katerina Florou

Abstract:

Two decades after coined the term "learner corpora" as collections of texts created by foreign or second language learners across various language contexts, and some years following suggestion to incorporate "focusing on form" within a Task-Based Learning framework, this study aims to explore how learner corpora, whether annotated with errors or not, can facilitate a focus on form in an educational setting. Argues that analyzing linguistic form serves the purpose of enabling students to delve into language and gain an understanding of different facets of the foreign language. This same objective is applicable when analyzing learner corpora marked with errors or in their raw state, but in this scenario, the emphasis lies on identifying incorrect forms. Teachers should aim to address errors or gaps in the students' second language knowledge while they engage in a task. Building on this recommendation, we compared the written output of two student groups: the first group (G1) employed the focusing on form phase by studying a specific aspect of the Italian language, namely the past participle, through examples from native speakers and grammar rules; the second group (G2) focused on form by scrutinizing their own errors and comparing them with analogous examples from a native speaker corpus. In order to test our hypothesis, we created four learner corpora. The initial two were generated during the task phase, with one representing each group of students, while the remaining two were produced as a follow-up activity at the end of the lesson. The results of the first comparison indicated that students' exposure to their own errors can enhance their grasp of a grammatical element. The study is in its second stage and more results are to be announced.

Keywords: Corpus interlanguage analysis, task based learning, Italian language as F1, learner corpora

Procedia PDF Downloads 20

Authors: Yukiko Sasaki Alam, Shahid Alam

Abstract:

Syntactic parsing is vital for semantic treatment by many applications related to natural language processing (NLP), because form and content coincide in many cases. However, it has not yet reached the levels of reliable performance. By manually examining and analyzing individual machine translation output errors that involve syntax as well as semantics, this study attempts to discover what is required for improving syntactic and semantic parsing.

Keywords: syntactic parsing, error analysis, machine translation, deep parsing

Procedia PDF Downloads 521