Infection control techniques used in South African dental practices

ThesisIn dentistry, blood borne microorganisms, including hepatitis B virus and human immunodeficiency virus (HIV), pose a risk for occupational exposure among oral health care workers. Impressive technological advances enable dental practitioners to use valid, practical, measurable and sustainable infection control practices. The unique nature of dental procedures and settings, requires specific and unique preventative strategies to minimise disease transmission. Since 1993 it has been recommended that South African dentists adhere to the recommendations for infection control of the Centers for Disease Control and Prevention. The main objective of this study was to examine the adherence to infection control recommendations in dental practices in South Africa, with specific attention paid to practices associated with the use of a steam autoclave steriliser. All dental practitioners registered with the Health Professions Council of South Africa were included in this study. Practitioners with foreign addresses were not included. A postal questionnaire was used for collecting data. 738 respondents returned completed questionnaires. 87% of respondents indicated that they treat each patient as a possible source of infection. Many respondents (53%) admitted that their preferred method of sterilising handpieces is wiping/soaking in liquid chemicals. Only 17% of the respondents indicated that they autoclave handpieces after each patient. These results indicate a serious need for South African infection control guidelines and audit recommendations specific to dental practices in order to promote a safer dental environment for the health care worker and patient

Professional Judgment in an Era of Artificial Intelligence and Machine Learning

Though artificial intelligence (AI) in healthcare and education now accomplishes diverse tasks, there are two features that tend to unite the information processing behind efforts to substitute it for professionals in these fields: reductionism and functionalism. True believers in substitutive automation tend to model work in human services by reducing the professional role to a set of behaviors initiated by some stimulus, which are intended to accomplish some predetermined goal, or maximize some measure of well-being. However, true professional judgment hinges on a way of knowing the world that is at odds with the epistemology of substitutive automation. Instead of reductionism, an encompassing holism is a hallmark of professional practice—an ability to integrate facts and values, the demands of the particular case and prerogatives of society, and the delicate balance between mission and margin. Any presently plausible vision of substituting AI for education and health-care professionals would necessitate a corrosive reductionism. The only way these sectors can progress is to maintain, at their core, autonomous professionals capable of carefully intermediating between technology and the patients it would help treat, or the students it would help learn

Horse Alert WA

Increasing awareness of emergency horse diseases, their management in Western Australia and practical strategies to minimise the risk of spreading disease. Horse Alert WA has been developed to help participants in the racing, sporting and recreational sectors of the horse industry in Western Australia to prepare for, recognise and respond effectively to an emergency disease that affects horses, such as the equine influenza outbreak in Australia in 2007. This manual provides biosecurity information to minimise the risks of a horse disease establishing and spreading in Western Australia, and guidance on the actions to take if an emergency disease occurs. Some strategies described will also assist in minimising the spread of common infections, such as strangles and equine herpes virus

DDASaccident449

At 11:12hrs on Wednesday 7th February 2007 [Demining group] MCT-6, a deminer was involved in an accident at Islam Qala Kalat-e-Nayab Ghafor MF-0069 Kohsan district Herat province. The accident occurred while the deminer was excavating with shovel

DDASaccident449

At 11:12hrs on Wednesday 7th February 2007 [Demining group] MCT-6, a deminer was involved in an accident at Islam Qala Kalat-e-Nayab Ghafor MF-0069 Kohsan district Herat province. The accident occurred while the deminer was excavating with shovel

Naval and Military Nursing in the British Empire c. 1763-1830

This dissertation analyses the work of female nurses in military and naval hospitals from the mid eighteenth century until the aftermath of the Napoleonic Wars in the early nineteenth century. Nursing history has primarily forgotten these women, or when they do enter into historical narratives, it is often as a foil when compared to the medical practitioner. Pre-Nightingale nurses are often framed by nursing historians as ineffective, ignorant drunkards, the embodiment of the Dickensian Sairey Gamp stereotype. By examining why medical practitioners and naval and military administrators decided to hire female nurses, it is possible to explore two frameworks of investigation in this dissertation. First, the importance of nurses to eighteenth-and early nineteenth-century military and naval clinical hospitals, was shown in official correspondence, regulations, and medical treatises. Examining the crucial role of nurses in maintaining a healthy healing environment through cleanliness and ventilation reintegrates nurses into a previously male medical practitioner dominated narrative. In Britain, both patient care and domestic duties were viewed, societally, in the eighteenth and early nineteenth centuries as distinctly female skills. At West Indian stations, the ideal nurses were also female. Yet, the additional layer of race and accompanying theories of racialized immunity to tropical diseases, combined with the stratified labour market of the islands, meant that Black women were considered by medical practitioners to be the best nurses. These considerations resulted in the employment of enslaved women at the Bermuda Naval Hospital. Second, I counter historiographical preconceptions about pre-Nightingale nursing through a detailed prosopographical analysis of the nursing workforce at Plymouth Naval Hospitals, in conjunction with the nursing regulations for military and naval medical systems of care. As the experiences of nurses of Plymouth Naval Hospital show, the physical stability of naval hospitals allowed for nurses to develop healing and care skills over a period of longstanding employment. These nurses were not, as the historiographical prejudice contends, primarily thieves and drunkards. Furthermore, a comparison of military and naval regulations demonstrates that the regulatory structure of naval hospitals, and the position of nurses in them, cannot be explained merely by the permanence of their institutions. Nursing and nurses were part of a broader professionalization of healing practices in the second half of the eighteenth century. As complex institutions, naval hospitals only functioned when everyone’s role in the hospital was clear. In the army, by contrast, the role of nurses was less explicit and not carefully delineated. When recollecting the pre-Nightingale period of nursing, it is often the military nurses who are recalled by nursing historians – women seen even at the time as replaceable, untrained, and unnecessary. Reconfiguring our view to include the naval nurse – valued, crucial to hospital operation, and with a defined role – complicates the long-standing progressivist account of nursing after Nightingale to illustrate continuity between the two periods

Development and applicability of a soft and flexible robotic arm in digestive surgery

Introduction The oncologic adequacy of laparoscopy in digestive surgery is still controversial, especially in some technically demanding operations like Total Mesorectal Excision (TME). Even if standard robotic platforms, i.e. the da Vinci Surgical System, can improve dexterity and manouvrability of surgical instruments, there is no evidence supporting its use in digestive and rectal cancer surgery. The only multi-centre prospective RCT (ROLARR trial) suggests that robotic TME has no advantages compared to laparoscopic TME in terms of clinical and oncologic outcomes. A possible explanation of this lack of real advantages is that the articulation is possible only on the tip of the instrument. The opportunity to have a robotic platform with modular flexibility on the whole length of the arm could overcome technical limitations, improving results and allowing standardization and diffusion of the procedures. Methods The 7FP STIFF FLOP project was financed by the European Commission in order to develop a STIFFness controllable Flexible and Learn-able manipulator for surgical operations. Engineers were inspired by the tentacles of an octopus. A prototype was realized, consisting of multiple soft, pneumatically actuated threechamber segments. Additional chambers are integrated within the segments to allow their stiffening, employing an approach based on the concept of granular jamming. The STIFF-FLOP segments are actuated using pressure regulators and the stiffening chambers are interfaced via valves, applying a vacuum to the granules in the chambers. Sensors are embedded in the STIFF-FLOP modules to measure interaction forces (between the robot and its environment) and the robot’s configuration. A newly developed user interface, based on a Delta robot design, is used to move and position the tip of the STIFF-FLOP arm inside the abdomen. Signals obtained from sensors are fed back to the user interface console providing the operator with force feedback. The entire soft robot is equipped with a 4 mm in diameter centre-free lumen, which allows the passage of the electrical wires needed for the laparoscopic miniaturized optic system positioned at the tip of the robot. Phantom test The prototype was tested in order to assess learnability and satisfaction of the operators. The test was designed as a spatial motion task, consisting of movements between predefined target points clockwise and counter clockwise in a 3D phantom of the abdominal cavity. The participants were asked to conclude the task for the first time with the STIFF-FLOP prototype (SF1), then to repeat the task using conventional laparoscopic instrumentation (LAP) and finally to perform the task once more with the STIFF-FLOP arm (SF2). Surface EMG signals from the forearm muscles were recorded during the test. Results SF1 took a longer time than the other tasks, i.e. 36.4% more than LAP (p=0.0071). However, from SF1 to SF2 there was a 32.1% time reduction (p=0.0232). EMG amplitude analysis showed a higher overall average muscle activity during LAP. Moving from LAP to SF2 there was a 25.9% reduction in average muscle activity (p=0.0128). Cadaver test. The main objective of the test was to validate the compatibility of the system with human anatomy for laparoscopic TME and to determine whether the soft robot could represent a potential improvement compared to standard rigid laparoscopic instrumentation. The study was performed on two cadavers prepared according to the method described by Thiel. Results The use of the STIFF-FLOP camera allowed the surgeon to clearly visualize the inferior mesenteric vessels and the autonomic nerves that were subsequently spared from injury. The ability to smoothly follow the sacral curve due to the flexibility of the manipulator allowed the surgeons to perform a very precise dissection of the posterior part of the mesorectum. The same procedure was performed on both human cadavers, demonstrating the ease of use of the system. Completion times of the procedure were 165 and 145 min, respectively. No intraoperative complications were recorded. No technical failures were registered. Conclusion The STIFF FLOP flexible robotic arm is an intuitive technology that can be easily learned. The prolonged use of the STIFF FLOP manipulator is more comfortable than standard laparoscopic instrumentation and can be used for a long time without exhaustion. The system is compatible with human anatomy and allows to perform a standard surgical abdominal operation. The STIFF FLOP arm seems to improve visualization of the operatory field especially in narrow spaces like the pelvis