Master of Science in Industrial and Human Factors Engineering (MSIHE) , Wright State University, 2015, Industrial and Human Factors Engineering

Vibrotactile feedback, used as sensory substitution for loss of haptic feedback, has been utilized to improve performance in manual control, teleoperation and during minimally invasive surgical tasks. Stochastic resonance (SR), introduced into the human control system as white noise at a sub-threshold level, has shown promise to improve the sensitivity of tactile receptors resulting in enhancement of performance for a variety of manual tracking and sensorimotor tasks. The purpose of this study was to determine if SR could improve performance (accuracy, speed) in a simulated laparoscopic palpation task and to compare it to vibrotactile feedback (VIB). It was hypothesized that both VIB and SR feedback would result in better performance over no feedback (Control). Furthermore, SR feedback was expected to lead to the greatest increase in performance by improving subjects' haptic sensitivity to tissue compliance and consistency. A total of 16 subjects (10 female, 6 male) performed a palpation task using laparoscopic tools to detect the presence of tumors (compacted felt) embedded in simulated tissue samples (silicone gel) in a laparoscopic trainer box. Subjects were randomly assigned to one of three different conditions: (1) Control and SR, (2) Control and VIB, (3) Control and VIB+SR and (4) Control and Control. The control condition was performed before the vibration condition to set a baseline for performance as well as to account for carry-over effects related to vibrotactilefeedback and human performance. The vibrotactile feedback and SR vibrations were administered via two different haptic actuators attached to subjects' dominant upper and lower arms, respectively. Each subject was presented 36 tissue samples (24 w/tumor, 12 non-tumor) in random order, under the control condition and then presented the same 36 samples in a different random order under the assigned vibration condition (SR, VIB, VIB+SR, Control), for a total of 72 tissue samples (48 w/tumor, 24 (open full item for complete abstract)

Committee: Carolin Cao Ph.D. (Committee Chair); Chandler Phillips M.D. (Committee Member); Joseph Slater Ph.D. (Committee Member) Subjects: Biomedical Engineering; Engineering; Health Care; Medicine; Neurobiology; Surgery

Master of Science in Electrical Engineering (MSEE), Wright State University, 2023, Electrical Engineering

Stochastic resonance (SR) is a phenomenon that can enhance the detection or transmission of weak signals by adding random noise to a non-linear system. SR introduced into the human motor control system as a subthreshold mechanical vibration has shown promise to improve sensitivity to haptic feedback. SR can be valuable in a laparoscopic surgery application, where haptic feedback is critical. This research sought to find if applying SR to the human motor control system improves performance in a laparoscopic probing task, if the performance differs based on the location of stochastic resonance application, and if there are sustained effects from SR after its removal. Subjects were asked to perform a palpation task using a laparoscopic probe to determine whether a series of simulated tissue samples contained a tumor. Subjects in the treatment groups were presented with a series of samples under the following conditions: Pre-SR, SR applied to the forearm or elbow, and Post-SR. Subjects in the control group did not have SR applied at any point. Performance was measured through the accuracy of tissue assessment, subjects' confidence in their assessment, and assessment time. Data from 27 subjects were analyzed to investigate the application of stochastic resonance and its sustained effects to improve haptic feedback sensitivity in a simulated laparoscopic task. The forearm group was shown to have significant improvement in the accuracy of tissue identification and sensitivity to haptic feedback with the application of SR. Additionally, the forearm group showed a greater improvement in accuracy and sensitivity than the elbow group. Finally, after SR was removed, the forearm group showed sustained significant improvement in accuracy and sensitivity. Therefore, the experiment results supported the hypotheses that stochastic resonance improves subjects' performance and haptic perception, that performance improvement differs based on application location, and that subjec (open full item for complete abstract)

Committee: Luther Palmer III, Ph.D. (Advisor); Caroline Cao Ph.D. (Committee Member); Katherine Lin M.D. (Committee Member) Subjects: Biomedical Engineering; Biomedical Research; Engineering; Health; Health Care; Mechanical Engineering; Surgery

DNP, Otterbein University, 2024, Nursing

Robotic-assisted surgery (RAS) is becoming more prevalent in modern surgical practice and is currently being utilized in a range of surgical specialties from colorectal and gynecological procedures to bariatrics and orthopedics. Every surgical procedure has potential risk to patients, however robotic-assisted laparoscopic prostatectomies (RALP) in the steep Trendelenburg (ST) position poses unique risk for peripheral nerve injury (PNI). Despite attempts to reduce the incidence rate of PNI during RALP, injuries are still occurring to patients causing patient harm and anesthesia provider litigation. The implementation of a CRNA based safety checklist may reduce the incidence rate of PNI and provider litigation for these procedures. The overall purpose of this quality improvement project is to reduce the risk of PNI to patients undergoing anesthesia during RALP. The primary aim of the project is to create, implement, and evaluate the effects an evidence-based clinical practice safety checklist for use in conjunction with the surgical timeouts will have on the incidence rate of PNI. The following objectives have been established to achieve the aim of this project: 1) create and incorporate a practice safety checklist for CRNAs to use during surgical timeouts, using best practice evidence from the literature, 2) compare pre-and post-implementation outcome findings using clinical observations audits and lastly 3) provide project findings, identified barriers, and recommendations for sustainment and continued monitoring, using a SWOT analysis briefing and discussion format to the key stakeholders.

Committee: Amy Bishop DNP, AGCNS (Committee Member); Chai Sribanditmongkol PhD, RN, IBCLC, CNS (Committee Member); Kacy Ballard DNP, CRNA (Advisor) Subjects: Nursing

Master of Science, The Ohio State University, 2022, Anatomy

Under ideal circumstances, surgical skills training should emulate live surgical conditions as closely as possible. While new anatomically accurate models and virtual/augmented reality simulators make surgical anatomical knowledge acquisition more accessible, research shows that these resources are limited in their ability to fully reflect the live human anatomy. As such, the animal and human body donor models have remained the gold standards for surgical simulation. And while there have been studies comparing the porcine and human body donor models, very little is known about Imperial College of London – Soft Preservation (alcohol-preserved) human body donors in the context of surgical training and education. The objective of our study was to examine the alcohol-preservation technique and to further elucidate its utility in general surgery resident education. Utilizing questionnaire-based feedback and semi-structured interviews, we analyzed quantitative and qualitative data obtained from the accounts of general surgery residents and surgical faculty instructors who experienced both the porcine and alcohol-preserved models at The Ohio State University Wexner Medical Center. Results indicated that the porcine and alcohol-preserved human body donor models were preferred for different aspects of surgical training. While the porcine model was preferred for its ability to teach tissue-handling and to simulate live blood flow, the alcohol-preserved human body donor model was unanimously preferred for its anatomical relevance, colon suturing/stapling, and reflection of live operating conditions. Surgical faculty specifically noted that while there is anatomical overlap between the two models with the anatomy of the rectum, “the small bowel and colon are dramatically different, which does not give the full breadth of colon resection needed for the human model.” In addition, the alcohol-preserved model was regarded as superior to the formalin-fixed human body dono (open full item for complete abstract)

Committee: Joy Balta (Advisor); Aslam Ejaz (Committee Member); Melissa Quinn (Committee Member) Subjects: Anatomy and Physiology

PhD, University of Cincinnati, 2010, Nursing: Nursing - Doctoral Program

Adherence to a regimen that includes follow-up appointments, diet, and physical activity after laparoscopic adjustable gastric banding, (LAGB) was recognized as a contributor to weight loss. Research suggested a positive association between adherence to this regimen and weight loss after LAGB. Research also suggested an inverse association between depression and adherence. It was hypothesized that subjects with depression would be less adherent to the post-operative regimen and would lose less weight after LAGB when compared with those without depression. This study was a retrospective review of 246 LAGB subjects from a bariatric surgery practice in the Midwest who met the National Institutes of Health (NIH) criteria for bariatric surgery. The purpose of the study was to examine the association between depression and adherence to the post-operative regimen, and subsequent weight loss after LAGB. The independent variables were depression and adherence to the post-operative regimen. The dependent variables were adherence to the post-operative regimen and weight loss after LAGB. Subjects were categorized as depressed or non-depressed and adherent or non-adherent to the post-operative regimen. The results did not support the hypotheses. Confounding factors (e.g., the effect of depression on self-reporting of adherence and changes in the state of depression) may have influenced the results. In addition, study limitations, such as self-reporting of depression and adherence to the post-operative regimen may have impacted the findings. The study's findings raise questions about current protocols that delay or deny LAGB due to depression. Well designed studies on the association between depression and adherence to the post-operative regimen, and subsequent weight loss after LAGB are lacking. Evidence is insufficient to support the use of the pre-operative mental health evaluation to determine LAGB candidacy. Future investigations of factors that may affect adherence to the (open full item for complete abstract)

Committee: Bonnie Brehm PhD (Committee Chair); Janice Dyehouse BSN, MSN, PhD (Committee Member); Christopher Lindsell PhD (Committee Member) Subjects: Nursing

Master of Family and Consumer Sciences (MFCS), Bowling Green State University, 2010, Family and Consumer Sciences/food and Nutrition

Background: Obesity trends continue to rise, and bariatric surgery has been deemed the only obesity treatment option which provides long term weight loss success. The Laparoscopic Sleeve Gastrectomy (LSG) is relatively new with excellent weight loss and minimal long term consequences. Due to the novelty of this procedure long term effects on nutritional status have yet to be clearly defined. Objective: The objective of this pilot study was to establish a baseline nutritional status, record prevalence of nutritional deficiency, as well as determine weight loss success in the LSG patient during the first 12 month post-surgery. Methods: A retrospective chart review of all LSG patients at a bariatric center in Ohio was performed. Twenty-seven patient charts were included with surgery dates between July 2008 and August 2010. Standard nutrition indicators were evaluated and only data from patients who had all three time points (initial, 6 months and 12 months) were used in the statistical analysis. Medical charts were excluded only due to surgical complications. Results: Average weight loss of 106.66±34.24 pounds over the first twelve months post LSG was noted. Nutritional status indicators which were highly significant (p<.002) include white blood cells and glucose. Both indicators appeared to decline over the course of the pilot study. The indicators which may be significant in other nutritional evaluations of LSG include protein, HDL, cholesterol, triglycerides, MCV and MCH. Indicators, such as protein, albumin, vitaminB12, and iron, which could be seriously affected by the anatomical changes of the LSG, were not significantly affected in the results of this pilot study. A decrease in protein over time was noted as significant with an alpha of .05 indicating that this decrease could be seen in other studies. Conclusions: In this biased patient population, the LSG does not appear to pose a threat to nutritional status. More research should be performed to review (open full item for complete abstract)

Committee: Dawn Anderson PhD (Advisor); Peter Lalor MD (Committee Member); Martha Sue Houston PhD, RD (Committee Member) Subjects: Nutrition