PREOPERATIVE AND POSTOPERATIVE PERCEPTIONS OF INFORMATIONAL NEEDS OF PATIENTS WHO UNDERWENT HEAD AND NECK CANCER SURGERY.
AuthorGil, Rakel Moyal.
KeywordsSurgery -- Psychological aspects.
Head -- Cancer -- Surgery.
Neck -- Cancer -- Surgery.
Cancer -- Surgery.
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
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Evaluating the Effects of Alvimopan, Liposomal Bupivacaine and Intravenous Acetaminophen in Colorectal Surgery PatientsBergstrom, Eric; Weinstein, Sara; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes. Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg). Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.
Analysis and Application of Opto-Mechanics to the Etiology of Sub-Optimal Outcomes in Laser Corrective Eye Surgery and Design Methodology of Deformable Surface Accommodating Intraocular LensesSchwiegerling, Jim T.; Mccafferty, Sean Joseph; Koch, Thomas L.; Wyant, Jim (The University of Arizona., 2015)Overview: Optical concepts as they relate to the ophthalmologic correction of vision in corneal laser vision correction and intraocular lens design was examined. Purpose: The interaction between the excimer laser and residual corneal tissue in laser vision correction produces unwanted side effects. Understanding the origin of these artifacts can lead to better procedures. Furthermore, accommodating intraocular lenses offer a potential for eliminating presbyopia. Understanding the properties of a new accommodating intraocular lens incorporating a deformable interface may lead to advances in cataract surgery. Introduction: Corneal surface irregularities following laser refractive procedures are commonly seen. They regularly result in a patient’s decreased best corrected visual acuity and decreased contrast sensitivity. These changes are only seen in biologic tissue and the etiology has been elusive. A thermal response has been theorized and was investigated in this research. In addition, intraocular lenses using a mechanically deforming interface to change their power in order to duplicate natural accommodation have been developed. The deforming interface(s) induce optical aberrations due to irregular deformations. Design efforts have centered on minimizing these deformations. Both of the ophthalmic applications have been analyzed using finite element analysis (FEA) to understand their inherent optical properties. Methods: FEA modeling of thermal theory has been applied to verify that excimer laser induced collagen contraction creates corneal surface irregularities and central islands. A mathematical model which indicates the viability of the theory was developed. The modeling results were compared to post ablation changes in eyes utilizing an excimer (ArF 193 nm), as well as non-ablative thermal heating in eyes with a CO₂ laser. Addition modeling was performed on an Intraocular lens prototype measuring of actuation force, lens power, interface contour, optical transfer function, and visual Strehl ratio. Prototype verified mathematical models were utilized to optimize optical and mechanical design parameters to maximize the image quality and minimize the required force. Results: The predictive model shows significant irregular central buckling formation and irregular folding. The amount of collagen contraction necessary to cause significant surface changes is very small (0.3%). Uniform scanning excimer laser ablation to corneal stroma produces a significant central steepening and peripheral flattening in the central 3mm diameter. Isolated thermal load from uniform CO₂ laser irradiation without ablation also produces central corneal steepening and paracentral flattening in the central 3mm diameter. The iterative mathematical modeling based upon the intraocular lens prototype yielded maximized optical and mechanical performance through varied input mechanical and optical parameters to produce a maximized visual Strehl ratio and a minimized force requirement. Conclusions: The thermal load created by laser irradiation creates a characteristic spectrum of morphologic changes on the porcine corneal stromal surface which correlates to the temperature rise and is not seen inorganic, isotropic material. The highly similar surface changes seen with both lasers are likely indicative of temperature induced transverse collagen fibril contraction and stress re-distribution. Refractive procedures which produce significant thermal load should be cognizant of these morphological changes. The optimized intraocular lens operates within the physiologic constraints of the human eye including the force available for full accommodative amplitude using the eye’s natural focusing feedback, while maintaining image quality in the space available. Optimized optical and mechanical performance parameters were delineated as those which minimize both asphericity and actuation pressure. The methodology combines a multidisciplinary basic science approach from biomechanics, optical science, and ophthalmology to optimize an intraocular lens design suitable for preliminary trials.