Effectiveness of an Educational Intervention with Guidelines from the Total Acceleration of Postoperative Recovery Project (ACERTO) in Gynecology / Efetividade de uma intervenção educativa com diretrizes do projeto Aceleração da Recuperação Total Pós-operatória (ACERTO) na ginecologia

Abstract Objective To evaluate the effectiveness of an educational intervention among gynecologists about recommendations of the Total Acceleration of Postoperative Recovery (ACERTO, in the Portuguese acronym) project derived from the solid foundations of Enhanced Recovery After Surgery (ERAS) guidelines to optimize hospital care for surgical-gynecological patients. Methods Educational intervention through monthly 1-hour long meetings (3 months), with the application of an objective questionnaire about specific knowledge of the ACERTO project between before and after educational intervention phases, for gynecologists, after approval by the ethics committee and signature of informed consent by participants, in a federal university hospital. Results Among the 25 gynecologists who agreed to participate, the educational intervention could be effective with a statistically significant difference between the phases before and after the intervention for the main recommendations of the ACERTO project, such as abbreviation of preoperative fasting (p = 0.006), venous thromboembolism prophylaxis (p = 0.024), knowledge and replication of ACERTO (p = 0.034), and multimodal analgesia (p = 0.021). Conclusion An educational intervention, through clinical meetings with exposition and discussion of the recommendations of the ACERTO project based on the ERAS protocol can be effective for the knowledge and possibility of practical application of the main measures, such as abbreviation of preoperative fasting, multimodal analgesia, and prophylaxis of thrombosis among gynecologists.

Resumo Objetivo Avaliar a efetividade de uma intervenção educativa entre ginecologistas de um hospital universitário a fim de capacitar o conhecimento científico das recomendações do projeto Aceleração da Recuperação Total Pós-operatória ACERTO, derivado das bases sólidas do protocolo Enhanced Recovery After Surgery (ERAS) para otimizar a assistência hospitalar de pacientes cirúrgico-ginecológicas. Métodos Intervenção educativa por meio de reuniões mensais por 3 meses, com duração de 1 hora, com aplicação de questionário objetivo com questões de conhecimentos específicos do projeto ACERTO com fases antes e depois da intervenção, para profissionais ginecologistas, após aprovação do comitê de ética em pesquisas (CEP) e assinatura do termo de consentimento livre e esclarecido (TCLE) pelos participantes. Resultados Dentre os 25 ginecologistas que aceitaram participar, a intervenção educativa se mostrou eficaz com diferença estatisticamente significante entre as fases antes e depois da intervenção para as principais recomendações do projeto ACERTO, como abreviação de jejum pré-operatório (p = 0.006), profilaxia de tromboembolismo venoso (p = 0.024), conhecimento e replicação do conhecimento do ACERTO (p = 0.006) e analgesia multimodal (p = 0.006). Conclusão Uma intervenção educativa, por meio de reuniões clínicas com exposição e discussão das recomendações do projeto ACERTO baseadas em evidências e derivadas do ERAS é eficaz para o conhecimento e possibilidade de aplicação prática de medidas como abreviação de jejum pré-operatório, analgesia multimodal e profilaxia de trombose entre ginecologistas.

A ocorrência de infecção por COVID-19 em pacientes assintomáticos na testagem pré-operatória / The occurrence of COVID-19 infection in preoperative testing of asymptomatic patients / La ocurrencia de infección por COVID-19 en pruebas preoperatorias de pacientes asintomáticos

Objetivo: Analisar a ocorrência de pacientes cirúrgicos assintomáticos com teste para COVID-19 positivo, delimitar o perfil epidemiológico, identificar o tipo de cirurgia e a especialidade, bem como determinar o tempo de execução do procedimento cirúrgico após testagem positiva. Método: Trata-se de um estudo de coorte retrospectiva, em um hospital de grande porte, filantrópico, de São Paulo, realizado no período de março a setembro de 2020, baseado na análise de dados de prontuário. Resultados: Foram 4.870 procedimentos cirúrgicos, dos quais 3.688 pacientes tiveram coleta de exame PCR. A ocorrência de pacientes cirúrgicos posi-tivos e assintomáticos foi de 1,7%; no perfil epidemiológico, observa-se predominância de sexo masculino, meia-idade, com classificação de risco anestésico ASA II e em procedimentos das especialidades de ortopedia, urologia, ginecologia e gastroenterologia. A execução do teste foi de dois dias pré-procedimento e a presença de pacientes com sintomas em até 14 dias após testagem foi de 0,5%. Conclusão: A ocorrência de pacientes cirúrgicos positivos e assintomáticos foi pequena dentro do quantitativo analisado, os achados deste estudo são similares aos de estudos nacionais e internacionais em relação a especialidade, comorbidades e idade

Objective: To analyze the occurrence of asymptomatic surgical patients with a positive COVID-19 test, delimit the epidemiological profile, iden-tify the type of surgery and specialty, as well as determine the time for performing the surgical procedure after a positive test. Method: This is a retrospective cohort study, in a large, philanthropic hospital in São Paulo, carried out from March to September 2020, based on the analysis of medical records. Results:There were 4,870 surgical procedures, of which 3,688 patients underwent a PCR test. The occurrence of positive and asymptomatic surgical patients was 1.7%; in the epidemiological profile, there is a predominance of males, middle-aged, with ASA II anesthetic risk classification and in procedures of the spe-cialties of orthopedics, urology, gynecology, and gastroenterology. The test was carried out two days before the procedure and the presence of patients with symptoms within 14 days after testing was 0.5%. Conclusion: The occurrence of positive and asymptomatic surgical patients was small within the quantita-tive analyzed, the findings of this study are similar to those of national and international studies in relation to specialty, comorbidities, and age

Objetivo: Analizar la ocurrencia de pacientes quirúrgicos asintomáticos con prueba COVID-19 positiva, delimitar el perfil epidemiológico, iden-tificar el tipo de cirugía y especialidad, así como determinar el tiempo para realizar el procedimiento quirúrgico luego de una prueba positiva. Método:Este es un estudio de cohorte retrospectivo, en un gran hospital filantrópico de São Paulo, realizado de marzo a septiembre de 2020, basado en el análi-sis de registros médicos. Resultados: Se realizaron 4.870 procedimientos quirúrgicos, de los cuales se recolectó examen PCR a 3.688 pacientes. La ocur-rencia de pacientes quirúrgicos positivos y asintomáticos fue de 1,7%; en el perfil epidemiológico predomina el sexo masculino, de mediana edad, con clasificación de riesgo anestésico ASA II y en procedimientos de las especialidades de ortopedia, urología, ginecología y gastroenterología. La prueba se realizó dos días antes del procedimiento y la presencia de pacientes con síntomas dentro de los 14 días posteriores a la prueba fue del 0,5%. Conclusión:La ocurrencia de pacientes quirúrgicos positivos y asintomáticos fue pequeña dentro de lo cuantitativo analizado, los hallazgos de este estudio son simi-lares a los de estudios nacionales e internacionales en relación a especialidad, comorbilidades y edad

Estrategia de superación para el desarrollo de habilidades del cirujano general en el preoperatorio mediato / An upgrading strategy for the development of skills in the general surgeon in the mediated preoperative period

Introducción: La superación profesional en cirujanos generales, particularizada en la atención preoperatoria, es una vía para acrecentar la educación permanente o continua, que contribuye a formar hombres de ciencias con determinados valores y actitudes. Objetivo: Diseñar una estrategia de superación para el desarrollo de las habilidades profesionales en la atención preoperatoria mediata que contribuya al mejoramiento del desempeño profesional de los médicos cirujanos generales. Métodos: Se utilizaron como métodos teóricos: análisis-síntesis, histórico-lógico, sistematización, inducción-deducción, modelación, análisis documental, sistémico estructural funcional; y como empírico, la observación científica. Resultados: El diseño de la estrategia respondió al desarrollo de las habilidades profesionales en la atención preoperatoria mediata y se fundamentó desde los referentes filosóficos, sociológicos, psicológicos, epistemológicos, pedagógicos y la educación médica. Se concibió en cuatro etapas y se utilizó el ciclo Deming, que establece relaciones esenciales con coherencia lógica interna a la educación médica, en particular en el área de la formación permanente y continuada de los profesionales de la salud. Conclusiones: El diseño de la estrategia profesional permite el enriquecimiento de las ciencias de la educación médica desde el posgrado como ciencia en construcción, específicamente en el área de la formación permanente y continua de médicos cirujanos generales. Al profundizar desde el plano interno, externo y contextual para el desarrollo de las habilidades profesionales en el preoperatorio mediato, la estrategia propuesta resulta dinámica, lo que permite el mejoramiento del desempeño profesional a partir de la superación(AU)

Introduction: Professional improvement in general surgeons, particularly in preoperative care, is a way to increase permanent or continuous education, which contributes to the creation of men of science with certain values and attitudes. Objective: To design an upgrading strategy for the development of professional skills in preoperative care that contributes to the improvement of professional performance in general surgeons. Methods: As theoretical methods, analysis-synthesis was used, together with the historical-logical method, systematization, induction-deduction, modeling, documentary analysis, and the structural-functional-systemic method; while, at the empirical level, scientific observation was used. Results: The design of the strategy responded to the development of professional skills in preoperative mediated care and was based on philosophical, sociological, psychological, epistemological, pedagogical and medical education referents. It was conceived in four stages and used the Deming cycle, which establishes essential relationships with internal logical coherence to medical education, particularly in the area of permanent and continuous education for health professionals. Conclusions: The design of the professional strategy allows the enrichment of medical education sciences from the postgraduate level as a science under construction, specifically in the area of permanent and continuous training of general surgeons. Insofar it deepens from the internal, external and contextual levels for the development of professional skills in the mediate preoperative period, the proposed strategy is dynamic, allowing for the improvement of professional performance from the point of view of self-upgrading(AU)

Prevalencia de portación nasal de Staphylococcus aureus sensible y resistente a la meticilina en candidatos a artroplastia total de cadera o rodilla / Prevalence of nasal carriage of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in candidates for total hip or knee arthroplasty

INTRODUCIÓN Las infecciones perioperatorias en cirugía de reemplazo articular son fuente importante de morbimortalidad, así como de altos costos económicos y sociales, tanto para el paciente como para su entorno. La colonización preoperatoria por Staphylococcus aureus ha sido reconocida como un factor de riesgo importante para desarrollar una infección de sitio quirúrgico.El objetivo de este estudio es conocer la prevalencia de portación nasal de S. aureus, tanto sensible a la meticilina (SASM) como resistente a la meticilina (SARM), en pacientes candidatos a cirugía de reemplazo articular de cadera o rodilla. MATERIALES Y MÉTODOS Se realizó un estudio observacional de una cohorte retrospectiva de pacientes con indicación de artroplastia total de cadera (ATC) y rodilla (ATR) electiva por artrosis severa en un hospital público de Chile. Los pacientes fueron sometidos a tamizaje preoperatorio de portación, cultivándose muestras obtenidas mediante hisopado de ambas fosas nasales. Los datos del laboratorio fueron recopilados y presentados como porcentaje de portación de S. aureus. RESULTADOS Se estudiaron 303 pacientes consecutivos de ATC y 343 de ATR. En total, 483 de los 646 pacientes (74,7%) tuvieron estudio preoperatorio de portación nasal. Se identificaron 123 pacientes (25,4%) portadores de S. aureus, de los cuales sólo 2 (0,41%) casos correspondieron a SARM. CONCLUSIÓN La prevalencia de portación nasal de S. aureus obtenida fue de 25%, similar a lo reportado en otras series. La prevalencia de SARM (0.41%), sin embargo, estuvo bajo lo descrito en la literatura internacional (0,6­6%). Sería de utilidad, dada la alta prevalencia de portación descrita en nuestro trabajo y de acuerdo a evidencia publicada recientemente, realizar protocolos de descolonización universales, sin necesidad de realizar tamizaje preoperatorio.

INTRODUCTION Surgical-site infections in joint replacement surgery are an important source of morbidity and mortality that entail high economic and social burden both for the patient and their environment. Preoperative colonization by Staphylococcus aureus has been recognized as an important risk factor for the development of surgical-site infection. The aim of the present study is to determine the prevalence of nasal colonization by S. aureus, both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) in patients who are candidates for total replacement of the hip or knee joints. MATERIALS AND METHODS A retrospective observational study of a cohort of 646 patients with an indication to undergo total hip arthroplasty (THA) or total knee arthroplasty (TKA) due to severe osteoarthritis was performed in a Public Hospital in Chile. The patients were submitted to a preoperative screening for S. aureus carriage, and the culture samples were obtained by swabbing both nostrils. The laboratory data was collected and presented as a percentage of carriage. RESULTS We consecutively examined 303 THA and 343 TKA patients. A total of 483 of the 646 patients (74.7%) underwent a preoperative study of nasal carriage. We identified 123 (25.4%) S. aureus carriers, and only found 2 (0.41%) cases corresponding to MRSA. CONCLUSION We found a prevalence of nasal carriage of S. aureus of 25.4%, a rate similar to that reported in other series. The prevalence of MRSA (0.41%), however, was lower than that reported in the international literature (0.6­6%). Given the high prevalence of carriage described in our work and according to recently published data, it would be worthwhile to carry out universal decolonization protocols, without the need for preoperative screening.

Bezoar. A propósito de un caso / Bezoar. A case report

Introducción: la obstrucción del intestino delgado (SBO) es una presentación común en cualquier unidad de cirugía general. Sin embargo, su diagnóstico y manejo preoperatorio a menudo pueden ser difíciles debido a sus múltiples causas. La obstrucción intestinal pequeña secundaria a la impactación de bezoar es considerablemente infrecuente, con una frecuencia reportada de aproximadamente 0.4% a 4%. La incidencia de bezoar como causa de obstrucción intestinal es baja. El método complementario con la mayor sensibilidad y especificidad continúa siendo CT del abdomen y la pelvis con contraste oral e intravenoso. El tratamiento debe ser quirúrgico. Modificar la dieta junto con el manejo de los trastornos es la mejor forma de prevención.

Introduction: Small Bowel Obstruction (SBO) is a common presentation in any general surgery unit. However, its diagnosis and preoperative management can often be difficult due to its multiple causes. Small bowel obstruction secondary to bezoar impaction is considerably uncommon, with a reported frequency of about 0.4% to 4%. The incidence of bezoar as a cause of intestinal obstruction is low. The complementary method with the highest sensitivity and specificity continues to be CT of the abdomen and pelvis with oral and intravenous contrast. Treatment must be surgical. Modifying the diet along with managing the disorders is the best form of prevention

Intracapsular Femoral Neck Fractures in the Elderly / Fraturas intracapsulares do colo femoral no idoso

Abstract Currently, intracapsular femoral neck fracture (IFNF) is still a great challenge for orthopedists. In spite of the progress that has been made, a high mortality rate persists in the first year, especially in Brazil, where there is no awareness that such fractures in elderly patients should be treated as amedical emergency. The present article seeks to provide an update on the preoperative, surgical, and postoperative approaches.

Resumo Atualmente, a fratura intracapsular do colo femoral (FICF) ainda é um grande desafio para os ortopedistas. Apesar dos grandes avanços feitos, persiste uma grande taxa de mortalidade no primeiro ano, sobretudo no Brasil, onde não há uma conscientização de que tais fraturas nos pacientes idosos devemser tratadas como uma urgênciamédica. O presente artigo busca fornecer uma atualização das condutas pré-operatórias, cirúrgicas e pós-operatórias.

Interacción enfermera-paciente para el éxito del proceso quirúrgico / Nurse-Patient Interaction in View of a Successful Surgical Process

Introducción: La interacción enfermera-paciente durante el período preoperatorio permite el afronte intraoperatorio y posoperatorio, pero no se hace por desidia o por sobrecarga laboral. Objetivo: Describir las reflexiones en torno a la interacción enfermera-paciente durante el período preoperatorio en un hospital público. Métodos: Investigación cualitativa descriptiva, realizada en el Hospital Belén en Lambayeque, Perú, durante abril y mayo del 2020. La población fueron 20 enfermeras experimentadas en atención preoperatoria. Se realizó muestreo no probabilístico, por técnica de bola de nieve que saturó con ocho enfermeras. Los datos se recolectaron con entrevista semiestructurada por llamada telefónica, y fueron procesadas mediante análisis de contenido. Resultados: Tres categorías: a) Elementos indispensables en la interacción: empatía y comunicación terapéutica, b) Interacción para valorar y cuidar de la dimensión emocional, espiritual y física del paciente en el preoperatorio, c) Beneficios de la interacción para la recuperación en el posoperatorio basados en la educación al paciente y su familia. Conclusiones: La interacción enfermera-paciente se inicia a través de la empatía que siente la enfermera y la confianza que genera en el paciente, lo que favorece la comunicación terapéutica, esencial para valorar y cuidar de las necesidades emocionales, espirituales y físicas previa a la intervención quirúrgica. Asimismo, la educación sanitaria al paciente y al familiar es fundamental para el cumplimiento de las indicaciones en el posoperatorio, de manera que haya una recuperación exitosa. Sin embargo, se necesita adecuada dotación del personal de enfermería y comunicación asertiva entre el equipo de salud y la familia(AU)

Introduction: Nurse-patient interaction during the preoperative period allows intraoperative and postoperative coping, but is not done out of idleness or work overload. Objective: To describe the reflections about nurse-patient interaction during the preoperative period in a public hospital. Methods: Descriptive and qualitative research carried out at Belén Hospital in Lambayeque, Peru, during April and May 2020. The study population consisted of twenty nurses experienced in preoperative care. Nonprobabilistic sampling was done, using the "snowball" technique, permitting to identify eight nurses and thus reach saturation. The data were collected with a semistructured interview by telephone call and processed by content analysis. Results: Three categories emerged: a) indispensable elements for interaction: empathy and therapeutic communication; b) interaction to value and care for the emotional, spiritual and physical dimensions of the patient in the preoperative period; and c) benefits of interaction for recovery in the postoperative period based on patient and family education. Conclusions: Nurse-patient interaction starts through the empathy felt by the nurse and the trust that thus produced in the patient, which favors therapeutic communication, essential to value and care for the emotional, spiritual and physical needs prior to surgery. Likewise, health education to the patient and family is essential to comply with postoperative indications, in view of a successful recovery. However, an adequate nursing staff and assertive communication between the health care team and the family are needed(AU)

Intervención de enfermería durante el preoperatorio en cirugía cardiovascular / Nursing intervention during the pre-operative period in cardiovascular surgery

Introducción: La adecuada intervención de enfermería puede mejorar los resultados posoperatorios, el estrés y el conocimiento; y reducir las complicaciones. Objetivo: Exponer una intervención personalizada de enfermería para modificar los estados emocionales, y la capacidad de afrontamiento y adaptación durante el preoperatorio de cirugía cardiovascular en el Centro de Investigaciones Médico Quirúrgicas. Métodos: Se realizó un estudio longitudinal y preexperimental, que incluyó 88 personas que acudieron al Servicio de Cirugía Cardiovascular del Centro de Investigaciones Médico Quirúrgicas en un período de dos años. Se aplicaron los test Inventario de Ansiedad Rasgo-Estado y del Inventario de Depresión Rasgo-Estado, para medir la ansiedad y la depresión; así como el test ESCAPS (Instrumento de medición del proceso de afrontamiento y adaptación) y una entrevista semiestructurada que exploró conocimiento. Los resultados iniciales y finales se compararon, y se expresaron en números absolutos, porcentajes y media. Se aplicó la prueba de Chi cuadrado a las variables cualitativas y el test de Student para medias independientes a las variables cuantitativas, con un intervalo de confianza del 95 por ciento. Resultados: Predominaron los hombres (57,9 por ciento) con edad media de 57,73 ± 11,9 años. Luego de la intervención se redujeron la ansiedad en un 36,6 por ciento (p < 0,001) y la depresión en un 72,7 por ciento (p = 0). Aumentaron el conocimiento (76,1 por ciento; p = 0,037) y la capacidad de afrontamiento y adaptación (0,11 puntos). Solo se encontró asociación entre la ansiedad y la depresión con las complicaciones (p = 0,008 y p < 0,001 de forma respectiva). Conclusiones: La intervención de enfermería modificó de manera positiva la ansiedad y la depresión, al optimizar la capacidad de afrontamiento y adaptación(AU)

Introduction: Adequate nursing intervention can improve post-operative outcomes, stress and knowledge; and reduce complications. Objective: Present a personalized nursing intervention in the pre-operative period of cardiovascular surgery at the Center for Medical and Surgical Research. Methods: A longitudinal and pre-experimental study was conducted, which included 88 people who attended the Cardiovascular Surgery Service of the Center for Medical and Surgical Research in a period of two years. The Trait-State Anxiety Inventory and Trait-State Depression Inventory tests were applied to measure anxiety and depression; as well as the ESCAPS test (Instrument for measuring the coping and adaptation process) and a semi-structured interview that explored knowledge. A personalized nursing intervention was performed. The initial and final results were compared, and expressed in absolute numbers, percentages and average. The Chi-square test was applied to the qualitative variables and the Student test for independent means to the quantitative variables, with a 95 percent confidence interval. Results: Men (57.9 percent) with a mean age of 57.73 ± 11.9 years predominated. After the intervention, anxiety was reduced by 36.6 percent (p < 0.001) and depression by 72.7 percent (p = 0). Knowledge increased (76.1 percent; p = 0.037) and coping and adaptive capacity (0.11 points). Only an association was found between anxiety and depression with complications (p = 0.008 and p < 0.001 respectively). Conclusions: Nursing intervention positively modified anxiety and depression by optimizing coping and adaptation capacity(AU)

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Desarrollo de las habilidades profesionales del cirujano general en la atención preoperatoria mediata / Development of the general surgeon professional skills in the mediate preoperative care

Introducción: El avance en los disímiles tratamientos y habilidades profesionales en torno a la intervención quirúrgica en el continente americano va aparejado al desarrollo que existe en Europa, y Cuba no queda exenta de los progresos alcanzados hasta la actualidad. Objetivo: Diagnosticar las insuficiencias en el desarrollo de las habilidades profesionales de los cirujanos generales, en la atención preoperatoria mediata. Métodos: Se realizó una investigación cuasi - experimental de 60 médicos especialistas y residentes, encargados de la atención preoperatoria mediata en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta mayo de 2021, para lo cual se conformaron 2 grupos: A (de estudio) y B (de control), con 30 integrantes cada uno. Se analizaron las variables seleccionadas y se definieron las dimensiones para demostrar la correspondencia con los indicadores de dichas variables. Resultados: Existió un predominio del sexo masculino en ambos grupos y de las edades entre 15 - 44 años (83,3 % en el grupo A y 90,0 % en el B). Las dimensiones más afectadas en orden decreciente fueron: superación, cognitiva, científico - investigativa y axiológica. La triangulación de los instrumentos arrojó que la variable desempeño profesional se encontraba con un nivel de afectación alto. Conclusiones: Las indagaciones teóricas y empíricas para la caracterización del estado actual de los cirujanos generales permitieron determinar, que existían insuficiencias en todas las dimensiones exploradas, lo cual dificultó el desarrollo de las habilidades profesionales relacionadas con la atención preoperatoria mediata.

Introduction: The advance in the dissimilar treatments and professional skills around the surgical intervention in the American continent goes together with the development that exists in Europe, and Cuba is not exempt of the progresses reached until the present time. Objective: To diagnose the inadequacies in the development of the general surgeons professional skills, in the mediate preoperative care. Methods: A quasi-experimental investigation of 60 specialist doctors and residents, in charge of the mediate preoperative care was carried out in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, from December, 2019 to May, 2021, for which 2 groups were conformed: A (study group) and B (control group), with 30 members each one. The selected variables were analyzed and the dimensions to demonstrate the correspondence with the indicators of these variables were defined. Results: There was prevalence of the male sex in both groups and the 15 - 44 age group (83.3 % in group A and 90.0 % in group B). The most affected dimensions in decreasing order were: training, cognitive, scientific - investigative and axiological. The triangulation of the instruments showed that the variable professional performance was in a high level of affectation. Conclusion: The theoretical and empiric investigations for the characterization of the current state of the general surgeons allowed to determine that inadequacies existed in all the explored dimensions, which made difficult the development of the professional skills related to the mediate preoperative care.

Recomendações para o preparo do paciente em pré-operatório de cirurgias cardíacas: revisão de escopo / Recommendations for patient preparation in the preoperative period of cardiac surgeries: a scoping review / Recomendaciones para la preparación del paciente en el preoperatorio de cirugías cardíacas: revisión del alcanc

OBJETIVO: Mapear a produção de conhecimento a respeito das recomendações para o preparo pré-operatório de qualquer tipo de cirurgia cardíaca, eletiva ou de urgência, de pacientes com idade superior a 18 anos em unidades de internação hospitalar. MÉTODO: Revisão de escopo realizada em dezembro de 2020, em 11 fontes de dados, seguindo as recomendações do Instituto Joanna Briggs, com análise de dados descritiva. RESULTADOS: Foram selecionados e caracterizados 27 estudos, identificando-se como principais recomendações pré-operatórias de cirurgia cardíaca: a educação pré-operatória, medicações, escalas para estratificação de risco pós-operatório, treinamento muscular inspiratório e realização de exames. CONCLUSÃO: As recomendações apresentaram eficácia na estabilidade hemodinâmica, atenuação do medo e ansiedade do paciente quanto à cirurgia, de arritmias, internação hospitalar, taxa de mortalidade e complicações pós-operatórias.

OBJECTIVE: To map the production of knowledge regarding the recommendations for the preoperative preparation of any type of cardiac surgery, whether elective or urgent, of patients over 18 years old in hospitalization units. METHOD: A scoping review carried out in December 2020 in 11 data sources, following the Joanna Briggs Institute recommendations, with descriptive data analysis. RESULTS: A total of 27 studies were selected and characterized, identifying the following as the main preoperative recommendations for cardiac surgeries: preoperative education, medications, scales for postoperative risk stratification, inspiratory muscle training and tests. CONCLUSION: The recommendations presented efficacy in hemodynamic stability, attenuation of the patient's fear and anxiety regarding the surgery, of the number of arrhythmias and hospitalizations, of the mortality rate and of postoperative complications.

OBJETIVO: Mapear la producción de conocimiento sobre las recomendaciones para la preparación preoperatoria de cualquier tipo de cirugía cardiaca, electiva o urgente, de pacientes mayores de 18 años en unidades de hospitalización. MÉTODO: Revisión de alcance realizada en diciembre de 2020, en 11 fuentes de datos, siguiendo las recomendaciones del Instituto Joanna Briggs, con análisis descriptivo de datos. RESULTADOS: Se seleccionaron y caracterizaron 27 estudios, las principales recomendaciones preoperatorias para cirugía cardiaca que se identificaron son: educación preoperatoria, medicamentos, escalas para estratificación de riesgo postoperatorio, entrenamiento de músculos inspiratorios y exámenes. CONCLUSIÓN: Las recomendaciones fueron efectivas para mejorar la estabilidad hemodinámica, disminuir el miedo y la ansiedad del paciente por la cirugía, las arritmias, el tiempo de estancia hospitalaria, la tasa de mortalidad y las complicaciones postoperatorias.

Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Evaluation of psychological symptoms in patients before and after simultaneous pancreas-kidney transplantation: a single-center cross-sectional study

Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.

Audiovisual aids in preoperative cardiac surgery education: a scoping review / Recurso audiovisual en la educación durante el período preoperatorio de cirugías cardíacas: revisión de alcance / Recurso audiovisual na educação em pré-operatório de cirurgia cardíaca: revisão de escopo

ABSTRACT Objective: to map, in the scientific literature, the use of audiovisual aids as an educational strategy during the preoperative period of cardiac surgery. Method: a scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the studies, applying the exclusion and inclusion criteria in the search by the audiovisual aid, cardiac surgery and preoperative care variables, including those that answered the research question. Results: final sample of nine studies, where the most used audiovisual aids were videos followed by apps, used because they are easily accessible and democratic. Such tools in health education optimize the team's time and promote patient education, improving the postoperative period, in addition to reducing risks and improving adherence to the treatment. Conclusion: it was possible to map the audiovisual aids used in the health education of surgical patients, such as videos, apps and information systems. These tools facilitate Nursing guidelines in the preoperative period of cardiac surgeries, increasing the patient's knowledge about the surgery.

RESUMEN Objetivo: mapear en la literatura científica el uso de recursos audiovisuales como estrategia educativa durante el período preoperatorio de cirugías cardíacas. Método: revisión de alcance que siguió la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron los estados, aplicando los criterios de exclusión e inclusión en la búsqueda por medio de las siguientes variables: recurso audiovisual, cirugía cardíaca y cuidados preoperatorios, incluyéndose los que respondían a la pregunta de la investigación. Resultados: la muestra final estuvo compuesta por nueve estudios, en los que los recursos audiovisuales más utilizados fueron los vídeos seguidos de aplicaciones, usados por ser de fácil acceso y democráticos. Estas herramientas de educación en salud optimizan el tiempo del equipo y promueven la educación del paciente, mejorando así el período postoperatorio, además de reducir riesgos y mejorar la adhesión al tratamiento. Conclusión: fue posible mapear los recursos audiovisuales utilizados en la educación en salud de los pacientes quirúrgicos, como ser vídeos, aplicaciones y sistemas de información. Estas herramientas facilitan las pautas orientadoras de la Enfermería en el período preoperatorio de cirugías cardíacas, incrementando así el conocimiento de los pacientes sobre las cirugías.

RESUMO Objetivo: mapear na literatura científica a utilização de recurso audiovisual como estratégia educativa durante o pré-operatório de cirurgia cardíaca. Método: revisão de escopo seguindo a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram os estudos, aplicando os critérios de exclusão e inclusão na busca pelas variáveis recurso audiovisual, cirurgia cardíaca e cuidados pré-operatórios, tendo sido incluídos aqueles que respondiam à questão de pesquisa. Resultados: amostra final de nove estudos, nos quais os recursos audiovisuais mais utilizados foram os vídeos seguidos de aplicativos, usados por serem de fácil acesso e democráticos. Essas ferramentas na educação em saúde otimizam o tempo da equipe e promovem a educação do paciente, melhorando o pós-operatório. Além de reduzir riscos e melhorar a adesão ao tratamento. Conclusão: foi possível mapear os recursos audiovisuais utilizados na educação em saúde dos pacientes cirúrgicos, como vídeos, aplicativos e sistemas de informações. Essas ferramentas são facilitadoras das orientações de enfermagem no pré-operatório de cirurgia cardíaca, aumentando o conhecimento do paciente sobre a cirurgia.

Preoperative botulinum A toxin as an adjunct for abdominal wall reconstruction: a single-center early experience at an Academic Center in New York / Toxina botulínica A pré-operatória como adjuvante na reconstrução da parede abdominal: experiência inicial em Centro Acadêmico em Nova York

ABSTRACT Introduction: the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. Methods: a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. Results: 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). Conclusion: preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated.

RESUMO Introdução: a toxina botulínica A (TBA) tem sido usada para alcançar a separação química dos componentes, com resultados favoráveis para o reparo de hérnias ventrais complexas (HVC) com ou sem perda de domínio (PD). O objetivo deste estudo é descrever nossa experiência inicial com a separação química dos componentes nos Estados Unidos. Métodos: estudo retrospectivo observacional com todos os pacientes submetidos a reparo de hérnia ventral complexa com ou sem PD entre julho de 2018 e junho de 2020. A TBA pré-operatória foi injetada em todos os pacientes, guiada por ultrassonografia, bilateralmente entre os músculos laterais para alcançar a denervação química antes da operação. Dados demográficos dos pacientes, local da hérnia, dados peri-operatórios e pós-operatórios são descritos. Resultados: 36 pacientes foram submetidos a esta técnica antes do reparo da hérnia. A idade mediana foi 62 anos (30-87). O tamanho mediano pré-operatório do defeito herniário foi 12cm (6-25) e o defeito mediano intra-operatorio foi 13cm (5-27). O volume mediano do saco herniário pré-operatório foi 1.338mL (128-14.040), o volume mediano da cavidade abdominal pré-operatório foi 8.784 (5.197-18.289) mL e a razão dos volumes foi 14%. A duração mediana da operação para aplicação da TBA foi 45 minutos (28-495). O seroma foi a complicação mais comum no pós-operatório, em oito pacientes (22%). O seguimento pós-operatório mediano foi de 43 dias (0-580). Conclusão: a separação pré-operatória de componentes com TBA é tratamento adjuvante seguro e eficaz em reparos de HVC em que aproximação da fáscia é antecipadamente desafiadora.

Transferencia de trapecio inferior con injerto autólogo de semitendinoso y recto interno / Transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendon

Existen múltiples opciones de tratamientos para las rupturas masivas irreparables posterosuperiores del manguito rotador. Describiremos la transferencia del trapecio inferior con aumentación utilizando semitendinoso y recto interno autólogos, bajo asistencia. De esta manera devolvemos el balance muscular y restablecemos las cuplas de fuerza para la correcta movilidad del hombro afectado. Esta técnica se realiza con dos incisiones y tres portales artroscópicos: la primera para la toma del recto interno y semitendinoso en la rodilla del mismo lado del hombro afectado (aumentación), y la segunda en la escápula para la toma del trapecio inferior y para el pasaje de los tendones al espacio subacromial y posterior fijación con anclas sin nudo

In massive irreparable posterosuperior rotator cuff ruptures, there are several options for treatment. We will describe the transfer of the lower trapezius muscle tendon augmented with semitendinosus and gracillis tendons autologous, under arthroscopic assistance. In this way, muscular balance is restored for correct shoulder mobility. This technique is performed with two incisions and three arthroscopic portals, the first for harvest of the gracillis and semitendinosus tendons, in the knee on the same side of the affected shoulder (augmentation) and the second in the scapula for the harvest of the lower trapezius muscle tendon, and for passage to the subacromial, and fixation with knotless anchors

Optimización preoperatoria del paciente antes de una artroplastía de cadera o rodilla: parte 1 / Preoperative patient optimization before hip or knee arthroplasty. Part 1

Las artroplastias de cadera y rodilla son estrategias que han demostrado ser efectivas en el tratamiento de la patología degenerativa articular. El reemplazo articular mejora la calidad de vida de la mayoría de los pacientes cuando el tratamiento conservador falla. Sin embargo, estas son cirugías mayores que conllevan un riesgo significativo de complicaciones, incluyendo la necesidad de una revisión. El propósito de este artículo es analizar los factores de riesgo modificables del paciente antes de la cirugía, a fin de disminuir el riesgo de complicaciones posoperatorias. Estudios recientes han descripto ciertos factores de riesgo modificables, inherentes al paciente y que incrementan la posibilidad de complicaciones posoperatorias luego de un reemplazo articular de cadera o rodilla. Estos incluyen obesidad, malnutrición, tabaquismo, diabetes, anemia, deficiencia de vitamina D, consumo de opioides, artropatías inflamatorias, insuficiencia renal crónica y colonización por estafilococco meticilino-resistente. Si conseguimos optimizar estas condiciones durante el preoperatorio, reduciremos el riesgo de complicaciones posoperatorias. Nivel de Evidencia: IV

Hip and knee arthroplasties are well-known effective strategies for joint osteoarthritis. Joint replacement reliably improves quality of life for most patients when non-operative measures have failed. However, these are major surgeries that carry significant risks, including the need for revision surgery. The purpose of this article is to discuss preoperative modifiable risks parameters of the patient prior to joint replacement to decrease complication risks. Recent studies have described several modifiable factors that increase the risk of postoperative complications following hip and knee replacement. These include obesity, malnutrition, tobacco use, diabetes, anaemia, vitamin D deficiency, opioid use, inflammatory arthropathy, kidney chronic insufficiency and meticilin-resistant staphylococci colonization. If we achieve preoperative optimization of these conditions, we should minimize the risk of adverse outcomes. Level of Evidence: IV

Cuidados de enfermería al paciente trasplantado renal período pre-operatorio, pos trasplante inmediato y temprano en la Unidad de Trasplante Renal del Hospital de Especialidades Carlos Andrade Marín / Nursing care of the renal transplant patient pre-operative, immediate posttransplant and early post-transplant periods in the Renal Transplant Unit of the Carlos Andrade Marín Specialties Hospital

El trasplante renal es considerado como la mejor alternativa de tratamiento sustitutivo para la enfermedad renal crónica terminal (ERCT)1, es el procedimiento quirúrgico que consiste en reemplazar un riñón sano de un donante vivo o cadavérico a una persona con diagnóstico de ERCT, que ayuda a mejorar su calidad de vida, la reinserción a sus actividades sociales, físicas, emocionales, laborales y sexuales. La Organización Nacional de Trasplantes de España (ONT) en el año 2018, reportó que en la Unión Europea se realizaron 21 102 y en Latinoamérica 12 806 trasplantes renales2, en Ecuador el Ministerio de Salud Pública (MSP) en los años 2007-2020 reportó un total de 1 6153, le correspondió al Hospital de Especialidades Carlos Andrade Marín (HECAM) el 32% del total de trasplantes renales realizados entre el periodo 2007-20184. La evaluación del potencial receptor es realizada por un equipo multidisciplinario con formación académica, experiencia certificada en los diferentes procesos y acreditados por el Instituto Nacional de Donación y Trasplantes (INDOT)5. Los cuidados de enfermería enmarcados en esta ruta, son especializados e integrales, que incluyen los períodos pre operatorio, pos trasplante inmediato y temprano al incorporar además un proceso educativo entre enfermera, paciente y familia/ cuidador, con el fin de preservar la sobrevida del injerto.

Renal transplantation is considered the best alternative replacement treatment for end-stage chronic kidney disease (ESRD)1, it is the surgical procedure that consists of replacing a healthy kidney from a living or cadaveric donor to a person diagnosed with ESRD, which helps to improve their quality of life, reintegration to their social, physical, emotional, work and sexual activities. The National Transplant Organization of Spain (ONT) in 2018, reported that In the European Union 21 102 and in Latin America 12 806 renal transplants were performed2, in Ecuador the Ministry of Public Health (MSP) in the years 2007-2020 reported a total of 1 6153, corresponded to the Carlos Andrade Marín Specialties Hospital (HECAM) 32% of the total number of renal transplants performed between 2007-20184. The evaluation of the potential recipient is performed by a multidisciplinary team with academic training, certified experience in the different processes and accredited by the National Institute of Donation and Transplantation (INDOT)5. The nursing care framed in this route is specialized and comprehensive, including the pre-operative, immediate post-transplant and early post-transplant periods, incorporating an educational process between nurse, patient and family/caregiver, in order to preserve graft survival.

Avaliação perioperatória do paciente hipertenso / Perioperatory evaluation of the hypertensive patient

Uma relação contínua e independente é observada entre pressão arterial (PA) e incidência de acidente vascular cerebral, infarto do miocárdio, morte súbita, insuficiência cardíaca, doença arterial periférica e doença renal. A importância de um controle rígido da PA na prevenção de eventos cardiovasculares a longo prazo está bem estabelecida e baseada em fortes evidências, contudo, ainda não há um embasamento robusto no período perioperatório. Apesar das poucas evidências de que o aumento da PA no período perioperatório afete o resultado cirúrgico, a hipertensão não controlada neste contexto continua sendo uma das principais razões para a suspensão de cirurgias. Pacientes hipertensos estão mais susceptíveis a instabilidade hemodinâmica, arritmias cardíacas, isquemia miocárdica, complicações neurológicas e renais no pós-operatório. A escolha do tipo de monitorização da PA em pacientes com hipertensão não controlada varia em função do risco do paciente devido à sua patologia prévia e risco cardiovascular, bem como do risco do tipo de intervenção cirúrgica.Serão revisados os principais aspectos da avaliação do risco cirúrgico, as implicações clínicas, assim como a abordagem do paciente hipertenso no período perioperatório.

A continuous and independent relationship is found between blood pressure (BP) and the incidence of stroke, myocardial infarction, sudden death, heart failure, peripheral arterial disease, and kidney disease. The importance of strict BP control in the prevention of long-term cardiovascular events is well established and based on strong evidence, however, there is still no robust basis for the perioperative period. Despite the little evidence that the increase in BP in the perioperative period affects the surgical outcome, uncontrolled hypertension in this context remains one of the main reasons for the suspension of surgeries. Hypertensive patients are more susceptible to hemodynamic instability, cardiac arrhythmias, myocardial ischemia, neurological and renal complications in the postoperative period. The choice of the type of BP monitoring in patients with uncontrolled hypertension varies depending on the patient's risk due to their previous pathology and cardiovascular risk, as well as the risk of the type of surgical intervention. The main aspects of surgical risk assessment will be reviewed, the clinical implications, as well as the approach of the hypertensive patient in the perioperative period.

WeChat-Assisted Preoperative Health Education Reduces Burden of Care on Parents of Children with Simple Congenital Heart Disease: a Prospective Randomized Controlled Study

Abstract Objective: The purpose of this study was to explore the clinical effect of preoperative health education based on the WeChat platform for parents of children with simple congenital heart disease. Methods: In this study, participants were randomly divided into an intervention group (WeChat group, n=40) and a control group (leaflet group, n=40) in our center. All parents were required to complete the Family Caregiver Task Inventory (FCTI) on the first visit and the Zarit Burden Interview (ZBI) and FCTI before the operation. Clinical, family and relevant data from children and parents were collected and subsequently analyzed. Results: Before the operation, the FCTI score and the ZBI score in the WeChat group were significantly lower than those in the control group (P=0.010, P=0.027, respectively). Compared to the FCTI score on the first visit, the preoperative status score was significantly lower in the WeChat group (P=0.008). The rate of loss to follow-up and complications in the WeChat group was also significantly lower than in the control group (P=0.003). Conclusion: Preoperative health education assisted by the WeChat platform for parents of children with simple congenital heart disease can effectively improve the parents' care ability and reduce the burden of care, preoperative complications and the rate of loss to follow-up.