Inteligencia artificial en medicina y procedimientos quirúrgicos: impacto en la toma de decisiones y la salud / Artificial Intelligence in Medicine and Surgical Procedures: Impact on Decision Making and Health

Introducción: Las revisiones sistemáticas de la literatura constituyen una herramienta metodológica práctica para la búsqueda de información sobre investigaciones clínicas, aplicaciones tecnológicas y la toma de decisiones de impacto en la salud. Objetivo: Describir cómo influye la inteligencia artificial en la toma de decisiones médicas según el grado de concordancia entre estas evidencias y los sistemas expertos aplicados en las especialidades clínicas y quirúrgicas de impacto en la salud, según reportes entre 2010 y 2019. Métodos: Se realizó una revisión sistemática con el uso de un modelo de bases de datos relacional y un modelo de entidad relación para garantizar la entidad referencial de la que hacen parte las bases de datos y los artículos, así como la calidad de cada uno de los artículos mediante clasificación por grados de concordancia entre muy concordante o no concordante con la temática de interés y la toma de decisiones de impacto en la salud. Conclusiones: Las aplicaciones como los sistemas expertos, los aprendizajes de máquinas y la robótica aportan innovación a las instituciones y un cambio revolucionario en lo académico, clínico y epidemiológico(AU)

Introduction: Systematic reviews of the literature constitute a practical methodological tool for the search of information on clinical research, technological applications and health impact decision-making. Objectives: To describe how artificial intelligence influences medical decision-making according to the degree of agreement between this evidence and the expert systems applied in clinical and surgical specialties with an impact on health, according to reports from 2010 to 2019. Methods: A systematic review was conducted with the use of a relational database model and a relationship entity model to guarantee the referential entity of which the databases and articles are part, as well as the quality of each of the articles classified by degrees of agreement between very concordant or not concordant with the topic of interest and the decision making of impact on health. Conclusions: Applications such as expert systems, machine learning and robotics bring innovation to institutions and a revolutionary change in academic, clinical and epidemiological areas(AU)

Global Surgery at the National Landscape: Perspectives after the XXXIV Brazilian Congress of Surgery / Cirurgia Global no Cenário Nacional: Perspectivas após o 34º Congresso Brasileiro de Cirurgia

ABSTRACT The XXXIV Brazilian Congress of Surgery included Global Surgery for the first time in its scientific program. Global Surgery is any action in research, clinical practice, and policy-making that aims to improve access and quality of care in surgical specialties. In 2015, The Lancet Commission on Global Surgery highlighted that five billion people lack safe, timely, and affordable surgical care. Even more critical, nine of ten people cannot access essential surgical care in low and middle-income countries, where a third of the worldwide population resides, and only 6% of global surgical procedures are performed. Although Brazilian researchers and institutions have been contributing to lay the movement's foundations since 2014, Global Surgery remains a barely debated subject in the country. It is urgent to expand the field and break paradigms regarding the surgeons' role in public health in Brazil. Accomplishing these standards requires a joint effort to strategically allocate resources and identify collaboration opportunities, including those from medical societies and regulatory bodies. As members of the International Student Surgical Network of Brazil - a nonprofit organization by and for students, residents, and young physicians focused on Global Surgery - we review why investing in surgery is cost-effective to strengthen health systems, reduce morbimortality, and lead to economic development. Additionally, we highlight and propose key recommendations to foster the field at the national level.

RESUMO O 34° Congresso Brasileiro de Cirurgia incluiu Cirurgia Global pela primeira vez em seu programa científico. Cirurgia Global é qualquer ação em pesquisa, prática clínica e políticas em saúde que visa melhorar o acesso e a qualidade do atendimento em especialidades cirúrgicas. Em 2015, a Comissão da The Lancet em Cirurgia Global destacou que cinco bilhões de pessoas carecem de assistência cirúrgica segura, oportuna e acessível. Ainda mais crítico, nove em cada dez pessoas não têm acesso a cuidados cirúrgicos essenciais em países de baixa e média renda, onde um terço da população mundial reside e apenas 6% dos procedimentos cirúrgicos globais são realizados. Embora pesquisadores e instituições brasileiras tenham contribuído para lançar as bases internacionais e nacionais do movimento desde 2014, a Cirurgia Global ainda é um assunto pouco debatido no país. Assim, faz-se urgente expandir essa área de conhecimento e quebrar paradigmas quanto ao papel do cirurgião na saúde pública no Brasil. Isso requer um esforço conjunto para alocar recursos de forma estratégica bem como para identificar oportunidades de colaboração, incluindo as sociedades médicas e os órgãos reguladores. Como membros da International Student Surgical Network of Brazil - organização sem fins lucrativos feita por e para estudantes, residentes e jovens médicos com foco na Cirurgia Global - revisamos por que investir em Cirurgia é uma medida custo-efetiva para fortalecer os sistemas de saúde, reduzir a morbimortalidade e promover o desenvolvimento econômico. Além disso, destacamos e propomos recomendações-chave para fomentar a Cirurgia Global a nível nacional.

Women Representation in Surgical Specialties: Reflections about Gender Equity after the 34th Brazilian Surgical Conference / Representatividade das Mulheres nas Especialidades Cirúrgicas: Reflexões sobre Equidade de Gênero após o 34º Congresso Brasileiro de Cirurgia

ABSTRACT In September 2021, the 34th Brazilian Surgical Conference hosted the "Panel: Women in Surgery" - the only session in the event solely composed of female speakers. Although gender inequities in surgery are well recognized in the international literature, the panel portrayed how distant we are from the desired equity in our country. In addition, the session emphasized the need to broaden the debate and identify the mechanisms for greater inclusion and maintenance of women in the surgical career. In this editorial, we provide a historical overview of gender disparities in the Brazilian surgical ecosystem, highlight the contributing factors to a reduced number of female surgeons, and how the structure of medical societies may influence the rise of women to leadership positions. Accordingly, we discuss the benefits of gender diversity for surgeons, patients, and institutions. Furthermore, we analyze the representation of women in the Brazilian College of Surgeons since its foundation and in the scientific sessions at the conference, demonstrating that more initiatives are required to encourage female representation in the college. Finally, we propose a series of recommendations to foster engagement and contribute to the prosperity of women surgeons in Brazil.

RESUMO Em setembro de 2021, o 34º Congresso Brasileiro de Cirurgia sediou o "Painel de debates: Mulheres na Cirurgia" - o único espaço do evento composto somente por mulheres. Embora a existência de iniquidades de gênero na cirurgia seja bem reconhecida na literatura internacional, esse painel retratou como estamos distantes da almejada equidade em nosso país. Além disso, a sessão enfatizou a necessidade de ampliar o debate e identificar os mecanismos para maior inclusão e retenção das mulheres na carreira cirúrgica. Neste editorial, apresentamos panorama histórico e atual das disparidades de gênero no ecossistema cirúrgico brasileiro; destacamos os fatores que contribuem para o número reduzido de cirurgiãs e, como a estrutura das sociedades médicas influencia na ascensão de mulheres para cargos de liderança. Em seguida, discutimos os benefícios da diversidade de gênero para cirurgiões, pacientes e instituições. Ademais, analisamos a representatividade feminina no Colégio Brasileiro de Cirurgiões desde a fundação e nos espaços científicos do congresso, demonstrando que mais medidas serão necessárias para incentivar maior protagonismo feminino no colégio. Finalmente, propomos uma série de recomendações para fomentar o engajamento e contribuir para a prosperidade das cirurgiãs no Brasil.

Conocimiento de los residentes de especialidades médico-quirúrgicas en Colombia acerca del estado epiléptico / Knowledge regarding status epilepticus among medical-surgical specialties residents in Colombia

Introducción: el estado epiléptico es una emergencia con serias implicaciones a nivel social y económico, cuando no se maneja de manera adecuada puede llevar a la muerte. Debe abordarse por el primer especialista que tenga contacto con el paciente. En Colombia no hay estudios acerca de la adherencia a guías de práctica clínica. Objetivo: evaluar cuál es el conocimiento acerca del estado epiléptico en residentes de especialidades médico quirúrgicas en Colombia. Métodos: estudio de corte transversal descriptivo. Se aplicó una encuesta por medio de formulario google, diseñada con base en las guías de práctica clínica rutinaria para el manejo de esta patología. Resultados: respondieron la encuesta 76 residentes de neurología, medicina interna, medicina de urgencias y cuidado crítico, la edad más frecuente fue 26 a 31 años, con una relación hombre mujer de 46/54%. Discusión: las preguntas concernientes a las definiciones operativas y a los tiempos de acción fueron las que tuvieron una mejor consistencia al responderse, hay una importante falencia en la selección y uso de medicamentos anticrisis en el contexto del estado epiléptico, por lo que es importante fortalecer la educación médica en éstos aspectos académicos.

Introduction: status epilepticus is a medical emergency associated with serious social and economic implications. When not managed appropriately it may lead to death. It should be addressed promptly by the first specialist who has contact with the patient. There are no studies investigating adherence to clinical practice guidelines in Colombia. Objective: to evaluate the knowledge regarding status epilepticus among medical-surgical specialties residents in Colombia. Methods: a descriptive cross-sectional study. A survey was applied by means of a google form developed based on the routine status epilepticus clinical practice guidelines. Results: 76 neurology, internal medicine, emergency medicine and critical care residents responded to the survey. The most common age was 26 to 31 years, with a male to female ratio of 46/54%. Discussion: the questions about operational definitions and times of action were answered in a more consistent manner. There is an important limitation in the selection and use of antiseizure medications in the context of status epilepticus, so it is important to strengthen medical education in these academic aspects.

Desarrollo de técnicas microquirúrgicas usando tinción vascular con y sin silicona en placenta humana con modelos craneales 3D / Development of microsurgical techniques using vascular staining with and without silicone in human placenta with 3D cranial models

En las ultimas décadas, ha habido un cambio en la formación en las especialidades quirúrgicas, lo cual ha llevado a plantearse la necesidad de adquisición de habilidades por fuera del quirófano por medio de la simulación. El objetivo de este trabajo es demostrar que el uso de placentas humanas con modelo craneal tridimensional (3D), es un método de alta fidelidad y retroalimentación para el desarrollo de técnicas microquirúrgicas. Se realizó un estudio de evaluación técnica en el Laboratorio de Microcirugía Dr. Evandro de Oliveira del Hospital de la Beneficiencia de Portugal de São Paulo, utilizando 15 placentas con técnicas de coloración y preservación vascular con silicona para moldes; realizando ejercicio de anastomosis vasculares, ejercicios de disección parenquimatosa placentaria que remedan la disección aracnoidea y del valle silviano, además de simulación de resección de tumores. Cualitativamente la placenta humana es un método con alta fidelidad y retroalimentación, además, es de acceso universal para la adquisición de habilidades microquirúrgicas, que asociada a un modelo craneal 3D permite el perfeccionamiento de craneotomías, coordinación visomotriz, propiocepción y relación de profundidad que se requieren para abordajes neuroquirúrgicos.

In the last decades, there has been a change in training in surgical specialties, which has led to the need to acquire skills outside the operating room through simulation. The aim of this work is to demonstrate that the use of human placentas with a three-dimensional (3D) cranial model is a high fidelity and feedback method for the development of microsurgical techniques. A technical evaluation study was carried out in the Dr. Evandro de Oliveira Microsurgery Laboratory of the Hospital de la Beneficiencia de Portugal in São Paulo, using 15 placentas with coloration techniques and vascular preservation with silicone for molds; performing vascular anastomosis, placental parenchymal dissection exercises that mimic arachnoid and sylvian fissure dissection, in addition to simulating tumor resection. Qualitatively, the human placenta is a method with high fidelity and feedback, and it is also universally accessible for the acquisition of microsurgical skills, which, associated with a 3D cranial model, allows the refinement of the craniotomies, visomotor coordination, proprioception, and depth relationship required for neurosurgical approaches.

Fundamentos teóricos que sustentan la superación y el desempeño profesional de cirujanos generales en la atención preoperatoria / Theoretical foundations supporting professional improvement and performance of general surgeons in preoperative care

Introducción: El proceso de superación de los profesionales dedicados a las especialidades quirúrgicas y a la atención preoperatoria de los enfermos, es vital y constituye una vía para gestionar la actualización de conocimientos y habilidades. Estos favorecen la elevación de la calidad del desempeño, con el fin de evitar suspensiones quirúrgicas, que muchas veces tienen solapadas limitaciones e insuficiencias del personal médico. Objetivo: Identificar los fundamentos teóricos que sustentan la superación y el desempeño profesional de los cirujanos generales para el mejoramiento de la calidad en la atención preoperatoria. Métodos: Se utilizaron el análisis-síntesis, histórico-lógico, sistematización, hermenéutico-dialéctico, observación científica y análisis documental. Desarrollo: En la literatura aparecen disimiles artículos en relación al mejoramiento del desempeño profesional. Estos proponen estrategias de superación profesional que llevan a una mejoría indiscutible de la calidad en atención brindada a los enfermos, la interrelación e interconexión entre la superación y el desempeño profesional para gestionar la actualización de conocimientos y habilidades en la atención preoperatoria, constituye el eslabón fundamental. Conclusión: El presente trabajo permitió identificar y opinar acerca de los fundamentos teóricos necesarios para el proceso de superación profesional y hacia el mejoramiento del desempeño profesional de los cirujanos generales en la atención preoperatoria, demostrando relación directa entre ambas categorías(AU)

Introduction: The process of improvement for professionals dedicated to surgical specialties and preoperative care of patients is vital and constitutes a way to manage the updating of knowledge and skills. These favor the increase in the quality of performance, a fact aimed at avoiding surgical suspensions, which often have overlapping limitations and inadequacies of medical personnel. Objective: To identify the theoretical foundations supporting professional improvement and performance of general surgeons in view of improving the quality of preoperative care. Methods: Analysis-synthesis, the historical-logical method, systematization, the hermeneutic-dialectic method, scientific observation and documentary analysis were used. Development: In the literature, there are dissimilar articles about the improvement of professional performance. These propose professional improvement strategies leading to the undeniable improvement in the quality of care provided to patients; the interrelation and interconnection between improvement and professional performance to manage the updating of knowledge and skills in preoperative care constitutes the fundamental link. Conclusion: The present work allowed identifying and commenting about the theoretical foundations necessary for the process of professional improvement and aimed at the improvement of professional performance of general surgeons in preoperative care, demonstrating a direct relationship between both categories(AU)

Development and content validation of an instrument for evaluating competencies in Pediatric Surgery Residency / Desenvolvimento e validação de conteúdo de instrumento para avaliação das competências na residência em cirurgia pediátrica

Abstract: Introduction: a specific instrument is needed to monitor the development of competencies in pediatric surgery during the residency. Objective: to develop an instrument in conformity with the "Milestone Project", using the competencies determined by the Brazilian Association of Pediatric Surgery, for use in the Pediatric Surgery Residency in Brazil. Method: the research was developed in three stages: the development of the initial instrument, qualification with a focal group of experts, and instrument evaluation by Brazilian pediatric surgeons in order to validate and quantify the instrument's acceptance. Result: The initial instrument was created with 4 competencies and 13 sub-competencies, each with 5 levels of assessment. Four experts performed the initial qualification, which resulted in 44 adaptations, and the instrument was finalized with 4 competencies subdivided into 10 sub-competencies, each with 5 levels of assessment. Subsequently, the instrument was evaluated by the Brazilian Pediatric Surgery Group and the Brazilian Pediatric Urology Group. There were 40 expert responses, with a total of 2394 positive responses from the 50 assessment items. The instrument had a general acceptance of 91.2%, being considered applicable (96.7%), reproducible (93.3), relevant to the covered topics (96%), technically (93.6%) and theoretically appropriate (93.3%), reliable (85.5%), and dependable (79.8%). Conclusion: an instrument was developed to assist in the assessment of competencies developed during residency in pediatric surgery in conformity with the Milestone Project. This instrument has been validated by experts and considered applicable, reproducible, relevant, technically and theoretically adequate, reliable and dependable.

Resumo: Introdução: Uma adequada formação na residência em cirurgia pediátrica deve avaliar e acompanhar constantemente o desenvolvimento de competências e, para isso, necessita de um instrumento específico como ferramenta de avaliação. Objetivo: Este estudo tem como objetivo apresentar um instrumento de avaliação nos moldes do "Milestone Project" com base nas competências determinadas pela Associação Brasileira de Cirurgia Pediátrica, para uso nos programas de residência médica em cirurgia pediátrica no Brasil. Método: Adotaram-se as seguintes etapas: desenvolvimento do instrumento, qualificação de um grupo de especialistas e avaliação do instrumento por cirurgiões pediatras brasileiros, a fim de validar e quantificar a aceitação do instrumento quanto à fidedignidade, confiabilidade, aplicabilidade, reprodutibilidade, relevância dos temas abordados e adequação dos pontos de vista técnico e teórico. Resultados: O instrumento inicial possuía quatro competências gerais e 13 subcompetências específicas, com cinco níveis de avaliação. Quatro experts realizaram a qualificação que gerou 44 adaptações, finalizando o instrumento com quatro competências gerais subdividias em dez subcompetências, com cinco níveis avaliativos. Sequentemente, o instrumento foi avaliado pelo Grupo Brasileiro de Cirurgia Pediátrica e pelo Grupo Brasileiro de Urologia Pediátrica. Houve 40 respostas de especialistas, 2.394 respostas positivas dos 50 itens. O instrumento teve aceitação de 91,2% e foi considerado aplicável (96,7%), reprodutível (93,3), relevante (96%), tecnicamente adequado (93,6%), teoricamente adequado (93,3%), confiável (85,5%) e fidedigno (79,8%). Conclusão: Esse instrumento nos moldes do "Milestone Project" foi validado por cirurgiões pediatras e considerado aplicável, reprodutível, relevante, adequado, sob os pontos de vista técnico e teórico, confiável e fidedigno.

Promovendo equidade de gênero nas especialidades cirúrgicas: experiência de programa de mentoria na América Latina / Promoting gender equity in surgical specialties: experience from a mentorship program in Latin America

Resumo: Introdução: Cirurgia global é uma área que advoga por melhores desfechos e equidade para todos que demandam assistência cirúrgica, anestésica e obstétrica. No Brasil, embora as mulheres componham 46,6% da demografia médica em 2020, inequidades de gênero persistem nas especialidades cirúrgicas. O objetivo deste artigo é relatar a experiência do programa de mentoria do Gender Equity Initiative in Global Surgery como mecanismo de promoção de equidade de gênero. Relato de experiência: O programa almeja capacitar, empoderar e amplificar vozes de minorias de gênero, sendo voluntário e sem fins lucrativos. Baseia-se na criação de pequenos grupos heterogêneos, com diferentes graus de experiência acadêmica e pessoal. As inscrições ocorrem por formulário on-line, com perguntas relacionadas à identidade, a interesses e expectativas dos aplicantes, sendo os grupos organizados de acordo com essas informações. Os mentores são selecionados com base em: nível de treinamento, especialidade, identidade de gênero e expectativas. Realizam-se três acompanhamentos por preenchimento de questionário pelos participantes. Discussão: A necessidade de programas como este durante a pandemia é evidente, mostrando-se como uma iniciativa positiva para desenvolver estratégias de enfrentamento dos desafios vivenciados. Este relato fornece uma visão geral de como um programa de mentoria pode contribuir para que mais estudantes de Medicina sejam incentivados a seguir carreiras em cirurgia, anestesia e obstetrícia, de modo a promover equidade de gênero para além da perspectiva binária, e discute as principais dificuldades em se estabelecerem programas como esse na América Latina. Conclusão: É preciso reforçar que não basta apenas dar suporte a mulheres (cis e trans) e pessoas de gênero não binário, mas também educar a sociedade para compreender identidades de gênero além da perspectiva binária, reconhecendo os impactos nas relações de trabalho e perspectivas de carreira, especialmente dentro do campo cirúrgico.

Abstract: Introduction: Global surgery is an area that advocates for better outcomes and equity for everyone who requires surgical, anesthetic, and obstetric assistance. In Brazil, although women represent 46.6% of medical demographics in 2020, gender equity disparities persist in surgical specialties. The objective of this article is to report the experience of the mentoring program from the Gender Equity Initiative in Global Surgery as a mechanism for promoting gender equity. Experience report: The voluntary and non-profit program aims to train, empower, and amplify voices of gender minorities. It is based on the creation of small heterogeneous groups, with different degrees of academic and professional experience. Applications are made via an online form, with questions related to the identity, interests, and expectations of applicants, and the groups are organized according to this information. Mentors are selected based on the level of training, specialty, gender identity, and expectations. The participants then have three follow-up sessions conducted by completing questionnaires. Discussion: The need for programs like this during the pandemic is evident, proving to be a positive initiative to develop strategies to tackle the challenges experienced. This report provides an overview of how a mentoring program can contribute to greater adherence for medical students to pursue careers in surgery, anesthesia, and obstetrics, promoting gender equity beyond the binary perspective and discussing the main difficulties in establishing similar programs in Latin America. Conclusion: It is necessary to reinforce that educating and supporting women (cisgender and transgender) and non-binary gendered people are not enough, but to educate society to understand gender identities beyond the binary perspective, recognizing the impacts on work relationships and career perspectives, especially within the surgical field.

Surgery course load in Brazilian medical schools / Carga horária de cirurgia em escolas médicas do Brasil

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools' geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country's 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools' administrators to assess and plan the surgery course load in their institutions.

Resumo: Introdução: A cirurgia é um importante componente dos currículos dos cursos de graduação em Medicina. Este estudo foi realizado por não se conhecer a carga horária de cirurgia nas escolas médicas brasileiras. Objetivo: Analisar a carga horária de cirurgia de escolas médicas brasileiras. Método: Este estudo foi transversal e descritivo, realizado em escolas médicas brasileiras reconhecidas pelo Ministério da Educação que iniciaram atividades até 31 de dezembro de 2017 e disponibilizavam matriz curricular e/ou projeto político-pedagógico com carga horária de cirurgia na internet até setembro de 2018. As variáveis estudadas foram carga horária total e de cirurgia antes do internato e durante esse período, região geográfica e gratuidade das escolas. Os dados foram analisados por meio de estatística descritiva, teste t de Student, análise de variância e testes U de Mann-Whitney e de Kruskal-Wallis, rejeitando-se a hipótese nula quando p < 0,05. Resultados: Foram incluídas 205 das 323 escolas médicas existentes, das quais 175 disponibilizavam carga horária de cirurgia no internato; 157, antes do internato; e 129, disponibilizavam ambas as cargas horárias. A mediana da carga horária total de cirurgia foi de 815,0 horas (P25 - 75 = 677,5 - 992,0; limites: 340,0 - 1.665,0 horas), e a carga horária média antes do internato foi de 268,7 horas (desvio padrão = 140,3; limites: 32,0 - 780,0), ambas sem diferença estatística por região geográfica ou gratuidade da escola. A mediana da carga horária do internato foi de 540,0 horas (P25 - 75 = 400,0 - 712,0; limites: 170,0 - 1.410,0), sem diferença estatística por região geográfica, mas maior nas escolas gratuitas. Em relação à carga horária total do currículo do curso, a porcentagem média da carga horária de cirurgia antes do internato foi 3,2% (desvio padrão = 1,7); a porcentagem mediana da carga horária de cirurgia no internato, 6,4% (P25 - 75 = 5,0 - 8,2); e a porcentagem mediana da carga horária de ambos os períodos foi de, 9,7% (P25 - 75 = 8,3 - 11,8). Conclusões: Apesar da variação nos limites extremos da carga horária de cirurgia, a mediana de seu total e sua média antes do internato são semelhantes por região geográfica e gratuidade da escola, e sua mediana no internato é também semelhante por região, mas maior em escolas médicas gratuitas. Os valores encontrados neste estudo podem ajudar os gestores na avaliação e no planejamento da carga horária de cirurgia em suas escolas.

Transition of care in pediatric surgery / Transição de cuidados na cirurgia pediátrica

ABSTRACT Objective To identify among pediatric surgeons across Brazil how the transition of pediatric patients to adult clinics is carried out. Methods A questionnaire was emailed to pediatric surgeons registered with the Associação Brasileira de Cirurgia Pediátrica in 2018. The data assessed included training time, maximum age of care, subspecialty of practice, outpatient follow-up of adult patients, reason for continuing care of adult patients, referral to adult specialties, concern with transition of care, and what has been done to improve it. Results Most pediatric surgeons had more than 20 years of experience, and approximately 61% worked simultaneously at a public hospital, private hospital and private office. The maximum age of care at public, private hospitals and private offices proved to be quite varied. The follow-up of patients aged over 18 years at public hospitals, private hospitals and private clinics wase 32%, 23.58% and 20.75%, respectively. The main reason for patients aged over 18 years continued to be accompanied by pediatric surgeons was lack of knowledge about the disease by adult specialties. Most patients were referred to the adult specialty of the hospital, and roughly 37% of pediatric surgeons responded that they were in contact with the adult specialty. Most believed in autonomy of care of their patients and were concerned with transition of care. Conclusion Transition of care is a relevant issue that needs to be studied and debated to ensure an appropriate long-term follow-up.

RESUMO Objetivo Identificar entre os cirurgiões pediátricos de todo o Brasil como é realizada a transição de cuidados dos pacientes pediátricos para as clínicas adultas. Métodos Um questionário foi enviado por e-mail para cirurgiões pediátricos cadastrados na Associação Brasileira de Cirurgia Pediátrica no ano de 2018. Foram avaliados dados como tempo de formação, idade máxima de atendimento, subespecialidade de atuação, seguimento ambulatorial de pacientes adultos, motivo pelo qual continuava atendendo pacientes adultos, encaminhamento para especialidades adultas, preocupação com a transição de cuidados e o que tinha realizado para aprimorá-la. Resultados A maioria dos cirurgiões pediátricos tinha mais de 20 anos de experiência, e cerca de 61% atuavam simultaneamente em hospital público, hospital privado e clínica privada. A idade máxima de atendimento nos hospitais públicos e privados e nas clínicas privadas mostrou-se bastante variada. O acompanhamento de pacientes acima de 18 anos nos hospitais públicos, nos hospitais privados e nas clínicas privadas foi, respectivamente, 32%, 23,58% e 20,75%. O principal motivo pelo qual o paciente acima de 18 anos continuava sendo acompanhado por cirurgiões pediátricos foi falta de conhecimento da patologia pelas especialidades adulta. A maioria dos pacientes era encaminhada para a especialidade adulta do próprio hospital, e cerca de 37% dos cirurgiões pediátricos responderam que mantinham contato com a especialidade adulta. A maioria acreditava na autonomia de cuidados de seus pacientes e estava preocupada com a transição de cuidados. Conclusão A transição de cuidados é um assunto relevante e que precisa ser estudado e debatido para que se possa assegurar um adequado seguimento a longo prazo.

Nuevo modelo de simulador para neuroendoscopía / New simulator model for neuroendoscopy

Introducción: El entrenamiento en simuladores es considerado una herramienta fundamental en las especialidades quirúrgicas, contribuyendo en el aprendizaje de una determinada técnica quirúrgica.Existen modelos de simulación sintéticos que replican la anatomía ventricular con alta fidelidad sin embargo tienen un costo elevado. Algunos centros describieron el uso de cadáveres humanos pero la disponibilidad del material suele ser limitada y la adquisición dificultosa. Otros autores utilizan entrenamiento en modelos biológicos vivos (roedores de laboratorio) que presentan la ventaja de tener alta fidelidad en cuanto a la consistencia de tejidos, sin embargo, la utilización de estos modelos se encuentra cuestionados desde el aspecto ético. Material y Métodos: Se presenta un modelo de simulación que utiliza unidades de cerebro bovino y membrana amniótica. Colocamos el cerebro bovino y las unidades de membrana amniótica dentro de un recipiente esférico de poliestireno expandido. Una vez que se forma la esfera, insertamos dos trocares que nos permitirán insertar el neuroendoscopio y llenarlo con agua. Resultado: Presentamos un nuevo modelo accesible y realista para la simulación neuroendoscópica que reproduce ejercicios de biopsia, coagulación de tejidos, fenestración y dilatación de membrana. Conclusión: Los simuladores para neuroendoscopía descritos hasta ahora son confiables, pero conllevan un alto costo. Los modelos con animales vivos, aunque con menor costo, son cuestionados desde un punto de vista ético.En el trabajo actual, describimos un modelo de simulador neuroendoscópico ventricular de alta fidelidad que, debido a su bajo costo, permite ser replicado en cualquier centro de entrenamiento que tenga un neuroendoscopio.

Objectives: Ventricular endoscopy is considered an excellent technique. However, without an optimal learning curve, it could lead to deadly complications.There are synthetic simulation models that replicate the ventricular anatomy with high fidelity but high costs. Some low-cost models have been published using human corpses for endoscopic training; however, materials' acquisition is difficult. A different option is live biological models (laboratory rodents), although cost is lower, they are questioned from an ethical point of view.The ideal simulator, in addition to aspiring maximum fidelity, must be accessible, affordable and easy to replicate to facilitate repetitive training. Methods: A simulation model using bovine brain and membrane units made by a soda cup covered by an amniotic membrane. We placed the bovine brain and the amniotic membrane units inside an expanded polystyrene spherical container; once the sphere is formed, we inserted two trocars, which will enabled us to insert the neuroendoscope and fill it with water. Result: We introduced an attainable and realistic new model for neuroendoscopic simulation, which replicates biopsy, tissue coagulation, fenestration, and membrane dilatation exercises. Conclusion: Simulators for neuroendoscopy described so far are reliable, but they entail a high cost. Models with live animals, although with lower cost, are questioned from an ethical point of view.In the current work, we describe a high fidelity ventricular neuroendoscopic simulator model that, due to its low cost, allows to be replicated in any training center that has a neuroendoscope

Niveles de empatía en médicos residentes: un estudio del Hospital de Clínicas de la Universidad Nacional de Asunción / Empathy levels in resident physicians: a study of the Hospital de Clinicas of the National University of Asunción

Introducción: En general se presenta una disminución de la empatía durante la formación médica, que genera médicos con baja empatía. Es por ello que la empatía debe ser estudiada desde el pregrado y, sobre todo, en aquellos profesionales de la salud que pasan varias horas realizando actividades asistenciales como lo son los médicos residentes. Metodología: Este fue un estudio observacional, analítico de prevalencia, con muestreo no probabilístico de casos consecutivos. Se incluyeron médicos residentes de Medicina Interna, Medicina Familiar, Clínica Quirúrgica, Psiquiatría y Pediatría. El tamaño de muestra quedó establecido en 98 participantes. Para medir la empatía se utilizó el Índice de Reactividad Interpersonal. Resultados: Los resultados informaron que el 55% eran mujeres y el 33,7% de Medicina Interna. Las medias en las subescalas, toma de perspectiva, fantasía, preocupación empática y distrés fueron: 33,33; 2,84; 3,71 y 2,57; respectivamente. Se observaron diferencias significativas en los puntajes de empatía observados entre médicos distintas especialidades. Conclusión: Esto podría reflejar la noción de que diferentes individuos con diferentes grados de habilidades interpersonales, reflejados en sus puntajes de empatía, se sienten atraídos por diferentes especialidades médicas. Palabras clave: empatía; cuerpo médico de hospitales; psicometría.

Introduction: In general, there is a decrease in empathy during medical training, which generates doctors with low empathy. That is why empathy must be studied from the undergraduate school and, above all, in those health professionals who spend several hours doing medical activities such as resident physicians. Methodology: This was an observational, analytical of prevalence study, with non-probabilistic sampling of consecutive cases. Resident physicians of Internal Medicine, Family Medicine, Surgical Clinic, Psychiatry and Pediatrics were included. The sample size was established in 98 participants. To measure empathy, the Interpersonal Reactivity Index was used. Results: The results reported that 55% were women and 33.7% of Internal Medicine. The averages in the subscales, perspective taking, fantasy, empathic concern and distress were: 33.33; 2.84; 3.71 and 2.57; respectively. Significant differences were observed in the empathy scores observed among different medical specialties. Conclusion: This could reflect the notion that different individuals with different degrees of interpersonal skills, reflected in their empathy scores, are attracted to different medical specialties. Keywords: Empathy; Medical Staff, Hospital; Psychometrics.

Why Work for Women in Urology? / ¿Por qué trabajar para mujeres en urología?

"Destiny guides our fortunes more favorably than we could have expected" wrote Miguel de Cervantes Saavedra, author of the legendary novel Don Quixote of La Mancha. These words describe exactly what has happened to us over the past year. We met by chance at a urology congress last August in the City of Barranquilla. We took the opportunity to sit down unsuspectingly with coffee in hand and started talking about the big picture of urology in the world and especially in Latin America. We soon realized that despite being born in two countries as different as the United States and Colombia, we both shared similar barriers as women urologists. The truth is that despite the increase in the number of women in careers such as medicine, the growth in terms of medical and surgical specialties is still very low. According to the latest census of the American Urological Association (AUA), female urologists currently make up only 9.9% of the total membership in the US academy.[1] What is contradictory is that many studies have evaluated the change in the workforce that has been occurring in this branch of medicine for a few years, since it is assumed that by 2060 there will be a growth in the number of women of 3.7% versus 1.3% compared to men.[2] These two surprising facts forced us to think about the need to find solutions.

"El destino guía nuestra suerte más favorablemente de lo que podíamos esperar", escribió Miguel de Cervantes Saavedra, autor de la legendaria novela Don Quijote de la Mancha. Estas palabras describen exactamente lo que nos ha ocurrido en el último año. Nos conocimos por casualidad en un congreso de urología el pasado mes de agosto en la ciudad de Barranquilla. Aprovechamos la oportunidad para sentarnos desprevenidamente con un café en la mano y empezamos a hablar sobre el gran panorama de la urología en el mundo y especialmente en Latinoamérica. Pronto nos dimos cuenta que a pesar de haber nacido en dos países tan diferentes como Estados Unidos y Colombia, ambas compartíamos barreras similares como mujeres urólogas. Lo cierto es que a pesar del aumento del número de mujeres en carreras como medicina, el crecimiento en cuanto a especialidades médicas y quirúrgicas es aún muy bajo. Según el último censo de la Asociación Americana de Urología (AUA), en la actualidad las mujeres urólogas representan sólo el 9,9% del total de miembros de la academia estadounidense[1] Lo contradictorio es que muchos estudios han evaluado el cambio en la fuerza laboral que se viene dando en esta rama de la medicina desde hace algunos años, pues se presume que para el año 2060 habrá un crecimiento en el número de mujeres del 3,7% frente al 1,3% de los hombres[2] Estos dos sorprendentes datos nos obligaron a pensar en la necesidad de encontrar soluciones.

Does Mentoring Women Matter, and if so, How Much? / ¿Importa la mentoría a las mujeres y, de ser así, cuánto?

The presence of women in medicine and urology has been increasing. However, there is a large disparity in leadership positions. In 2017, women constituted 3.3% of chairs, 4.5% of vice-chairs, and 7.9% of division directors in the United States,[1] similar positions in Colombia. It is unclear why this deep gender gap exists in urology. Multifactorial and specialty-specific factors may include lack of mentorship, sponsorship, and limited female role models in leadership positions.[2] According to the Association of Medical Colleges (AAMC), many women do not find mentors in surgical specialties. This lack of mentorship may limit women from accessing similar opportunities to their male counterparts.

La presencia de mujeres en la medicina y la urología ha ido en aumento. Sin embargo, existe una gran disparidad en los puestos de liderazgo. En 2017, las mujeres constituían el 3,3% de las cátedras, el 4,5% de las vicepresidencias y el 7,9% de los directores de división en Estados Unidos,[1] cargos similares en Colombia. No está claro por qué existe esta profunda brecha de género en urología. Según la Asociación de Facultades de Medicina (AAMC), muchas mujeres no encuentran mentores en las especialidades quirúrgicas. Esta falta de mentores puede limitar el acceso de las mujeres a oportunidades similares a las de sus homólogos masculinos.

Caracterización antropométrica de las vértebras cervicales de la Osteoteca de la Universidad de Ciencias Médicas de Matanzas / Anthropometric characterization of cervical vertebras of the Osteotheque of the University of Medical Sciences of Matanzas

RESUMEN Introducción: los estudios actuales sobre la caracterización antropométrica de las vértebras, reviste importancia para las especialidades de Ortopedia y Neurocirugía por el interés quirúrgico que tiene este conocimiento. Objetivo: caracterizar las dimensiones antropométricas de las vértebras cervicales pertenecientes a la Osteoteca de la Universidad de Ciencias Médicas de Matanzas. Materiales y métodos: se realizó un estudio descriptivo, observacional. El universo de estudio estuvo integrado por 63 vértebras cervicales existentes en la Osteoteca. Se realizaron medidas del cuerpo, agujero vertebral, agujeros transversos y forma de los mismos. Resultados: los valores de las medidas del cuerpo vertebral mostraron un predominio de la media del diámetro transversal con 24,24 mm, sobre el anteroposterior de 15,57 mm. El diámetro transversal del agujero vertebral, midió 25,70 mm y el anteroposterior fue menor con 17,06 mm. Al estudiar la forma de los agujeros transversos, en total predominó el tipo redondo; mientras que al compararlos según lateralidad, en el lado izquierdo predominó el tipo redondo, mientras que en el derecho fue el tipo oval paralelo. Se observó en ambos agujeros transversos el predominio del diámetro transverso sobre el paralelo y comparando los agujeros entre sí, se oapreció una media mayor de ambos diámetros en los agujeros del lado izquierdo. Conclusiones: existió un predominio del diámetro transversal en el cuerpo y el agujero vertebral. Es más frecuente el tipo de agujero transverso redondo y los agujeros izquierdos presentaron mayores dimensiones (AU).

ABSTRACT Introduction: current studies on vertebras anthropometric characterization are of great importance for the specialties of Orthopedics and Neurosurgery due to the surgical interest of this knowledge. Objective: to characterize the anthropometric dimensions of the cervical vertebras belonging to the Osteotheque of the University of Medical Sciences of Matanzas. Materials and Methods: an observational, descriptive study was carried out. The universe of study was integrated by 63 cervical vertebras kept in the Osteotheque. Measures of the body, vertebral foramen and foramen transversarium were taken and their form was described. Results: the values of the vertebral body measures showed the predominance of the average transverse diameter with 24.24 mm, over the anterior-posterior one of 15.57 mm. The transverse diameter of the vertebral foramen was 25.70 mm, and the anterior-posterior one was 17.06 mm. When studying the form of the transverse foramens, in general the round kind predominated; at the comparison according to laterality, the round kind predominated in the left side while in the right the oval parallel one predominated. In both foramens transversaria the predominance of the transverse diameter over the parallel one was observed and when comparing both foramens, a higher diameter average was found in the left side foramens. Conclusions: there is a predominance of the transverse diameter in the body and vertebral foramen. The most frequent foramen was the round transverse one and left foramens had higher dimensions (AU).

Survival of the FITTER: Moving Forward Together for a Premier Journal in Vascular Surgery

No abstract available.

Training and cultivation of non-technical skills in gastrointestinal surgeons / 中华胃肠外科杂志

Non-technical skill (NTS) in gastrointestinal surgeon is an important part of surgical performance and surgical education. NTS is essential for safe and effective surgery. NTS has four aspects: situation awareness, decision making, communication and teamwork, and leadership. There is evidence that training and assessment of NTS of professional physicians is very important for doctors' career and plays an important role in improving medical quality and ensuring patient safety. The training and assessment of NTS is a great reference to the training of gastrointestinal surgeons in China. In addition, the establishment of a training system for professional gastrointestinal surgeons in line with China's characteristic as soon as possible will improve the overall quality of professional gastrointestinal surgeons in China and better serve the vast number of patients.

Implementação de um modelo de triagem cirúrgica para casos urgentes em um hospital terciário / Implementation of a surgical screening system for urgent and emergent cases in a tertiary hospital

RESUMO Objetivo: avaliar a aplicabilidade do sistema de classificação de cores "Timing of Acute Care Surgery" (TACS) em um hospital público terciário de um país em desenvolvimento. Métodos: estudo longitudinal, retrospectivo, de um único centro, de março a agosto de 2016 e o mesmo período em 2017. Optou-se pela seleção de quatro especialidades cirúrgicas com alta demanda de urgências, as quais foram previamente treinadas sobre o sistema TACS. Para comparação com as classificações prévias de urgência e emergência, emergências foram consideradas como vermelhas e laranjas e urgências como amarelas, com intervalo de tempo ideal para cirurgia de uma hora e de seis horas, respectivamente. Resultados: os procedimentos não eletivos representaram 61% do número total de cirurgias. As classificações vermelha, laranja e amarela foram predominantes. Houve melhora significativa do tempo para a cirurgia na cor amarela após o sistema TACS. Períodos diurnos e noturnos influenciaram os resultados, com melhores resultados durante o período noturno. Conclusão: este é o primeiro estudo que usou o sistema TACS no dia a dia de um centro cirúrgico, e demonstrou que o sistema TACS melhorou o tempo de atendimento das cirurgias classificadas como amarelas.

ABSTRACT Objective: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. Methods: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. Results: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. Conclusion: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.

Do Not Be Afraid of the Robot / No le tenga miedo al robot

Minimally invasive surgery is one of the areas of greatest development in surgical specialties in several parts of the world, and Colombia has not been the exception. In urology, as in all specialties, the evolution in technology has optimized the diagnosis and the treatment of most of the pathologies. The purpose has always been that the patients who undergo surgery have a pleasant, less stressful experience, without compromising the perioperative and postoperative results

La cirugía mínimamente invasiva es una de las áreas de mayor desarrollo en las especialidades quirúrgicas en varias partes del mundo, y Colombia no ha sido la excepción. En urología, como en todas las especialidades, la evolución en la tecnología ha optimizado el diagnóstico y el tratamiento de la mayoría de las patologías. El propósito siempre ha sido que los pacientes sometidos a cirugía tengan una experiencia agradable, menos estresante, sin comprometer los resultados perioperatorios y postoperatorios.