Aquisição e retenção de conhecimentos e habilidades em bases da técnica cirúrgica por estudantes de Medicina / Acquisition and retention of knowledge and abilities on basic surgical technique by students of Medicine

O médico de formação geral necessita possuir competências essenciais em cirurgia para a realização de pequenos procedimentos cirúrgicos. Tais competências precisam ser adquiridas ao longo do curso de graduação, cabendo ao currículo da escola médica oportunizá-las. Objetivo: este trabalho tem o objetivo de verificar a aquisição e a retenção de conhecimentos e de habilidades em bases da técnica cirúrgica por estudantes de Medicina ao longo de um curso médico. Metodologia: trata-se de um estudo longitudinal e quase-experimental na Fase 1 e transversal e observacional na Fase 2, em educação médica, realizado com a participação de estudantes do curso de Medicina da UNIFENAS, câmpus Alfenas, distribuídos entre 6º, 7º, 9º e 11º períodos do curso, que verificou a aquisição e a retenção de conhecimentos e de habilidades em bases da técnicas cirúrgicas proporcionadas ao longo do currículo. Os participantes foram submetidos a testes teóricos e práticos pré e pós a atividade curricular de cirurgia desses períodos. Resultados: o desempenho geral dos participantes nas provas, teórica e prática, revela uma relevante aquisição de conhecimento e de habilidades cirúrgicas em alunos do 6º período após a realização da disciplina de Bases da Técnica Cirúrgica (BTC) (p<0,001). Entretanto, a retenção desses conhecimentos e habilidades sofre queda progressiva, atingindo seu nadir 18 meses após a aquisição (p<0,001), com uma tímida recuperação nos estágios de Clínica Cirúrgica I e II, em que a maior exposição às atividades práticas nesses estágios pareceu favorecer a recuperação de habilidades práticas, ainda que não tenham retornado ao patamar da aquisição, no 6º período, porém o mesmo não se deu com o conhecimento. Conclusão: 1. A disciplina de BTC, ofertada no 6º período do curso de Medicina da UNIFENAS, câmpus Alfenas, permite uma adequada aquisição de conhecimentos e de habilidades em técnicas cirúrgicas aos estudantes. 2. Existe uma queda progressiva no desempenho em técnicas cirúrgicas dos alunos ao longo do currículo de cirurgia entre o 6º e o 9º períodos, com uma pequena recuperação no 11º período do curso. 3. A retenção de conhecimentos e de habilidades em técnicas cirúrgicas por estudantes de Medicina ao longo do curso atinge seu nadir aos 18 meses. 4. Os estágios de Clínica Cirúrgica I e II favorecem a recuperação de habilidades em técnicas cirúrgicas mais do que de conhecimentos

The general medical practitioner needs to have essential surgical skills to perform minor surgical procedures. These competencies need to be acquired throughout the undergraduate course, and the medical school curriculum must opportunize them. Objective: This study aims to verify the acquisition and retention of knowledge and skills on Bases of Surgical Technique by medical students throughout a medical course. Methodology: This is a longitudinal and quasi-experimental study in Phase 1 and transversal and observational in Phase 2 in medical education carried out with the participation of students from UNIFENAS medical school, Campus Alfenas, distributed between 6th, 7th, 9th and 11th periods of the course, which verified the acquisition and retention of knowledge and skills in Bases of Surgical Techniques provided throughout the curriculum. The participants were submitted to theoretical and practical tests before and after the curricular activity of surgery of these periods. Results: The general performance of the participants in the tests, theoretical and practical, reveals a relevant acquisition of knowledge and surgical skills in students of the 6th period after completion Bases of Surgical Technique discipline (BST) (p <0.001). However, the retention of this knowledge and skills suffers a progressive decrease, reaching its nadir 18 months after the acquisition (p <0.001), with a slight recovery in the stages of Surgical Clinic I and II, where the greater exposure to the practical activities in these stages seemed to favor the recovery of practical skills, although they did not return to the level of the acquisition, in the 6th period, but the same did not happen with the knowledge.Conclusion: 1. The BST discipline, offered in the 6th period of UNIFENAS medical course, Alfenas campus, allows an adequate acquisition of knowledge and skills in surgical techniques to students. 2. There is a progressive decrease in the performance of students in surgical techniques throughout the 6th and 9th periods, with a slight recovery in the 11th period of the course.3. The retention of knowledge and skills in surgical techniques by medical students throughout the course reaches its nadir at 18 months. 4. The stages of Surgical Clinic I and II favor the recovery of skills in surgical techniques rather than knowledge.

Los equipos quirúrgicos avanzados en los escenarios contemporáneos de acciones combativas / Advanced surgical teams in contemporary scenarios of combat actions

Introducción: con el uso de la plataforma de Servicios de Información Ebsco Host, se accedió a las bases de datos a texto completo Academic Search Premier y Medline Complete. Objetivo: revisar la información contenida en los Descriptores MeSH 2014 acerca de Forward Surgical Teams, Iraq and Afghanistan. De dicha búsqueda surgieron evidencias bibliográficas de la utilización, empleo y desarrollo de los Forward Surgical Teams de los Servicios Médicos de las Fuerzas Armadas Norteamericanas (Ejército de Tierra), Francia, Reino Unido y Finlandia. Métodos: se expone el modo de empleo y la sucesiva tendencia a su perfeccionamiento operacional y tecnológico durante las últimas guerras en Medio Oriente a propósito del despliegue de tropas norteamericanas y de la coalición de la ONU en la cruzada contra el terror liderada por los Estados Unidos de Norteamérica. Los aspectos reportados en el artículo se refieren a la composición, despliegue y utilización táctica de los Forward Surgical Teams, a la aplicación de diversos protocolos de diagnóstico y tratamiento para la recepción y manejo de las bajas sanitarias debido a las acciones combativas y el afrontamiento de la preparación del personal médico y de enfermería antes, durante y después del despliegue de la institución médica(AU)

Introduction: Using Ebsco Host Information Services platform, the full-text Academic Search Premier and Medline complete databases were accessed. Objective: Review the information contained in 2014 MeSH Descriptors about Forward Surgical Teams, Iraq and Afghanistan. From this search bibliographical evidences emerged of the use, employment and development of the Forward Surgical Teams of the Medical Services of the Armed Forces in United States of America (Army), France, United Kingdom, and Finland. Method: It is presented here the way of employment and the successive trend towards its operational and technological improvement during the last wars in the Middle East on the deployment of US troops and the UN coalition in the United States-led crusade against terror of North America. The aspects reported in the article refer to the composition, deployment and tactical use of the Forward Surgical Teams, to the application of various diagnostic and treatment protocols for the reception and management of health casualties due to combat actions and the coping of the preparation of medical and nursing personnel before, during, and after deployment of the medical institution(AU)

El ambiente quirúrgico seguro: paradigma emergente en la práctica profesional de la cirugía / The safe surgical environment: emergent paradigm in the surgical professional practice

Desde que las Guerras Mundiales que se escenificaron en el siglo XX, en los teatros operacionales del conflicto en Europa, Norte de Africa, medio oriente, Asia, I y II Guerras Mundiales, Corea, Viet Nam, Afganistán Guerra Arabe- Israelí obligó a los países involucrados a atender a los millones de víctimas resultantes, planificando, organizando y rediseñando a pasos acelerados las estructuras de asistencia médica, capaces de suministrar recursos de atención masivo del trauma y estrategias para tratar a sus soldados y a la población civil. La consecuencia positiva para el avance de la medicina y especialmente de la cirugía de estos tragicos sucesos, fue la aparición y el desarrollo de la "cirugía compleja" y la conquista del abordaje quirúrgico de regiones del cuerpo humano, hasta ese momento vedados a la actividad del tratamiento quirúrgico: cavidad craneal, cirugía torácica, trauma cardiovascular, cirugía intestinal de urgencia, anestesia y manejo respiratorio, antibióticos, derivados sanguíneos, resucitación cardio-respiratoria y evacuación y trasporte de heridos. Varias décadas después el desarrollo de esta cirugía compleja, produjo un aumento desmesurado de la morbi-mortalidad ocasionado principalmente por los efectos de la anestesia inadecuada, hemorragias masivas, infección-sepsis y factores de error humano. Surgen entonces nuevas líneas de investigación clínica para identificar y disminuir estos factores. Esos esfuerzos logran al final del siglo XX y comienzos del XXI, resultados tangibles y eficaces mejorando los resultados finales de la cirugía. Por estos logros surge un nuevo paradigma en el mundo de la cirugía, conocido como "el ambiente quirúrgico seguro"; que comprende estrategias operativas y organizacionales, tales como: reingeniería de quirófanos, innovaciones tecnológicas, digitalización de aparatos de registro y la protección integral de los equipos humanos interactuantes en los servicios quirúrgicos. En este ensayo se describen...

Since the occurrence of the World Wars in the 20th. Century, at the military operational theatres in Europe, North Africa, Meddle East, Korea, Viet nam, Afghanistan and Israel the countries involved in these conflicts were forced to render medical care to the million of casualities in thousands of battlefields, specially organizing massive trauma care to military personnel also to civilian populations. The positive result of this tragic scenarios was that medicine as a whole and surgery, was the development of the so called "complex surgical care", and the conquest of the surgical approach of different regions of the human body, until then impossible to reach with therapeutic efficacy: intracranial structures, thoracic surgery, cardio-vascular injuries, acute intestinal trauma anesthesia and respiratory ventilation, antibiotics, blood replacement, cardio pulmonary resuscitation; and triage and the planning of transport of wounded soldiers. Some decades later, the development of the complex surgery reachers alarming levels of morbidity and mortality, mainly due to inadequate delivered anasthesia, massive hemorrhage, uncontrolled bacterial infections-sepsis and lethal consequences of human errors. New lines of clinical investigations and research conducted in the late XX century and early XXI century gave the answers to obtain strategies to diminish and fight this adverse factors; improving better outcomes for surgical therapies. This achievement gave birth to a new paradigm into the surgical world which is identified nowadays as the "safe surgical environment", compromising new strategies to redesing surgical operating rooms, application of technological discoveries, digitalization of patient's surveillance and bio protection of the surgical personnel avoiding events as accidents, thermal injuries, and infections with transmissible diseases in this scenario. In this paper will be described fundamental definitions of novel paradigm, reviewing concepts...

Tres médicos mexicanos y su referencia al ejercicio ético moral de la medicina: segunda mitad del siglo XIX / Three Mexican physicians and their moral and ethical reference to the practice of medicine: second half of the 19 century

En la actualidad se habla cada vez más de la suficiencia tecnológica, del aislamiento humano y de la evasión por parte del personal de salud hacia las necesidades afectivas de los pacientes; este enfoque no es reciente. A través de múltiples fuentes, los médicos del siglo XIX mexicano externaron sus inquietudes respecto a la manera como se llevaba a cabo la atención del enfermo; aseguraban que el progreso científico estaba originando la deshumanización de la medicina, haciendo olvidar que el médico trabaja con seres sensibles e inteligentes y que, por tanto, debía ajustar su proceder de acuerdo con la personalidad de sus pacientes. Ante tal situación, los médicos decimonónicos invitaban a la reflexión, a cumplir una serie de deberes frente al enfermo, ante sus colegas y ante las autoridades gubernamentales, lo que nos lleva a concluir que los principios éticos siempre han estado vigentes. Este artículo analiza en particular la postura de tres profesionales de la salud: Francisco Flores (1855-1931), Porfirio Parra (1854-1912) y Adrián de Garay (1860-192?), respecto a cómo debía ser el ejercicio de su profesión; externan que los principios éticos debían estar presentes en todo momento.

Worldwide, the technological revolution is taking place, but the human aspect of health care demonstrates that medical personnel often avoid the responsibility for the emotional care of their patients. This is not a recent point of view. In many ways, during the 19th century, Mexican physicians were outspoken about the problems in regard to the manner in which care of sick persons was carried out. They were certain that scientific progress was the origin of medical dehumanization, frequently forgetting that physicians were treating sensitive and intelligent persons and, therefore, must adjust their behavior in accordance with their patients. Because of this situation, 19th century physicians were invited to share a list of responsibilities and duties to patients, among their professional colleagues as well as among government authorities. In particular, the philosophies of three health professionals were analyzed, Francisco Flores (1855-1931), Porfirio Parra (1854-1912) and Adrián de Garay (1860-192?), in regard to how the practice of medicine should be exercised and that the underlying ethical and moral principles must always be present.

Características clínicas y terapéuticas de los pacientes que ingresaron con diagnóstico de hemorragia digestiva superior, en el hospital central de Maracay, Edo. Aragua-Venezuela. 2001-2005

La Hemorragia Digestiva Superior (HDS) es la emergencia más importante y seria en gastroenterología. A pesar de los avances en el manejo médico-quirúrgico y endoscópico la mortalidad ha permanecido invariable. La causa más frecuente son las úlceras gastroduodenales. El abordaje inicial es médico. La utilidad de la Endoscopia Digestiva Superior es ilimitada, diagnostica la lesión, la ubica, permite efectuar tratamiento y orienta el pronóstico, resangrado y la mortalidad. Objetivo: analizar manifestaciones clínica, etiología y manejo terapéutico de los pacientes con HDS que ingresaron en el HCM 2001-2005. Métodos: estudio descriptivo-retrospectivo para caracterizar clínicamente a los pacientes con diagnóstico de HDS en HCM 2001-2005. Resultados: se revisaron 223 casos, encontrando predominio del grupo etario de 61-80 años (38%), del sexo masculino (63%), úlceras gastroduodenales (37%) como causa más frecuente, la melena (49%) como manifestación clínica, el 64% tuvieron antecedentes patológicos personales, 15% consume Antinflamatorios no Esteroideos (AINES), con un promedio de estancia hospitalaria de 4 días y de 1 transfusión sanguínea por evento de sangrado. Conclusión: la HDS se caracterizó por ocurrir más frecuentemente entre la quinta y sexta década de la vida, en el sexo masculino, asociada a patologías de base, donde se aplicó un manejo terapéutico conservador.

Upper Gastrointestinal Bleeding (UGB) is the most important and serious emergency in the area of Gastroenterology. In spite of the great advances in endoscopic and surgical techniques, the mortality rate has remained invariable. Gastro-duodenal ulcers are the most frequent cause. The preliminary approach is medical. The value of Upper Digestive Endoscopy is unlimited, it diagnoses and locates the lesion, allowing treatment procedures and permitting a prognosis assessment (re - bleeding and mortality). Objective: To analyze clinical manifestations, etiology and therapeutic handling of patients with UGB admitted to the HCM during 2001-2005. Methods: Retrospective- Descriptive Study to clinically characterize the patients with a diagnosis of UGB at the HCM during 20001-2005. Results: 223 cases were considered, finding predominance in the 61-80 age group (38%), males (63%), gastroduodenal ulcers (37%) as the most frequent cause, melena (49%) as clinical manifestation, and 64% had a personal pathological background, 15% used non-steroidal anti-inflammatory drugs (NSAID), with an average hospital stay of 4 days and 1 blood transfusion per bleeding event. Conclusion: UGB occurred more frequently between the fifth and the sixth decade, in males, associated with base pathologies. They were handled through a conservative therapeutic approach.