Avaliação do perfil do egresso e da residência médica em ortopedia e traumatologia do HCFMRP-USP / Evaluation of the graduate profile and of the medical residency in orthopedics and traumatology at HCFMRP-USP

Resumo Introdução: Bons programas de residência médica (PRM) devem investir na estruturação e no desenvolvimento contínuo dos serviços de assistência no contexto da rede de saúde, na organização da estrutura de apoio às atividades didáticas e assistenciais, e na remuneração e capacitação contínua de preceptores e coordenadores. Objetivo: Este estudo observacional, transversal e descritivo buscou caracterizar o perfil dos egressos do Programa de Residência Médica em Ortopedia e Traumatologia (PRMOT) do HCFMRP-USP e coletar dados sobre as características do programa que orientem ações de aperfeiçoamento na metodologia de ensino. Método: Participaram do estudo egressos do PRMOT ou que concluíram os programas de complementação especializada e residência médica em cirurgia da mão entre 1964 e 2020. Resultado: Foi encaminhado um questionário a 302 indivíduos (73,6% do total de egressos), obtendo 214 respostas (70,8% dos indivíduos contatados ou 52,2% do total de egressos). Indivíduos do sexo masculino correspondem a 92,5% dos egressos, e 71,9% residem no estado de São Paulo. As duas subespecialidades mais cursadas foram cirurgia do joelho e da mão. A pós-graduação stricto sensu fez parte da formação acadêmica de 40,6% dos egressos, dos quais 60,7% trabalharam com ensino médico. Dos egressos, 71% atuam na subespecialidade escolhida. Na avaliação do ensino do PRMOT e do grau de satisfação profissional, os aspectos que se destacaram positivamente foram: capacitação para atendimento em níveis terciário e secundário, número de atendimentos, variabilidade dos casos e preparo para o mercado de trabalho. Os aspectos que se destacaram negativamente foram: remuneração mensal, carga horária de aulas teóricas e realização de procedimentos cirúrgicos. Conclusão: O estudo conseguiu traçar o perfil do egresso e determinar os pontos fortes e as oportunidades de melhoria do PRMOT do HCFMRP-USP.

Abstract Introduction: Good Medical Residency Programs (PRM) must invest in the structuring and continuous development of care services in the health network setting; in the organization of the support structure for teaching and care activities and in the remuneration and continuous training of preceptors and coordinators. Objective: This study is an observational, cross-sectional, and descriptive investigation aimed at providing an in-depth understanding of the characteristics of individuals who have successfully completed the medical residency program in Orthopedics and Traumatology (MRPOT) at the Clinic Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Additionally, the study seeks to gather comprehensive data regarding the features of the educational program in order to offer insights for potential enhancements. The study encompassed a total of 418 participants who completed their training between 1964 and 2020. Methods: This group includes physicians who not only graduated from the MRPOT but also those who completed supplementary specialized programs and medical residencies in hand surgery, all within the same department. Data were systematically collected through an electronic questionnaire. Results: Among the participants, 302 graduates (73.6% of the total cohort) were identified, and responses were obtained from 214 individuals, which corresponds to 70.8% of the reached contacts or 52.2% of the entire graduate pool. The predominant demographic of the sample is male, with 198 respondents (92.5%), most of whom reside in the state of São Paulo (154 individuals, 71.9%). A significant portion of the participants, 184 (86%), pursued further specialized training or embarked on additional medical residencies within the field. The most prevalent subspecialties within this group are Knee Surgery, accounting for 63 individuals (34.2%), and Hand Surgery, comprising 49 individuals (26.6%). Postgraduate education played a role in the academic training of 87 respondents (40.6%). Research activities primarily took place within public universities (81%) and were carried out by 79 graduates (36.9%). A substantial proportion, 130 individuals (60.7%), had prior experience in medical education, either as preceptors or professors for both undergraduate and medical residency levels. The majority of participants, 152 individuals (71%), currently practice within their respective subspecialties. However, a considerable number of graduates also engage in traumatology (34.1%) and general orthopedics (31.8%). The evaluation of the educational framework of the program and the level of professional satisfaction revealed notable aspects that received positive assessments from the respondents. These included the diversity and volume of cases, training tailored for tertiary and secondary care, and preparation for the professional sphere. On the other hand, concerns were raised regarding the adequacy of monthly remuneration, the scarcity of theoretical instruction, and the limited exposure to surgical training. These specific areas garnered lower scores both in the objective metrics and subjective feedback. Conclusion: This study effectively delineated the characteristics of MRPOT graduates and identified the program's key strengths. Simultaneously, it highlights areas that have drawn criticism and warrant attention.

Safety, osseointegration, and bone ingrowth analysis of PMMA-based porous cement on animal metaphyseal bone defect model.

Bone defects created after curettage of benign bone tumors are customarily filled with solid poly(methyl methacrylate) (PMMA) or other bone substitutes. In this study, we depicted a porous PMMA-based cement (produced by mixing sodium bicarbonate and citric acid) and evaluated the prospect of its clinic application. Cement samples were characterized by high-performance liquid chromatography (HPLC) coupled to mass spectrometry and its cytotoxicity evaluated in fibroblast cultures. Implantation in rabbits allowed the histologic analysis of bone, kidneys, and liver for toxicity and coagulation tests, and MRI images for hemostasis evaluation. Osseointegration was analyzed through radiography, microtomography (micro-CT), SEM, and histology of sheep specimens. Rabbit specimens were analyzed 1, 4, and 7 days after implantation of porous or solid bone cement in 6.0 mm femoral defects. Sheep specimens were analyzed 3 and 6 months after implantation or not of porous or solid cement in 15.0 mm subchondral tibial defects. The production process did not release any detectable toxic substance but slightly reduced fibroblast proliferation in vitro. Until 7 days after surgery, no local or systemic alterations could be detected in histology, or hematoma formation in histology or MRI. Sheep implants showed 6 mm linear ingrowth from the bone-cement interface and 20% bone ingrowth considering the whole defect area. Radiography, micro-CT, SEM, and histology confirmed these findings. We conclude that our porous PMMA-based cement is an attractive alternative treatment for bone defect filling that combines osseointegration and early weight bearing. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 649-658, 2018.

Caracterização de pacientes no pós-operatório imediato segundo a presença de náuseas e vômitos / Characterization of patients in the immediate postoperative by presence of nausea and vomiting / Caracterización de pacientes en el postoperatorio inmediato según la presencia de náuseas y vómitos

As náuseas e ou vômitos no pós-operatório são as principais complicações após procedimentos anestésico-cirúrgicos, ocorrendo em cerca de 20 a 30% dos pacientes, contribuindo para a demora do retorno às funções normais, a elevação dos custos hospitalares e o menor grau de satisfação do paciente. O objetivo desta pesquisa foi caracterizar pacientes com sintomas de náuseas e vômitos nas primeiras 24 horas de pós-operatório. Estudo descritivo, desenvolvido em Enfermarias Cirúrgicas e Unidade de Recuperação Anestésica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. A coleta de dados no pré-operatório foi realizada por meio de entrevista estruturada e exame físico e os dados relacionados aos períodos intra e pós-operatórios foram coletados por meio de análise de prontuário. Dos 100 participantes do estudo, sete apresentaram náuseas e vômitos. Esses sintomas foram mais frequentes nos sujeitos do sexo feminino, que não fumavam, com idade superior a 46 anos e obesos ou sobrepesos. O número reduzido de pacientes que apresentaram náuseas e vômitos no pós-operatório pode estar relacionado à prevenção desses sintomas no pós-operatório ou ao não registro das náuseas e vômitos pelos profissionais.

The postoperative nausea and vomiting are the main complications after anesthetic-surgical procedures, occurring in about 20 to 30% of patients, helping to delay the return to normal function, the rise in hospital costs and lower degree of patient satisfaction. The aim of this study was to characterize patients with symptoms of nausea and vomiting in the first 24 hours postoperatively. A descriptive study developed in Surgical Wards and Anesthetic Recovery Unit, Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Data collection preoperatively was conducted by structured interview and physical examination and data related to the intra and post-operative data were collected through review of medical records. Of the 100 study participants, seven had nausea and vomiting. These symptoms were more common in female subjects, who did not smoke, older than 46 years and classified as obese or overweight. The small number of patients who experienced postoperative nausea and vomiting may be related to prevention of these symptoms postoperatively or no record of nausea and vomiting by professionals.

Las náuseas y los vómitos en el postoperatorio son las principales complicaciones después de los procedimientos anestésico-quirúrgicos, que ocurre en aproximadamente el 20 a 30% de los pacientes, contribuyendo para el retraso del regreso a las funciones normales, el aumento de los costos hospitalarios y menor grado de satisfacción del paciente. El objetivo de esta investigación fue caracterizar a los pacientes con síntomas de náuseas y vómitos en las primeras 24 horas del postoperatorio. Estudio descriptivo, desarrollado en Enfermerías Quirúrgicas y Unidad de Recuperación Anestésica del Hospital de Clínicas de la Facultad de Medicina de Ribeirão Preto, Universidad de São Paulo. La recolección de datos en el postoperatorio fue realizada por medio de entrevista estructurada y examen físico y los datos relativos a los períodos intra y postoperatorio se recogieron mediante el análisis de los historiales médicos. De los 100 participantes en el estudio, siete presentaban náuseas y vómitos. Estos síntomas fueron más frecuentes en los sujetos del sexo femenino, que no fumaban, con edad superior a los 46 años y obesos o sobrepesos. El número reducido de pacientes que presentaron náuseas y vómitos en el postoperatorio puede estar relacionado con la prevención de estos síntomas en el postoperatorio o por no haber registro de náuseas y vómitos por los profesionales.

Medida da ansiedade e depressão em pacientes no pré-operatório de cirurgias eletivas / Measure of anxiety and depression in postoperative patients undergoing elective surgeries / Medidas de ansiedad y depresión en pacientes en preoperatorio de cirugías electivas

Os procedimentos cirúrgicos aliados à hospitalização representam uma ameaça ao doente e sua família, devido às alterações físicas, reações psicológicas e sociais. Este estudo foi realizado com o objetivo de avaliar a presença de sinais e sintomas de ansiedade e depressão e verificar associações das patologias com as variáveis sexo e idade, em pacientes no pré-operatório de cirurgias eletivas.Os dados foram coletados em um Hospital Universitário de Ribeirão Preto e a amostra foi composta por 100 sujeitos que responderam a Escala de Ansiedade e Depressão Hospitalar (HADS) e a um instrumento de dados sociodemográficos e clínicos, e informações relativas às condições do período perioperatório. Na avaliação de ansiedade e depressão, 40% dos indivíduos foram considerados casos de ansiedade e 22% dos indivíduos foram considerados casos de depressão. Encontrou-se relação estatisticamente significante dos níveis dessas patologias com as variáveis sexo masculino (p=0,001), feminino (p=0,000) e idade até 45 anos (p=0,000)...

Surgical procedures associated with hospitalization represent a threat to the patient and his/her family, due to physical alterations and psychological and social reactions. This study aimed at assessing the presence of signs and symptoms of anxiety and depression and at verifying associations of the pathologies with the variables gender and age in postoperative patients undergoing elective surgeries.Data were collected in a teaching hospital of Ribeirão Preto and the sample was comprised of 100 participants who completed the Hospital Anxiety and Depression Scale (HADS) and an instrument designed to collect clinical and sociodemographic data, as well as information regarding the particpants'conditions in the postoperative period. In the assessment of anxiety and depression, 40% of the subjects were considered to have anxiety and 22% of the subjects were considered to be suffering from depression. A statistically significant relationship was found between the levels of the pathologies and the variables male (p=0.001), female (p=0.000) and age younger than 45 years (p=0.000)...

Los procedimientos quirúrgicos sumados a la hospitalización representan una amenaza al enfermo y su familia, debido a las alteraciones físicas, reacciones psicológicas y sociales. Se objetivó evaluar la presencia de signos y síntomas de ansiedad y depresión y verificar asociaciones de las patologías con las variables sexo y edad con pacientes en preoperatorio de cirugías electivas. Datos recolectados en Hospital Universitario de Ribeirão Preto-SP, muestra compuesta por 100 sujetos que respondieron a la Escala de Ansiedad y Depresión Hospitalaria (HADS) y a un instrumento de datos sociodemográficos y clínicos, e informaciones relativas a las condiciones del período perioperatorio. En la evaluación de ansiedad y depresión, 40% de los individuos fueron considerados casos de ansiedad, y 22% casos de depresión. Se encontró relación estadísticamente significativa de los niveles de dichas patologías con las variables sexo masculino (p=0,001), femenino (p=0,000) y edad hasta 45 años (p=0,000)...