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BMC Surg ; 21(1): 196, 2021 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-33865366


BACKGROUND: During the worldwide COVID-19 pandemic, the quality of surgical education experiences sudden major restrictions. Students' presence in the operating theater and on wards is reduced to a bare minimum and face-to-face teaching is diminished. Aim of this study was therefore to evaluate alternative but feasible educational concepts, such as an online-only-platform for undergraduates. OBJECTIVE: A new online platform for undergraduate surgical education was implemented. A virtual curriculum for online-only education was designed. METHODS: A video-based online platform was designed. Following this, a cohort of medical students participating in a (voluntary) surgical course was randomized into a test and control group. Prior to conducting a written exam, students in the test group prepared using the video platform. Students in the control group prepared with standard surgical text books. Results of the exam were used to compare educational means. RESULTS: Students in the test group preparing through the video-based online platform reached significantly higher scores in the written exams (p = 0.0001) than students of the control group. A trend towards reduced preparation time that did not reach statistical significance was detectable in the test group (p = 0.090). Scores of "perceived workload" and "desire to become a surgeon" offered no differences between the groups. (p = 0.474 and 1.000). CONCLUSIONS: An online-only, virtual curriculum proved feasible for surgical education in undergraduates. While blended learning concepts were applied in both groups, only the test group had access to case-based videos of surgical procedures and scored significantly better in the written exams. Thus, video-based virtual education offers a realistic alternative to face-to-face teaching or conventional text books in times of restricted access to the operating theatre.

Educación a Distancia , Evaluación Educacional , Cirugía General/educación , Humanos , Pandemias , Grabación en Video
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 77-82, 20210000.
Artículo en Español | LILACS | ID: biblio-1178631


El empiema es una colección de líquido purulento en el espacio pleural. La causa más común es la neumonía. Las opciones de tratamiento incluyen toracocentesis terapéutica, colocación de catéter de drenaje, terapia fibrinolítica, pleurodesis y cirugía, como la decorticación pleural. El drenaje pleural es eficaz en la etapa I y la cirugía está reservada para casos complicados (estadios II y III). En estos casos, es necesaria la decorticación pulmonar. Actualmente, el enfoque más favorecido para la decorticación es mediante una toracotomía abierta. Este es un estudio observacional, descriptivo, de corte transversal, retrospectivo, con un muestreo no probabilístico de casos consecutivos que tuvo como población accesible a pacientes con el diagnostico de empiema en quienes se realizó una decorticación pleural en el Hospital de Clínicas por el Departamento de Cirugía de Tórax durante el periodo de marzo 2016 a febrero 2019. Un total de 24 pacientes con el diagnóstico de empiema fueron sometidos a una decorticación pleural. La etiología de empiema más frecuente (75%) fue el derrame paraneumónico. Las complicaciones post quirúrgicas estuvieron presentes en 9 (37,5%) pacientes, de estos, 4 (17%) presentaron fuga aérea durante los primeros días postoperatorios. Se constató la resolución completa del cuadro en 21 (87,5%) pacientes y 3 (12,5%) pacientes presentaron colección residual pleural. Se constató recurrencia en 1 (4%) paciente, requiriendo un re intervención quirúrgica. En conclusión, la casuística de nuestro departamento de tórax coincide en cuanto a valores internacionales de complicaciones, resolución y mortalidad.

Empyema is a collection of purulent fluid in the pleural space. The most common cause is pneumonia. Treatment options include therapeutic thoracentesis, drainage catheter placement, fibrinolytic therapy, pleurodesis, and surgery, such as pleural decortication. Pleural drainage is effective in stage I and surgery is reserved for complicated cases (stages II and III). In these cases, pulmonary decortication is necessary. Currently, the most favored approach to decortication is by open thoracotomy. This is an observational, descriptive, cross-sectional, retrospective study, with a non-probabilistic sampling of consecutive cases that had as the accessible population, patients with the diagnosis of empyema in whom pleural decortication was performed at the Clinica´s Hospital of San Lorenzo, by the Department of Thoracic Surgery during the period from March 2016 to February 2019. A total of 24 patients with the diagnosis of empyema underwent pleural decortication. The most frequent aetiology of empyema (75%) was parapneumonic effusion. Post-surgical complications were present in 9 (37.5%) patients, of these, 4 (17%) presented air leakage during the first postoperative days. Complete resolution of the condition was verified in 21 (87.5%) patients and 3 (12.5%) patients presented residual pleural collection. Recurrence was found in 1 (4%) patient, requiring reoperation. In conclusion, the casuistry of our thoracic department coincides in terms of international values of complications, resolution and mortality.

Neumonía , Cirugía Torácica , Toracotomía , Drenaje , Pleurodesia , Toracocentesis , Cirugía General , Tórax , Terapia Trombolítica , Estudios Retrospectivos , Catéteres
BJS Open ; 5(2)2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33688941


BACKGROUND: Twitter engagement between surgeons provides opportunities for international discussion of research and clinical practice. Understanding how surgical tweet chats work is important at a time when increasing reliance is being placed on virtual engagement because of the COVID-19 pandemic. METHODS: Individual tweets from the May 2019 #BJSConnect tweet chat were extracted using NodeXL, complemented by Twitter searches in an internet browser to identify responses that had not used the hashtag. Aggregate estimates of tweet views were obtained from a third-party social media tool (Twitonomy) and compared with official Twitter Analytics measurements. RESULTS: In total 37 Twitter accounts posted 248 tweets or replies relating to the tweet chat. A further 110 accounts disseminated the tweets via retweeting. Only 58.5 per cent of these tweets and 35 per cent of the tweeters were identified through a search for the #BJSConnect hashtag. The rest were identified by searching for replies (61), quoting tweets (20), and posts by @BJSurgery that used the hashtag but did not appear in the Twitter search (22). Studying all tweets revealed complex branching discussions that went beyond the discussed paper's findings. Third-party estimates of potential reach of the tweet chat were greatly exaggerated. CONCLUSION: Understanding the extent of the discussion generated by the #BJSConnect tweet chat required looking beyond the hashtag to identify replies and other responses, which was time-consuming. Estimates of reach using a third-party tool were unreliable.

Cirugía General , Publicaciones Periódicas como Asunto , Medios de Comunicación Sociales , Comunicación , Humanos , Reino Unido
Rev Esp Salud Publica ; 952021 Mar 03.
Artículo en Español | MEDLINE | ID: mdl-33654051


OBJECTIVE: In Spain, the number of persons that are in a surgery waiting list as well as the available surgery resources, differ across autonomous communities. The pandemic generated by COVID-19 has increased these waiting lists. In this study two objectives were pursued: on the one hand, to determine which are the resources that are determining the number of persons that are in a surgery waiting list per 1,000 inhabitants; on the other hand, to estimate the impact that the current pandemic has on the latter. METHODS: To estimate which are the resources that are having a greater impact on the waiting lists and to forecast the effect that the COVID-19 has on them, we use dynamic panel data models. The data on the surgery resources and on the waiting lists by autonomous communities is obtained from the Surveys on Health, Hospital Statistics and reports on waiting lists of the Ministry of Health, Consumption and Social Well Being and the Counsels. The sample period is 2012-2017 (last published year for surgery resources). In addition, a literature review is conducted and it shows the important and complexity of waiting list like a gestion tool of health system (Science, SciELO and Dialnet web data bases). RESULTS: COVID-19 will increase the waiting lists by approximately 7.6% to 19.14%, depending on the autonomous community. Not all the available surgery resources have the same relevance nor an equal effect on the reduction of the waiting lists. The most significant resources are the beds and operating rooms per 1,000 inhabitants. The hospital expenditure is not so relevant. CONCLUSIONS: The panel data models estimate the relation between the surgery resources and the waiting list. The latter is deemed complex and different across autonomous communities. In addition, these models allow to predict the expected increase in the waiting lists and are, thus, a useful instrument for their management.

/epidemiología , Cirugía General/estadística & datos numéricos , Listas de Espera , Recolección de Datos , Capacidad de Camas en Hospitales , Humanos , Internet , Quirófanos , España
Sao Paulo Med J ; 139(1): 53-57, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656133


BACKGROUND: The COVID-19 pandemic has affected healthcare systems worldwide. The effect of the pandemic on emergency general surgery patients remains unknown. OBJECTIVE: To reveal the effects of the COVID-19 pandemic on mortality and morbidity among emergency general surgery cases. DESIGN AND SETTING: Data on patients who were admitted to the emergency department of a tertiary hospital in Samsun, Turkey, and had consultations at the general surgery clinic were analyzed retrospectively. METHODS: Our study included comparative analysis on two groups of patients who received emergency general surgery consultations in our hospital: during the COVID-19 pandemic period (Group 2); and on the same dates one year previously (Group 1). RESULTS: There were 195 patients in Group 1 and 132 in Group 2 (P < 0.001). While 113 (58%) of the patients in Group 1 were women, only 58 (44%) were women in Group 2 (P = 0.013). Considering all types of diagnosis, there was no significant difference between the two groups (P = 0.261). The rates of abscess and delayed abdominal emergency diseases were higher in Group 2: one case (0.5%) versus ten cases (8%); P < 0.001. The morbidity rate was higher in Group 2 than in Group 1: three cases (1.5%) versus nine cases (7%); P = 0.016. CONCLUSIONS: The COVID-19 pandemic has decreased the number of unnecessary nonemergency admissions to the emergency department, but has not delayed patients' urgent consultations. The pandemic has led surgeons to deal with more complicated cases and greater numbers of complications.

Servicio de Urgencia en Hospital/estadística & datos numéricos , Cirugía General/estadística & datos numéricos , Pandemias , Femenino , Humanos , Masculino , Estudios Retrospectivos , Turquia/epidemiología
Am J Surg ; 221(2): 331-335, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33729917


BACKGROUND: The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles. METHODS: 10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors. RESULTS: There is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of "works quickly," "high energy," and "mostly provides broad oversight," and for the prevention-associated behaviors of "works slowly and deliberately," "quiet and calm," and "preference for vigilant strategies." CONCLUSION: Residents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.

Cirugía General/educación , Internado y Residencia/métodos , Quirófanos/métodos , Cirujanos/psicología , Competencia Clínica/normas , Docentes Médicos/psicología , Femenino , Cirugía General/métodos , Humanos , Masculino , Motivación , Autonomía Profesional , Autocontrol , Encuestas y Cuestionarios , Confianza
Sensors (Basel) ; 21(4)2021 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-33668544


Surgeons' procedural skills and intraoperative decision making are key elements of clinical practice. However, the objective assessment of these skills remains a challenge to this day. Surgical workflow analysis (SWA) is emerging as a powerful tool to solve this issue in surgical educational environments in real time. Typically, SWA makes use of video signals to automatically identify the surgical phase. We hypothesize that the analysis of surgeons' speech using natural language processing (NLP) can provide deeper insight into the surgical decision-making processes. As a preliminary step, this study proposes to use audio signals registered in the educational operating room (OR) to classify the phases of a laparoscopic cholecystectomy (LC). To do this, we firstly created a database with the transcriptions of audio recorded in surgical educational environments and their corresponding phase. Secondly, we compared the performance of four feature extraction techniques and four machine learning models to find the most appropriate model for phase recognition. The best resulting model was a support vector machine (SVM) coupled to a hidden-Markov model (HMM), trained with features obtained with Word2Vec (82.95% average accuracy). The analysis of this model's confusion matrix shows that some phrases are misplaced due to the similarity in the words used. The study of the model's temporal component suggests that further attention should be paid to accurately detect surgeons' normal conversation. This study proves that speech-based classification of LC phases can be effectively achieved. This lays the foundation for the use of audio signals for SWA, to create a framework of LC to be used in surgical training, especially for the training and assessment of procedural and decision-making skills (e.g., to assess residents' procedural knowledge and their ability to react to adverse situations).

Colecistectomía Laparoscópica , Competencia Clínica , Cirugía General , Reconocimiento de Normas Patrones Automatizadas , Cirugía General/normas , Humanos , Quirófanos , Habla
BMC Surg ; 21(1): 119, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685436


BACKGROUND: During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed. OBJECTIVE: To compare the characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. METHODS: Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We retrospectively compared the characteristics of patients who were admitted with various conditions during three periods. RESULTS: Patients' mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0, respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P < 0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. CONCLUSIONS: Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.

Servicio de Urgencia en Hospital , Cirugía General , Hospitales Públicos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Cirugía General/estadística & datos numéricos , Humanos , Israel/epidemiología , Estudios Retrospectivos
BMC Surg ; 21(1): 123, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685437


Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care.

Cirugía General , Laparoscopía , Cirugía General/educación , Humanos , Irlanda , Laparoscopía/educación , Reino Unido
Med. U.P.B ; 40(1): 35-45, 03/03/2021. tab, Ilus
Artículo en Español | LILACS, COLNAL | ID: biblio-1177493


Objetivo: Revisar las metodologías y los materiales utilizados en la enseñanza de técnicas quirúrgicas para personal de la salud, publicados durante los últimos siete años. Metodología: Se realizó una revisión bibliográfica en la base de datos PubMed sobre materiales y metodologías utilizados en educación quirúrgica determinando criterios de inclusión y exclusión para filtrar los diferentes artículos. Resultados: Se encontraron 1190 artículos, de los cuales se descartaron 826 por no cumplir con el rango de la revisión sistemática. Se utilizaron 59 artículos que cumplieron los criterios de inclusión y de exclusión para la revisión. Conclusiones: El entrenamiento para obtener habilidades en técnicas quirúrgicas a través de la simulación es una oportunidad para estudiantes y maestros de avanzar en el saber y el hacer; se deben acoplar los materiales con el espacio para obtener resultados esperados. La investigación continúa con el fin de encontrar mejores opciones para la adquisición de las destrezas y habilidades quirúrgicas.

Objective: To review the methodologies and materials used in the teaching of surgical techniques for health personnel, which have been published over the last seven years. Methodology: A literature review was carried out in the PubMed database on materials and methodologies used in surgical education, based on inclusion and exclusion criteria to filter the different articles. Results: A total of1 190 articles were found, of which 826 were discarded for not meeting the range of the systematic review.59 articles that did meet the inclusion and exclusion criteria were used for the review. Conclusions: Training to obtain skills in surgical techniques through simulation is an opportunity for students and teachers to advance in knowing and doing; materials must be matched with the circumstances to obtain expected results. New research must be carried out in order to find better options for the acquisition of surgical skills and abilities.

Objetivo: Revisar as metodologias e materiais utilizados no ensino de técnicas cirúrgicas para profissionais de saúde, publicados nos últimos sete anos. Metodologia: Foi realizada uma revisão bibliográfica na base de dados PubMed sobre materiais e metodologias utilizadas na educação cirúrgica, determinando critérios de inclusão e exclusão para filtrar os diferentes artigos. Resultados: foram encontrados 1190 artigos, dos quais 826 foram descartados por não atenderem à abrangência da revisão sistemática. 59 artigos que atenderam aos critérios de inclusão e exclusão foram utilizados para a revisão. Conclusões: O treinamento para obtenção de habilidades em técnicas cirúrgicas por meio de simulação é uma oportunidade para alunos e professores avançarem no saber e no fazer; os materiais devem ser combinados com a lacuna para obter os resultados esperados. A pesquisa continua a fim de encontrar melhores opções para a aquisição de habilidades e habilidades cirúrgicas.

Humanos , Animales , Simulación , Cirugía General , Personal de Salud , Técnicas , Materiales , Docentes
Iatreia ; 34(1): 54-63, ene.-mar. 2021. graf
Artículo en Español | LILACS | ID: biblio-1154358


RESUMEN Introducción: durante el entrenamiento quirúrgico los residentes invierten grandes esfuerzos para alcanzar un desempeño óptimo. Sin embargo, como resultado de las altas demandas y pobres recursos en el trabajo, experimentan variables grados de desgaste profesional, estrés y escaso bienestar. Las estrategias de recuperación del trabajo representan una promisoria área de desarrollo para modificar estos resultados negativos. Nuestro objetivo es sintetizar la evidencia disponible sobre las estrategias de recuperación del trabajo en residentes de cirugía. Métodos: basados en el marco teórico de la psicología organizacional positiva, en esta revisión narrativa sintetizamos la evidencia proveniente de estudios originales publicados entre 2010-2019, respecto a cuatro estrategias de recuperación: 1. El distanciamiento psicológico del trabajo; 2. La relajación: 3. Control del tiempo libre; y 4. Búsqueda de retos fuera del trabajo. Resultados: un total de 18 estudios fueron incluidos. La mayoría de las intervenciones se fundamentan en el mindfulness (atención plena) como estrategia de relajación, pero su efectividad en la reducción de los niveles de estrés de los residentes de cirugía es pobre. La literatura es limitada para concluir sobre la efectividad de los otros grupos de estrategias de recuperación. Conclusión: las estrategias más utilizadas para la recuperación del trabajo en residentes de cirugía, están en fase de desarrollo inicial. Su efectividad es limitada para la reducción del estrés y el desgaste profesional. Estos resultados ofrecen oportunidades de investigación futura.

SUMMARY Introduction: During surgical training, residents invest great efforts to achieve optimal performance. However, as a result of the highest demands and poor resources at work, they experience varying degrees of burnout, stress and poor wellbeing. The recovery strategies to work represent a promising area of development to modify these negative results. Our goal is to synthesize the available evidence. Methods: Based on the theoretical framework of positive organizational psychology, in this narrative review we synthesized the evidence from original studies published between 2010-2019, regarding to four recovery strategies: 1) psychological detachment from work, 2) relaxation, 3) control of free time, and 4) search for challenges outside of work. Results: A total of 18 studies were included. Most of the interventions are based on mindfulness as a relaxation strategy, but its effectiveness in reducing stress levels among surgery residents is poor. The literature is limited to conclude the effectiveness of the other groups of recovery strategies. Conclusion: Most strategies for work recovery in surgery residents are in an initial development. Its effectiveness is limited in reducing stress and professional burnout. These results offer opportunities for future research.

Humanos , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cirugía General , Agotamiento Profesional , Atención Plena
J Surg Res ; 262: 240-243, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33549329


As the SARS-COV-2 pandemic created the need for social distancing and the implementation of nonessential travel bans, residency and fellowship programs have moved toward a web-based virtual process for applicant interviews. As part of the Society of Asian Academic Surgeons 5th Annual Meeting, an expert panel was convened to provide guidance for prospective applicants who are new to the process. This article provides perspectives from applicants who have successfully navigated the surgical subspecialty fellowship process, as well as program leadership who have held virtual interviews.

/prevención & control , Cirugía General/educación , Internado y Residencia/organización & administración , Selección de Personal/métodos , Comunicación por Videocoferencia/organización & administración , /epidemiología , Certificación/organización & administración , Certificación/normas , Docentes/psicología , Docentes/normas , Becas/organización & administración , Becas/normas , Humanos , Internado y Residencia/normas , Liderazgo , Pandemias/prevención & control , Selección de Personal/organización & administración , Selección de Personal/normas , Consejos de Especialidades , Cirujanos/psicología , Cirujanos/normas
Am Surg ; 87(3): 333-335, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33625869


Debriefing after a major event is a key component in ongoing improvement in performance. Likewise, reflecting on one's career at the time of leaving the operating room environment is an opportunity to transmit the lessons learned from decades of surgical practice. The authors, recently retired from daily operating and leaders in American surgery, reflect on the impact of surgical life on surgeons and their personal lives. Observations regarding selection of medical students, surgical trainees and practice models are presented from this perspective.

Actitud del Personal de Salud , Cirugía General , Calidad de Vida/psicología , Estudiantes de Medicina/psicología , Cirujanos/psicología , Equilibrio entre Vida Personal y Laboral , Cirugía General/educación , Cirugía General/organización & administración , Humanos , Internado y Residencia , Mentores , Jubilación , Cirujanos/educación , Estados Unidos