Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39.928
Filtrar
1.
Can J Surg ; 63(5): E418-E421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009901

RESUMO

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.


Assuntos
Congressos como Assunto/organização & administração , Infecções por Coronavirus/prevenção & controle , Currículo , Cirurgia Geral/educação , Cooperação Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Canadá/epidemiologia , Congressos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Cirurgia Geral/métodos , Guiana/epidemiologia , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Quênia/epidemiologia , Nigéria/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Suíça/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Estados Unidos/epidemiologia , Comunicação por Videoconferência/organização & administração , Comunicação por Videoconferência/normas , Ferimentos e Lesões/cirurgia
3.
Rev. SOBECC ; 25(3): 128-135, 30-09-2020.
Artigo em Inglês | LILACS | ID: biblio-1122400

RESUMO

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.


Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.


Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.


Assuntos
Humanos , Cirurgia Geral , Lista de Checagem , Segurança do Paciente , Protocolos , Hospitais , Hospitais Públicos
4.
Rev. SOBECC ; 25(3): 151-158, 30-09-2020.
Artigo em Português | LILACS | ID: biblio-1122702

RESUMO

Objetivo: Determinar o perfil de geração e mensurar os custos dos materiais utilizados no gerenciamento de resíduos de serviços de saúde em um centro cirúrgico. Método: Trata-se de pesquisa exploratória, descritiva, com abordagem quantitativa, na modalidade estudo de caso. O local foi o Centro Cirúrgico do Hospital Universitário da Universidade de São Paulo. A amostra estratificada foi de 1.120 cirurgias, e os resíduos foram pesados por 82 dias. Resultados: Os resíduos do Centro Cirúrgico representaram 6,38% do total hospitalar. O grupo mais representativo foi A-infectantes (50,62%). A média de geração foi de 3,72 kg por cirurgia. A sala de operação foi o local que mais gerou resíduos (55,93%), e as cirurgias buco-maxilares as que mais geraram resíduos, em termos de massa. O custo de um quilo foi: Grupo A (R$ 1,10), Grupo B (R$ 5,70), Grupo D Reciclado (R$ 0,96), Grupo D Não Reciclado (R$ 1,01) e Grupo E (R$ 3,23). Conclusão: O custo total médio por cirurgia foi de R$ 8,641, e sua redução depende da negociação de compra dos itens de consumo que tiveram maior representatividade nos custos.


Objective: To determine the waste generation profile and measure the costs of materials used in medical waste management in a surgical site. Method: This is an exploratory-descriptive survey, with a quantitative approach, in the case study modality. The site was the surgical site of the University Hospital of Universidade de São Paulo. The stratified sample was of 1,120 surgeries, and the waste was weighed for 82 days. Results: The surgical site waste accounted for 6.38% of the total hospital waste. The most representative group was A-infectious (50.62%). The mean generation was 3.72 kg per surgery. Most of the waste was generated in the operating room (55.93%), and oral maxillary surgeries generated most of the waste in terms of mass. The cost per kilo was: Group A (R$ 1.10), Group B (R$ 5.70), Group D Recycled (R$ 0.96), Group D Nonrecycled (R$ 1.01) and Group E (R$ 3.23). Conclusion: The mean total cost per surgery was R$ 8.641, and its reduction depends on strategies of purchasing consumable supplies that had greater impact on costs.


Objetivo: Determinar el perfil de generación y medir los costos de los materiales utilizados en la gestión de los Residuos De Los Servicios De Salud en un Centro Quirúrgico. Método: Esta es una investigación exploratoria, descriptiva, con un enfoque cuantitativo, en la modalidad de estudio de caso. El sitio fue el Centro Quirúrgico del Hospital Universitario de la Universidad de São Paulo. La muestra estratificada fue de 1.120 cirugías y los residuos se pesaron durante 82 días. Resultados: Los residuos del Centro Quirúrgico representaron el 6,38% del total del hospital. El grupo más representativo fue A-infeccioso (50,62%). La generación promedio fue de 3,72 kg por cirugía. El quirófano fue el lugar que generó la mayor cantidad de residuos (55,93%) y las cirugías orales-maxilares las que generaron la mayor cantidad de residuos, en términos de masa. El costo de un kilo fue: Grupo A (R$ 1,10), Grupo B (R$ 5,70), Grupo D Reciclado (R$ 0,96), Grupo D No Reciclado (R$ 1,01) y Grupo E (R$ 3,23). Conclusión: El costo total promedio por cirugía fue de R$ 8,641 y su reducción depende de la negociación de compra de los artículos de consumo que tuvieron mayor representatividad en los costos.


Assuntos
Humanos , Cirurgia Geral , Centros Cirúrgicos , Gerenciamento de Resíduos , Resíduos , Custos e Análise de Custo , Hospitais , Resíduos de Serviços de Saúde
5.
Rev. SOBECC ; 25(3): 179-186, 30-09-2020.
Artigo em Português | LILACS | ID: biblio-1122818

RESUMO

Objetivo: Analisar as produções científicas sobre cancelamento de cirurgias eletivas pelas causas institucionais. Método: Revisão integrativa da literatura, sistematizada pelo acrônimo Participante, Interesse e Contexto (PICo), de acordo com a estratégia PICo e procedimentos definidos pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca bibliográfica foi realizada em setembro de 2018 e atualizada em maio de 2020, nas bases de dados Sistema Online de Busca e Análise de Literatura Médica (MEDLINE)/PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Base de Dados em Enfermagem (BDEnf ) da Biblioteca Virtual em Saúde (BVS), Scopus (Elsevier) do Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Eletrônica Científica Online (SciELO). Foram consideradas publicações de 2008 até 2020, nos idiomas português, inglês e espanhol. Resultados: Foram identificados, na busca bibliográfica, 920 estudos, sendo 263 duplicados, restando 657 para seleção. Ao final, foram incluídos 15 estudos na síntese. Conclusão: As causas institucionais identificadas foram o avanço de horário da cirurgia anterior, gerando a indisponibilidade de salas cirúrgicas, problemas estruturais, falta ou defeitos em equipamentos e recursos humanos insuficientes.


Objective: To analyze scientific productions about elective surgery cancellation due to institutional causes. Method: Integrative literature review, systematized by the acronym Problem, Interest, and Context (PICo), according to PICo strategy and procedures defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Bibliographic search was carried out in September 2018 and updated in May 2020 in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs), Nursing Database (BDEnf ) of the Virtual Health Library (VHL), Scopus (Elsevier) of the Periodical Portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ­ CAPES), and Scientific Electronic Library Online (SciELO). Publications from 2008 to 2020 in Portuguese, English, and Spanish were retrieved. Results: We found 920 studies in the bibliographic search, 263 of them were duplicates, and 657 remained for selection. In the end, 15 studies were included in the review. Conclusion: The institutional causes identified were delay in the previous surgery, leading to unavailability of operating rooms, structural problems, lack of or defects in equipment, and insufficient human resources.


Objetivo: Analizar producciones científicas sobre la cancelación de cirugías electivas por causas institucionales. Método: Revisión bibliográfica integral, sistematizada por el acrónimo Participante, Interés y Contexto (PICo), de acuerdo con la estrategia y los procedimientos PICo definidos por el Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda bibliográfica se realizó en septiembre de 2018 y se actualizó en mayo de 2020, en las bases de datos MEDLINE/Pubmed, LILACS y BDEnf de la Biblioteca Virtual en Salud, SCOPUS (Elsevier) del Portal de revistas Capes y SciELO. Consideró publicaciones de 2008 a 2020, en portugués, inglés y español. Resultados: En la búsqueda bibliográfica, se identificaron 920 estudios, 263 de los cuales se duplicaron, dejando 657 para la selección. Al final, se incluyeron 15 estudios en la síntesis. Conclusión: Las causas institucionales identificadas fueron el tiempo de avance de la cirugía previa, generando la falta de disponibilidad de quirófanos, problemas estructurales, falta o defectos en los equipos y recursos humanos insuficientes.


Assuntos
Humanos , Cirurgia Geral , Enfermagem , Indicadores de Qualidade em Assistência à Saúde , Salas Cirúrgicas , Equipamentos e Provisões , Recursos Humanos
6.
Rev. argent. neurocir ; 34(3): 223-225, sept. 2020.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1120955

RESUMO

Introducción: En 1957, Takeuchi y Shimizu describen una vasculopatía oclusiva que involucra la arteria carótida interna bilateral, con la formación de vasos colaterales. En 1969, Suzuki y Takaku denominan a la conexión vascular colateral en las imágenes de angiografía "moyamoya" que significa nube de humo.2,3 Objetivos: El propósito del siguiente video es la descripción detallada de una cirugía de revascularización directa a través de un bypass temporosilviano en paciente con enfermedad Moyamoya. Materiales y Métodos: Se describe el caso de un paciente masculino de 27 años de edad que presentó de accidente vascular cerebral hemorrágico derecho. En la angiografía se diagnosticó estenosis del 70% de la arteria carótida interna supraclinoidea derecha, acompañado de estenosis de la arteria cerebral media y cerebral anterior homolateral. Se realizó cirugía de revascularización cerebral directa con bypass temporosilviano derecho.4,5 Resultados: Luego de realizado el bypass se confirmó adecuada permeabilidad del mismo y en la angiografía postoperatoria se observó el desarrollo de circulación colateral a través de la anastomosis. El paciente no presentó déficit en el periodo postoperatorio. Conclusión: Aunque la incidencia de enfermedad de Moyamoya no es elevada, es una causa probable de stroke isquémico o hemorrágico en niños y adultos. El manejo adecuado es fundamental para mejorar el pronostico a largo plazo de los pacientes con esta rara patología.


Introduction: In 1957, Takeuchi and Shimizu describes an occlusive vasculopathy involving the bilateral internal carotid arteries, with the formation of collateral vessels. In 1969, Suzuki and Takaku designate the collateral vascular connections in the angiographical images "moyamoya" which means puff of smoke.2,3 Objectives: The purpose of the following video is the detailed description of a direct revascularization surgery through a temporosilvian bypass in a patient with Moyamoya disease. Materials and methods: We present a case of a 27-year-old male patient with a history of right hemorrhagic cerebral vascular accident. In the angiography, 70% stenosis of the right supraclinoid internal carotid artery was diagnosed, accompanied by stenosis of the middle and anterior homolateral cerebral artery. Direct cerebral revascularization surgery was performed with right temporosilvian bypass.4,5 Results: After performing the bypass, adequate permeability is confirmed and in the postoperative angiography the development of collateral circulation through the anastomosis was observed. The patient did not present a deficit in the postoperative period. Conclusion: Although the incidence of Moyamoya disease is not high, it is a probable cause of ischemic or hemorrhagic stroke in children and adults. Proper management is essential to improve the long-term prognosis of patients with this rare pathology.


Assuntos
Humanos , Masculino , Doença de Moyamoya , Cirurgia Geral , Revascularização Cerebral
7.
Rev. argent. neurocir ; 34(3): 226-234, sept. 2020. ilus, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1120960

RESUMO

El origen subcortical de la epilepsia ha sido tema de profundo debate durante muchísimo tiempo y solo se le otorgaba a las estructural subcorticales un rol en la distribución, modulación y alteración de la actividad cortical. Sin embargo, los estudios neurofisiológicos y de neuroimágenes de las últimas décadas han provisto de la información suficiente como para confirmar que algunas crisis epilépticas pueden iniciarse en estructuras subcorticales. Presentamos 4 pacientes pediátricos con lesiones cerebelosas y epilepsia refractaria, revisamos la bibliografía, analizamos las formas de presentación, los hallazgos neurofisiológicos y resultados a largo plazo con cirugía


The subcortical origin of epilepsy has been a subject of debate and only the subcortical structures were given a role in the distribution, modulation and alteration of cortical activity. However, neurophysiological and neuroimaging studies of recent decades have provided enough information to confirm the onset of some epileptic seizures in subcortical structures. We present 4 pediatric patients with cerebellar lesions and refractory epilepsy, we reviewed the literature, analyzed the forms of presentation, the neurophysiological findings and long-term results with surgery


Assuntos
Humanos , Feminino , Epilepsia , Convulsões , Cirurgia Geral , Epilepsia Resistente a Medicamentos
8.
Rev. argent. neurocir ; 34(3): 235-239, sept. 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1120967

RESUMO

Introducción: Las lesiones durales son complicaciones frecuentes en la cirugía de columna. La fuga de liquidocefalorraquideo (LCR) puede originar hemorragia en todos los compartimientos del cerebro. La mayoría ocurre en venas ubicadas en región cerebelosa.Material y método: Se presenta un caso de hemorragia subaracnoidea posterior a una descompresión lumbar mínimamente invasiva asociada a desgarro dural. Resultados: Evoluciona en el postoperatorio con síntomas neurológicos de cefaleas y trastornos del sensorio por lo que se decide evaluarlo con estudios por imágenes vasculares cerebrales identificándose sangrado subaracnoideo.Discusión: El sitio más frecuente de hemorragia intracraneal posterior a una cirugía de columna es el cerebelo. El mecanismo de acción de este tipo de sangrados es desconocido y controversial, hay algunos reportes que sugieren que se trataría de un sangrado venoso. El síntoma más característico de este síndrome es la cefalea. Aunque se desconoce la etiología exacta, se postula que la pérdida de volumen de LCR causa una caída en la presión intracraneal, lo que lleva a un agrandamiento de los senos venosos durales que predisponen al paciente a un hematoma subdural espontáneoConclusión: La fuga de LCR, las alteraciones asociadas al edema cerebral en la hipotensión cerebral podría ser llave del mecanismo que desencadena una hemorragia subaracnoidea.


compartments of the brain. Most occur in veins located in the cerebellar region.Material and method: A case of subarachnoid hemorrhage after a minimally invasive lumbar decompression associated with dural tear is presented.Results: It evolves in the postoperative period with neurological symptoms of headaches and sensory disorders, so it is decided to evaluate it with studies by cerebral vascular images identifying subarachnoid bleeding.Discussion: The most frequent site of intracranial hemorrhage after spinal surgery is the cerebellum. The mechanism of action of this type of bleeding is unknown and controversial, there are some reports that suggest that it would be a venous bleeding. The most characteristic symptom of this syndrome is headache. Although the exact etiology is unknown, it is postulated that the loss of CSF volume causes a drop in intracranial pressure, which leads to an enlargement of the dural venous sinuses that predispose the patient to a spontaneous subdural hematomaConclusion: CSF leakage, alterations associated with cerebral edema in cerebral hypotension could be key to the mechanism that triggers a subarachnoid hemorrhage.


Assuntos
Humanos , Masculino , Hemorragia Subaracnóidea , Cirurgia Geral , Edema Encefálico , Hemorragias Intracranianas , Hematoma Subdural
9.
S Afr Med J ; 110(8): 777-782, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880306

RESUMO

History provides wonderful insights into how society develops, providing innumerable lessons that can be used as individuals and institutions move into the future. The history of medicine provides particular value, yet it is so often overlooked by the present, society taking for granted what has often been a tremendous struggle to achieve. This overview of the history of paediatric surgery at the University of the Witwatersrand provides amazing insights into what has been achieved in a period spanning three centuries.


Assuntos
Cirurgia Geral/história , Hospitais Universitários/história , Pediatria/história , Docentes de Medicina/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , África do Sul
10.
Chirurgia (Bucur) ; 115(4): 469-475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876020

RESUMO

Background: The Covid-19 pandemic in Northern Italy has slowed down the clinical surgical activity. A system of hub and spoke hospitals was set up to take care of oncological patients with the consequent almost complete abolition of the elective surgical activity for non-oncological pathologies. Methods: We retrospectively analyzed the surgical volumes of 4 different non academic general hospitals in Lombardy belonging to 4 different provinces. The quarter March April May 2019 was compared with the same period of 2020. All different procedures were listed. The cost analysis was performed using the DRG system. Results: In the four hospitals involved the surgical procedures reduced from 1903 to 350 with a drop of the 81.6%. Procedures for cancer from 403 to 161 with a drop of 60.1%. Procedures for benign disease from 1310 to 118 with a drop of the 91%. Emergencies from 190 to 71 with a drop of the 62.6%. State refund for the procedures performed from 6.708.023 to 1.678.154 with a drop of 75%. Conclusions: Elective surgery was dramatically impaired by the Covid-19 pandemic. Above all procedures for non oncological and non urgent patients were particularly affected. In view of a possible second wave of the pandemic, the surgical planning must select patients not only on onco logical criteria but rather on clinical ones. An ad hoc hub and spoke hospitals pathway has to be implemented for benign surgical diseases by whoever is facing the Covid pandemic at its spike.


Assuntos
Infecções por Coronavirus/epidemiologia , Cirurgia Geral/tendências , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Betacoronavirus , Humanos , Itália , Pandemias , Estudos Retrospectivos , Resultado do Tratamento
11.
S Afr Med J ; 110(9): 916-919, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32880278

RESUMO

BACKGROUND: In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. OBJECTIVES: To report changes in SA hospital surgical practices in response to COVID-19 preparedness. METHODS: In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. RESULTS: A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. CONCLUSIONS: Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Cirurgia Geral/educação , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Betacoronavirus , Tomada de Decisão Clínica , Estudos Transversais , Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Hospitais Privados , Hospitais Públicos , Humanos , Salas Cirúrgicas , Pandemias , Seleção de Pacientes , África do Sul/epidemiologia , Inquéritos e Questionários , Telefone , Comunicação por Videoconferência
12.
Surg Clin North Am ; 100(5): 849-859, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882167

RESUMO

Over the last 2 decades, rural locations have realized a steady decrease in surgical access and direct care. Owing to societal expectations for equal general and subspecialty surgical care in urban or rural areas, the ability to attract, train, and hold onto the rural surgeon has come into question. Our current general surgery training curriculum has been reevaluated as to its relevance for rural surgery and several alternatives to the traditional surgical training model have been proposed. The authors discuss and evaluate current and proposed methods for surgical training curriculums and methods for rural surgeon retention through continuing education models.


Assuntos
Cirurgia Geral/educação , Serviços de Saúde Rural , Currículo , Internato e Residência , Estados Unidos
13.
Surg Clin North Am ; 100(5): 861-868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882168

RESUMO

The scope of practice of a rural surgeon depends not only the individual skillset of the surgeon, but also local resources.


Assuntos
Cirurgia Geral , Serviços de Saúde Rural , Âmbito da Prática , Procedimentos Cirúrgicos Operatórios , Humanos , Estados Unidos
14.
Surg Clin North Am ; 100(5): 869-877, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882169

RESUMO

Rural hospitals are closing at an increasing rate. From 2010 to 2014, 47 rural hospitals closed, affecting 1.5 million people. The presence of surgeons is critical to keeping these hospitals open; to provide initial trauma care, cancer screening, and care to populations that cannot easily travel; and to provide solid general surgery procedures to almost 60 million Americans. Actions to provide surgeons trained for rural practice include exposure of surgery to students in high school (and earlier), recruitment of rural students into medical school, rural rotations in medical school, rural tracts within surgical residencies, and programs to support and retain rural surgeons.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Serviços de Saúde Rural , Recursos Humanos , Currículo , Cirurgia Geral/educação , Estados Unidos
15.
Surg Clin North Am ; 100(5): 879-891, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882170

RESUMO

The article describes the barriers rural surgeons face when attempting to measure, analyze, and benchmark the quality and value of the care they provide for their patients. Examples of suboptimal care are presented as well as special geographic and resource-related circumstances for many of these disparities of care. The article includes in-depth descriptions of the American College of Surgeons (ACS) Optimal Resources for Surgical Quality and Safety Program and the ACS Rural Hospital Surgical Verification and Quality Improvement Program. The article concludes by discussing several documented clinical, economic, and social advantages of keeping surgical care local.


Assuntos
Cirurgia Geral/normas , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Melhoria de Qualidade , Estados Unidos
16.
Surg Clin North Am ; 100(5): 909-920, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882173

RESUMO

Advanced technology has resulted in major changes in surgery and medicine over the past three decades. There are many barriers to the adoption of advanced technologies, which can be more prevalent in rural hospitals and surgical practices. Despite barriers to implementation of new technologies in rural communities, many rural hospitals have endorsed and invested in these technologies for the benefit of the hospital and community. The rural surgeon is often the driving force in evaluating and deciding on new technologies for their surgical program. This article discusses advantages, challenges, and limitations in the use of advanced technologies in rural locations.


Assuntos
Tecnologia Biomédica , Cirurgia Geral/métodos , Serviços de Saúde Rural , Procedimentos Cirúrgicos Operatórios/métodos , Hospitais Rurais , Humanos , Procedimentos Cirúrgicos Robóticos , Telemedicina , Estados Unidos
17.
Surg Clin North Am ; 100(5): 937-948, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882175

RESUMO

Regionalization of surgery is an important component of surgical outcomes. This has been based on numerous studies validating the relationship of surgical volume to surgical outcomes. The Mayo Clinic is actively engaged in regionalization of surgery within its health system. It has embraced a nonvolume outcome approach focusing on outcomes using electronic medical record data mining and National Surgical Quality Improvement Program. Implementing surgical regionalization is supported but ineffectively implemented. In addition, the implementation process has been poorly described in the literature. The Mayo clinic has actively implemented regionalization within its health system, which includes supporting the health system.


Assuntos
Assistência à Saúde/organização & administração , Cirurgia Geral/organização & administração , Instalações de Saúde , Humanos , Minnesota
18.
Surg Clin North Am ; 100(5): 949-970, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882176

RESUMO

This is a systematic review of original research articles that use qualitative methods to investigate rural surgery over the last decade (2010-2019). This review found that interviews and focus groups were common, most often engaging with patients and health care professionals. Thematic analysis and grounded theory were data analysis methods most frequently used among these qualitative rural surgery studies. Studies in this review often pertained to obstetrics or the provision of other other surgical services. Areas for future qualitative research on rural surgery are surgical teamwork, scope of practice, workforce shortages, and issues related to the aging rural patient.


Assuntos
Cirurgia Geral , Pesquisa Qualitativa , Serviços de Saúde Rural , Humanos , Estados Unidos
20.
Br J Hosp Med (Lond) ; 81(9): 1-6, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32990069

RESUMO

Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.


Assuntos
Competência Clínica , Infecções por Coronavirus , Educação , Cirurgia Geral/educação , Pandemias , Pneumonia Viral , Treinamento por Simulação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação/métodos , Educação/organização & administração , Avaliação Educacional , Humanos , Modelos Anatômicos , Modelos Educacionais , Pandemias/prevenção & controle , Satisfação Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Autoimagem , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Reino Unido
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA