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1.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
2.
Stud Health Technol Inform ; 264: 1974-1975, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438435

RESUMO

We developed and evaluated the usability of Check-up Surgery, a surgery application from the mApp® Platform. The Usability Engineering Cycle was used as method of development. The results showed that the Check-up Surgery application had excellent usability criteria with an average of 4.63 to 4.70 by 81% of the evaluators. For all the interviewees there was statistical significance in relation to the usability criteria of the application, with pValue ≤.05.


Assuntos
Interface Usuário-Computador , Cirurgia Geral
4.
Am Surg ; 85(7): 677, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405406
5.
Am Surg ; 85(7): 678-684, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405407
6.
Rev. SOBECC ; 24(2): 69-75, abr-.jun.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1006164

RESUMO

Objetivo: Identificar a prevalência dos procedimentos cirúrgicos realizados em idosos em um centro cirúrgico de um hospital público do interior do estado de São Paulo e caracterizar tais procedimentos. Método: Estudo transversal, retrospectivo, quantitativo. A amostra constou de 7.483 procedimentos cirúrgicos em idosos, realizados entre 2013 e 2015. Os dados foram coletados a partir do sistema de cirurgia da instituição sede do estudo. Resultados: A faixa etária na qual prevaleceram os procedimentos foi entre 60 e 70 anos de idade; a maior média de tempo para recuperação da anestesia foi entre 71 e 80 anos. As especialidades que mais realizaram procedimentos foram: ortopedia, urologia e oftalmologia. As anestesias mais empregadas foram: geral inalatória, endovenosa, local com sedação e raquideana; 37,3% usaram o serviço de anestesia, porém não estava descrito em prontuário qual foi o tipo de anestesia realizada. Os óbitos decorrentes dos procedimentos ou complicações das cirurgias foram 1.140; três deles ocorreram no centro cirúrgico e os demais, em enfermarias ou unidades de cuidados intensivos. Conclusão: Os dados aqui apresentados reforçam a necessidade de novos modelos de assistência, com melhorias da assistência multidisciplinar geriátrica, no atendimento perioperatório aos pacientes idosos


Objective: To identify the prevalence of surgical procedures performed in the elderly in a surgical center of a public hospital in the state of São Paulo and to characterize such procedures. Method: Cross-sectional, retrospective, quantitative study. The sample consisted of 7,483 surgical procedures performed in the elderly, between 2013 and 2015. Data were collected from the surgical information system of the institution under study. Results: The age range was between 60 and 70 years of age; the highest average anesthesia recovery time was between 71 and 80 years. The specialties that performed the most procedures were: orthopedics, urology and ophthalmology. The most commonly used anesthesias were: general inhalation, intravenous, local with sedation and spinal; 37,3% used anesthesia, however the type was not described in the patient medical records. There were 1,140 deaths resulting from the procedures or complications; three of them occurred in the surgical center, while the others occured in the intensive care unit or ward. Conclusion: The data presented here reinforce the need for new models of care, with improvements in geriatric multidisciplinary care, in perioperative care for the elderly


Objetivo: Identificar la prevalencia de los procedimientos quirúrgicos realizados en ancianos en un centro quirúrgico de un hospital público del interior del estado de São Paulo y caracterizar tales procedimientos. Método: Estudio transversal, retrospectivo, cuantitativo. La muestra constató de 7.483 procedimientos quirúrgicos en ancianos, realizados entre 2013 y 2015. Los datos fueron recolectados a partir del sistema de cirugía de la institución sede del estudio. Resultados: El grupo de edad en el que prevalecieron los procedimientos fue entre 60 y 70 años de edad; la mayor media de tiempo para la recuperación de la anestesia fue entre 71 y 80 años. Las especialidades que más realizaron procedimientos fueron: ortopedia, urología y oftalmología. Las anestesias más empleadas fueron: general inhalatoria, endovenosa, local con sedación y raquídea; 37,3% usaron el servicio de anestesia, pero no estaba descrito en prontuario cuál fue el tipo de anestesia realizada. Las muertes derivadas de los procedimientos o complicaciones de las cirugías fueron 1.140; Y tres de ellos ocurrieron en el centro quirúrgico y los demás, en enfermerías o unidades de cuidados intensivos. Conclusión: Los datos aquí presentados refuerzan la necesidad de nuevos modelos de asistencia, con mejoras de la asistencia multidisciplinaria geriátrica, en la atención perioperatoria a los pacientes ancianos.


Assuntos
Pessoa de Meia-Idade , Idoso , Cirurgia Geral , Idoso , Análise Quantitativa , Anestesia
7.
Stud Health Technol Inform ; 262: 15-18, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349254

RESUMO

Access to mentors for education in surgical subspecialties is a challenge in many hospitals. Videoconferencing (VC) provides real-time communication between mentors and mentees despite dispersed geographical locations. In Norway, an educational pathway of a specific laparoscopic surgical procedure was carried out using VC. The surgical training lasted for three months and was video recorded. The dataset covers the educational procedure, constituting of a trajectory of eight patient cases. During a model of stepwise distancing of the physical presence of the mentor, the collaborative work using VC leads the mentee to become an expert. VC is a tool for both collaboration and representation, as the picture on the VC offers the same information to both the mentor and the mentee. The communication is characterized by guidance and explanations of why specific actions are necessary for problem-solving. The use of VC was a presumption for becoming an expert in this procedure.


Assuntos
Cirurgia Geral , Mentores , Videoconferência , Comunicação , Cirurgia Geral/educação , Humanos , Aprendizagem , Noruega
8.
Adv Exp Med Biol ; 1156: 49-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338777

RESUMO

Technology for developing three-dimensional (3D) virtual models in anatomical sciences education has seen a great improvement in recent years. Various data used for creating stereoscopic virtual models have also been constantly improving. This paper focuses specifically on the methodologies of creating stereoscopic virtual models and the techniques and materials used in developing stereoscopic virtual models from both our previous studies and other published literature. The presentation and visualization of stereoscopic models are highlighted, and the benefits and limitations of stereoscopic models are discussed. The practice of making 3D measurements on the lengths, angles, and volumes of models can potentially be used to help predict typical measurement parameters of anatomical structures and for the placement of surgical instruments. Once stereoscopic virtual models have been constructed, their visualization and presentation can be implemented in anatomy education and clinical surgical trainings.


Assuntos
Anatomia , Percepção de Profundidade , Cirurgia Geral , Imagem Tridimensional , Modelos Anatômicos , Anatomia/educação , Anatomia/métodos , Cirurgia Geral/educação , Humanos , Imagem Tridimensional/métodos
9.
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267899

RESUMO

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.


Assuntos
Tratamento de Emergência/métodos , Cirurgia Geral/organização & administração , Avaliação de Resultados (Cuidados de Saúde) , Transferência de Pacientes/organização & administração , Qualidade da Assistência à Saúde , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Relações Interinstitucionais , Tempo de Internação , Masculino , Maryland , Estudos Retrospectivos , Contrato de Transferência de Pacientes
12.
Am Surg ; 85(6): 606-610, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267901

RESUMO

The objective of this study was to assess the results of a structured remediation program for surgical residents scoring poorly on the American Board of Surgery In-Training Examination®. Residents scoring below the threshold (<20th percentile) were placed in a remediation program consisting of textbook-based review and mandatory weekly quizzes overseen by the program director. The effects of the program were assessed over a five-year period (2014-2018). Of 168 tests taken, 23 (13.7%) instances of scoring below the threshold occurred (average percentile 11, range 1-19). Postremediation scores in the subsequent year improved with a median (IQR) percentile increase of 29 [23.5, 46] (P < 0.001). Two residents scored below the threshold twice; all others continued to score above the threshold. Participation in a structured remediation program results in dramatic improvement in American Board of Surgery In-Training Examination® performance, and a single occurrence of poor performance does not necessarily lead to a permanent handicap in academic performance.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Ensino de Recuperação/organização & administração , Adulto , Currículo , Bases de Dados Factuais , Avaliação Educacional , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(Suppl. 2b): 267-267, Jun. 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1014949

RESUMO

INTRODUÇÃO: A cirurgia de revascularização do miocárdio (CRM) é considerada uma das escolhas de tratamento para aliviar sintomas, melhorar qualidade de vida e diminuir mortalidade de pacientes com doença arterial coronariana. O procedimento cirúrgico é considerado de alta complexidade e acomete a função pulmonar levando a complicações no pós-operatório. Com isso, o objetivo do estudo foi verificar a relação entre os valores espirométricos e a força muscular inspiratória com possíveis complicações peri e pós-operatórias da CRM. MÉTODO: Estudo observacional longitudinal com pacientes recrutados na fila de revascularização do miocárdio eletiva. Incluídos pacientes clinicamente estáveis, ambos os sexos, idade acima de 18 anos e excluídos condições psiquiátricas ou neurocognitivas que impeçam a obtenção de dados clínicos e/ou com problemas músculo-esqueléticos e aqueles que não concordaram com o termo de consentimento. A coleta de dados foi dividida em etapa pré-operatória, intra-operatória e pós-operatória. Avaliados espirometria, força muscular inspiratória, dados referente à cirurgia, e intercorrências peri e pós-operatórias. ANÁLISE ESTATÍSTICA: As variáveis quantitativas foram expressas em média e desvio padrão, e as variáveis qualitativas pela frequência absoluta e porcentagem. Para a comparação entre os grupos para as variáveis quantitativas foi usado o teste t-Student, quando houve suposição de normalidade foi utilizado o teste de Kolmogorov-Smirnov. Caso a suposição seja rejeitada foi utilizado o teste de Mann-Whitney. Para verificar a associação entre variáveis categóricas utilizou o teste exato de Fisher ou Qui-quadrado, e foi calculada a estimativa de odds ratio. O nível de significância adotado foi de 5%. RESULTADOS: Elegíveis 97 participantes e excluídos 45, restando 52 participantes, no qual 27 apresentaram algum tipo de complicação ou foram a óbito. Identificou-se como preditores de complicações e mortalidade intra-hospitalar valores espirométricos pré-operatórios abaixo do predito do volume expirado forçado no primeiro segundo (VEF1) com p=0,035 e capacidade vital forçada (CVF) com p=0,0001, e valores reduzidos de força muscular inspiratória (p=0,01). CONCLUSÃO: O presente estudo identificou como preditores de complicações e mortalidade intra-hospitalar, valores espirométricos pré-operatórios abaixo do predito (VEF1 e CVF) e valores reduzidos de força muscular inspiratória. (AU)


Assuntos
Humanos , Cirurgia Geral , Força Muscular , Revascularização Miocárdica
15.
Handchir Mikrochir Plast Chir ; 51(3): 193-198, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31167280

RESUMO

BACKGROUND: The national competency-based catalogue of learning objectives in surgery (NKLC) for undergraduate surgical education in Germany consists of 230 objectives and defines competence levels for each objective. These levels range from "competence level 1: factual knowledge" to "competence level 3: independent action". The German second state examination is not based on these objectives, although it is known that assessment drives learning. This study analyses the proportion of hand surgery-based learning objectives in the NKLC and compares the results with the hand surgery questions of the German second medical licensing examination compiled by the Central German Institute for Medical and Pharmaceutical Examinations (IMPP). METHODS: Hand surgery teaching objectives in the NKLC were identified by five hand surgeons. All exam questions addressing these objectives were identified in the German second medical licensing examinations held from autumn 2009 through autumn 2014 (n = 11). The analysis included the number of hand surgery questions for each examination, the number of learning objectives and the different levels of competence. RESULTS: Forty-seven learning objectives of the NKLC were identified as "hand surgery-related" (20.4 % of all NKLC learning objectives). Nine of them were classified as learning objectives that were "only covered by hand surgery" (3.9 % of all NKLC learning objectives). Two hundred and twenty questions (6.3 % of the total number of 3480 questions) addressed hand surgery-related objectives. Per exam, an average of 20 ± 8.2 questions (minimum: 9; maximum: 37) addressed a hand surgery-related learning objective. An average of 0.5 ± 0.7 questions per exam were related to objectives that only covered hand surgery (minimum: 0; maximum: 2). During the study period, 16 learning objectives were not tested at all (13.7 % of all NKLC learning objectives). These untested objectives included 5 objectives of competence level 1 (10.6 % of all NKLC learning objectives). Six of the 9 objectives that are only covered by hand surgery were not assessed at all. CONCLUSIONS: The number of hand surgery-based learning objectives in the NKLC appears to be high. However, many of these learning objectives are not addressed in the second medical licensing examination. We recommend better adjustments between the state examinations and the NKLC.


Assuntos
Currículo , Educação de Graduação em Medicina , Cirurgia Geral , Licenciamento , Competência Clínica , Cirurgia Geral/educação , Alemanha , Metas , Mãos/cirurgia , Humanos
16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46516

RESUMO

Site da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço


Assuntos
Cabeça , Pescoço , Cirurgia Geral
17.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46518

RESUMO

Site da Sociedade Brasileira de Cirurgia Pediátrica


Assuntos
Cirurgia Geral , Pediatria , Saúde da Criança
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