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1.
Prensa méd. argent ; 105(9 especial): 526-531, oct 2019. tab, fig
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046381

RESUMO

In the case of lung cancer, surgery is the only method of therapy that gives the patient a chance to recover. However, even after radical surgery, up to 50 ­ 60 % of patients die in the subsequent five years from the disease progression. This study was aimed at identifying the technical particularities of surgery, depending on the side of the lung affected by a tumor and the possibility of applying the methods that improve the results of surgical therapy. The study was performed at the Thoracic Department of the Republican Clinical Oncology Dispensary in Ufa and the 1st Surgical Department of the Regional Oncology Center of the Regional Clinical Hospital in Khanty- Mansiysk. The study involved a total of 156 patients (including 148 male and eight female patients). The main result of the study has been the confirmation of the advantages of bronchoplastic surgery, which do not increase post-surgery mortality and improve the post-surgery period, and the relevant principles of preserving surgery.


Assuntos
Humanos , Cirurgia Geral/métodos , Procedimentos Cirúrgicos Operatórios/mortalidade , Mortalidade , Neoplasias Pulmonares/cirurgia
2.
Anesthesiol Clin ; 37(3): 411-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337475

RESUMO

The decision to offer surgery to an older adult with medical comorbidities involves candid conversations between the surgeon, patient, and caregivers. Tools are available to physicians that facilitate patient empowerment. Beyond short-term risks, the conversation should include the potential for institutional discharge, functional and cognitive decline, and longer term mortality.


Assuntos
Cirurgia Geral/métodos , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Idoso , Idoso de 80 Anos ou mais , Anestesiologistas , Humanos , Complicações Pós-Operatórias/prevenção & controle , Cirurgiões
3.
Anesthesiol Clin ; 37(3): 493-505, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337480

RESUMO

Older people are the fastest growing segment of the population and over-represented among people requiring emergency general surgery. Independent of comorbid and procedural factors, perioperative risk increases with increasing age. This effect is amplified with frailty or sarcopenia. Multidisciplinary perioperative care aligned with goals of care is most likely to achieve optimal patient and health system outcomes; however, substantial knowledge gaps exist in emergency general surgery for older people. Anesthesiologists are uniquely positioned to address these knowledge gaps, including optimizing goal-directed intraoperative care, appropriate provision of acute postoperative monitoring, and integration of principles of geriatric medicine in perioperative care.


Assuntos
Serviços Médicos de Emergência/métodos , Cirurgia Geral/métodos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Anestesiologistas , Humanos , Assistência Perioperatória
4.
Surgery ; 166(4): 489-495, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31326186

RESUMO

BACKGROUND: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes. RESULTS: Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59-3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12-2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01-1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65-2.61). CONCLUSION: After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.


Assuntos
Emergências , Cirurgia Geral/métodos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Vida Independente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Estados Unidos
5.
Plast Reconstr Surg ; 144(2): 298e-305e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348370

RESUMO

BACKGROUND: The prevalence of burnout is increasing among all physicians, including plastic surgeons. Burnout is not simply synonymous with being overworked. It is a complex physical, intellectual, and psychological entity that arises when the expectation and reality of the job do not match. In this article, the authors' goal is to define burnout, summarize its causes and consequences, and offer the plastic surgeons methods to prevent and address it. METHODS: A literature search of articles on burnout in medicine was performed. Articles that were relevant were selected, and were qualitatively analyzed to answer our questions on the definition, prevalence, causes, consequences, and treatments of burnout. RESULTS: Sixty-five relevant articles were included. The prevalence of burnout among physicians ranges between 29 and 55 percent. Risk factors for physician burnout include increased workload and call, junior academic rank, and fair physician health. There is significant overlap among burnout, depression, and substance abuse, and suicide is much more common among physicians than among the general population. Preventing burnout involves a multiprong approach that addresses the physical, intellectual, and psychological dimensions of the physician. CONCLUSIONS: In this article, concrete steps to prevent and address burnout are presented to plastic surgeons. For physicians, the most important elements for burnout avoidance are the prevention of emotional exhaustion, and the development of professional autonomy and control.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgiões/psicologia , Cirurgia Plástica/efeitos adversos , Carga de Trabalho/psicologia , Adulto , Feminino , Cirurgia Geral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Medição de Risco , Estresse Psicológico , Cirurgia Plástica/métodos , Estados Unidos
6.
Chin Med Sci J ; 34(2): 103-109, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31315751

RESUMO

With the continuous progress of virtual simulation technology, medical surgery visualization system has been developed from two-dimensional to three-dimensional, from digital to network and intelligentization. The visualization system with mixed reality technology will also be used in all stage of medical surgery, such as case discussion, surgical planning, intraoperative guidance, post-operative evaluation, rehabilitation, so as to further promote high intelligence, high precision of medical surgery, and consequently improve effectiveness of treatment and quality of medical service. This paper discusses the composition and technical characteristics of medical operation visualization system based on mixed reality technology, and introduces some typical applications of mixed reality technology in medical operation visualization, which provides a new perspective for the application of mixed technology in medical surgery.


Assuntos
Tecnologia Biomédica/métodos , Simulação por Computador , Cirurgia Geral/métodos , Realidade Aumentada , Humanos , Imagem Tridimensional
7.
Thorac Surg Clin ; 29(3): 329-337, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31235302

RESUMO

Virtual reality and augmented reality technologies have evolved with a growing presence in both clinical care and surgical training.


Assuntos
Cirurgia Geral/educação , Planejamento de Assistência ao Paciente , Treinamento por Simulação/métodos , Realidade Virtual , Cirurgia Geral/métodos , Humanos
8.
J Grad Med Educ ; 11(3): 328-331, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210866

RESUMO

Background: Improvements in personal technology have made video recording for teaching and assessment of surgical skills possible. Objective: This study compared 5 personal video-recording devices based on their utility (image quality, hardware, mounting options, and accessibility) in recording open surgical procedures. Methods: Open procedures in a simulated setting were recorded using smartphones and tablets (MOB), laptops (LAP), sports cameras such as GoPro (SC), single-lens reflex cameras (DSLR), and spy camera glasses (SPY). Utility was rated by consensus between 2 investigators trained in observation of technology using a 5-point Likert scale (1, poor, to 5, excellent). Results: A total of 150 hours of muted video were reviewed with a minimum 1 hour for each device. Image quality was good (3.8) across all devices, although this was influenced by the device-mounting requirements (4.2) and its proximity to the area of interest. Device hardware (battery life and storage capacity) was problematic for long procedures (3.8). Availability of devices was high (4.2). Conclusions: Personal video-recording technology can be used for assessment and teaching of open surgical skills. DSLR and SC provide the best images. DSLR provides the best zoom capability from an offset position, while SC can be placed closer to the operative field without impairing sterility. Laptops provide best overall utility for long procedures due to video file size. All devices require stable recording platforms (eg, bench space, dedicated mounting accessories). Head harnesses (SC, SPY) provide opportunities for "point-of-view" recordings. MOB and LAP can be used for multiple concurrent recordings.


Assuntos
Cirurgia Geral/instrumentação , Cirurgia Geral/métodos , Gravação em Vídeo/instrumentação , Competência Clínica/normas , Computadores de Mão , Educação Médica/métodos , Humanos , Fotografação/instrumentação , Fotografação/métodos , Smartphone , Estudantes de Medicina , Gravação em Vídeo/métodos
9.
Surgery ; 166(1): 82-87, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31036332

RESUMO

BACKGROUND: Aging populations have led to increasing numbers of seniors presenting for emergency surgery. Older patients are at a higher risk of postoperative complications, prolonged hospitalization, and increased institutionalization. We hypothesized that increased frailty would be a risk factor for increased health care costs in elderly surgical patients who have undergone emergency abdominal surgery. METHODS: A prospective cost analysis of emergency general surgery patients 65 years of age and older was conducted. Demographic and clinical characteristics were obtained. Preadmission Clinical Frailty Scale score and Clavien-Dindo postoperative complications were collected. Patients were followed for 6 months after discharge. Hospitalization costs were calculated using the Alberta Health Services (AHS) microcosting database; other costs were obtained from Alberta Health Services and Alberta Health databases. The primary outcome was total insured cost (2016 Can$). Multivariate generalized linear regression of log-transformed costs was conducted. RESULTS: Overall, 321 patients were enrolled. Mean age was 76.1 years (standard deviation 7.8), median Clinical Frailty Scale was 3, mean length of stay was 15.9 days (standard deviation 23.4), and 48% suffered a complication. Median total insured cost was Can$18,021 and median total cost was Can$26,739. Multivariate analysis found American Society of Anesthesiologists score (adjusted ratio [AR] = 1.24, P = .001), CFS (AR = 1.27, P < .001), major complications (AR = 2.11, P < .001), and minor complications (AR = 1.48, P < .001) lead to increased total insured costs. CONCLUSION: Costs increased-after adjusting for age, comorbidities, and preadmission function as frailty-and American Society of Anesthesiologists score increased if minor or major complications occurred. The detection of frailty represents an opportunity to target risk-reduction strategies and interventions to improve outcomes and decrease cost.


Assuntos
Análise Custo-Benefício/economia , Fragilidade/mortalidade , Cirurgia Geral/economia , Cirurgia Geral/métodos , Tempo de Internação/economia , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos de Coortes , Tratamento de Emergência , Feminino , Avaliação Geriátrica , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
10.
J BUON ; 24(1): 410-414, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30942005

RESUMO

Guy de Chauliac, the most famous surgeon of the middle age, influenced the practice of surgery for centuries. His landmark work, in seven treatises, "Chirurgia Magna" was translated from Latin to French and became popular across Europe, educating hundreds of surgeons. In his book, a series of text fragments were dedicated in cancer such as breast tumor removal, amputation for soft tissue carcinomas of the extremities and cancer treatment using arsenic. Chauliac was probably the first physician to suggest the excision of cancer at early stage and this is considered as a promoter of surgical oncology.


Assuntos
Cirurgia Geral/métodos , Oncologia/métodos , Cirurgiões , História Medieval , Humanos
11.
Nutrients ; 11(4)2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31010007

RESUMO

Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol (n = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; p < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group (p = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.


Assuntos
Cirurgia Geral/métodos , Tempo de Internação , Desnutrição/diagnóstico , Programas de Rastreamento , Avaliação Nutricional , Estado Nutricional , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Antropometria , Cuidados Críticos , Proteínas na Dieta/administração & dosagem , Doenças do Sistema Digestório/cirurgia , Ingestão de Alimentos , Comportamento Alimentar , Feminino , Humanos , Masculino , Desnutrição/complicações , Desnutrição/dietoterapia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Mortalidade , Neoplasias/cirurgia , Readmissão do Paciente , Transferência de Pacientes
13.
J Surg Res ; 239: ix-x, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31030888
14.
Surgery ; 166(2): 184-192, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30979427

RESUMO

BACKGROUND: Glucose variability is common among hospitalized patients, but the prognostic implications among patients hospitalized in surgical wards are unknown. The objective of this study was to investigate the association between glucose variability, length of stay, and mortality. METHODS: Historical prospectively collected data of patients ≥18 years of age, hospitalized in general surgery wards between January 2011 and December 2017. Glucose variability was assessed by coefficient of variance and standard deviation of glucose values during hospitalization. The main outcomes were length of stay and 30-day and end-of-follow-up mortality. RESULTS: The cohort included 8,894 patients (mean age 63 ± 19 years, 48% male, mean follow-up 3.0 ± 1.8 years). A total of 2,012 (23%) patients had diabetes mellitus. The mean length of stay was longer with a higher coefficient of variance or standard deviation in patients without and with diabetes mellitus. The 30-day mortality was 6%, associated with a higher versus a lower coefficient of variance (9% vs 3%) and standard deviation (9% vs 3%) in patients without diabetes mellitus and with diabetes mellitus (9% vs 5%; 8% vs 5%, respectively). Mortality at the end of follow-up was increased in patients without diabetes mellitus with a higher coefficient of variance (27% vs 18%) and standard deviation (29% vs 17%) and in patients with diabetes mellitus (33% vs 24% and 32% vs 21%, respectively). Multivariate analysis indicated an increased risk for 30-day and end-of-follow-up mortality, in both groups. Adjustment for glucocorticoid treatment or hypoglycemia did not affect the results. In patients with a high or low coefficient of variance, mortality was higher with median glucose levels during hospitalization ≥180 mg/dl, compared with <180 mg/dl. CONCLUSION: In patients with and without diabetes mellitus hospitalized in general surgery wards, increased glucose variability is associated with longer hospitalization and increased short-term and long-term mortality.


Assuntos
Glicemia/análise , Causas de Morte , Diabetes Mellitus/mortalidade , Cirurgia Geral/métodos , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diabetes Mellitus/sangue , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais
15.
Coluna/Columna ; 18(1): 51-54, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984323

RESUMO

ABSTRACT Objective: To evaluate the insertion torque and the pulling force of each screw with different diameters and tap. Methods: Polyurethane blocks with a pilot hole of 2.7 mm were used in the study. An experimental group with 5 blocks was formed, the insertion torque was evaluated with a torque meter, and the pullout strength of each Globus screw of 5.5 mm and 6.5 mm was assessed. Results: The comparison of the insertion torque on the 5.5 mm screws with pilot hole without tapping and with a smaller diameter than that of the screw (4.5 mm) and a different thread, and with the tapping with the same diameter as that of the screw (5.5 mm) and equal or different thread presented a statistical difference with a higher value of the insertion torque in the group in which the tapping was not performed. As for the pulling force of the 5.5 mm screw, the non-tapping of the pilot hole resulted in statistical difference with the same diameter of the screw (5.5 mm) and with a different thread of the screw. The pullout force on the 6.5 mm screw was higher in the group where the pilot hole was not tapped according to the non-parametric Kruskal-Wallis test, with significance level of p <0.05 in the comparison of the groups. Conclusions: Pilot hole tapping reduced insertion torque and pullout resistance of the pedicle screw influencing the fixation with tapping with the same screw diameter and different thread design.


RESUMO Objetivo: Avaliar o torque de inserção e a força de arrancamento de cada parafuso com diferentes diâmetros e machos. Métodos: Foram utilizados no estudo blocos de poliuterano com orifício piloto de 2,7mm, sendo feito um grupo experimentais com 5 blocos sendo avaliado o torque de inserção com torquímetro e avaliado o arrancamento de cada parafuso de parafusos Globus 5,5mm e 6,5mm. Resultados: A comparação do torque de inserção nos parafusos de 5,5mm entre a utilização de orifício piloto sem macheamento e o macheamento com diâmetro inferior ao diâmetro do parafuso (4,5mm) e rosca diferente, e com o macheamento com diâmetro igual do parafuso (5,5mm) e com rosca igual ou diferente apresentou diferença estatística com maior valor do torque de inserção no grupo em que o macheamento não foi realizado. Na força de arrancamento do parafuso 5.5mm o não macheamento do orifício piloto apresentou diferença estatística com o mesmo diâmetro do parafuso (5,5mm) e rosca diferente do parafuso. A força de arrancamento no parafuso 6,5mm foi maior no grupo em que o orifício piloto não foi macheado utilizando o teste não paramétrico de Kruskal Wallis com nível de significância adotado (p < 0,05) na comparação dos grupos. Conclusões: O macheamento do orifício piloto diminuiu o torque de inserção e resistência ao arrancamento do parafuso pedicular influenciando a fixação com macheamento com o mesmo diâmetro do parafuso e desenho de rosca diferente.


RESUMEN Objetivo: Evaluar el torque de inserción y la fuerza de extracción de cada tornillo con diferentes diámetros y machos. Métodos: Se utilizaron en el estudio bloques de poliuretano con agujero piloto de 2,7 mm. Se formó un grupo experimental con 5 bloques, y el torque de inserción se evaluó con llave de par y se analizó la fuerza de extracción de cada tornillo Globus de 5,5 mm e 6,5 mm. Resultados: La comparación del torque de inserción en los tornillos de 5,5 mm con agujero piloto sin taladramiento y con un diámetro más pequeño que el del tornillo (4,5 mm) y un roscado diferente, y con el taladramiento con el mismo diámetro que el del tornillo (5,5 mm) y con el roscado igual o diferente presentó una diferencia estadística con un valor más alto del torque de inserción en el grupo en el que no se realizó taladramiento. En cuanto a la fuerza de extracción del tornillo 5,5 mm el no taladramiento del agujero piloto resultó en una diferencia estadística solamente con el mismo diámetro del tornillo (5,5 mm) y con roscado diferente del tornillo. La fuerza de extracción en el tornillo de 6,5 mm fue mayor en el grupo que en el agujero piloto no tuvo taladramiento, de acuerdo con la prueba no paramétrica de Kruskal-Wallis, con nivel de significación de p < 0,05 en la comparación de los grupos. Conclusiones: El taladramiento del agujero piloto redujo el torque de inserción y la resistencia a la extracción del tornillo pedicular, lo que influye con la fijación con taladramiento con el mismo diámetro del tornillo e diferentes diseños de roscado.


Assuntos
Parafusos Ósseos , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Cirurgia Geral/métodos
16.
Surg Infect (Larchmt) ; 20(2): 139-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30628859

RESUMO

BACKGROUND: Abdominal infections following surgery have many severe consequences. Several effective, well-evaluated infection prevention and control processes exist to avoid these infections. METHODS: This manuscript reviews and provides supporting evidence for common management strategies useful to avoid postoperative abdominal infection. RESULTS: Prevention of abdominal infection begins with preparation of the environment using standard infection control practices. Peri-operative use of systemic antibiotics, an antibiotic bowel preparation in colorectal surgery, and effective antiseptic preparation of the surgical site all reduce infection rates. Peri-operative supplemental oxygenation, maintenance of core body temperature, and physiologic euglycemia will reduce both incisional and organ-space infections in the abdominal surgery patient. Strategic use of irrigation and drain placement may be useful in some circumstances. CONCLUSION: Specific methods of prevention are documented to reduce intra-abdominal infections. Prevention requires a multi-disciplinary team including the surgeon, anesthesiologist, and all operating room personnel.


Assuntos
Cirurgia Geral/métodos , Controle de Infecções/métodos , Infecções Intra-Abdominais/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos
17.
Br J Surg ; 106(2): e44-e52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620060

RESUMO

BACKGROUND: The field of global surgery has gained significant recent momentum, catalysed by the 2015 publication of the Lancet Commission on Global Surgery, Disease Control Priorities 3 and World Health Assembly resolution 68.15. These reports characterized the global burden of disease amenable to surgical care, called for global investment in surgical systems, and recognized surgery and anaesthesia as essential components of universal health coverage. METHODS: A strategy proposed to strengthen surgical care is the development of national surgical, obstetric and anaesthesia plans (NSOAPs). This review examined how NSOAPs could contribute to the achievement of sustainable development goals (SDGs) 1, 3, 5, 8, 9, 10, 16 and 17 by 2030, focusing on their potential impact on the healthcare systems in Ethiopia, Tanzania and Zambia. RESULTS: Due to the cross-cutting nature of surgery, obstetrics and anaesthesia, investing in these services will escalate progress to achieve gender equality, economic growth and infrastructure development. Universal health coverage will not be achieved without addressing the financial ramifications to the poor of seeking and receiving surgical care. NSOAPs provide a strategic framework and a data collection platform for evidence-based policy-making, accountability and implementation guidance. CONCLUSION: The development and implementation of data-driven NSOAPs should be recognized as a powerful road map to accelerate achievement of the SDGs by 2030.


Assuntos
Anestesiologia/métodos , Assistência à Saúde/métodos , Cirurgia Geral/métodos , Obstetrícia/métodos , Desenvolvimento Sustentável , Etiópia , Feminino , Saúde Global , Metas , Disparidades em Assistência à Saúde , Humanos , Recém-Nascido , Masculino , Gravidez , Melhoria de Qualidade , Tanzânia , Zâmbia
18.
Br J Surg ; 106(2): e34-e43, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620068

RESUMO

BACKGROUND: Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. METHODS: This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included. RESULTS: Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery. CONCLUSION: Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.


Assuntos
Tecnologia Biomédica/métodos , Assistência à Saúde/métodos , Difusão de Inovações , Cirurgia Geral/métodos , Assistência à Saúde/normas , Países em Desenvolvimento , Saúde Global , Humanos
19.
Surgery ; 165(5): 860-867, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30224084

RESUMO

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.


Assuntos
Anatomia Transversal/ética , Cirurgia Geral/ética , Ilustração Médica/história , Síndromes de Compressão Nervosa/cirurgia , Neuralgia/cirurgia , Adulto , Anatomia Transversal/história , Dissecação/ética , Dissecação/história , Feminino , Cirurgia Geral/métodos , História do Século XX , Holocausto , Humanos , Socialismo Nacional , Síndromes de Compressão Nervosa/complicações , Neuralgia/etiologia , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , II Guerra Mundial
20.
Surg Infect (Larchmt) ; 20(1): 10-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30300553

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) is an important surgical complication. Emergency general surgery (EGS) is a developing area of the acute care surgical practice. Few studies evaluating the incidence and risk factors of CDI in this patient population are available. PATIENTS AND METHODS: A prospectively maintained Acute and Critical Care Surgery registry spanning from 2008 to 2015 was queried for cases of operative EGS with clinical suspicion of CDI post-operatively. Diagnosis of CDI was made using toxin A/B assay in stools. Demographics, co-morbidities, surgical procedures, length of stay (LOS), intensive care unit LOS, antibiotic use, and death were obtained. The patients positive and negative for CDI were compared using chi-squared and Student's t-test. Multi-variable logistic regression was used to determine risk factors for CDI. RESULTS: A total of 550 patients were identified. The total incidence of CDI was 12.7%. There was no significant difference in demographics between CDI positive and negative patients. Average time to CDI diagnosis was 10.1 ± 8.5 days post-operatively. Patients who received three or more antibiotic classes were at higher risk of CDI developing post-operatively (83% vs. 75%, p = 0.04). The CDI positive patients underwent an EGS significantly earlier than CDI negative patients (0.9 ± 2.3 vs. 3.2 ± 9.2 days, p < 0.001). The most common procedures were partial colectomies (21.4%); small bowel resections/repairs (12.9%); gastric repair for perforated peptic ulcer (10%); skin and soft tissue procedure (7.1%), and laparotomies (5.7%). There was no difference in outcomes between the groups. On linear regression, an EGS performed later after admission was an independent risk factor for lower CDI (OR 0.87; CI 95% [0.79-0.96], p < 0.01). CONCLUSION: Patients undergoing an early EGS have a high incidence of CDI. The number of antibiotic classes administered post-operatively affects CDI status. Bowel resections appear to be at increased risk for CDI. Clinicians should have a high index of suspicion and low threshold for testing C. difficile in high-risk EGS patients.


Assuntos
Infecções por Clostridium/epidemiologia , Serviços Médicos de Emergência/métodos , Cirurgia Geral/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
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