Rev Col Bras Cir
· 2024 · PMID 38597571
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PURPOSE: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. METHODS: continuou...PURPOSE: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. METHODS: continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it's validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. RESULTS: 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture's surgical management, which increased the severe complications' incidence (p=0.005). CONCLUSION: the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.
Rev Col Bras Cir
· 2024 · PMID 38324886
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The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providi...The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
Rev Col Bras Cir
· 2024 · PMID 38198355
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INTRODUCTION: medical training should provide the future professional, in addition to theoretical knowledge, general and specific skills. In urology, urogenital training simulators have been presented as an ally in impro...INTRODUCTION: medical training should provide the future professional, in addition to theoretical knowledge, general and specific skills. In urology, urogenital training simulators have been presented as an ally in improving the degree of confidence and development of competencies for undergraduate medical students. METHODS: exploratory descriptive research with a quantitative approach, of an experimental nature, of the randomized controlled type with cross-sectional cut. Conducted with the students of the 4th year of medicine of a Higher Education Institution in the West of Paraná. RESULTS: 91 students attended a theoretical class with a complete explanation of the activities to be performed and answered the initial questionnaire about the degree of confidence to perform tasks in three stations with male urogenital training simulators (prostatic touch, bladder catheterization and scrotal evaluation). Of these, 45 received guidance and training with the simulators prior to the stations, while 46 should demonstrate skills directly in the three stations, mimicking patient care, only with information from the theoretical classes. The students who received previous guidance with the simulators had their scores in the development of competence higher. And, when they repeated the questionnaire about the degree of confidence to demonstrate skills with the mannequins, there was a higher degree of confidence in performing the tasks, except for the execution of a task considered more difficult. CONCLUSION: there was an improvement in the degree of confidence and in the development of competencies of undergraduate medical students with the orientations in the male urogenital training simulators.
Messias BA, Almeida PL, Ichinose TMS
… +5 more, Mocchetti ÉR, Barbosa CA, Waisberg J, Roll S, Ribeiro Junior MF
Rev Col Bras Cir
· 2023 · PMID 38088634
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INTRODUCTION: it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this...INTRODUCTION: it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. METHOD: Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. RESULT: 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). CONCLUSION: Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
Rev Col Bras Cir
· 2023 · PMID 38055551
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Progress Testing (PT) is an assessment tool whose use has grown throughout Brazil in the last decade. PT makes it possible to assess the students' knowledge gain throughout the undergraduate course and, for their interpr...Progress Testing (PT) is an assessment tool whose use has grown throughout Brazil in the last decade. PT makes it possible to assess the students' knowledge gain throughout the undergraduate course and, for their interpretations to be valid, their items (questions) must have adequate quality from the point of view of content validity and reliability of results. In this study, we analyzed the psychometric characteristics of the items and the performance of students in the content area of surgery from 2017 to 2023. For the analyses, we used the assumptions of Classical Test Theory, Bloom's taxonomy and Cronbach's alpha reliability coefficient. The items were easy (average difficulty index between 0.3-0.4), with fair to good discrimination (discrimination index between 0.3-0.4) and with a predominance of medium to high taxonomy. Reliability remained substantial over the years (>0.6). Students' knowledge gain in surgery was found to be progressive and more important from the 3rd year of the undergraduate course, reaching approximately 70-75% in the 6th year. This measurements framework can be replicated in other contexts for a better understanding of student learning and for qualification of evaluation processes.
Ribeiro Junior MAF, Smaniotto R, Gebran A
… +4 more, Zamudio JP, Mohseni S, Rodrigues JMDS, Kaafarani H
Rev Col Bras Cir
· 2023 · PMID 38055550
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INTRODUCTION: the ability of the care team to reliably predict postoperative risk is essential for improvements in surgical decision-making, patient and family counseling, and resource allocation in hospitals. The Artifi...INTRODUCTION: the ability of the care team to reliably predict postoperative risk is essential for improvements in surgical decision-making, patient and family counseling, and resource allocation in hospitals. The Artificial Intelligence (AI)-powered POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator represents a user-friendly interface and has since been downloaded in its iPhone and Android format by thousands of surgeons worldwide. It was originally developed to be used in non-traumatic emergency surgery patients. However, Potter has not been validated outside the US yet. In this study, we aimed to validate the POTTER calculator in a Brazilian academic hospital. METHODS: mortality and morbidity were analyzed using the POTTER calculator in both trauma and non-trauma emergency surgery patients submitted to surgical treatment between November 2020 and July 2021. A total of 194 patients were prospectively included in this analysis. RESULTS: regarding the presence of comorbidities, about 20% of the population were diabetics and 30% were smokers. A total of 47.4% of the patients had hypertensive prednisone. After the analysis of the results, we identified an adequate capability to predict 30-day mortality and morbidity for this group of patients. CONCLUSION: the POTTER calculator presented excellent performance in predicting both morbidity and mortality in the studied population, representing an important tool for surgical teams to define risks, benefits, and outcomes for the emergency surgery population.
Rev Col Bras Cir
· 2023 · PMID 38055549
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OBJECTIVES: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence...OBJECTIVES: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence of the lesion. METHODS: a cross-sectional, observational, retrospective study of patients submitted to cold knife conization (CKC) or the loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2 or 3. The colposcopic lesion size, age, surgical method, involvement of the surgical margins, and p16/Ki-67 immunomarker expression were analyzed in relation to lesion persistence and recurrence. RESULTS: seventy-one women were treated with cold knife conization and 200 were treated with loop electrosurgical excision. Of these, 95 had cervical intraepithelial neoplasia 2, 173 had cervical intraepithelial neoplasia 3, 183 had free surgical margins, 76 had compromised margins, and 12 showed damage by processing artifact or fragments. Among the 76 cases with positive margins, 55, 11, and 10 showed endocervical margin involvement, ectocervical margin involvement, and both endocervial and ectocervical margin involvement, respectively. Of the 264 followed-up patients, 38 had persistent or recurrent disease. A multiple logistic regression indicated that positive endocervical margins are the only independent risk factor for the persistence/recurrence of cervical intraepithelial neoplasia. No significant association was identified between the colposcopic lesion size, age, surgery type, or p16/Ki-67 immunomarker expression and lesion persistence or recurrence.
Rev Col Bras Cir
· 2023 · PMID 37991064
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INTRODUCTION: the persistence of long-term symptoms of COVID-19 represents a new challenge for the medical-scientific community, it is the condition called long-term COVID-19. Irritable Bowel Syndrome (IBS) is one of the...INTRODUCTION: the persistence of long-term symptoms of COVID-19 represents a new challenge for the medical-scientific community, it is the condition called long-term COVID-19. Irritable Bowel Syndrome (IBS) is one of the most common Disorders of the Gut-Brain Interaction and its post-infection development is already validated. According to the Rome IV criteria, it is characterized by the presence of recurrent abdominal pain, on average, at least 1 day a week in the last 3 months with onset of symptoms at least 6 months before diagnosis, associated with 2 or more factors: related to defecation and/or associated with change in stool frequency and/or associated with change in stool form. This study aimed to review data on post-COVID-19 IBS. METHODS: this is an integrative review of studies published between January 1, 2020 and April 30, 2023, which presented data on IBS with previously diagnosed COVID-19 disease. The PubMed database was used, the descriptors were "Irritable bowel syndrome" AND "COVID-19"; the reference list of the articles was also retrieved. RESULTS: eight studies were reviewed, it was observed that 0.6% to 11.6% of patients had IBS again after a minimum period of 6 months of infection. Risk factors were female gender, severity of COVID-19, presence of acute-phase gastrointestinal symptoms, and depression/anxiety. CONCLUSION: the results obtained suggest that COVID-19 may be associated with the emergence of de novo IBS. Further studies are needed to investigate its long-term effects and clinical spectra.
Rev Col Bras Cir
· 2023 · PMID 37991063
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INTRODUCTION: historically, surgical medical specialties are mostly male, a scenario which, in recent years, has undergone changes. In this sense, despite the relevance of the growth of female participation in the medica...INTRODUCTION: historically, surgical medical specialties are mostly male, a scenario which, in recent years, has undergone changes. In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country. OBJECTIVE: discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties. METHODS: this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics. RESULTS: males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female. CONCLUSION: it is evident that female participation in the surgical medical field has increased significantly over the last few years.
Rev Col Bras Cir
· 2023 · PMID 37991062
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INTRODUCTION: Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A...INTRODUCTION: Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. METHODS: patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. RESULTS: while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. CONCLUSION: this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.
Rev Col Bras Cir
· 2023 · PMID 37971116
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OBJECTIVE: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. METHODS: a cross-sectional study was conducted with 94 pati...OBJECTIVE: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. METHODS: a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. RESULTS: all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. CONCLUSION: the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.
Gonçalves HS, Rezende ML, Cunha IVDS
… +3 more, Cesar AS, Cabral FLD, Trindade LMDF
Rev Col Bras Cir
· 2023 · PMID 37971115
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INTRODUCTION: thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can be superficial or immediately lifeth...INTRODUCTION: thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can be superficial or immediately lifethreatening for victims. In Brazil, most assistance is due to urban violence. OBJECTIVE: evaluate the clinical and epidemiological aspect of patients who are victims of thoracic trauma treated at Hospital de Urgência de Sergipe, Aracaju/SE, Brazil. METHOD: cross-sectional, observational and prospective study, carried out for eleven months, with 100 polytraumatized patients. A semi-structured form was applied, and the data were systematized, analyzed and statistically tested considering a 5% margin of error. Results: 85% of the patients were male, with a mean age of 39.3 and an age range of 30 to 49 years; 57% of them had incomplete primary education, 70% had a family income of up to 2 minimum wages and 41% were from Greater Aracaju. As for the mechanism of trauma, 33% were car-related, with blunt trauma as the main mechanism, and rib fractures as the main consequence. Among penetrating injuries, CWI (26%) and GSW (21%) were the most prevalent, with hemothorax being the main consequence. Most patients underwent thoracostomy (59%). CONCLUSION: the profile found was of young men, victims of urban violence. The thoracostomy was resolving in most cases and should be instituted promptly when necessary. A smaller number of patients may require thoracotomy, especially in the presence of hemodynamic instability.
Rev Col Bras Cir
· 2023 · PMID 37971114
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BACKGROUND: training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for...BACKGROUND: training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers. METHODS: we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9. RESULTS: the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing. CONCLUSION: the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.
Paiva RA, Queiroz FL, França Neto PR
… +5 more, Costa BXMD, Cardoso LAB, Estrada DML, Mota FFD, Lacerda Filho A
Rev Col Bras Cir
· 2023 · PMID 37851759
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INTRODUCTION: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in pr...INTRODUCTION: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy. METHODS: prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy. RESULTS: In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001. CONCLUSIONS: the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.
Rev Col Bras Cir
· 2023 · PMID 37851758
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INTRODUCTION: Surgical site infections are one of the main problems related to health care. In Brazil, they are responsible for 14 to 16% of infections related to health care. This study sought to analyze the effect of i...INTRODUCTION: Surgical site infections are one of the main problems related to health care. In Brazil, they are responsible for 14 to 16% of infections related to health care. This study sought to analyze the effect of implementing a package of measures to reduce surgical site infections (SSI) in heart surgeries, kidney transplants and herniorrhaphies and to evaluate adherence to the safe surgery checklist in a university hospital. METHODS: this is a retrospective cohort study with data collection in a time series for the period from 2018 to 2020. RESULTS: we analyzed 222 medical records referring to the surgeries under study performed in the year 2020, in which data were collected from the patients and the care package prevention measures. SSI data and adherence to the safe surgery checklist were analyzed in the years 2018, 2019 and 2020, totaling 268, 300 and 222 procedures analyzed, respectively. CONCLUSION: the study showed a significant reduction in the SSI rate with greater adherence to the protocol, which was not maintained and was influenced by the COVID-19 pandemic. Thus, the sustainability of this action represents a challenge to be overcome, in order to establish a safer environment for the patient and a better quality of service.