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  1 / 32312 MEDLINE  
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[PMID]:29304127
[Au] Autor:Zhou Y; Wijewickrema S; Ioannou I; Bailey J; Kennedy G; Nestel D; O'Leary S
[Ad] Endereço:Department of Surgery (Otolaryngology), University of Melbourne, Melbourne, Australia.
[Ti] Título:Do experts practice what they profess?
[So] Source:PLoS One;13(1):e0190611, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We investigated the variation of drilled regions of expert and trainee surgeons performing virtual temporal bone surgery to identify their compliance with standard drilling procedures. To this end, we recruited seven expert and six trainee ENT surgeons, who were asked to perform the surgical preparations for cochlear implantation on a virtual temporal bone. The temporal bone was divided into six regions using a semi-automated approach. The drilled area in each region was compared between groups using a sign test. Similarity within groups was calculated as a ratio of voxels (3D points) drilled by at least 75% of surgeons and at least 25% of surgeons. We observed a significant difference between groups when performing critical tasks such as exposing the facial nerve, opening the facial recess, and finding the round window. In these regions, experts' practice is more similar to each other than that between trainees. Consistent with models of skills development, expertise and expert-performance, the outcome of the analysis shows that experts perform similarly in critical parts of the procedure, and do indeed practice what they profess.
[Mh] Termos MeSH primário: Cirurgia Geral/recursos humanos
Osso Temporal/cirurgia
[Mh] Termos MeSH secundário: Fidelidade a Diretrizes
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190611


  2 / 32312 MEDLINE  
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[PMID]:29391105
[Au] Autor:Showen A; Russell TA; Young S; Gupta S; Gibbons MM
[Ad] Endereço:University of California, Los Angeles, California, USA.
[Ti] Título:Hyperglycemia Is Associated with Surgical Site Infections among General and Vascular Surgery Patients.
[So] Source:Am Surg;83(10):1108-1111, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Surgical site infection (SSI) is a common cause of morbidity in general and vascular surgery patients. There is inconsistent evidence on the association of glycemic status with SSI, and its utility in predicting and mitigating SSI. General and vascular surgery patients at a public teaching hospital had the following markers of glycemic status prospectively collected: preoperative hemoglobin A1c (HbA1c) and capillary blood glucose (cBG, within six months before surgery), perioperative cBG (within 24 hours before surgery), and postoperative cBG (peak value up to 48 hours after surgery). Patient records were assessed for SSI within 30 days of surgery. Over a two-month period, 229 patients underwent surgery. The overall SSI rate was 9.6 per cent. Preoperative HbA1c >7 per cent and postoperative cBG ≥180 mL/dL occurred in 25.9 and 27.0 per cent of patients, respectively. Preoperative HbA1c >7 per cent was significantly associated with SSI [odds ratio (OR) 2.26, 80 per cent confidence interval (CI) 1.01-5.07], as was postoperative cBG ≥180 mg/dL (OR 2.12, 80 per cent CI 1.02-4.41). There was no significant correlation between preoperative or perioperative cBG and SSI. In conclusion, SSI and hyperglycemia were frequent among the study population, and positively associated. Glycemic status may be used for improved preoperative risk assessment, and as it is potentially mutable, to reduce SSI.
[Mh] Termos MeSH primário: Hiperglicemia/complicações
Infecção da Ferida Cirúrgica/etiologia
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Seguimentos
Cirurgia Geral
Seres Humanos
Hiperglicemia/diagnóstico
Razão de Chances
Período Pós-Operatório
Período Pré-Operatório
Estudos Prospectivos
Medição de Risco
Fatores de Risco
Infecção da Ferida Cirúrgica/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  3 / 32312 MEDLINE  
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[PMID]:29283526
[Au] Autor:Viesca C; Mariblanca RR
[Ti] Título:Vesalius: His Presence in New Spain.
[So] Source:Vesalius;22(1):43-62, 2016 Jun.
[Is] ISSN:1373-4857
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:In this paper we present a review of Mexican medical literature in the 16th and 17th centuries, analyzing the presence of Vesalius anatomical contributions and the conservation of Galen teachings in the official circles. We start with the anecdotal identification of don Carlos, son of Philip II, with Gregorio López, a hermit living in New Spain in the second half of the 16th century, as a legendary possibility of being a celebrated patient of Vesalius. After a short review of the birth and early diffusion of Vesalius anatomy in Spain, we analyze the early anatomical and surgical books written and published in New Spain; those of Alonso López de Hinojosos (1578, 1595), Agustín Farfán (1592), Juan de Barrios (1607), Gerónimo Bezerra and Diego Osorio y Peralta (1685), identifying their acceptance or negation of the validity of Vesalius' discoveries and the tensions existing between those two intellectual positions. In the following pages we will present and discuss the nature, dimensions and impact of Vesalius' Fabrica knowledge in the medical thought of Colonial Mexico.
[Mh] Termos MeSH primário: Anatomia/história
Cirurgia Geral/história
Livros de Texto como Assunto/história
[Mh] Termos MeSH secundário: Colonialismo
História do Século XVI
México
Espanha
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Ps] Nome de pessoa como assunto:Vesalius A; Lopez G; Lopez de Hinojosos A; Farfan A; de Barrios J; Bezerra G; Osorio y Peralta D
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:QIS
[Da] Data de entrada para processamento:171229
[St] Status:MEDLINE


  4 / 32312 MEDLINE  
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[PMID]:29283524
[Au] Autor:Van Hee R
[Ti] Título:The Influence of Vesalius' Fabrica on Surgery in the 16th & 17th century.
[So] Source:Vesalius;22(1):8-28, 2016 Jun.
[Is] ISSN:1373-4857
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:The innovation in anatomy, brought about by Andreas Vesalius1, particularly by means of his Fabrica, has had an important influence on the practice of surgery2. Various surgeons of the 16th and the 17th century have implemented different approaches in operative techniques, based on the anatomical knowledge drawn upon the Fabrica. Examples are given in this paper concerning Pierre Franco, Ambroise Paré, Giovanni Andrea della Croce, Girolamo Fabrici d'Acquapendente, Wilhelm Fabry von Hilden and Paul Barbette, who all, in one way or another, have proposed surgical techniques that required precise anatomical understanding, which was provided by the new Vesalian anatomy of the human body. The concept, adopted by many medico-historical scholars, that the anatomy of Vesalius had only limited repercussions on Modern Surgery, therefore needs reconsideration.
[Mh] Termos MeSH primário: Cirurgia Geral/história
Cirurgiões/história
Livros de Texto como Assunto/história
[Mh] Termos MeSH secundário: França
Alemanha
História do Século XVI
História do Século XVII
Seres Humanos
Itália
Países Baixos
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Ps] Nome de pessoa como assunto:Franco P; Pare A; della Croce GA; Fabrici d'Acquapendente G; Fabry von Hilden W; Barbette P; Vesalius A
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:QIS
[Da] Data de entrada para processamento:171229
[St] Status:MEDLINE


  5 / 32312 MEDLINE  
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[PMID]:29260213
[Ti] Título:The War Surgeon.
[So] Source:JAMA;318(23):2359, 2017 12 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Medicina Militar/história
Cirurgiões/história
[Mh] Termos MeSH secundário: Cirurgia Geral/história
História do Século XX
Seres Humanos
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.10499


  6 / 32312 MEDLINE  
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[PMID]:29239595
[Au] Autor:Darrow JJ
[Ti] Título:Explaining the absence of surgical procedure regulation.
[So] Source:Cornell J Law Public Policy;27(1):189-206, 2017.
[Is] ISSN:1069-0565
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Each year in the United States, surgeons perform approximately 64 million surgical procedures, ranging from tooth extraction to open heart surgery. Yet, notwithstanding the frequency of surgical procedures and their often critical importance to patient health, no state or federal agency either approves the use of new surgical procedures or directly regulates existing procedures. The absence of surgical procedure regulation differs from the regulation of new pharmaceutical products, which can be introduced into interstate commerce only after the Food and Drug Administration (FDA) has reviewed "adequate and well-controlled [clinical] investigations" and concluded the data from those studies sufficiently establish the drug's safety and efficacy. Surgical procedures, by contrast, are more often conveyed from professor to student, the result being that surgical approaches may vary considerably from one geographic region to another. Whether different techniques produce different outcomes is not always clear, in part because the absence of regulation means that evidence often has not been systematically generated or may be in a form not suitable for comparison. Commentators have noted the differing treatment that persists between surgery and pharmaceuticals and have offered a number of justifications. For example, they have suggested that the surgical profession should self-regulate, that excessive regulation could deter surgeries of unproven benefit even when the surgery may be in the best interest of the patient, and that surgical trials could disrupt the doctor-patient relationship, such as by emphasizing uncertainty in a context where patient trust is important. In the context of innovative (as opposed to established) surgical procedures, controlled trials might be disfavored due to concern that desperate patients might unwisely submit themselves to risky experimental treatments undertaken by overzealous researchers. When commentators advocate for increased surgical regulation, they generally limit their calls for reform to innovative surgical procedures. The absence of direct regulation, however, has implications for the quality of evidence available to support an optimal choice from among all of the alternatives in the surgeon's armamentarium, whether innovative or standard, and whether surgical or non-surgical. This Article first examines the current framework of indirect regulation surrounding surgical procedures and then offers potential explanations as to why surgical procedures themselves are not already subject to direct federal regulation. Finally, it considers possible contributions of increased surgical regulation, including the identification of evidence gaps, the generation or collection of evidence to fill those gaps, and the impact on surgeon decision-making and patient consent.
[Mh] Termos MeSH primário: Cirurgia Geral/normas
Regulamentação Governamental
Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência
[Mh] Termos MeSH secundário: Credenciamento
Seres Humanos
Privilégios do Corpo Clínico
Ensaios Clínicos Controlados Aleatórios como Assunto
Procedimentos Cirúrgicos Operatórios/normas
Terminologia como Assunto
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE


  7 / 32312 MEDLINE  
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[PMID]:28448382
[Au] Autor:Ibrahim AM; Lillemoe KD; Klingensmith ME; Dimick JB
[Ad] Endereço:*Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI †Department of Surgery, Massachusetts General Hospital, Boston, MA ‡Department of Surgery, Washington University School of Medicine, St. Louis, MO.
[Ti] Título:Visual Abstracts to Disseminate Research on Social Media: A Prospective, Case-control Crossover Study.
[So] Source:Ann Surg;266(6):e46-e48, 2017 Dec.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pesquisa Biomédica
Cirurgia Geral
Publicações Periódicas como Assunto
Mídias Sociais
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002277


  8 / 32312 MEDLINE  
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[PMID]:28464985
[Au] Autor:Smink DS
[Ad] Endereço:Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: dsmink@partners.org.
[Ti] Título:Why training in nontechnical skills is essential.
[So] Source:Surgery;162(1):182, 2017 07.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Cirurgia Geral/educação
Equipe de Assistência ao Paciente/organização & administração
Treinamento por Simulação/organização & administração
[Mh] Termos MeSH secundário: Adaptação Psicológica
Avaliação Educacional
Seres Humanos
Salas Cirúrgicas/organização & administração
Estudos Prospectivos
Habilidades Sociais
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


  9 / 32312 MEDLINE  
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[PMID]:27777269
[Au] Autor:Savulescu J; Wartolowska K; Carr A
[Ad] Endereço:Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, Oxford, UK.
[Ti] Título:Randomised placebo-controlled trials of surgery: ethical analysis and guidelines.
[So] Source:J Med Ethics;42(12):776-783, 2016 Dec.
[Is] ISSN:1473-4257
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Use of a placebo control in surgical trials is a divisive issue. We argue that, in principle, placebo controls for surgery are necessary in the same way as for medicine. However, there are important differences between these types of trial, which both increase justification and limit application of surgical studies. We propose that surgical randomised placebo-controlled trials are ethical if certain conditions are fulfilled: (1) the presence of equipoise, defined as a lack of unbiased evidence for efficacy of an intervention; (2) clinically important research question; (3) the risk to patients is minimised and reasonable; (4) there is uncertainty about treatment allocation rather than deception; (5) there is preliminary evidence for efficacy, which justifies a placebo-controlled design; and (6) ideally, the placebo procedure should have some direct benefit to the patient, for example, as a diagnostic tool. Placebo-controlled trials in surgery will most often be justified when surgery is performed to improve function or relieve symptoms and when objective outcomes are not available, while the risk of mortality or significant morbidity is low. In line with medical placebo-controlled trials, the surgical trial (1) should be sufficiently powered and (2) standardised so that its results are valid, (3) consent should be valid, (4) the standard treatment or rescue medication should be provided if possible, and (5) after the trial, the patients should be told which treatment they received and there should be provision for post-trial care if the study may result in long-term negative effects. We comment and contrast our guidelines with those of the American Medical Association.
[Mh] Termos MeSH primário: Temas Bioéticos
Pesquisa Biomédica/ética
Cirurgia Geral/ética
Efeito Placebo
Ensaios Clínicos Controlados Aleatórios como Assunto/ética
Projetos de Pesquisa
Procedimentos Cirúrgicos Operatórios/ética
[Mh] Termos MeSH secundário: Análise Ética
Ética em Pesquisa
Guias como Assunto
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1136/medethics-2015-103333


  10 / 32312 MEDLINE  
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[PMID]:28448921
[Au] Autor:Hollensteiner M; Fürst D; Esterer B; Augat P; Schrödl F; Hunger S; Malek M; Stephan D; Schrempf A
[Ad] Endereço:Research Group for Surgical Simulation Linz, Upper Austria University of Applied Sciences, School of Applied Health and Social Sciences, Garnisonstr. 21, 4020 Linz, Austria; Institute of Biomechanics, Trauma Clinic (BGU) Murnau and Paracelsus Medical University Salzburg, Prof. Küntscher Straße 8, 82
[Ti] Título:Novel bone surrogates for cranial surgery training.
[So] Source:J Mech Behav Biomed Mater;72:49-51, 2017 Aug.
[Is] ISSN:1878-0180
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Parietal graft lifts are trained on human or animal specimens or are directly performed on patients without extensive training. In order to prevent harm to the patient resulting from fast rotating machinery tools, the surgeon needs to apply appropriate forces. Realistic haptics are essential to identify the varying parietal bone layers and to avoid a penetration of the brain. This however, requires experience and training. Therefore, in this study, bone surrogate materials were evaluated with the aim to provide an anatomically correct artificial skull cap with realistic haptic feedback for graft lift training procedures. Polyurethane composites made of calcium carbonate and calcium phosphate were developed and were used to create customized bone surrogates, imitating both cancellous and cortical bone. Mechanical properties of these surrogates were validated for drilling, milling and sawing by comparison with human parietal bones. For that, surgical tool tips were automatically inserted into artificial and human bones in a customized test bench and the maximum axial insertion forces were analyzed. Axial tool insertion measurements in human parietal bones resulted in mean maximum forces of 1.8±0.5N for drilling, 1.7±0.3N for milling and 0.9±0.1N for sawing. Calcium carbonate-based materials achieved higher forces than the human bone for drilling and milling, and lower forces for sawing. The calcium phosphate-based bone surrogates showed comparable axial insertions forces for all investigated tools and were identified as a suitable surrogate for drilling (p=0.87 and 0.41), milling (p=0.92 and 0.63) and sawing (p=0.11 and 0.76) of the cortical layer and the cancellous bone, respectively. In conclusion, our findings suggest, that a suitable material composition for artificial parietal bones has been identified, mimicking the properties of human bone during surgical machinery procedures. Thus, these materials are suitable for surgical training and education in simulator training.
[Mh] Termos MeSH primário: Poliuretanos/química
Crânio/cirurgia
[Mh] Termos MeSH secundário: Retroalimentação
Cirurgia Geral/métodos
Seres Humanos
Fenômenos Mecânicos
Ortopedia/métodos
Treinamento por Simulação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Polyurethanes)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171225
[Lr] Data última revisão:
171225
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE



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