RESUMO
OBJECTIVE: To assess the efficacy of two antimicrobial prophylaxis regimens, a short cycle and the standard one, on the prevalence of acute postoperative infection in orthopedic surgery for acute and chronic disease of a thoracic and a pelvic limb. MATERIAL AND METHODS: Prospective, observational, experimental randomized, double-blind trial in patients undergoing orthopedic surgery due to acute or chronic disease, between April and September 2009. The sample size was determined using the formula to calculate the finite population. Two groups were formed: one was given cefalotin for 24 hours plus ten additional days of dicloxacillin, the standard regimen and a second one that received cefalotin for 24 hours and placebo for ten days. The wound was assessed during hospitalization and it was checked on days 5, 8, 14 and 30. A statistical software was used for the statistical analysis, which included Student's t-test and chi2, and descriptive statistics for percentages, frequencies, means and standard deviations. The protocol was approved by the local health research committee. RESULTS: One hundred and thirty-one patients were included. Group I included 62 patients with cefalotin/dicloxacillin and Group II 69 patients with cafalotin/placebo for 10 days. In Group I one patient had infection and in Group II there were 3 cases, with p = 0.50 when chi2 was applied. CONCLUSIONS: Antimicrobial prophylaxis with 24 hour-cefalotin has the same effect on the prevalence of postoperative infection than a prolonged cycle of cefalotin plus dicloxacillin, according to the chi2 test. It is clear that there is no considerable benefit in giving antibiotics indiscriminately and for long periods of time compared with protection from infection in clean wounds.
Assuntos
Antibioticoprofilaxia/métodos , Procedimentos Ortopédicos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Estudos Longitudinais , Masculino , Procedimentos Ortopédicos/métodos , Prevalência , Estudos Prospectivos , Ferimentos e Lesões/cirurgiaRESUMO
BACKGROUND: There is a shortcoming in the diagnostic integration of the mechanism of injury and the radiographic findings. This leads to diagnostic errors and a poor surgical planning with labor and legal repercussions. The purpose is to find out which is the prevailing clinical skill in various Orthopedics residencies by applying a measurement tool prepared ex profeso. MATERIAL AND METHODS: This is an exploratory study conducted in nine Orthopedics residency sites; a measurement tool was designed with theoretical and empirical adequacy with 0.96 reliability (Kuder-Richardson). It includes ten clinical cases with 200 questions providing only X-ray images of a traumatic event exploring the following aspects: I. Kinematics of trauma, II. Clinical diagnosis, III. Radiographic interpretation, IV. Treatment, and V. Prognosis. It was applied to residents of all grades at each of the participating sites. RESULTS: Most of the sites had a low to intermediate level of clinical skills. Upon assessing the results (82 residents) differences were found in indicators I, II, IV and in the overall skills. No significant differences were seen at the sites in indicators III and V. The assessment of sites by indicators showed that site one had more refined skills for clinical diagnosis, while site six for radiographic interpretation. CONCLUSIONS: There are differences in the development level of the clinical skills studied. The low to intermediate skills may be explained by the different educational strategies applied at the sites studied without ruling out the experience acquired in each academic grade. It is possible to improve the results by implementing participative strategies.