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PURPOSE: The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery. METHODS: We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome. RESULTS: We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p ≤ 0.00001), IOL centration (D = -0.07, 95% CI:-0.09-[-0.05], p ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p = 0.05). CONCLUSIONS: Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values.
Assuntos
Extração de Catarata , Terapia a Laser , Facoemulsificação , Complicações Pós-Operatórias , Acuidade Visual , Humanos , Extração de Catarata/efeitos adversos , Extração de Catarata/instrumentação , Extração de Catarata/métodos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acuidade Visual/fisiologiaRESUMO
OBJECTIVE: We investigated the effects of the Health Belief Model (HBM)-based intervention on nurses' behaviors in terms of keeping surgical instruments moist. MATERIALS AND METHODS: Pre- and post-training surveys about instrument moistening were conducted with the same 356 nurses from a hospital in China. Both of the surveys contained questionnaire concerning general knowledge relating to instrument moistening, perception scale-based questions concerning the same issue, and an inspection form concerning the implementation of moistening procedures. Three months' training was provided for the nurses. RESULTS: After training, the nurses' knowledge, attitudes, beliefs, and behaviors for instrument moistening were improved. CONCLUSIONS: The HBM-based intervention can bring about a significant improvement in nurses' compliance with surgical instrument moistening requirements, and corresponding improvements in instrument cleanliness and patient safety.
OBJETIVO: Investigar los efectos de la intervención basada en el modelo de creencias de salud en los comportamientos de las enfermeras en términos de mantener húmedos los instrumentos quirúrgicos. MÉTODO: Se realizaron encuestas previas y posteriores a la capacitación sobre la humectación de instrumentos con las mismas 356 enfermeras de un hospital en China. Ambas encuestas contenían un cuestionario sobre el conocimiento general relacionado con la humectación del instrumento, preguntas basadas en escalas de percepción sobre el mismo tema y un formulario de inspección sobre la implementación de los procedimientos de humectación. Se proporcionó una formación de 3 meses a las enfermeras. RESULTADOS: Después de la capacitación se mejoraron los conocimientos, las actitudes, las creencias y los comportamientos de las enfermeras para la humectación del instrumento. CONCLUSIONES: La intervención basada en el modelo de creencias en salud puede generar una mejora significativa en el cumplimiento de los requisitos de humectación del instrumental quirúrgico por parte de las enfermeras, y las correspondientes mejoras en la limpieza del instrumental y la seguridad del paciente.
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Competência Clínica , Modelo de Crenças de Saúde , Humanos , Hospitais , Segurança do Paciente , EsterilizaçãoRESUMO
BACKGROUND: Surgical reconstruction of the posterior cruciate ligament (PCL) can be technically challenging given the proximity of the popliteal artery to the PCL tibial insertion. This "no-safe zone" makes some knee surgeons less confident and willing to perform this surgical procedure. SURGICAL TECHNIQUE: We present a PCL tibial inlay reconstruction technique using a set of instruments involving three tools (a slot cut, a bone plug positioner, and an impactor). CONCLUSION: This set of instruments allows a more reproducible posteromedial approach and to produce a PCL tibial slot in a posterior cruciate ligament inlay reconstruction with the patient supine in bicruciate ligament injury reconstruction.
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Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Humanos , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/lesões , Artroscopia/métodos , Articulação do Joelho/cirurgia , Tíbia/cirurgiaRESUMO
PURPOSE: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. METHODS: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. RESULTS: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. CONCLUSIONS: The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.
Assuntos
Lentes Intraoculares , Lentes Intraoculares Multifocais , Facoemulsificação , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Implante de Lente Intraocular/métodos , Acuidade Visual , Desenho de PróteseRESUMO
Objetivo: analisar o percentual de instrumentais cirúrgicos que compõem a caixa de laparotomia exploradora e não são utilizados durante as cirurgias. Método: estudo descritivo, transversal com abordagem quantitativa, que contabilizou instrumentais constituintes da caixa de laparotomia exploradora utilizados e não utilizados durante 13 cirurgias realizadas em um período de 17 dias, em um hospital do interior paulista. Resultados: nas 13 cirurgias analisadas, obteve-se um total de 1300 (100%) pinças presentes nas caixas, onde 832 (64%) não foram utilizadas e 468 (36%) foram utilizadas. Nos tempos cirúrgicos, o maior número de uso foi de 166 (35,5%) artigos, para preensão e afastadores. Conclusão: houve 64% de instrumentais não utilizados nas cirurgias analisadas. Há necessidade de implementar estratégias gerenciais que reduzam os números encontrados e, consequentemente, reduzam gastos, para gerar menor desperdício e reduzir falhas no gerenciamento de recursos materiais.
Objective: to analyze the percentage of surgical instruments that make up the operating laparotomy box and are not used during surgeries. Method: descriptive, cross-sectional study with quantitative approach, which counted instrumental constituents of the exploratory laparotomy box used and not used during 13 surgeries performed in a period of 17 days, in a hospital in the interior of São Paulo. Results: in the 13 surgeries analyzed, a total of 1300 (100%) tweezers were obtained in the boxes, where 832 (64%) were not used and 468 (36%) were used. In surgical times, the highest number of use was 166 (35.5%) articles, for seizures and reparators. Conclusion: there were 64% of instruments not used in the analyzed surgeries. There is a need to implement management strategies that reduce the numbers found and, consequently, reduce expenses, to generate less waste and reduce failures in the management of material resources.
Objetivo: analizar el porcentaje de instrumentos quirúrgicos que componen la caja de laparotomía quirúrgica y no se utilizan durante las cirugías. Método: estudio descriptivo, transversal con enfoque cuantitativo, que contó constituyentes instrumentales de la caja de laparotomía exploratoria utilizada y no utilizada durante 13 cirugías realizadas en un período de 17 días, en un hospital del interior de São Paulo. Resultados: en las 13 cirugías analizadas, se obtuvieron un total de 1300 (100%) pinzas en las cajas, donde no se utilizaron 832 (64%) y 468 (36%). En tiempos quirúrgicos, el mayor número de uso fue de 166 (35,5%) artículos, para convulsiones y reparadores. Conclusión: hubieran 64% de instrumentos no utilizados en las quirurgias analizadas. Es necesario implementar estrategias de gestión que reduzcan los números encontrados y, en consecuencia, reduzcan los gastos, para generar menos residuos y reducir las fallas en la gestión de los recursos materiales.
Assuntos
Instrumentos Cirúrgicos/estatística & dados numéricos , Esterilização/estatística & dados numéricos , Gastos em Saúde , Estudos Transversais , Custos e Análise de Custo , Laparotomia/instrumentaçãoRESUMO
Resumo Objetivo Elaborar e validar uma proposta para avaliação do desempenho de detergentes na limpeza de produtos para saúde. Métodos Foi desenvolvida proposta para avaliar o desempenho de detergentes rotineiramente utilizados em Centros de Material e Esterilização por meio de um estudo experimental utilizando monitores de limpeza e lavadora ultrassônica. Monitores de limpeza foram dispostos na cuba de uma lavadora ultrassônica. O parâmetro adotado para avaliação do desempenho dos detergentes foi a remoção completa da sujidade dos monitores. Foram avaliados resíduos de proteínas de amostras tubulares de aço inoxidável e de policloreto de polivinila, após contato com carga orgânica desafio e limpeza em lavadora ultrassônica. Foram considerados reprovados os testes que apresentavam gradação da coloração azul e aprovados os testes que permaneciam com a coloração marrom, como indicado nas instruções de uso. Todos os testes foram realizados em triplicata ou quintuplicada. Adicionalmente, foram realizados controles positivos. Resultados O uso do teste com tiras de papel alumínio, foil test, mostrou-se de fácil aplicação e capaz de diferenciar a cavitação em diferentes pontos da cuba da lavadora ultrassônica. Os indicadores de limpeza impregnados com resíduos orgânicos e os monitores de proteína utilizados na proposta apresentaram resultados variados, possibilitando diferenciar a eficácia da limpeza para cada detergente utilizado. Portanto, além de disponíveis no mercado, são ferramentas simples que possibilitaram a avaliação dos detergentes. Conclusão A proposta desenvolvida mostrou-se factível e simples e considerou produtos e equipamentos rotineiramente encontrados em Centros de Material e Esterilização.
Resumen Objetivo Elaborar y validar una propuesta para evaluación del rendimiento de detergentes en la limpieza de productos de salud. Métodos Mediante un estudio experimental con el uso de monitores de limpieza y lavadora ultrasónica, se elaboró una propuesta para evaluar el rendimiento de detergentes utilizados habitualmente en centros de material y esterilización. Se colocaron monitores de limpieza en el tanque de una lavadora ultrasónica. El parámetro adoptado para evaluar el rendimiento de los detergentes fue la eliminación completa de la suciedad de los monitores. Se evaluaron residuos de proteínas de muestras tubulares de acero inoxidable y de cloruro de polivinilo, después del contacto con carga orgánica desafío y limpieza en lavadora ultrasónica. Las pruebas que presentaron una gama de coloración azul fueron reprobadas, y las que permanecían con coloración marrón fueron aprobadas, como indicado en las instrucciones de uso. Todas las pruebas fueron realizadas en triplicado o quintuplicado. Adicionalmente se realizaron controles positivos. Resultados El uso de las pruebas con tiras de papel de aluminio, foil test, demostró ser de fácil aplicación y con capacidad para diferenciar la cavitación en diferentes puntos del tanque de la lavadora ultrasónica. Los indicadores de limpieza impregnados de residuos orgánicos y los monitores de proteína utilizados en la propuesta presentaron resultados variados, lo que permitió diferenciar la eficacia de la limpieza en cada detergente usado. Por lo tanto, además de estar disponibles en el mercado, son herramientas simples que permiten la evaluación de los detergentes. Conclusión La propuesta desarrollada demostró ser factible y simple, e incluyó productos y equipos encontrados habitualmente en centros de material y esterilización.
Abstract Objective To develop and validate a proposal to evaluate the performance of cleaning detergents for health products. Methods A proposal was developed to evaluate the performance of detergents routinely used in Materials and Sterilization Center through an experimental study using cleaning monitors and an ultrasonic washer. Cleaning monitors were placed in the ultrasonic washer tub. The parameter adopted to evaluate the performance of detergents was the complete removal of stain from the monitors. Protein residues from tubular stainless steel and polyvinyl chloride samples were evaluated after contact with challenge organic matter and cleaning in an ultrasonic washer. Tests that showed a gradation of blue color were considered to have failed and tests that remained with a brown color were approved, as indicated in instructions for use. All tests were performed in triplicate or quintuplicate. Additionally, positive controls were performed. Results The use of the foil test with strips proved to be easy to apply and capable of differentiating cavitation at different points in the ultrasonic washer tub. The cleaning indicators impregnated with organic residues and the protein monitors used in the proposal presented varied results, making it possible to differentiate the cleaning effectiveness for each detergent used. In addition to their availability on the market, these simple tools made it possible to evaluate the detergents. Conclusion The proposal developed proved to be feasible and simple and considered products and equipment routinely found in Materials and Sterilization Centers.
RESUMO
Objetivo: Conhecer as estratégias utilizadas por instrumentadores para o controle de materiais e instrumental cirúrgico no intraope-ratório. Método: Estudo descritivo e qualitativo, realizado em hospital privado. Participaram 13 instrumentadores cirúrgicos. Os dados foram coletados entre agosto e setembro de 2022 por meio de entrevistas gravadas em áudio. Como instrumento para coleta dos dados, utilizou-se um roteiro estruturado, contendo sete perguntas, e questões referentes ao perfil da amostra. Foram incluídos técnicos de enfermagem forma-dos, atuantes como instrumentadores cirúrgicos. Foram excluídos instrumentadores ausentes no período da coleta de dados. Os dados foram analisados por meio da análise de conteúdo. Resultados: Com base na análise dos dados, emergiram quatro categorias: protocolo de cirurgia segura; controle de materiais e instrumentais; desafios no seguimento do protocolo de cirurgia segura; facilitadores do seguimento do proto-colo de cirurgia segura. Conclusão: Pôde-se conhecer as estratégias utilizadas por instrumentadores cirúrgicos para o controle dos materiais dispostos na mesa de instrumentação durante o intraoperatório. Pressa de profissionais, falta de adesão e o não seguimento de rotinas insti-tucionais caracterizam-se como desafios para o seguimento das etapas do protocolo de cirurgia segura
Objective: To know the strategies used by surgical technologists to control materials and surgical instruments in the intraopera-tive period. Method: This qualitative descriptive study was carried out in a private hospital. A total of 13 surgical technologists participated in the research. Data were collected during audio-recorded interviews between August and September 2022. The data collection instrument was a structured questionnaire consisting of seven questions, as well as items related to the sample profile. We included trained nursing technicians, working as surgical technologists. Those who were absent during data collection were excluded. Data were analyzed by con-tent analysis. Results: The data analysis produced four categories: surgical safety checklist; control of materials and instruments; challenges in following the surgical safety checklist; facilitators to following the surgical safety checklist. Conclusions: The study allowed us to know the strategies used by surgical technologists to control the materials arranged on the instrument table during the intraoperative period. The haste of professionals, lack of adherence, and non-compliance with institutional routines are regarded as challenges in following the steps of the surgical safety checklis
Objetivo: Conocer las estrategias utilizadas por instrumentistas para el control de materiales e instrumental quirúrgico en el intraope-ratorio. Método: Estudio descriptivo y cualitativo, realizado en hospital privado. Participaron 13 instrumentistas quirúrgicos. Los datos fueron colectados entre agosto y septiembre de 2022 por medio de entrevistas grabadas en audio. Como instrumento para colecta de los datos, se utilizó um guion estructurado, conteniendo siete preguntas, y cuestiones referentes al perfil de la muestra. Fueon incluidos técnicos de enfermería egre-sados, actuantes como instrumentistas quirúrgicos. Fueron excluidos instrumentistas ausentes en el período de la colecta de datos. Los datos fue-ron analizados por medio del análisis de contenido. Resultados: Con base en el análisis de los datos, emergieron cuatro categorías: protocolo de cirugía segura; control de materiales e instrumentales; desafíos en el seguimiento del protocolo de cirugía segura; facilitadores del seguimiento del protocolo de cirugía segura. Conclusión: Se pueden conocer las estrategias utilizadas por instrumentistas quirúrgicos para el control de los materiales dispuestos en la mesa de instrumentación durante el intraoperatorio. Prisa de profesionales, falta de adhesión y el no seguimiento de rutinas institucionales se caracterizan como desafíos para el seguimiento de las etapas del protocolo de cirugía segura
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Medidas de Segurança , Instrumentos Cirúrgicos/normas , Enfermagem Perioperatória/normas , Período Intraoperatório , Pesquisa QualitativaRESUMO
Resumen OBJETIVO: Diseñar y validar un instrumento para evaluar el nivel de conocimiento en la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló con base en el marco teórico; el cuestionario fue objeto de análisis por parte de un grupo de expertos que se basaron en la metodología Delphi. Se obtuvo un constructo de 20 preguntas y se emprendió un estudio para evaluar la pertinencia del instrumento. La confiabilidad se evaluó con el coeficiente de Kuder-Richardson, prueba Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Los datos se procesaron en el programa SPSS versión 21. RESULTADOS: El instrumento se aplicó a 66 médicos residentes con media de edad de 28.5 ± 0.7 años. El coeficiente de Kuder-Richardson fue 0.608. Las pruebas de Kaiser-Meyer-Olkin y Bartlett mostraron que se trató de un instrumento multidimensional. CONCLUSIONES: Se obtuvo un instrumento válido, confiable y multidimensional para determinar el nivel de conocimientos en relación con la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia.
Abstract OBJECTIVE: To design and validate an instrument to assess the level of knowledge of Salinas forceps application in Gynecology and Obstetrics residents. MATERIALS AND METHODS: Descriptive, cross-sectional, validation-type study of an instrument. The first construct was developed based on the theoretical framework; the questionnaire was analyzed by a group of experts based on the Delphi methodology. A construct of 20 questions was obtained and a study was undertaken to assess the relevance of the instrument. Reliability was evaluated with the Kuder-Richardson coefficient, Kaiser-Meyer-Olkin test and Bartlett's sphericity test. The data were processed in SPSS version 21. RESULTS: The instrument was applied to 66 resident physicians with a mean age of 28.5 ± 0.7 years. The Kuder-Richardson coefficient was 0.608. The Kaiser-Meyer-Olkin and Bartlett tests showed that it was a multidimensional instrument. CONCLUSIONS: A valid, reliable and multidimensional instrument was obtained to determine the level of knowledge in relation to the application of Salinas forceps in Gynecology and Obstetrics residents.
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BACKGROUND: Nurses' perception toward their behaviors for keeping surgical instruments moist has been rarely studied. METHODS: The survey which utilized a questionnaire regarding respondent's demographic information and a self-designed nurses' perception-behavior scale for keeping surgical instruments moist was conducted with 360 nurses from a hospital in China. RESULTS: Total score of nurses' perception-behavior scale for keeping surgical instruments moist was 139.93 ± 15.145. Score of nurses' perception-behavior scale for keeping surgical instruments moist varied with age, length of service, and job title, with a statistically significant difference (p < 0.05). Length of service was the main factor affecting nurses' perception toward their behaviors for keeping surgical instruments moist. CONCLUSIONS: Nurses should be offered intensive training on keeping surgical instruments moist due to their inadequate perception on it. The nurses' change in health beliefs and behaviors must be based on developing the right attitude.
OBJETIVO: La percepción de los enfermeros sobre sus comportamientos para mantener húmedo el instrumental quirúrgico ha sido poco estudiada. MÉTODOS: La encuesta que utilizó un cuestionario sobre la información demográfica del encuestado y una escala de percepción y comportamiento de las enfermeras de diseño propio para mantener húmedos los instrumentos quirúrgicos se realizó con 360 enfermeras de un hospital en China. RESULTADOS: La puntuación total de la escala de percepción-conducta de las enfermeras para mantener húmedo el instrumental quirúrgico fue de 139.93 ± 15.145. La puntuación de la escala de percepción-conducta de las enfermeras para mantener húmedos los instrumentos quirúrgicos varió con la edad, la duración del servicio y el cargo, con una diferencia estadísticamente significativa (p < 0,05). El tiempo de servicio fue el principal factor que influyó en la percepción de los enfermeros sobre sus comportamientos para mantener húmedo el instrumental quirúrgico. CONCLUSIÓN: Se debe ofrecer a las enfermeras un entrenamiento intensivo sobre el mantenimiento de la humedad del instrumental quirúrgico por su inadecuada percepción al respecto. El cambio de creencias y comportamientos de salud de las enfermeras debe basarse en el desarrollo de la actitud correcta.
Assuntos
Modelo de Crenças de Saúde , Instrumentos Cirúrgicos , Humanos , Estudos Transversais , PercepçãoRESUMO
INTRODUCCIÓN. La cirugía robótica se realiza gracias al sistema telemanipulado, alcanzando tareas repetitivas, precisas y mínimamente invasivas. En Ecuador inició en el año 2016, incluyendo este procedimiento a pediatría en el 2021. OBJETIVO. Describir las características clínicas y resultados quirúrgicos de pacientes pediátricos intervenidos por cirugía robótica. MATERIALES Y MÉTODOS. Estudio transversal analítico. Población de 278 y muestra de 40 datos de historias clínicas electrónicas de pacientes pediátricos intervenidos por cirugía robótica de agosto del 2021 a marzo del 2022 en el Hospital Carlos Andrade Marín. Criterios de inclusión: pacientes pediátricos intervenidos por cirugía robótica en el Hospital de Especialidades Carlos Andrade Marín. Criterios de exclusión: pacientes adultos, haber sido intervenidos quirúrgicamente por técnicas abiertas o laparoscópica. La información se obtuvo del sistema AS400; se creó una base de datos anonimizando a los pacientes. Se aplicó un análisis univariado y para determinar significancia estadística se utilizó la prueba de Chi-2. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS: De los pacientes del estudio: 45,00% (18; 40) era adolescente. El 52,50% (21; 40) no presentó comorbilidades. 50,00% (20; 40) de las intervenciones fueron colecistectomía. 55% (22; 40) fué por diagnóstico prequirúrgico y posquirúrgico gastrointestinal y hepático. El 95,00% (38; 40) no presentó complicaciones. El 100% (40; 40) presentó sangrado G1. El 97,50% (39; 40) no presentó eventos, y el 72,5% (29; 40) no presentó dolor. El promedio de peso de los pacientes fue 41 kilogramos, con una media de 3 días de estancia hospitalaria, un promedio de 65 minutos de cirugía total y 15 minutos de docking, los cuales son estadísticamente significativos con una p= 0,001. CONCLUSIONES. Se registró las características clínicas y resultados quirúrgicos de pacientes pediátricos intervenidos por cirugía robótica. La cirugía robótica se aplicó con seguridad en pacientes pediátricos del Hospital Carlos Andrade Marín.
INTRODUCTION. Robotic surgery is performed thanks to the telemanipulated system, achieving repetitive, precise and minimally invasive tasks. In Ecuador it started in the Hospital de Especialidades Carlos Andrade Marín in 2016, including this procedure to pediatrics in 2021. OBJECTIVE. To describe the clinical characteristics and surgical outcomes of pediatric patients operated by robotic surgery. MATERIALS and METHODS. Analytical cross-sectional study. Population of 278 and sample of 40 data from electronic medical records of pediatric patients operated by robotic surgery from August 2021 to March 2022 at the Carlos Andrade Marin Hospital. Inclusion criteria: pediatric patients who underwent robotic surgery at the Hospital de Especialidades Carlos Andrade Marín. Exclusion criteria: adult patients, having undergone open or laparoscopic surgery. The information was obtained from the AS400 system; a database was created by anonymizing the patients. Univariate analysis was applied and the Chi-2 test was used to determine statistical significance. The information collected was analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences. RESULTS: Of the patients in the study: 45,00% (18; 40) were adolescents. 52,50% (21; 40) had no comorbidities. 50,00% (20; 40) of the interventions were cholecystectomy. 55% (22; 40) were for preoperative and postoperative gastrointestinal and hepatic diagnosis. 95,00% (38; 40) had no complications. 100% (40; 40) presented G1 bleeding. 97.50% (39; 40) did not present events, and 72,5% (29; 40) did not present pain. The average weight of the patients was 41 kilograms, with a mean hospital stay of 3 days, an average of 65 minutes of total surgery and 15 minutes of docking, which are statistically significant with a p= 0,001. CONCLUSIONS. The clinical characteristics and surgical results of pediatric patients who underwent robotic surgery were recorded. Robotic surgery was safely applied in pediatric patients at the Carlos Andrade Marin Hospital.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pediatria , Centro Cirúrgico Hospitalar , Instrumentos Cirúrgicos , Robótica , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Robóticos , Infecções Respiratórias , Doenças Cardiovasculares , Serviços de Saúde da Criança , Laparoscopia , Equador , Doenças do Sistema Endócrino , Gastroenteropatias , Varicocele , Hemorragia , Manifestações NeurológicasRESUMO
In this review, I summarise the circumstances leading to the collaboration between London and Örebro on the basic research performed to study potential mechanisms underlying the improved patency of saphenous veins harvested by the no-touch technique. Histological studies reveal various forms of vascular damage to saphenous vein grafts harvested in conventional coronary artery bypass grafting (CABG) whereas no-touch grafts retain a normal architecture. The perivascular fat that remains intact on no-touch saphenous vein grafts seems to play a particularly important role as the "protector" of all layers of the graft. In addition, the perivascular fat is a source of adipose cell-derived factors that may contribute to the success of the no-touch technique. While a number of trials have compared no-touch with conventional grafts following CABG, these have generally been limited to short follow-up periods, low patient numbers, and inadequate histological data. When handling no-touch saphenous vein at harvesting, there is no direct contact of the vein by surgical instruments, spasm does not occur, and high-pressure intraluminal distension is not required. While damage to both endothelial and vascular smooth muscle cells are evident at the microscopic and ultrastructural level in conventional saphenous vein grafts, their structure in no-touch grafts is preserved. Also, in no-touch veins, the vasa vasorum remains intact and transmural blood supply is maintained. This microvascular network is disrupted during conventional harvesting, a situation likely to stimulate processes involved in graft occlusion. The use of excess graft material for histology is to be encouraged for the assessment of vascular damage and even surgeon competence. If you don't look, you don't find.
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Ponte de Artéria Coronária , Veia Safena , Ponte de Artéria Coronária/métodos , Humanos , Londres , Veia Safena/transplante , Vasa Vasorum , Grau de Desobstrução Vascular/fisiologiaRESUMO
BACKGROUND: The complex and specific surgical instruments (SI) acquired from loaner companies are provided non-sterile and must be reprocessed before each use. We evaluated the management practices of SI in loaner companies in a high (Australia) and a middle-income (Brazil) country. METHODS: Seven company managers in Australia and eight in Brazil replied to the self-administrated survey. RESULTS: Failures to meet recommended practices were detected, including standard operating procedure (SOP) provision, minimum delivery time, transport container and decontamination in loaner companies in both countries. Six of seven loaner companies in each country provided SOP for instrument reprocessing (one company in Brazil did not reply). Solicitation of the SI may occur 12 h before need in Brazil, and delivery of the set could be accepted 4 h before surgery in both countries. Transport of SI on stainless steel/aluminium trays was reported by 42.85% and 28.6% of companies in Brazil and Australia, respectively. In Australia, 57.1% of the loaner companies affirmed they performed cleaning only if the SI were visibly dirty. In Brazil, 62.5% of the companies reported they use alcohol to wipe SI. CONCLUSIONS: There is a need for standardisation of requirements and process verification improvement in loaner SI reprocessing and management.
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Aço Inoxidável , Instrumentos Cirúrgicos , Humanos , Países Desenvolvidos , Brasil , AustráliaRESUMO
ABSTRACT Introduction: Aortic stenosis is the most common heart valve disease in the world, and patients that present with symptoms have a high mortality rate. Aortic valve replacement has the objective of promote left ventricular remodeling, reduce symptoms, and increase overall survival. The objective of this study is to evaluate reverse remodeling of the left ventricle in patients with severe and symptomatic aortic stenosis who underwent surgical or percutaneous transcatheter aortic valve replacement. Methods: This is a longitudinal, prospective, non-concurrent, non-randomized unicentric study with patients who underwent aortic valve replacement. Echocardiogram was performed before and after replacement procedure to evaluate several remodeling indexes. Results: Of 91 patients, 77 (84.6%) underwent surgical aortic valve replacement, and 14 (15.4%) underwent percutaneous transcatheter aortic valve replacement. Mean age was 68,96±11,98 years, and most patients were male. Remodeling evaluation revealed that patients who decreased left ventricular index mass (53% vs. 38.9%; P=0,019) and those who reduced the mass/volume ratio (30.4% vs. 68.9%; P<0,001) presented with positive left ventricular remodeling. No endpoint difference was found in those with positive remodeling. Conclusion: Regarding the left ventricular remodeling in patients with severe and symptomatic aortic valve stenosis who underwent percutaneous transcatheter or surgical valve replacement, there is a positive increment in remodeling, however it remains in concentric hypertrophic shape. Implication of these findings remains uncertain and to be studied in large dedicated trials with clinical endpoints.
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INTRODUCTION: Aortic stenosis is the most common heart valve disease in the world, and patients that present with symptoms have a high mortality rate. Aortic valve replacement has the objective of promote left ventricular remodeling, reduce symptoms, and increase overall survival. The objective of this study is to evaluate reverse remodeling of the left ventricle in patients with severe and symptomatic aortic stenosis who underwent surgical or percutaneous transcatheter aortic valve replacement. METHODS: This is a longitudinal, prospective, non-concurrent, non-randomized unicentric study with patients who underwent aortic valve replacement. Echocardiogram was performed before and after replacement procedure to evaluate several remodeling indexes. RESULTS: Of 91 patients, 77 (84.6%) underwent surgical aortic valve replacement, and 14 (15.4%) underwent percutaneous transcatheter aortic valve replacement. Mean age was 68,96±11,98 years, and most patients were male. Remodeling evaluation revealed that patients who decreased left ventricular index mass (53% vs. 38.9%; P=0,019) and those who reduced the mass/volume ratio (30.4% vs. 68.9%; P<0,001) presented with positive left ventricular remodeling. No endpoint difference was found in those with positive remodeling. CONCLUSION: Regarding the left ventricular remodeling in patients with severe and symptomatic aortic valve stenosis who underwent percutaneous transcatheter or surgical valve replacement, there is a positive increment in remodeling, however it remains in concentric hypertrophic shape. Implication of these findings remains uncertain and to be studied in large dedicated trials with clinical endpoints.
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Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Prognóstico , Estudos Prospectivos , Remodelação VentricularRESUMO
BACKGROUND: Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country. METHODS: Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible. RESULTS: A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices. CONCLUSION: There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff.
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Esterilização , Instrumentos Cirúrgicos , Austrália , Brasil , Estudos Transversais , Humanos , Inquéritos e QuestionáriosRESUMO
ABSTRACT BACKGROUND: The laparoscopic approach for inguinal hernia repair has been widely used since its introduction in the 1990s. As a step in the procedure, the surgeon must access the preperitoneal space through an incision in the peritoneum, creating an adequate dissection for mesh placement. At the end of the procedure, the peritoneal flap must be closed to avoid adhesions. There are several methods to close the peritoneum. AIMS: The aim of this study was to propose a simple method for closing the peritoneal flap, using titanium clips, exposing its advantages and disadvantages. METHODS: Description of the peritoneum flap closure technique, using titanium clips, in the last 15 years. RESULTS: The pneumoperitoneum was reduced to a pressure of 7 mmHg; then, the two edges of the peritoneal flap were approximated together and, with the aid of a Maryland grasper, were kept together; titanium clips were used to close the flap. The process is repeated along the entire peritoneal incision until it is completely closed. CONCLUSIONS: The use of titanium clips proved to be a fast, inexpensive, and effective method for closing the peritoneal flap in videolaparoscopic inguinal hernioplasties, with no major or recurrent complications reported. Therefore, it is an effective and safe method for the closure of the peritoneal defect.
RESUMO RACIONAL: A via de acesso laparoscópica para correção de hérnia inguinal tem sido amplamente empregada desde sua introdução na década de 1990. Como etapa do procedimento, o cirurgião deve acessar o espaço pré-peritoneal por meio de uma incisão no peritônio, criando uma adequada dissecção para a colocação da tela. Ao final do procedimento, o retalho peritoneal deve ser fechado para evitar aderências. Existem vários métodos para fechar o peritônio. OBJETIVOS: Propor um método simples para o fechamento do flap peritoneal, utilizando clipes de titânio, expondo suas vantagens e desvantagens. METHODS: Descrição da técnica de fechamento do peritônio, utilizando clips de titânio, nos últimos 15 anos. RESULTADOS: O pneumoperitôneo foi reduzido até uma pressão de 7mmHg; em seguida, as duas bordas do retalho peritoneal foram aproximadas e, com auxílio de uma pinça Maryland, foram mantidas unidas; o clipe de titânio foi utilizado para o fechamento do retalho. A técnica foi repetida ao longo de toda a incisão peritoneal, até o seu fechamento completo. CONCLUSÕES: O uso de clipes de titânio mostrou-se um método rápido, barato e eficaz no fechamento do flap peritoneal nas hernioplastias inguinais videolaparoscópicas, sem grandes ou recorrentes complicações relatadas. Portanto de um método eficaz e seguro para o fechamento do defeito peritoneal.
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ABSTRACT Objective: To evaluate the effectiveness of automated cleaning of 4 mm liposuction cannulas using ultrasonic washer machine, screening for dirt using a cannulate microscope device and the screening of viable strains of Staphylococcus aureus, with microbiological analysis. Method: Experimental study with 14 units of 4 mm liposuction cannulas performed at the Central Sterile Services Department and at the Microbiology Laboratory of a Hospital Complex, located in Porto Alegre, RS, Brazil, from October 2018 to April 2019. Results: Of the 14 liposuction cannulas that constituted the sample, 42.9% remained dirty despite automated cleaning, and all of them showed recovery of viable microrganisms in the microbiological laboratory. Conclusion: The study showed that it is not possible to ensure the cleaning efficacy of automated cleaning of 4 mm liposuction cannulas, especially due to the conformation of the material with internal spaces with accumulation of dirt.
RESUMEN Objetivo: Evaluar la efectividad de la limpieza automatizada mediante la lavadora ultrasónica de las cánulas de liposucción de 4 mm, mediante el rastreo de la suciedad interna, utilizando el dispositivo de microscopía para canulados y el cribado de cepas viables de Stphylococcus aureus, mediante análisis microbiológico. Método: Estudio experimental realizado con 14 cánulas de liposucción de 4 mm en un Centro de Material y Esterilización y en el laboratorio de microbiología de un hospital de Porto Alegre, Brasil, de octubre de 2018 a abril de 2019. Resultados: De 14 cánulas de liposucción que constituyeron la muestra, el 42,9% permaneció sucio, incluso después de la limpieza automática y todos mostraron recuperación de micoorganismos viables en el laboratorio de mocrobiogía . Conclusión: El estudio mostró que no es posible garantizar la efectividad de la limpieza automática en las cánulas de liposucción de 4 mm, especialmente por la conformación del material con lugares donde se acumula suciedad.
RESUMO Objetivo: Avaliar a eficácia da limpeza automatizada realizada com lavadora ultrassônica de cânulas de aspiração de 4 mm, por meio do rastreamento de sujidade interna feito com aparelho de microscopia para canulados e o rastreamento de cepas viáveis de Staphylococcus aureus, por análise microbiológica. Métodos: Estudo experimental realizado com 14 cânulas de lipoaspiração de 4 mm em um Centro de Material e Esterilização e no laboratório de microbiologia de um hospital de Porto Alegre, Brasil, no período de outubro de 2018 a abril de 2019. Resultados: Das 14 cânulas de lipoaspiração que constituíram a amostra, 42,9% permaneceram com sujidade mesmo após a limpeza automatizada e todas apresentaram recuperação de microrganismos viáveis nos testes do laboratório de microbiologia. Conclusão: O estudo mostrou não ser possível garantir a eficácia da limpeza automatizada nas cânulas de lipoaspiração de 4 mm, em especial devido à conformação do material com locais onde acumula sujidade.
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Objetivo: Identificar as causas de não conformidades em Produtos para Saúde distribuídos por um centro de esterilização localizado na região metropolitana de Belo Horizonte, MG, Brasil. Métodos: Estudo descritivo, de natureza quantitativa que foi realizado entre janeiro e dezembro de 2019. Os dados foram coletados através de um instrumento estruturado para avaliação sistemática dos itens e analisados estatisticamente de forma descritiva. Resultados: Foram avaliados 2.944 produtos para saúde, que variou de 66 a 284/mês, com média de 245 (±56). Foram identificados 24 itens inadequados o que gerou uma taxa de não conformidade de 0,96%. As principais causas foram atribuídas à embalagem manchada (20,8%), aos produtos para saúde sem identificação (20,8%), problemas na selagem (16,6%) e embalagem violada (12,5%). Conclusão: As principais causas de não conformidades encontradas sugerem a realização de um controle criterioso de qualidade em cada etapa do reprocessamento de materiais para não comprometer a segurança do paciente.
Objective: To identify the causes of non-conformities in Health Products distributed by a sterilization center located in the metropolitan region of Belo Horizonte, MG, Brazil. Methods: This was a study described, of a quantitative nature that was carried out between January and December 2019. The data were collected through a structured instrument for systematic evaluation of the items and analyzed using the technique of descriptive statistics. Results: A total of 2,944 health products were evaluated during the study period, which ranged from 66 to 284/month, with an average of 245 (± 56). There were 24 inappropriate items that generated a noncompliance rate of 0.96%. The main causes were attributed to stained packaging (20.8%), health products without identification (20.8%), sealing problems (16.6%) and violated packaging (12.5%). Conclusion: The main causes of nonconformities found in this study suggest the performance of a careful quality control at each stage of the reprocessing cycle so as not to compromise patient safety.
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Vigilância de Produtos Comercializados , Controle de Qualidade , Instrumentos Cirúrgicos , Esterilização , EnfermagemRESUMO
ABSTRACT In this review, I summarise the circumstances leading to the collaboration between London and Örebro on the basic research performed to study potential mechanisms underlying the improved patency of saphenous veins harvested by the no-touch technique. Histological studies reveal various forms of vascular damage to saphenous vein grafts harvested in conventional coronary artery bypass grafting (CABG) whereas no-touch grafts retain a normal architecture. The perivascular fat that remains intact on no-touch saphenous vein grafts seems to play a particularly important role as the "protector" of all layers of the graft. In addition, the perivascular fat is a source of adipose cell-derived factors that may contribute to the success of the no-touch technique. While a number of trials have compared no-touch with conventional grafts following CABG, these have generally been limited to short follow-up periods, low patient numbers, and inadequate histological data. When handling no-touch saphenous vein at harvesting, there is no direct contact of the vein by surgical instruments, spasm does not occur, and high-pressure intraluminal distension is not required. While damage to both endothelial and vascular smooth muscle cells are evident at the microscopic and ultrastructural level in conventional saphenous vein grafts, their structure in no-touch grafts is preserved. Also, in no-touch veins, the vasa vasorum remains intact and transmural blood supply is maintained. This microvascular network is disrupted during conventional harvesting, a situation likely to stimulate processes involved in graft occlusion. The use of excess graft material for histology is to be encouraged for the assessment of vascular damage and even surgeon competence. If you don't look, you don't find.