Situación del ejercicio profesional del licenciado en instrumentación y área quirúrgica en Paraguay

Introducción: en Paraguay en 1996 se crea la Escuela de Instrumentación y Área Quirúrgica, vinculada a una universidad pública, a partir del 2008 se crean otras ofertas en el sector privado. El instrumentador quirúrgico puede desempeñarse como instrumentador, circulante, coordinador general de quirófanos y coordinador de la central de esterilización. Objetivo: conocer la situación del ejercicio profesional del licenciado instrumentador quirúrgico en Paraguay. Metodología: estudio descriptivo, cuantitativo y trasversal. La muestra es de 167 licenciados, egresados de instituciones pública y privadas. Muestreo no probabilístico por conveniencia, el instrumento de recolección de datos es un cuestionario electrónico. Resultados: el 74 % son mujeres, el 50 % presenta un rango de edad de 21 a 30 años, 79,6 % egresados de una institución pública, 40 % dice tener dificultad moderada para el primer empleo. El acceso al empleo, 71 % fue por contactos personales, el 72 % se dedica a instrumentar, el 60 % tiene una antigüedad laboral de 1 a 5 años. Entre los posgrados, el 30 % posee didáctica universitaria. Discusión: instrumentador quirúrgico, reúne las exigencias para ocupar otras funciones además de instrumentar y circular en el quirófano. Igualmente, en otros estudios se evidencia menor participación en el área administrativa, docencia, mercadeo y ventas. Han trascurrido 20 años del egreso de las primeras promociones, siendo una profesión novel, poco visualizado. Es de subrayar que el estado puede ahorrar recursos económicos al contratar a instrumentadores, puesto que son expertos en los cuidados asépticos y competentes en optimizar los tiempos quirúrgicos al que se expone el paciente.

Introduction: In Paraguay the school of Instrumentation and Surgical Area was created in 1996 linked to the National University, and in 2008 onwards other offers were created in the private sector. The Surgical Instrument Technician can work as instrumentalist, circulating nurse, general coordinator of operating rooms, and coordinator of the central sterilization unit. Objective: to know the work environment of the professional and licensed Surgical Instrument Technician in Paraguay. Methodology: descriptive, quantitative and cross-sectional study. The sample is 167 graduates, graduates of public and private institutions. Non-probability sampling for convenience, the data collection instrument is an electronic questionnaire. Results: 74% are women, 50% have an age range between 21 and 30 years old, 79.6% graduated from a public institution, 40% say they have moderate difficulty finding their first job in the field. Access to employment, 71% was through personal contacts, 72% is dedicated to work as Instrument Technicians, 60% have a job seniority of 1 to 5 years. Among the postgraduates, 30% are university didactics certified. Discussion: Surgical Instrument Technicians meet the requirements to perform other functions in addition to instrumentation and circulating nurses in the operating room. Similarly, other studies show less participation in the administrative area, teaching, marketing and sales. 20 years have elapsed since the first Technicians graduated, being a new profession, not given the importance it deserves. It is noteworthy that the state can save economic resources by hiring Surgical Instrument Technicians, since they are experts in aseptic care and competent in minimizing the amount of time the patient spends in surgery.

Estilos de aprendizaje en la práctica de estudiantes de instrumentación quirúrgica / Learning styles in the practice of surgical instrumentation students

Introducción: La instrumentación quirúrgica o enfermería de quirófano está regida por la ley 784 de 2002, de ahí que en su formación el estudiante deba adquirir habilidades y conocimientos mediados por los estilos de aprendizaje para responder al contexto hospitalario. Objetivo: Desarrollar una postura con respecto a los estilos de aprendizaje en la práctica clínica de los estudiantes de instrumentación quirúrgica de una universidad de ciencias de la salud de Bogotá. Desarrollo: El instrumentador quirúrgico se centra en el paciente, por lo tanto, su proceso formativo resulta demandante para el instructor y el estudiante; de ahí que sea necesaria una modificación de la dinámica educativa, puesto que las universidades deben identificar las debilidades en el aprendizaje y fortalecer en el estudiante los estilos de aprendizaje. De esta manera, se asume la postura de que el docente de instrumentación quirúrgica en la práctica tiene la responsabilidad de asumir el rol de su cargo y de docente, para aportar herramientas educativas que identifiquen y promuevan los estilos de aprendizaje de los estudiantes de ciencias de la salud. Conclusiones: Los estilos de aprendizaje se convierten en un elemento indispensable dentro del proceso formativo, no solo para los instrumentadores quirúrgicos, sino para cualquier otro profesional del área de la salud(AU)

Introduction: Surgical instrumentation or operating room nursing is governed by the law 784 of 2002; therefore, the training for this activity establishes that the student must acquire skills and knowledge mediated by learning styles, in order to respond to the hospital context. Objective: To develop a scientific position regarding the learning styles in clinical practice of the students of Operating Room Nursing from a health sciences university in Bogotá. Development: The surgical instrument nurse focuses on the patient; therefore, the training process of this person is demanding for both the instructor and the student; hence, a modification of the educational dynamics is necessary, since universities must identify weaknesses in learning and strengthen student learning styles. In this way, the position is assumed that the teacher of operating room nurses in practice has the responsibility of assuming the role of his/her position and as a teacher, to provide educational tools that identify and promote the learning styles of health science students. Conclusions: Learning styles become an indispensable element in the training process, not only for surgical room nurses, but for any other health professional(AU)

Instrumentación quirúrgica: de la formación de grado a las competencias requeridas en puestos jerárquicos en la Ciudad Autónoma de Buenos Aires, Argentina / Surgical instrumentation: from undergraduate education to required competences in hierarchical positions in the Autonomous City of Buenos Aires, Argentina

La Licenciatura en Instrumentación Quirúrgica se ha propuesto desarrollar las competencias propias del profesional que actúa en un ámbito de gestión, sin descuidar las que sostiene el instrumentador en su práctica asistencial. El objetivo de esta investigación es articular los contenidos que se brindan en instituciones educativas de formación de grado para instrumentadores quirúrgicos, con las competencias que se requieren para desempeñarse en diferentes puestos jerárquicos. Se realizó un estudio cualitativo, descriptivo, de corte transversal, en el cual se procedió a entrevistar a siete profesionales de la salud que ocupan un cargo jerárquico, utilizando una guía de preguntas abiertas cuyos resultados se trabajaron mediante el análisis de contenido. También se compararon los listados de las asignaturas que se brindan en la Licenciatura para Instrumentadores Quirúrgicos en distintas universidades, cotejando los resultados con los de las entrevistas. Estas evidenciaron que los licenciados ocupan cargos jerárquicos de importancia en las instituciones para las que se desempeñan, donde necesitan poner en juego competencias como la comunicación, la gestión y el liderazgo, entre otras. En las licenciaturas ofrecidas a instrumentadores quirúrgicos se dictan asignaturas que brindan a los profesionales conocimientos generales acerca de gestión, administración, investigación y educación, concluyendo que la formación de grado sirve como base a la hora de adentrarse en el mundo laboral; no obstante, el contenido de las asignaturas varía según cada institución; por lo tanto, el nivel de formación de los licenciados resulta dispar y muchos deben realizar otros cursos o capacitaciones para complementarla. (AU)

The incorporation of a bachelor's degree for surgical-instrumentation practitioners, the academic field aims to develop the competencies required by professionals in management positions while improving the ones of surgical-instrumentation practitioners in an operating room. The following research articulated the academic training provided by different higher education institutions with the competences required to perform in several hierarchical positions. We conducted a qualitative, descriptive and cross-sectional study: we carried out interviews with seven health-professionals who work in different hierarchical roles, using open-ended questions, whose answers were studied through content analysis; and we analyzed the study-plans for Surgical Instrumentation degrees offered by a select group of universities. We also compared the lists of the subjects of the different universities that are offered in the degree for surgical instrumenters, collating the results with the interviews. The interviews revealed that graduates often get middle-level management roles that require not only the competences directly related to their surgical-assistance practice, but also a set of skills regarding human-management, such as administration, communication and leadership among others. Generally, in the analyzed bachelor's degrees curricula, the contents are properly organized and provide students with abilities in management, administration, investigation and education, concluding undergraduate academic education is an added value in graduates' resume for labor insertion. However, it exits a variation in the subject's content between higher education institutions, which creates a disparity in the academic level between graduates from different universities and force some of them to take further courses and trainings to complement their academic background. (AU)

Ruptura atraumática del bazo: a propósito de un caso / Atraumatic splenic rupture: report of a case

Se presenta el caso de un masculino de 33 años de edad, portador de cuatro hernias discales, que fue sometido a una instrumentación, donde perdió tres litros de sangre y recibió múltiples transfusiones, al día después inició con dolor y alteración de la sensibilidad en la pierna izquierda, por lo que lo vuelven a intervenir ya que un tornillo estaba mal posicionado. Fue dado de alta. A los dos días presentó hematemesis, epistaxis e ictericia, fue llevado al hospital donde falleció por un shock hipovolémico, debido a una ruptura del bazo. La ruptura atraumática del bazo, es conocida por ser una entidad infrecuente, que puede ocurrir en ausencia de factores de riesgo como el trauma o alguna patología de fondo.

Case of a 33 years old male bearing four discs hernias who went through surgical instrumentation, where he lost 3 liters of blood and received multiple transfusions. Next day reported pain and sensitivity alteration on the left leg; returns to surgery because one bold was not well positioned. Released from the hospital, and two days later returned with hematemesis, epistaxis, and jaundice, went back to the hospital where he died from a hypovolemic shock due to a spleen rupture. The non-traumatic spleen rupture is very infrequent in absence of risk factors, such as trauma or a base pathology.

Hemangioblastoma cereberoloso en el síndrome de von Hippel-Lindau, como causa de muerte: reporte de un caso / Case report: cereberoloso in Von Hippel-Lindau disease, hemangioblastoma cause of death

El síndrome de von Hippel-Lindau es una enfermedad caracterizada por el desarrollo de tumores como hemangioblastomas del sistema nervioso central y de la retina, quistes renales, hepáticos y pancreáticos; carcinoma renal de células claras, feocromocitoma, así como adenomas en el oído interno, la nariz y la laringe. En la mayoría de los casos hay un antecedente familiar positivo del síndrome 8. A continuación se presenta el caso de una femenina de 35 años de edad, sin antecedentes personales patológicos conocidos, con antecedente familiar positivo por la enfermedad de von Hippel-Lindau. Según la historia de sus familiares, la mujer presentaba “ataques de rigidez” de dos semanas de evolución, posterior a uno de estos ataques fue atendida por paramédicos quienes la declararon fallecida. Según la autopsia médico legal se diagnosticó una hidrocefalia obstructiva secundaria a hemangioma cerebeloso y hallazgos compatibles con el Síndrome de von Hippel-Lindau. El objetivo de este artículo es resaltar los hallazgos postmortem de esta entidad y su relación con la causa de la muerte.

Von Hippel-Lindau syndrome is characterized by tumors as central nervous system and retinal hemangioblastomas; renal, liver and pancreas cysts; clear cells renal carcinoma, pheochromocytoma and adenomas of the ear, nose and larynx. In most cases there is a positive family history of the syndrome 8. The follow case is about a female how was 35 years old without known medical history. She had a positive family history of von Hippel-Lindau, and her family told us about she had “stiffness attacks” and two weeks later had another stiffness attack so it was treated by paramedics who declared her dead. In agreement with the forensic autopsy findings the diagnosis was hydrocephalus induced by brain stem hemangioma and the findings were compatible with von Hippel-Lindau. The aim of this article is to highlight the most important postmortem findings of this syndrome and its relation to the cause of death.

Class and research progress of energy-based surgical instrumentations / 国际生物医学工程杂志

Energy-based surgical instrumentation (ESI) are surgical devices ablating or cutting tissues via the application of electrical,luminous,acoustic or other energy.High frequency electrotomes are widely used due to the low price,but they produce smoke in the process of surgery and incisions heal slowly.Ultrasonically activated scalpels' cutting performance is satisfying with easily healing incisions while its coagulating capability is poor.Laser scalpels are qualified for both cutting and coagulating in spite of the need of novel technology to overcome the characteristic that tissues absorb laser wavelength selectively.

New technique of occlusal splint fabrication using dental modeling compound

INTRODUCTION: The restoration of function after surgery with mandibular reconstruction is of utmost importance. Mastication and deglutition are compromised if pre-operative dental occlusion is not reestablished. For this purpose, occlusal splints are fabricated pre-operatively. Various methods of occlusal splint fabrication are at hand. DESIGN: Surgical Instrumentation SETTING: Tertiary Academic Hospital OBJECTIVE: This paper presents a simple, quick and inexpensive way of fabricating an occlusal splint with the use of dental modeling compound. MATERIALS AND METHODS: The dental modeling compound is used pre-operatively to make an occlusal appliance. Occlusal splint fabricated with this method was used in 6 patients who underwent segmental mandibular resection with reconstruction for various pathologies. Post-operatively, patients were assessed in terms of occlusion, type of diet and pain on mastication. RESULTS: Out of the 6 patients, only 5 patients were available for evaluation. One patient suffered a myocardial infarction 3 days post-operation and subsequently died. The five patients had good mandibular-maxillary relation post-surgery. They were able to tolerate regular diet with no pain on mastication. CONCLUSION: In conclusion, we have discussed a simple, quick and cost-effective way of fabricating an occlusal splint for use in mandibular reconstruction. (Author)

Clinical Analyzed of Thoracic Level Spinal Cord Injured Patients

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.