Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery

Abstract This paper is a transcript of the 29th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors—including treatment, decision-making, and quality—can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.

A novel two-surgeon technique of simultaneous bilateral cataract surgery with complete delinking

Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon technique of SBCS on a 50-year-old mentally subnormal patient. Under general anesthesia, two surgeons performed phacoemulsification simultaneously, using two separate microscopes, irrigation lines, phaco machines, instruments, and assistants. Intraocular lens (IOL) implantation was performed in both eyes (OU). The patient had a visual recovery from 5/60, N36 in OU preoperatively to 6/12, N10 in OU on post-operative day 3 and 1 month, with no complications. This technique can potentially reduce the risk of endophthalmitis, repeated and prolonged anesthesia, and the number of hospital visits. To the best of our knowledge, this two-surgeon technique of SBCS has never been reported in the literature.

Competencias profesionales en especialistas en cirugía general

Introducción: el nivel de competencias de los profesionales ha constituido una preocupación de los sistemas de salud para incrementar la calidad de los servicios. Las funciones y acciones de los cirujanos generales son de vital importancia, por lo que resulta imprescindible que el capital humano que se desempeña en esta actividad posea las competencias requeridas. Esto motivó la realización de una tesis doctoral, que tiene como objetivo la elaboración de una metodología para la formación y desarrollo de las competencias profesionales en los especialistas en cirugía general. La investigación, cuyos resultados preliminares constituyen el presente trabajo, se realizó en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Objetivo: caracterizar el estado actual de las competencias profesionales en los especialistas en cirugía general. Materiales y métodos: del nivel teórico, se utilizaron: análisis documental, análisis sintético, análisis histórico-lógico, sistematización, inducción-deducción, modelación y enfoque de sistema. Del nivel empírico, la encuesta. Resultados: se mostraron algunas deficiencias en las competencias profesionales e insatisfacciones que afectan la cultura organizacional. Conclusiones: el proceso realizado, combinado con los fundamentos teóricos, ratificó la necesidad de la elaboración de una metodología para la formación y desarrollo de competencias profesionales en los especialistas en cirugía general, como alternativa de las ciencias de la educación médica para resolver las dificultades encontradas.

Introduction: the professionals' level of competences has been a concern of health systems to increase the quality of the services. The functions and actions of general surgeons are of vital importance, so it is essential for the human capital that carries out this activity, to have the required competences. This motivated the completion of a doctoral thesis which aims to the realization of a methodology for training and developing professional competences in general surgery specialists. The research, whose preliminary results are the present work, was carried out in the Clinical Surgical University Hospital Comandante Faustino Perez Hernandez, in Matanzas. Objective: to characterize the current state of professional competences in general surgery specialists. Materials and methods: from the theoretical level, the following methods were used: documental analysis, synthetic analysis, historic logical analysis, systematization, induction-deduction, modeling and system approach. From the empiric level, the survey was used. Results: some deficiencies in the professional competences and in satisfactions that affect the organizational culture were shown. Conclusions: the process carried out, combined with theoretical fundaments, ratified the need of elaborating a methodology for training and developing professional competences in general surgery specialists, as alternative to the medical education sciences for solving the difficulties found.

The role and value of surgeon-engineer interaction during preoperative planning of patient-specific instrumentation assisted total knee arthroplasty / 中华骨科杂志

Objective:To investigate the significance and importance of the interaction between surgeons and engineers during the preoperative planning phase of total knee arthroplasty (TKA) when utilizing patient-specific instrumentation (PSI).Methods:A retrospective review was conducted on 202 knees of PSI-assisted TKA performed on 178 patients between June 2018 and August 2022. The patients' mean age was 68.4±6.2 years, ranging from 53 to 86 years. Among the participants, there were 149 females and 29 males, 93 left knees and 109 right knees. The study involved 171 patients of osteoarthritis (193 knees) and 7 patients of rheumatoid arthritis (9 knees), with 194 knees presenting varus knees and 8 knees with valgus knees. The preoperative plan documents, from the initial engineer-designed plan to the final plan approved by the surgeon, were analyzed to assess the frequency, parameters, and reasons for adjustments made during the planning process.Results:The planning of the 202 PSI-assisted TKA was subjected to at least one round of surgeon-engineer interaction. Among the 202 TKA planning, 117 knees (57.9%) underwent modifications after discussion, with most plans (100 knees, 49.5%) being confirmed after one round of modification. Two rounds of modifications were performed on 10 knees (5.0%), and three rounds on 5 knees (2.5%). A maximum of four rounds of modifications were made on two knees (0.9%). Furthermore, in the case of the remaining 85 knees (42.1%), the surgeons promptly consented to the engineers' initial planning following the discussions. Specific adjustments were made in 106 knees (52.5%) regarding femoral parameters, 57 knees (28.2%) concerning tibial parameters, and 46 knees (22.8%) requiring adjustments to both femoral and tibial parameters. Notably, the most frequently adjusted parameter was the osteotomy thickness of the posterior femoral condyles, which was modified in 94 knees (80.3%). The reasons for adjusting femoral or tibial parameters were summarized, revealing the main factors as follows: 1) Discrepancy between the mediolateral and anteroposterior diameters of the femoral condyle; 2) Twisted deformity of the proximal tibia; 3) Severe flexion contracture deformity of the knee; 4) Collapse of the medial or lateral tibial plateau; 5) Evident anterior arch deformity of the femur.Conclusion:The interaction between surgeons and engineers plays a pivotal role in the preoperative phase of PSI-assisted TKA. Effective collaboration allows surgeons to accurately analyze the unique anatomical characteristics and pathological changes of each patient in a three-dimensional perspective, facilitating the formulation of individualized surgical plans.

Expectativas y realización profesional en Cirugía General y subespecialidades quirúrgicas: situación actual de los cirujanos jóvenes en Córdoba / Expectations and professional fulfillment in general surgery and surgical sub-specialties: current situation of young surgeons in Cordoba

RESUMEN Antecedentes: en la Argentina, la especialidad Cirugía General se encuentra en crisis y esta situación alarmante se halla vinculada a las malas condiciones laborales del cirujano general. Objetivo: describir la percepción que el cirujano joven tiene al terminar su programa de formación, en relación con su perspectiva laboral, actividad quirúrgica y académica. Material y métodos: estudio transversal basado en una encuesta dirigida a cirujanos jóvenes en Córdoba, Argentina. Resultados: participaron 53 encuestados. El 58% eran hombres y la mediana de edad fue 32 años. El 72% ejercía Cirugía General y el 55% trabajaba en el sector privado. El 34% pertenecía a la Asociación de Cirugía de Córdoba y el 23% a la Asociación Argentina de Cirugía. En cuanto a la experiencia profesional, el 53,1% eran cirujanos junior y el 64% eran competentes para realizar procedimientos de baja o mediana complejidad. En relación con la perspectiva laboral, el 89% consideró que el cirujano joven no consigue salida laboral rápida y el 96,2% refirió que sus prácticas no eran bien remuneradas. Respecto de la calidad de vida personal y laboral, el 57% manifestó frustración e incertidumbre económica. En cuanto a las cirujanas, la tasa de inequidades de género y hostigamiento sexual en el ámbito laboral fue del 73% y 50%, respectivamente. Conclusión: encontramos la percepción de un bajo nivel de competencia para las cirugías de mayor complejidad y una baja tasa de adherencia a sociedades quirúrgicas. Debido a la escasa oferta laboral existe gran frustración e incertidumbre económica. Actualmente, predomina y persiste el maltrato y hostigamiento hacia las cirujanas.

ABSTRACT Background: In Argentina, the specialty of general surgery is in crisis, and this alarming situation is associated with the poor working conditions of general surgeons. Objective: The aim of this study is to describe the perception of young surgeons at the end of their training program, in relation to their job prospects, surgical and academic activity. Material and methods: We conducted a cross-sectional study based on a survey responded by young surgeons in Cordoba, Argentina. Results: The survey was responded by 53 young surgeons; 58% were men and median age was 32 years. Seventy-two percent practiced general surgery and 55% worked in the private setting. Thirtyfour percent were members of Asociación de Cirugía de Córdoba and 23% belonged to Asociación Argentina de Cirugía. As for professional experience, 53.1% were junior surgeons and 64% were capable of performing low or medium complexity procedures. Eighty-nine percent considered that young surgeons do not get a job quickly and 96.2% reported that they were not well paid for their practice. When asked about their personal and professional quality of life, 57% expressed frustration and economic uncertainty. Among women surgeons, 73% reported gender inequities and 50% reported sexual harassment in the workplace. Conclusion: Young surgeons perceived they had low level of competencies for high complexity surgical procedures and reported low rate of membership in surgical societies. Most of them feel frustrated due to scarce job opportunities and expressed economic uncertainty. Nowadays, abuse and harassment of women surgeons still prevails and persists.

Síndrome de burnout en cirujanos generales en tiempos de la pandemia COVID-19

Objetivo: Evaluar el síndrome de burnout (SB) en cirujanos generales. Material y Método: Se realizó un estudio de corte transversal en nuestro centro hospitalario, en agosto de 2021. La muestra estuvo formada por 56 profesionales de la salud que incluyeron a residentes y especialistas en cirugia general quienes prestaron servicio en el contexto de la COVID-19. Resultados: La prevalencia del burnout fue del 71%, la edad media fue de 34 años y los residentes fueron los más afectados (62,5%). La distribución por sexo fue de 82,5% en masculinos y 17,5% en el sexo femenino. Del total de evaluados, 23 son casados y 17 solteros, predominando los cirujanos con hijos (60%). Discusión: Entre los pocos estudios publicados sobre el SB en trabajadores de la salud en tiempos de COVID-19 se ubican como posibles factores predisponentes: a las privaciones de sueño, el riesgo biológico ocupacional intrínseco, la cuarentena obligada a la que tienen que someterse los trabajadores de la salud fuera de casa y los dilemas éticos en la toma de decisiones de atención a pacientes. Sin embargo, un estudio ha mostrado que los estresores vinculados al SB más importantes son la falta de equipo de protección personal, el miedo al contagio de COVID-19 y el miedo de contagiar a los familiares. Conclusión: Existe una alta prevalencia del SB en cirujanos generales en el contexto de la pandemia COVID-19. Los más afectados fueron residentes jóvenes de sexo masculino, casados, con hijos y con bajos ingresos económicos.

Objective: To evaluate the burnout syndrome (BS) in general surgeons. Material and Method: A cross-sectional study was carried out in our hospital in August 2021. The sample consisted of 56 health professionals that included residents and specialists in general surgery who provided service in the context of COVID-19 Results: The prevalence of burnout was 71%, the mean age was 34 years and the residents were the most affected (62.5%). Sex was 82.5% in males and 17.5% in females. Of the total evaluated, 23 are married and 17 are single, with a predominance of surgeons with children (60%). Discussion: Among the few studies published on BS in health workers in times of COVID-19, the following are located as possible predisposing factors: sleep deprivation, intrinsic occupational biological risk, the forced quarantine that patients have to undergo. out-of-home health workers and ethical dilemmas in patient care decision-making. However, a study has shown that the most important stressors linked to BS are the lack of personal protective equipment, the fear of contagion of COVID-19 and the fear of infecting family members. Conclusion: There is a high prevalence of BS in general surgeons in the context of the COVID-19 pandemic. The most affected were young male residents, married, with children and with low income.

Desafíos del cirujano general en la realización de la ecografía en la evaluación del trauma / Challenges of the General Surgeon in the Performance of Trauma Assessment Ultrasound

Introducción: El trauma es la pandemia que cada año cobra muchas vidas, los avances tecnológicos no han podido detenerla, sin embargo, estos han ayudado en la evaluación más efectiva de los pacientes. La ecografía realizada por médicos no radiólogos se ha convertido en una herramienta necesaria en la evaluación del paciente traumatizado. Objetivo: Describir los conocimientos que debe adquirir el cirujano general para realizar ecografía en la evaluación del trauma. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se describió los elementos que tiene que conocer el cirujano general para realizar ecografía en la evaluación del trauma. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1971 hasta diciembre de 2019 a los cuales se tuvo acceso y se realizó la evaluación de la validez interna de la evidencia, así como de su calidad global. Los idiomas utilizados en la búsqueda fueron el español e inglés. Desarrollo: La mayoría de los estudios aceptan a la ecografía como herramienta de evaluación en el trauma y su utilización sistemática por médicos no radiólogos. Conclusiones: Los principios básicos de la ecografía en el trauma tienen que ser parte de las herramientas de un cirujano general del siglo xxi. Los errores más frecuentes, responden a la no realización sistemática y a la falta de entrenamiento. Cada vez son menos las contraindicaciones de la ecografía en el trauma, pero sí es marcada la dependencia del operador(AU)

Introduction: Trauma is the pandemic that every year claims many lives; technological advances have not been able to stop it, but have contributed with the more effective assessment of patients. Ultrasound performed by non-radiologists physicians has become a necessary tool in the assessment of the trauma patient. Objective: To describe the knowledge that the general surgeon should acquire to perform ultrasound for assessing trauma. Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. The elements that the general surgeon must know in order to perform ultrasound in the assessment of trauma were described. The search considered all types of studies published from January 1971 to December 2019 and that could be accessed; the internal validity of the evidence was assessed, together with its overall quality. The languages used in the search were English and Spanish. Development: Most studies accept ultrasound as an assessment tool in trauma and its systematic use by non-radiologist physicians. Conclusions: The basic principles of ultrasound in trauma have to be part of the tools of a general surgeon of the twenty-first century. The most frequent errors are due to lack of systematic use and lack of training. Contraindications of ultrasound in trauma are progressively less frequent, but there is a marked dependence on the person who operates(AU)

Cirujano académico, centro académico: su rol docencia, investigación y en la atención de pacientes / The academic surgeon, academic center: its teaching, research, and patient's assistance role

Resumen Un cirujano académico tiene características y atributos especiales que lo distinguen de otros cirujanos. Su misión no es solo asistencial, sino que además es un investigador, docente, comunicador, deber ejercer liderazgo, debe ser innovador. Además de su función primordial que es ofrecer la óptima atención de sus pacientes. Al estar inserto en un centro académico cumple estas funciones y se convierte, dado su prestigio, en un referente individual e institucional para la comunidad y los futuros cirujanos.

An academic surgeon has special characteristics and attributes that distinguish them from other surgeons. His mission is not only healthcare, but he is also a researcher, teacher, communicator, must exercise leadership, must be innovative and the final goal is his work is to offer optimal care for his patients. Being inserted in an academic center, it fulfills these functions and becomes, given its prestige, an individual and institutional reference for the community and future.

A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study

ABSTRACT BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

Atenção odontológica aos pacientes diabéticos no contexto da equipe multiprofissional / Dental care for diabetic patients in the context of the multidisciplinary team

O objetivo deste trabalho é analisar as práticas assistenciais multiprofissionais aos portadores de Diabetes Mellitus nos serviços públicos de saúde, levando-se em consideração a atenção à saúde bucal desses pacientes, com o intuito de propiciar assistência qualificada, melhores condições de saúde e, consequentemente, aliviar a carga econômica sobre o sistema de saúde e a sociedade. Para esse fim, foi realizada uma revisão da literatura de abordagem qualitativa via levantamentos bibliográficos, documental e da literatura cinzenta nas principais bases de dados eletrônicas, tais como: Scielo, PubMed, Portal Regional da Biblioteca Virtual de Saúde, Embase e Oasisbr. Estudos comprovam a importância da atenção multiprofissional aos portadores de diabetes e sugerem dificuldades na integração do cirurgião-dentista nas equipes de saúde apesar da relação definida entre diabetes e manifestações bucais, tornando necessário mais estudos sobre o tema e capacitação dos profissionais envolvidos com vistas a qualificação da assistência aos portadores de Diabetes Mellitus.

The objective of this study is to analyze the multidisciplinary care practices for patients with Diabetes Mellitus in public health services, taking into account the oral health care of these patients, with the aim of providing qualified assistance, better health conditions and, consequently, alleviating the economic burden on the health system and society. Therefore, a qualitative literature review was carried out through bibliographic, documentary and gray literature surveys in the main electronic databases such as: Scielo, PubMed, Regional Portal of the Virtual Health Library, Embase and Oasisbr. Studies prove the importance of multiprofessional care for people with diabetes and suggest difficulties in the integration of dentists into health teams, despite the defined relationship between diabetes and oral manifestations, which makes further studies on the subject and training of professionals involved with a view to the qualification of assistance to patients with Diabetes Mellitus.

Reflections on integrating humanistic quality education into surgery teaching / 中华医学教育探索杂志

In view of the problems existing in the educational philosophy of medical colleges in China, such as the separation of humanistic knowledge and medical knowledge, the small amount of humanities courses in curriculum arrangement, and the monotonous and boring teaching method of outdated teaching content, this study attempts to optimize the curriculum and increase the proportion of humanities courses; update teaching methods to allow new technologies and new ideas to activate the classroom; strengthen the application of humanistic knowledge in practice according to the characteristics of surgery teaching, so that students can experience humanistic quality education in a real environment; create a good atmosphere for the cultivation of humanistic quality of surgeons, so that students can always feel the edification of humanistic spirit.

Analysis of influencing factors of multi-site work-related musculoskeletal disorders in surgeons / 中国职业医学

@# Objective - - To analyze the prevalence and influencing factors of multi site work related musculoskeletal disorders （ ） Methods WMSDs in surgeons. A total of 102 surgeons from four hospitals were selected as study subjects by convenient sampling method. The Chinese version of Musculoskeletal Disorders Questionnaire was used to investigate the prevalence of ， Results WMSDs in the past one year the related individuals and occupational factors. The total prevalence of WMSDs among （ ）， （ ） （ ） surgeons was 54.9%. The top three sites were neck 48.0% lower back 35.3% and shoulder 32.4% . The prevalence of （ vs ，P ） WMSDs in multiple sites was higher than that in a single site 43.1% 11.8% <0.01 . Multivariate logistic regression ， ， analysis showed that surgeons who smoked were tired at work and had a bent back had a higher risk of developing WMSDs ［ （ - ）， （ - ）， （ - ）， P ］ odds ratios and 95% confidence intervals were 3.66 1.41 9.46 8.33 2.15 32.20 and 18.74 2.14 166.77 all <0.01 Conclusion - after excluding the influence of confounding factors. The prevalence rate of multi site WMSDs among surgeons is ， high and the influencing factors include bad living habits and occupational factors such as working load and working posture.

Application of parallelly promoting teaching in the training of ERCP skills for surgeons / 中华医学教育探索杂志

Objective:To explore the application of parallelly promoting teaching in a short-term refresher training of endoscopic retrograde cholangiopancreatography (ERCP) skills for surgeons.Methods:In the study, 30 surgeons who underwent a short-term refresher training of ERCP skills were randomized divided into the parallelly promoting teaching group (observation group) and the progressive teaching group (control group). The normative scores of operation, complications and the incidence of successful intubation between two groups were compared. SPSS 13.0 was performed for t test and chi-square test. Results:Compared with the surgeons in control group, the surgeons in observation group had significantly higher normative scores of operation [(79.86±3.73) vs. (77.20±2.31)], lower incidence of total complications (%) [(8.80±2.11) vs. (10.53±2.44)] and higher incidence of successful intubation (%) [(75.73±3.99) vs. (71.87±3.51)].Conclusion:Compared with the progressive teaching, the parallelly promoting teaching is more effective in the short-term refresher training of ERCP skills for surgeons.

Cirugías más frecuentes en el Centro Médico Naval en un período de 5 años / Most frequent surgeries at the Naval Medical Center in a 5-year period

Resumen: Introducción: El objetivo de este estudio es determinar los procedimientos quirúrgicos más frecuentemente realizados en el Centro Médico Naval, un Centro Médico de Tercer Nivel. Material y métodos: Se realizó un estudio observacional, exploratorio, descriptivo, trasversal y retrospectivo incluyendo todas las cirugías realizadas del 01 de enero de 2015 al 31 de julio de 2019, consultando los registros del quirófano y los expedientes electrónicos. Resultados: Se registraron 25,114 cirugías, con un promedio anual de 5,527 procedimientos y de 16 procedimientos diarios (rango de 2 a 25). Las especialidades que más cirugías realizaron fueron cirugía general, ortopedia, ginecoobstetricia y oftalmología. Las principales cirugías realizadas fueron la facoemulsificación de catarata con colocación de lente intraocular, endoscopías, cesáreas, colecistectomía laparoscópica, atención del trabajo de parto, reducción abierta con fijación interna de fracturas, apendicectomía abierta, hernioplastía inguinal y lavados quirúrgicos. El 59% de las cirugías se realizó en mujeres. El rango de edad de los pacientes fue desde recién nacido hasta los 101 años, estando la mayoría entre los 53 y 72 años. Conclusiones: El Centro Médico Naval destina la mayoría de los recursos de su quirófano para la atención obstétrica (cesárea y trabajo de parto), la atención de padecimientos crónico-degenerativos (cirugía de catarata, y endoscopías), atención de accidentes (reducción de fracturas y lavados quirúrgicos) y la resolución de padecimientos abdominales agudos como la apendicitis y la colecistitis.

Abstract: Introduction: The study objective was to determine the most frequently surgical procedures at the Naval Medical Center, a third level medical center. Material and methods: An observational, exploratory, descriptive, cross-sectional and retrospective study was conducted including all surgeries performed from January 1, 2015 to July 31, 2019, reviewing the surgical records and patient electronic files. Results: 25,114 surgeries were registered, with an annual average of 5,527 procedures and 16 daily procedures (range from 2 to 25). General surgery, orthopedics, gynecoobstetrics and ophthalmology were the specialties with the most amount of surgeries. The main surgeries were cataract phacoemulsification with intraocular lens placement, endoscopies, caesarean sections, laparoscopic cholecystectomy, labor delivery, open reduction with internal fracture fixation, open appendectomy, inguinal hernioplasty and surgical washes. 59% of the surgeries were performed in women. The age range of the patients was from newborn to 101 years, with most patients between 53 and 72 years. Conclusions: The naval medical center spend surgical resources for obstetric care (caesarean section and labor), care of chronic degenerative diseases (cataract surgery, and endoscopy), accident care (fracture reduction and surgical washes) and the resolution of acute abdominal conditions such as appendicitis and cholecystitis.

Visibilizando a las cirujanas en Chile / Making female surgeons visible in Chile

Resumen Introducción: La cirugía ha sido tradicionalmente considerada una especialidad masculina. Se desconoce si el aumento en el número de médicas en las últimas décadas ha producido un aumento significativo en el número de cirujanas. Objetivo: Analizar y visibilizar la participación actual e histórica de las mujeres en Medicina y en Cirugía General en Chile. Materiales y Método: Estudio retrospectivo de la cohorte de médicas/os y cirujanas/os egresados de escuelas de medicina chilenas desde el año 1970, complementado con estudio de corte transversal para conocer la información actual de las cirujanas y residentes. Las fuentes de datos fueron los Registros de la Superintendencia de Salud, CONACEM y el Catastro de la Asociación de Cirujanas. Resultados: Ha existido un aumento sostenido de médicas egresadas sobrepasando a sus pares masculinos a partir de 2018. Las cirujanas representan el 15% del total de cirujanas y cirujanos, y este número se ha duplicado por década a partir de los años 70. Actualmente, 33% de los residentes en formación son de género femenino. Las áreas más comunes de desarrollo son cirugía general (35%), y dentro de las subespecialidades: mama, plástica y cabeza y cuello. Conclusión: Las mujeres siguen siendo minoría en cirugía; sin embargo, se ha producido un aumento progresivo y se espera siga la misma tendencia. Es necesario visibilizar la importancia de las cirujanas para que sirvan como modelo a nuevas generaciones de estudiantes y así poder aumentar la representación femenina en la especialidad.

Introduction: Surgery traditionally has been considered a male discipline. It is unknown if the increase in the number of female doctors in the last decades has increased the number of female surgeons. Aim: Is to analyze and make visible the historical and current participation of women in Medicine and Surgery in Chile. Materials and Method: Retrospective cohort study of all medical doctors and surgeons graduated from chilean Universities since 1970 to date, and cross-sectional study to know current information of female surgeons and residents. Source of data were the Registries of Health Superintendence, CONACEM and the Registry of the Female Surgeon Association. Results: There has been a steady increase in the number of graduated female doctors in Chile, surpassing male doctors since 2018. Female surgeons are 15% of all surgeons, and the number has duplicated every decade since 1970s. Currently, 33% of the residents are female. Main area of developing is general surgery (35%), and within subspecialties: Breast, Plastics, and Head and Neck. Conclusions: Women are still underrepresented in Surgery: however, there has been a steady increase and that trend is expected to continue. It is necessary to make visible the importance of female surgeons to be able to increase female representation.

Inserción laboral del cirujano joven en la Ciudad de Buenos Aires. Necesidad de reestructuración del sistema de formación del cirujano general / Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

RESUMEN Antecedentes: la formación en cirugía se mantuvo uniforme desde la instauración del modelo de re sidencias. El avance de la ciencia ha llevado a la superespecialización y un 70% de los cirujanos conti núan en formación con una especialidad posbásica. Objetivos: identificar la proporción de cirujanos que derivan horas a otra actividad y analizar la inser ción laboral del cirujano. Material y métodos: estudio prospectivo, descriptivo, de corte transversal. 1) Encuesta, 2) Registros de la Dirección General de Docencia e Investigación, 3) Concursos y Perfiles profesionales de acceso público. Resultados: sobre 435 encuestados, al finalizar la residencia, un 73,3% continuó su formación en una posbásica. Solamente un 24,7% se insertó inmediatamente en el mercado como cirujano general. En cuanto a la inserción laboral actual de aquellos que finalizaron la formación como cirujano general, apenas un 17,4% se desempeña de manera exclusiva como cirujano general. Conclusiones: la falta de confianza para actuar de manera independiente y la necesidad de completar 4 años de formación para ingresar en el campo de interés aparecen como las problemáticas para resol ver. Se propone un programa de 5 años con formato 2+3. El período de formación básica abordará en 24 meses las generalidades de la práctica quirúrgica. El segundo, de formación avanzada, desarrollará en profundidad la subespecialidad elegida. El quinto año otorgará a todos la posibilidad de actuar a modo de cirujano independiente. Planteada como una subespecialidad, la Cirugía General volvería a ser un fin en sí misma y no un medio para llegar a una subespecialidad.

ABSTRACT Background: Training in surgery has remained relatively uniform since the residency programs were introduced. The continuous advances in science have led to the progressive super-specialization of surgeons; 70% of them continue their training with a subspecialty. Objectives: The aim of this study was to identify the proportion of surgeons who dedicate hours of their practice in another activity and to analyze how surgeons enter the workforce. Material and methods: We conducted a prospective and descriptive cross-sectional study with data from a survey, records of the General Directorate of Teaching and Research, and records of competitive selection processes and professional profiles available online. Results: Of 435 survey respondents, 73.3% of the resident graduates continued postresidency training in a surgical subspecialty. Only 24.7% immediately started working in general surgery. Among the graduate trainees in general surgery, only 17.4% were exclusively dedicated to general surgery. Conclusions: The lack of confidence to perform procedures independently and the need for completing 4 years of training in the residency program in general surgery to start training in the professional field of interest, appear as the issued to be solved. We propose a 5-year program with a 2+3 model. The initial period comprises 24 months of basic training covering the general aspects of surgical practice. The second period of advanced training will provide thorough training in the subspecialty chosen. In the last year of the 5-year program trainees will have the opportunity to act as attending surgeons. General surgery, conceived as a subspecialty, would regain its status as an objective and no longer a pathway to become a subspecialist.

Extracorporeal Circulation Training for Specialists in Cardiovascular Surgery / 日本心臓血管外科学会雑誌

In the U-40 column, we conducted a questionnaire survey of the U-40 generation on the theme of the specialist system for cardiovascular surgery and reported on the present condition and problems in obtaining certification. With the introduction of a new system, off the job training and participatory training using extracorporeal circulation techniques were newly mandated. In this article, we report the results and discussion of the questionnaire survey regarding the present condition of extracorporeal circulation training for the U-40 generation and the pros and cons of training programs.

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital / 中华创伤杂志(英文版)

PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

Role of the Japanese Training Facilities for Young Cardiovascular Surgeons / 日本心臓血管外科学会雑誌

The Japanese board of cardiovascular surgery has changed the requirements for the certification of cardiovascular surgeons. The requirements include Off the Job Training and the training of extracorporeal circulation. The role of training facilities should be changed because of its duty. We showed a questionnaire survey about the new requirements for young cardiovascular surgeons in Hokkaido. We hope this article shows what is required for the training facilities in the new era.

Conhecimento científico produzido sobre a Síndrome da Ardência Bucal nos últimos cinco anos / Scientific knowledge produced about Bucal Ardence Syndrome in the last five years

Objetivo: realizar revisão integrativa da literatura sobre a Síndrome da Ardência Bucal (SAB). Materiais e Método: trata-se de uma revisão integrativa da literatura sobre a SAB nos últimos cinco anos. Utilizou-se as bases de dados Medline, SciELO e Lilacs para a pesquisa, empregando de forma combinada os descritores relacionados à temática. Como critérios de inclusão, decidiu-se selecionar publicações sobre a temática que estivessem disponíveis para leitura em qualquer idioma dos últimos cinco anos. Foram excluídos os estudos sem relação com o tema. Resultados: após análise, apenas 42 estudos foram selecionados para esta revisão. A maior parte dos artigos era publicada em inglês, porém, foi o Brasil que apresentou o maior número de publicações. As pesquisas avaliadas demonstraram os seguintes resultados: o sexo feminino é o mais acometido; maior prevalência acima dos 60 anos; dor, queimação e xerostomia são os sintomas mais relatados. O laser foi bastante relatado como terapia, além do uso de fármacos. Conclusão: a revisão apresentada neste artigo constatou que a maioria dos artigos, apesar de oriundos do Brasil, foi publicada no idioma inglês. A maioria dos trabalhos destacou que indivíduos do sexo feminino acima dos 60 anos são mais acometidos. Pacientes com SAB apresentam dor e queimação em língua e palato, principalmente. Fatores psicológicos e gastrointestinais podem estar associados ao aparecimento desta síndrome, e os usos do laser e de fármacos fitoterápicos, ou não, parecem melhorar o quadro clínico dos indivíduos acometidos.(AU)

Objective: to perform an integrative review of the literature on Burning Mouth Syndrome (BMS). Materials and Method: This is an integrative review of the literature on Burning Mouth Syndrome over the last five years. The Medline, SciELO, and Lilacs databases were used for the research, using the descriptors related to the topic in combination. The inclusion criteria consisted of publications on the topic that were available for reading in any language over the last five years. Studies unrelated to the topic were excluded. Results: After the analysis, only 42 studies were selected for this review. Most articles were published in English but Brazil had the highest number of publications. The studies evaluated showed the following results: women are the most affected; highest prevalence over 60 years old; and pain, burning, and xerostomia are the most reported symptoms. The laser was extensively reported as therapy, as well as the use of other drugs. Conclusion: The review presented in this article found that most studies were published in Brazil but in the English language. Most studies highlighted that women over 60 years old are more affected. Patients with BMS experience pain and burning especially in the tongue and palate. Psychological and gastrointestinal factors may be associated with the onset of this syndrome, and the use of laser and other drugs, either herbal medicines or not, seems to improve the clinical condition of the individuals affected.(AU)