Instruments used in the assessment of expectation toward a spine surgery: an integrative review / Instrumentos utilizados en la evaluación de la expectación ante el tratamiento quirúrgico de la columna vertebral: revisión integrativa / Instrumentos utilizados na avaliação da expectativa diante do tratamento cirúrgico da coluna vertebral: revisão integrativa

Abstract OBJECTIVE To identify and describe the instruments used to assess patients' expectations toward spine surgery. METHOD An integrative review was carried out in the databases PubMed, CINAHL, LILACS and PsycINFO. RESULTS A total of 4,402 publications were identified, of which 25 met the selection criteria. Of the studies selected, only three used tools that had confirmed validity and reliability to be applied; in five studies, clinical scores were used, and were modified for the assessment of patients' expectations, and in 17 studies the researchers developed scales without an adequate description of the method used for their development and validation. CONCLUSION The assessment of patients' expectations has been methodologically conducted in different ways. Until the completion of this integrative review, only two valid and reliable instruments had been used in three of the selected studies.

Resumen OBJETIVO Identificar y describir los instrumentos utilizados para evaluar la expectación de los pacientes ante el tratamiento quirúrgico de la columna vertebral. MÉTODO Revisión Integrativa llevada a cabo en las bases de datos PubMed, CINAHL, LILACS y PsycINFO. RESULTADOS Identificamos 4.402 publicaciones, de las que 25 atendieron los criterios de selección. De los estudios seleccionados, solo en tres los autores utilizaron instrumentos que tenían validez y confiabilidad confirmadas para aplicarse; en cinco estudios, fueron utilizados scores clínicos, modificados para la evaluación de las expectaciones de los pacientes; y, en diecisiete, los investigadores diseñaron escalas sin la adecuada descripción del método utilizado para su desarrollo y validación. CONCLUSIÓN La evaluación de las expectaciones de los pacientes está siendo metodológicamente conducida de distintas maneras. Hasta la finalización de esta revisión integrativa, solo dos instrumentos, válidos y confiables, se habían utilizado en tres de los estudios seleccionados.

Resumo OBJETIVO Identificar e descrever os instrumentos usados para avaliar a expectativa dos pacientes diante do tratamento cirúrgico da coluna vertebral. MÉTODO Revisão Integrativa realizada nas bases de dados PubMed, CINAHL, LILACS e PsycINFO. RESULTADOS Identificamos 4.402 publicações, das quais 25 atenderam aos critérios de seleção. Dos estudos selecionados, apenas em três os autores utilizaram instrumentos que possuíam validade e confiabilidade confirmadas para serem aplicados; em cinco estudos foram utilizados escores clínicos, modificados para a avaliação das expectativas dos pacientes, e em dezessete os pesquisadores elaboraram escalas sem adequada descrição do método usado para o seu desenvolvimento e validação. CONCLUSÃO A avaliação das expectativas dos pacientes tem sido metodologicamente conduzida de diferentes maneiras. Até a finalização desta revisão integrativa, apenas dois instrumentos, válidos e confiáveis, haviam sido utilizados em três dos estudos selecionados.

Robotic and Navigation Systems in Orthopaedic Surgery: How Much Do Our Patients Understand?

BACKGROUND: Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems. METHODS: In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary. RESULTS: Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation. CONCLUSIONS: Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation.

Experiencia de prevención en salud mental pediátrica: psicoprofilaxis quirúrgica en pacientes sometidos a cirugía de escoliosis / Prevention experience in pediatric mental health: surgical pychoprophylaxis in patients undergoing scoliosis surgery

El presente artículo presenta un proyecto piloto de Psicoprofilaxis Quirúrgica en el Departamento de Traumatología, Unidad de Escoliosis, Hospital de niños Dr. Luis Calvo Mackenna. La Psicoprofilaxis Quirúrgica, enmarcada dentro de la psicología de la salud, tiene por objetivo apoyar al paciente que será sometido a cirugía, en el manejo de emociones, actitudes y comportamientos que se derivan de la situación quirúrgica, a través de una intervención psicoterapéutica preventiva, breve y focalizada. Se planteó una intervención psicológica para pacientes que debían ser sometidos a cirugía correctiva de escoliosis. Esta constó de 3 instancias: (a) entrevista inicial y evaluación de ansiedad, (b) intervención intrahospitalaria y (c) control postquirúrgico. En todas ellas se midió Nivel Anímico, Nivel de Actividad, Calidad del Sueño y Calidad de la Alimentación. Los resultados sugieren que si los pacientes tienen un adecuado conocimiento del proceso al cual se enfrentarán, aumentaría su sensación de control de la situación y por ende, disminuiría su ansiedad pre-quirúrgica. No obstante, no basta informar, sino que además es necesario adecuarse a las características de cada paciente al hacer entrega de la información, siendo este factor el que permitiría el cambio en los niveles de ansiedad pre-quirúrgica.

This article presents a trial scheme of surgical psychoprophylaxis in the Scoliosis Unit of the Traumatology department at “Doctor Luis Calvo Mackenna childrens” Hospital. This project arises from The surgical psychoprophylaxis is to an area within Health Psychology that aims to support the patient that will undergo surgery, by performing a brief preventive psychotherapeutic intervention that helps him/her to handle possible emotions, attitudes and behaviors that may appear as a result of the surgical experience. The intervention had three stages: (a) Initial interview and anxiety assessment (b) intra- hospital intervention (c) post surgical control. In each stage mood level was measured as well as activity level, sleep quality and feeding behavior quality. The results suggest that, if patients have adequate knowledge of the process they are going to face their feeling of control over the situation would increase and thus reduce preoperative anxiety. Nevertheless, informing is not enough but it is also necessary to adapt the delivery of information to each patient’s characteristics, for this would be the main factor that would allow changes in preoperative anxiety levels.

Para um cuidar sensível na ocorrência de dor em clientes submetidos a cirurgias ortopédicas / For a to take care sensitive in the occurrence of pain in customers submitted to orthopedical surgeries

Sendo a dor um problema no pós-operatório de cirurgias ortopédicas, investiga-se entre 18 clientes a freqüência e a terapêutica utilizada para sua resolução. Utilizou-se o método descritivo exploratório, entrevista e análise documental para pesquisar em um hospital do Espírito Santo - Brasil, em 2002. Observou-se que 100 por cento dos clientes queixaram-se de dor, sendo sua intensidade de leve a moderada em 86,9 por cento das ocorrências. Observou-se uma despreocupação com a dor desses clientes entre as equipes médica e de Enfermagem. O único analgésico IV prescrito em horário fixo foi a dipirona. Diante da não resolutividade dessa terapêutica medicamentosa, concluímos que a dor, também, é sujeita a fatores culturais e psicológicos e, assim, seu controle deve ser interdisciplinar, colaborativo e solidário com o cliente