Inteligencia artificial en medicina y procedimientos quirúrgicos: impacto en la toma de decisiones y la salud / Artificial Intelligence in Medicine and Surgical Procedures: Impact on Decision Making and Health

Introducción: Las revisiones sistemáticas de la literatura constituyen una herramienta metodológica práctica para la búsqueda de información sobre investigaciones clínicas, aplicaciones tecnológicas y la toma de decisiones de impacto en la salud. Objetivo: Describir cómo influye la inteligencia artificial en la toma de decisiones médicas según el grado de concordancia entre estas evidencias y los sistemas expertos aplicados en las especialidades clínicas y quirúrgicas de impacto en la salud, según reportes entre 2010 y 2019. Métodos: Se realizó una revisión sistemática con el uso de un modelo de bases de datos relacional y un modelo de entidad relación para garantizar la entidad referencial de la que hacen parte las bases de datos y los artículos, así como la calidad de cada uno de los artículos mediante clasificación por grados de concordancia entre muy concordante o no concordante con la temática de interés y la toma de decisiones de impacto en la salud. Conclusiones: Las aplicaciones como los sistemas expertos, los aprendizajes de máquinas y la robótica aportan innovación a las instituciones y un cambio revolucionario en lo académico, clínico y epidemiológico(AU)

Introduction: Systematic reviews of the literature constitute a practical methodological tool for the search of information on clinical research, technological applications and health impact decision-making. Objectives: To describe how artificial intelligence influences medical decision-making according to the degree of agreement between this evidence and the expert systems applied in clinical and surgical specialties with an impact on health, according to reports from 2010 to 2019. Methods: A systematic review was conducted with the use of a relational database model and a relationship entity model to guarantee the referential entity of which the databases and articles are part, as well as the quality of each of the articles classified by degrees of agreement between very concordant or not concordant with the topic of interest and the decision making of impact on health. Conclusions: Applications such as expert systems, machine learning and robotics bring innovation to institutions and a revolutionary change in academic, clinical and epidemiological areas(AU)

Vivencias y experiencias en las relaciones sociales durante la formación académica de médicos especialistas

Introducción: La formación académica en las especialidades médicas es un proceso continuo de entrenamiento teórico y práctico en el que las y los residentes interactúan constantemente con los coordinadores del programa, con residentes de diferentes programas y las y los trabajadores de los escenarios de prácticas. Se investigó por medio de entrevistas las relaciones que se presentan en diferentes especialidades. Objetivo: Conocer las vivencias y experiencias de la jerarquía de las y los residentes durante su proceso de formación en los escenarios de prácticas. Método: Estudio cualitativo de corte fenomenológico que aplicó entrevistas semi-estructuradas a 42 estudiantes de especialidades médico-quirúrgicas como: cirugía plástica, ginecología, medicina crítica, medicina interna, neurología, pediatría y psiquiatría, revisando de la batería de riesgo psicosocial el dominio de relaciones sociales y liderazgo. Resultados: Las y los entrevistados expresaron 195 referencias relacionadas con sus experiencias en las que el liderazgo de los coordinadores del programa es descrito como una interacción significativa que genera malestar psicológico o protección, junto con 158 referencias de estilo de retroalimentación en algunas vivencias, escaso o centrado en una nota cuantitativa, y 156 referencias de cómo veían la relación con sus residentes mayores desde una perspectiva jerárquica. Conclusiones: Las características de la jerarquía durante la residencia están determinadas por el estilo de liderazgo del coordinador del programa y los residentes replican el mismo modelo con sus compañeros de mismo año, superiores y residentes menores.

Introduction: Academic training in medical specialties is a continuous process of theoretical and practical training where residents constantly interact with program coordinators, residents of different programs and workers in internship scenarios; the relationships that occur in different residences were investigated through interviews. Objective: To know the life experiences of the hierarchy of resident doctors during their training process in the practice settings. Method: Qualitative phenomenological study that uses semi-structured interviews with 42 students of medical-surgical specialties such as: plastic surgery, gynecology, critical medicine, internal medicine, neurology, pediatrics and psychiatry, reviewing the psychosocial risk battery domain of social relations and leadership. Results: The interviewees expressed 195 references related to their experiences where the leadership of the program coordinators is described as a significant interaction generating psychological or protective discomfort, along with 158 references of feedback style in some experiences, scarce or focused on a quantitative note and 156 references of how they saw the relationship with their older residents from a hierarchical perspective. Conclusions: The characteristics of the hierarchy in the residence are determined by the leadership style of the program coordinator and the residents replicate the same model with their peers of the same year, superiors and minor residents.

Demographic and professional profile of Brazilian women in vascular surgery: final results / Perfis demográfico e profissional de mulheres brasileiras na cirurgia vascular: resultados finais

Abstract Background Gender diversity in health teams is associated with better productivity. As women's participation in surgery has been growing, it is important to improve knowledge about the elements that guide their professional development. Objectives The aim of this study was to outline the demographic and professional features of female vascular surgeons in Brazil. Methods A cross-sectional study was designed, in which a questionnaire was made available online for 60 days. Invitations to participate were distributed by institutional e-mail sent from the Brazilian Society of Angiology and Vascular Surgery (SBACV) to associate women surgeons. Results are presented as numbers and percentages. Odds ratios and chi-square tests were used for analysis. Results From a total of 810 invitations sent out, 281 questionnaires were completed. The most prevalent age groups were 25-35 years (n = 115) and 36-45 years (n = 114). Among those who worked exclusively in the private sector, 79.8% had at least one board certification (OR: 0.76, 95% CI: 0.65-0.89; p = 0.001). Regarding workload distribution, 64.4% and 34.2% reported that they spend more time in the clinic and hospital, respectively. Respondents with more years of experience reported a predominance of office practice (p = 0.002). Although 67.3% (n = 189) had published scientific papers, 68% (n = 191) had never held leadership roles. Conclusions The study respondents consisted of highly qualified women surgeons with respect to training, certification, and scientific engagement, but they remain underrepresented in professional management positions. Surgical societies and health institutions should act to promote inclusive and diverse leadership.

Resumo Contexto A diversidade de gênero em equipes médicas está associada a uma melhor produtividade. Com o aumento da participação feminina na cirurgia, é importante conhecer melhor os elementos que orientam o desenvolvimento dessas profissionais. Objetivos Delinear as características demográficas e profissionais das cirurgiãs vasculares no Brasil. Métodos Estudo de caráter transversal, em que foi disponibilizado um questionário on-line por 60 dias. O convite foi enviado pelo e-mail institucional da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) às cirurgiãs associadas. Os resultados são apresentados como números e porcentagens. Os testes de odds ratio (OR) e do qui-quadrado foram utilizados para a análise. Resultados De 810 convites enviados, 281 questionários foram respondidos. Os grupos etários predominantes foram 25-35 anos (n = 115) e 36-45 anos (n = 114). Entre as que trabalhavam exclusivamente no setor privado, 79,8% possuíam ao menos um Título de Especialista (OR: 0,76; intervalo de confiança de 95% 0,65-0,89; p = 0,001). Em relação à distribuição da carga horária, 64,4% e 34,2% relataram que passavam mais tempo no ambulatório e no hospital, respectivamente. Entre as com mais anos de experiência, houve predomínio da prática em consultório (p = 0,002). Embora 67,3% (n = 189) tenham publicado artigos científicos, 68% (n = 191) nunca ocuparam cargos de liderança. Conclusões As participantes do estudo consistiram em cirurgiãs altamente qualificadas em relação a treinamento, certificação e engajamento científico. No entanto, permanecem pouco representadas em cargos de gestão profissional. As sociedades cirúrgicas e as instituições de saúde devem agir para promover uma liderança inclusiva e diversa.

Perfil epidemiológico dos pacientes atendidos pelo serviço de cirurgia plástica do hospital João XXIII em Belo Horizonte/MG no período de março à agosto de 2013 / Epidemiological profile of patients treated by the plastic surgery service of the João XXIII hospital in Belo Horizonte/MG from March to August 2013

Introdução: O Serviço de Cirurgia Plástica Programada do Hospital João XXIII exerce o suporte às demais especialidades através de inter-consultas e, realiza atendimento aos pacientes com entrada no Hospital pela cirurgia plástica. O escopo deste estudo foi analisar o perfil epidemiológico dos pacientes atendidos durante o período de Março à Agosto de 2013. Métodos: Trata-se de um estudo observacional prospectivo com coleta de dados realizada através de anamnese e exame físico. Resultados: Dentre os pacientes avaliados 75,23% eram do sexo masculino e 21,34% do sexo feminino. A faixa etária predominante foi a economicamente ativa com 62,86% dos pacientes entre 16 e 45 anos. Foi observado que os acidentes de trânsito figuraram como os principais determinantes de atendimentos (44,85%). As escaras constituíram os diagnósticos mais frequentes e dentre as outras lesões avaliadas, observou-se que se concentraram nos membros. A Clínica Médica e a Ortopedia solicitaram o maior número de inter-consultas. Evidenciou-se que o tratamento através de abordagem cirúrgica (52,9%) e o acompanhamento com cuidados locais (47,1%) apresentaram frequências aproximadas. Conclusão: Na busca por propor medidas para prevenir e tratar as lesões próprias de abrangência da cirurgia plástica reparadora destacaram-se dois pontos: os acidentes de trânsito e as escaras de decúbito. Ambos com fatores determinantes bem elucidados, porém mantendo alta prevalência. Torna-se evidente a necessidade de atuação nas esferas públicas para uma melhor educação no trânsito e redução da ocorrência de acidentes. No âmbito hospitalar é primordial que se adotem medidas eficazes que impeçam o surgimento das temíveis escaras de decúbito.

Introduction: The Plastic Surgery Service of the João XXIII Hospital provides support to other specialties through interdepartmental consultation and follows patients admitted to the hospital for plastic surgery. This study analyzed the epidemiological profile of patients treated from March to August 2013. Methods: This was a prospective observational study with data collection performed by medical history and physical examination. Results: Of the patients evaluated, 75.23% were male and 21.34% female. The predominant age group was economically active, with 62.86% of the patients between 16 and 45 years. Traffic accidents were the main reason for care (44.85%). Pressure ulcers were the most frequent diagnoses, and other lesions evaluated were predominantly of the extremities. Internal Medicine and Orthopedics requested most consultations. Surgical treatment (52.9%) and follow-up with local care (47.1%) showed similar frequencies. Conclusion: In order to propose measures for prevention and treatment of injuries within the scope of reconstructive plastic surgery, two issues were highlighted: traffic accidents and pressure ulcers. Both have well-defined causes, but remain at high prevalence. The need for public action that promotes better traffic education and reduction of accidents is clear. In the hospital environment, it is essential to take effective measures to prevent the emergence of dreaded pressure ulcers.

Tratamiento de las lesiones del anillo pélvico con un fijador interno anterior: estudio experimental: presentación de resultados preliminares / Internal anterior fixator for pelvic ring injury treatment: experimental study: preliminary results presentation

La fijación externa para el tratamiento de las lesiones del anillo pélvico es una técnica bien descrita y ampliamente utilizada para la estabilización inicial de estas lesiones y en ocasiones como tratamiento definitivo. Sin embargo, se ha asociado con complicaciones como infección en el trayecto de los pines, aflojamiento aséptico, pérdida de la reducción, lesión neurológica, entre otras. Presentamos un método novedoso de fijación interna anterior para el tratamiento de las lesiones del anillo pélvico mediante el uso de tornillos pediculares espinales supra acetabulares unidos a una barra subcutánea. Se realizó un estudio experimental de tipo prueba terapéutica, en una institución de nivel IV, donde se trataron 4 pacientes desde enero a junio de 2012. Tiempo de curación, calidad y pérdida de la reducción, incidencia de complicaciones y movilidad y confort del paciente, entre otras variables, fueron evaluadas. Presentamos los resultados preliminares del tratamiento de las fracturas del anillo pélvico con esta técnica(AU)

External fixation for the treatment of pelvic ring injuries is a well described and widely used technique for initial stabilization of these injuries and sometimos as definitive treatment. However, it has been associated with complications such as infection in the path of the pins, aseptic loosening, loss of reduction, neurologic injury, among others. We present a novel method of anterior internal fixation for the treatment of pelvic ring injuries by using pedicle screw spinal supra acetabular aboye a bar attached to the skin. An experimental study was made conducted in a Level IV institution, where 4 patients were treated from January to June 2012. Healing time, quality and loss of reduction, incidence of complications and patient mobility and comfort, among other variables, were evaluated. We present preliminary results of treatment of pelvic ring fractures with this technique(AU)

Técnica de Copeland Kessel versus técnica de Bosworth en el tratamiento de la luxación acromio clavicular tipo III - V / Copeland Kessel technical versus Bosworth technical in treatment of acromio-clavicular dislocation type III - V

La luxación acromioclavicular es una patología condicionada por problemas traumáticos y aplicación de sobrecarga, que da como resultado una lesión del sistema capsulo-ligamentario y muscular, que conlleva a una lesión incapacitante al individuo que la padece; por lo general son del sexo masculino y por un mecanismo de lesión con contusión directa en la punta del hombro. La técnica de Copeland Kessel, es una alternativa para su estabilización, basándonos en la baja tasa de complicaciones y la reincorporación del paciente a su vida normal al cabo de 12 semanas(AU)

Acromioclavicular dislocation is a condition influenced by trauma and application problems of overload that results in injury to the capsular ligamentous system and muscle that leads to a disabling injury to the person who suffers it, usually are male and the mechanism is a direct contusion injury on the tip of the shoulder. Copeland Kessel technique is an alternative for stabilization, based on the low rate of complications and the patient return to normal alter 12 weeks(AU)

Fractura bilateral de calcáneo: reporte de un caso / Bilateral calcaneus fracture: case report

Las fracturas del calcáneo representan aproximadamente 2% de todas las fracturas del cuerpo humano y 60% de las fracturas del tarso. Menos del 7% son bilaterales. Las fracturas intra-articulares desplazadas (Sanders Tipo IV) son el resultado de traumatismos de alta energía, usualmente debido a precipitaciones o accidentes automovilísticos. Es una lesión compleja que se asocia con elevados índices de incapacidad cuando no es tratada de forma correcta y oportuna. Se trata de paciente masculino, de 38 años de edad, quien presenta una fractura bilateral de calcáneo Sanders tipo IV, manejada quirúrgicamente, mediante reducción directa, reconstrucción anatómica del calcáneo, osteosíntesis con placa anatómica y artrodesis subtalar. Las fracturas del calcáneo siguen siendo un gran reto para el cirujano ortopedista y traumatólogo debido a la controversia en cuanto a su manejo. El diagnóstico preciso y precoz, basado en estudios imagenológicos, es necesario para una adecuada caracterización de la fractura, planificación preoperatoria y resolución quirúrgica(AU)

Calcaneal fractures represent approximately 2% of all fractures of the body and 60% of fractures of the tarsus. Less than 7% are bilateral. The displaced intra-articular fractures (Sanders type IV) are the result of high energy trauma, usually because of rainfall or auto accidents. It is a complex injury that is associated with high rates of disability when not treated properly and timely. The case of male 38-year-old man presented with bilateral calcaneal fractures Sanders type IV, which were managed surgically by direct reduction of the calcaneus and anatomical reconstruction píate fixation and anatomic subtalar arthrodesis. Calcaneal fractures remain a major challenge for orthopedic surgeons and trauma due to controversy regarding their management. The early and accurate diagnosis based on imaging studies, it is necessary for proper characterization of the fracture, preoperative planning and surgical resolution(AU)

Osteotomía en Scarf: estudio de 25 casos / Scarf osteotomy: a report of 25 cases

Evaluar los resultados clínicos y radiográficos de la osteotomía en Scarf para el tratamiento del hallux valgas moderado-severo. Material y métodos: Realizamos un estudio retrospectivo con 25 osteotomías en Scarf realizadas desde marzo de 2009 a junio de 2011 con un seguimiento medio de 11 meses para el tratamiento del hallux valgus moderado-severo. Se realizó una valoración clínica de forma pre y postoperatoria según la escala funcional de la American Orthopaedic Foot and Ankle Society (AOFAS) y una valoración radiográfica, mediante la medición de los ángulos intermetatarsiano (IMA), de hallux valgus (HVA) y distal de la articulación metatarsofalángica (DMAA), también de forma pre y postoperatoria. Resultados: En el estudio, 19 pacientes fueron mujeres y 6 hombres, siendo la edad media de 45 años. La estancia media de ingreso fue de 1.2 días. Según la escala AOFAS, se obtuvo una puntuación global preoperatoria de 34.44 y postoperatoria de 92.4. En cuanto a los resultados radiológicos postoperatorios, obtuvimos un IMA medio de 8.84° y un HVA medio de 18.2°. El DMAA fue menor de 10° excepto en 1 paciente. Conclusión: La osteotomía en Scarf ofrece al paciente un apoyo temprano, una movilidad metatarso-falángica precoz y una rápida consolidación de la osteotomía. Obtuvimos unos buenos resultados a corto-medio plazo para el tratamiento del hallux valgus moderado-severo(AU)

To assess the clinical and radiographic results of the Scarf osteotomy in the treatment of moderatesevere hallux valgus. Patients and methods: We performed a retrospectiva study of 25 Scarf osteotomies from March 2009 to June 2011 with an average follow up of 11 months for the treatment of the moderate-several hallux valgus. We assessed the clinical outcome pre and postoperative according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale and radiological outcome, with measuring the angles intermetatarsal (IMA), of hallux valgus (HVA) and distal of metatarsal-phalang joint (DMAA), pre and postoperative. Results: In the study, 19 patients were women and 6 men with average age of 45 years. Tbe average stay of revenue was 1.2 days. According to the AOFAS scale, we obtained a global preoperative score of 34.44 and postoperative of 92.4. About the postoperative radiological findings, we obtained an average IMA of 8.84° and HVA of 18.2 °. Ttle DMAA was less than 10° except in 1 patient. Conclu ion: The Scarf osteotomy offers an early load, an early metatarsal-phalang joint mobility and an early osteotomy consolidation. We performed a good results in the short-medium term for the treatment of the moderate-severe hallux valgus(AU)

Prevalencia y factores asociados al consumo de sustancias psicoactivas legales farmacológicas en médicos residentes de una universidad de Bogotá / Prevalence and factors associated with the use of legal pharmacologic psychoactive substances in resident doctors of a university of Bogota

Objetivo: Identificar la prevalencia y los factores asociados al consumo de sustancias controladas en médicos residentes de una universidad de Bogotá. Año 2008. Metodología: Se realizó un estudio observacional de corte transversal, con una muestra de 157 residentes estratificada por especialidades médico quirúrgicas de programas de posgrado. Como criterios de inclusión se tomaron; ser médico residente matriculado actualmente en los programas académicos y ser mayor de 18 años. Se utilizaron como variables independientes la edad, el género, el estado civil, la relación familiar, el tipo de residencia, el ambiente laboral, el número de turnos por semana y como variables dependientes tipo de medicamento y su frecuencia de consumo. Resultados: En relación con el consumo de sustancias controladas se encontró que el 12.4% (N=39) consume o ha consumido alguna vez sustancias psicoactivas. El 10.4% (N=33) ha consumido alguna vez una sustancia controlada y 7.6% (N=25) las ha consumido durante la especialidad. Entre los factores asociados dados por el análisis bivariado se encontró asociación significativa entre el consumo de sustancias psicoactivas legales con el número de turnos por semana y un ambiente laboral en el que predomino el maltrato dado por turnos de castigo, insultos, falta de respeto y amenazas, (valor p <0,05), con el análisis multivariado no se encontró asociación. Conclusiones: Diferentes factores de riesgo se encuentran asociados al consumo de sustancias psicoactivas legales, en especial el ambiente laboral y el número de turnos por semana. La prevalencia de consumo de sustancias psicoactivas legales farmacológicas fue considerada como baja.

Objective: Identify the prevalence and factors associated with controlled substances among medical residents from a university in Bogota. Year 2008. Methodology: A cross-sectional observational study was performed with a sample of 157 residents stratified by medical – surgical specialties from postgraduate programs. Inclusion criteria were taken: being a resident doctor currently enrolled in academic programs and to be over 18 years. It was used independent variables as age, gender, marital status, family relationship, type of residence, work environment, number of rotations per week and dependent variables as frequency of use and type of drug consumed. Results: Regarding the use controlled substance, it was found that 12.4% (N = 39) consume or they’ve ever used psychoactive substances. 10.4% (N = 33) has ever used a controlled substance and 7.6% (N = 25) has consumed during the specialization. Among the associated factors which were given by means of the bivariant analysis, it was found a significant association among the use of legal psychoactive substances with the number of rotations per week and a work environment in which prevails the given mistreatment by punishment rotation, insults, disrespect and threats (p <0, 05), it was not found association by means of the multivariant analysis. Conclusions: Different risk factors are associated with controlled substance use, especially the work environment and the number of rotations per week. The prevalence of controlled substances was considered low.

Effects of Temperament and Character on the Specialty Interests of Medical Students

OBJECTIVES: In the previous studies, it has been suggested that temperament and character may affect specialty choice in medical students. The aim of this study is to investigate the effects of temperament and character on specialty interests in medical students. METHODS: A total 132 third-year medical students initially participated in this study. Among these participants, 128 students had filled out both demographic and Temperament and Character Inventory (TCI) questionnaires. Socio-demographic data, specialty interests and Cloninger's TCI scores were obtained. The specialty interests were categorized into surgical, medical and other departments. RESULTS: Among 128 students, 88 (68.7%), 29 (22.7%) and 22 (8.6%) students chose medical, surgical and other departments, respectively. Students choosing surgery departments showed lower Harm Avoidance scores (F = 4.39, df = 1, p = 0.04) and higher Self-Directedness scores (F = 4.30, df = 1, p = 0.04) than those who chose medical departments. There was no significant differences in Novelty Seeking, Reward dependence, Persistence, Cooperativeness, Self-Transcendence scores between groups. CONCLUSIONS: To the best of our knowledge, this is the first study that has demonstrated the relationship between TCI scores and specialty interests of medical students in Korea. The current study suggests that temperament and character influence specialty interests in medical students. These findings could have implications for medical education research and career counseling.