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.

Frecuencia de ansiedad y depresión en pacientes coordinados para cirugía electiva en el Hospital de Clínicas Manuel Quintela / Frequency of anxiety and depression in patients coordinated for elective surgery at the Hospital de Clínicas Manuel Quintela

Los trastornos depresivos y de ansiedad son más frecuentes en pacientes que se encuentran a la espera de un acto anestésico-quirúrgico. Estos se consideran factores de riesgo de complicaciones posoperatorias de allí el interés de detectarlos en la consulta preoperatoria. El objetivo del trabajo fue determinar la frecuencia de ansiedad y depresión en pacientes pre-quirúrgicos en el Hospital de Clínicas utilizando la Escala de Ansiedad y Depresión Hospitalaria (Hospital Anxiety and Depression Scale) validada en español mediante un estudio observacional, descriptivo y transversal. Se realizó una encuesta a una muestra tomada al azar, de pacientes prequirúrgicos obtenida de la consulta externa o de las consultas provenientes de salas de internación quirúrgica del Hospital de Clínicas entre julio y septiembre de 2019. La prevalencia global de ansiedad y depresión fue de 44% y 14,5%, respectivamente. Un mayor nivel de depresión fue asociado al sexo femenino, no encontrándose asociación entre otras variables como edad, tipo de cirugía u hospitalización, y la mayor frecuencia de cualquiera de los trastornos. Se concluye que los niveles de ansiedad son relativamente elevados y, junto a la depresión, pueden ser detectados en la consulta preoperatoria de manera sencilla utilizando el instrumento propuesto.

The depressive and anxiety disorders are more frequent in patients who are waiting a surgical procedure. These are risk factors of postoperative complications. The objective of this work was to determine the incidence of anxiety and depression in the preoperative period at the University Hospital using the Hospital Anxiety and Depression Scale validated in spanish through an observational, descriptive and cross-sectional study. A socio-demographic characterization of patients was carried out and aspects related to imminent surgery were described. The study was conducted in a random sample of pre-surgical patients who attended an outpatient clinic or were hospitalized at the Hospital de Clínicas, between July and September 2019. The global incidence of anxiety and depression was 44% and 14.5% respectively. A mayor level of depression was observed in females, no other statistically significant evidence was found to support an association between the other variables (age, type of surgery, hospitalization) and the higher prevalence of any of the disorders. We concluded that the level of anxiety is high in our population and deserves to be detected, through the implementation of a simple instrument.

Medición del estrés prequirúrgico en niños y preadolescentes que ingresan para cirugías de urgencia en el Hospital de Niños Sor María Ludovica de La Plata: estudio descriptivo / Measurement of pre-surgical stress in children and pre-adolescents admitted for emergency surgery in the Hospital de Niños Sor María Ludovica de La Plata: descriptive study

Introducción: como profesionales de la salud hemos observado distintas conductas en los pacientes pediátricos, sin psicoprofilaxis, que ingresan para ser intervenidos quirúrgicamente de urgencia; pacientes que, según su edad, su entorno social, familiar y cultural, podrán manifestar dichas conductas interpretadas como estrés, de distintas maneras. Objetivo: se midió el estrés prequirúrgico de los niños que fueron intervenidos quirúrgicamente de urgencia, los sábados y domingos por Guardia, en el Hospital de Niños Sor María Ludovica en la ciudad de La Plata. Materiales y métodos: hemos realizado un estudio piloto de diseño observacional, descriptivo, de corte transversal, aplicando para la recolección de datos la escala de YALE modificada (EAPY-m). Resultados: reclutamos 16 pacientes, de los cuales 10 fueron varones (62,50%), que ingresaron para ser tratados quirúrgicamente por las especialidades de traumatología y cirugía general en partes iguales. La mediana en edad fue de 7 años y la mediana en escolarización obligatoria de 6 años. Dentro de la muestra obtenida, un 56,25% concurrían a la escuela primaria y el 25% se encontraban en la etapa preescolar. La mitad de los niños tomaron como referente a su madre como la persona que lo calma y que les gustaría que estuviese presente en el momento previo a la cirugía. La conjunción de los resultados obtenidos ha superado los valores referenciales mínimos para la medición del estrés prequirúrgico: un 80% de los niños sufría de estrés prequirúrgico. Conclusiones: el estrés prequirúrgico es un hecho presente en los pacientes pediátricos que han sido incluidos en la realización del estudio, quedando en evidencia que la cirugía es un factor estresante para los niños. (AU)

Introduction: As health professionals, we have observed different behaviors in pediatric patients, without psychoprophylaxis, who are admitted for emergency surgery; patients who, according to their age, their social, family and cultural environment may manifest such behaviors interpreted as stress, in different ways. Objective: Therefore, the general objective of our research was to measure the presurgical stress of children who would undergo emergency surgery, on Saturdays and Sundays by guard, at the Sor María Ludovica children's hospital in the city of La Plata. Materials and methods: We have conducted a pilot study of observational, descriptive, cross-sectional design; applying the modified YALE scale (EArPY-m) for data collection. Results: We recruited 16 patients of which 10 were male (62.50%), who were admitted to be treated surgically by the specialties of traumatology and general surgery in equal parts. The median in age was 7 years and the median in compulsory schooling was 6 years. Within the sample obtained 56.25% attended primary school and 25% were in the preschool stage. 50% of the participants indicated that the mother was the one who calms them when they are nervous; while 43.75% was the mother who would like to be present at the time before surgery. The combination of the results obtained has exceeded the minimum reference values for the measurement of presurgical stress, 80% of children suffered from presurgical stress. Conclusions: We conclude that presurgical stress is a fact present in pediatric patients who have been included in the study, making it clear that surgery is a stressful factor for children. (AU)

Influência da ansiedade em adolescentes durante a internação cirúrgica: aprimorando assistência de enfermagem / Influence of anxiety in adolescents during surgical hospitalization: improving nursing care / Influência da ansiedade em adolInfluencia de la ansiedad en adolescentes durante la hospitalización quirúrgica: mejora de la atención de enfermeira

O estudo teve como objetivo identificar de acordo com a literatura os fatores que influenciam na ansiedade do adolescente no período de internação cirúrgica e determinar a influência da ansiedade durante esse período para direcionar a assistência de enfermagem. Para realização do estudo utilizou-se revisão sistemática da literatura. De acordo com os resultados encontrados foi possível identificar a importância da equipe de enfermagem para detectar os fatores de risco e períodos de instabilidade emocional, para garantir a melhoria da qualidade de vida, conforto e maior interação, dessa forma, minimizar a ansiedade durante a internação no período transoperatório.(AU)

The study aimed to identify according to the literature the factors that influence adolescent anxiety during the period of surgical hospitalization and determine the influence of anxiety during this period to direct nursing care. Systemic review of the literature was used to perform the study and according to the results, it was possible to identify the importance of the role of the nursing team to detect risk factors and periods of emotional instability, to ensure the improvement of quality of life, comfort and greater interaction and thus minimize anxiety and patient's fear during hospitalization in the surgery period.(AU)

El estúdio tuvo como objetivo identificar, según la literatura, los factores que influyen em la ansiedade de los adolescentes durante el período de hospitalización quirúrgica y determinar la influencia de la ansiedad durante este período para guiar la atención de enfermería. Para llevar a cabo el estúdio, se utilizo uma revisión sistemática de la literatura y de acuerdo com los resultados encontrados, fue posible identificar la importância de papel Del equipo de enfermería para detectar factores de riesgo y períodos de inestabilidad emocional, para garantizar la mejora de calidad de vida, la comodidad y mayor interacción y, por lo tanto, minimizar la ansiedade y el miedo del paciente durante la hospitalización em el período transoperatório.(AU)

Effects of psychological problems on surgical outcomes

SUMMARY Surgeons are becoming aware that surgical outcomes are not only based on technical skills. The impact of psychological problems on outcomes must be studied from both the patient's and the health care provider's viewpoint. Psychological problems may affect up to 20% of the population, with almost half of them non-treated. Surgeons have to deal with a significant number of patients with psychological problems, which affect surgical outcomes changing how symptoms, results and side effects are interpreted. Surgeons also face psychological problems at a significant rate. Although there are no studies on the effect of chronic psychological problems of the surgeon on outcomes, in simulated scenarios, acute stress usually leads to worse performance. Some initiatives can be implemented to improve outcomes based on the effect of psychological problems.

RESUMO Os cirurgiões atuais cada vez mais acreditam que o bom resultado das cirurgias não são frutos exclusivos de suas habilidades técnicas. O impacto dos fatores psicológicos nos resultados das cirurgias deve ser estudado do ponto de vista tanto dos pacientes quanto dos profissionais de saúde que os assistem. Os problemas psicológicos afetam mais de 20% da população em geral, sendo que metade destes não recebe qualquer tratamento específico. Assim, os cirurgiões tratam de números cada vez mais significativos de pacientes com problemas psicológicos. Esses problemas psicológicos afetam o resultado, na medida em que alteram a percepção e interpretação dos sintomas, resultados e efeitos colaterais dos procedimentos. Por outro lado, os próprios cirurgiões têm apresentado taxas crescentes de afecções psicológicas. Embora não existam estudos que demonstrem o impacto dos problemas psicológicos crônicos dos cirurgiões na evolução dos pacientes, em cenários simulados, observa-se que o estresse agudo desencadeia um desempenho pior desses profissionais. Concluímos, dessa maneira, que medidas direcionadas à detecção e tratamento dos problemas psicológicos, tanto dos pacientes quanto da equipe de saúde, devam ser implementadas visando melhores resultados cirúrgicos.

O corpo como função de suplência imaginária em um caso de psicose ordinária / The body as imaginary supplement function in a case of ordinary psychosis / El cuerpo como función de suplencia imaginaria en un caso de psicosis ordinária

O presente trabalho é fruto de uma pesquisa de doutorado para obtenção de dupla titulação realizada entre o Brasil e a França. O estudo foi conduzido a partir de entrevistas semiestruturadas realizadas com homens que haviam se submetido a intervenções médicas, com finalidade estética. Os entrevistados foram encaminhados pelos próprios médicos que realizaram as intervenções após consentimento dos participantes. Durante a realização das entrevistas foi encontrado um sujeito fazendo uso bastante particular de seu corpo. Tal uso suscitou a possibilidade de se tratar de um caso de psicose ordinária, estabilizada a partir da introdução de um termo com função de suplência imaginária à foraclusão do Nome-do-Pai. Assim, este artigo traz a análise dos relatos de um jovem homossexual de vinte e sete anos que realizou uma série de intervenções estéticas no corpo. Do sentimento de estranhamento pelo não reconhecimento da própria imagem no período pregresso à cirurgia de maior impacto ­ uma prótese peitoral masculina ­ até a assunção de um corpo ­ cuja função é de suplência imaginária à foraclusão do Nome-do-Pai ­ o jovem pôde estabilizar-se a partir da organização de uma tripla externalidade reconhecidamente em desordem: social, corporal e subjetiva. Ao final do trabalho reconhece-se a necessidade de novas investigações em torno dos possíveis efeitos clínicos e metapsicológicos decorrentes dos intensos processos de identificações necessários para sua estabilização.(AU)

The present work is the result of a double degree doctorate research carried out among Brazil and France. The study was conducted from semi-structured interviews with men that were submitted to medical interventions with aesthetic purpose. The interviewees were referred by the doctors who performed the interventions after consent of the participants During the accomplishment of the interviews it was detected a subject making a very particular use of his body. Such kind of use has raised the possibility of dealing with a case of ordinary psychosis, stabilized by the introduction of a term with an imaginary supplement function to the foreclosure of the Name-of-the-Father. Hence, this article considers the analysis of the reports of a young homosexual of twenty-seven years old who performed a series of aesthetic interventions in his body. From the feeling of estrangement, due to the non-recognition of the image itself in the period prior to the surgery with greater impact, - a male pectoral prosthesis - until the assumption of a body image ­ whose function is to do imaginary supplement to the foreclosure of the Name-of-the-Father ­ he was able to stabilize his psychic condition from the organization of a triple externality in disorder: social, corporal and subjective. At the end, the need for further research is recognized in view of the possible clinical and metapsychological effects due to the intense identification processes required for its stabilization.(AU)

El presente trabajo es fruto de una investigación de doctorado con doble titulación realizada entre Brasil y Francia. El estudio fue conducido a partir de entrevistas semiestructuradas realizadas con hombres que se habían sometido a intervenciones médicas, con finalidad estética. Los entrevistados fueron encaminados por los propios médicos que realizaron las intervenciones después del consentimiento de los participantes. Durante la realización de las entrevistas fue encontrado un sujeto haciendo un uso bastante particular de su propio cuerpo. Tal uso, suscitó la posibilidad de tratarse de un caso de psicosis ordinaria, estabilizada a partir de la introducción de un término con función de suplencia imaginaria a la "forclusión del Nombre-del-Padre". Así, este artículo trae el análisis de los relatos de un joven homosexual de veintisiete años que realizó una serie de intervenciones quirúrgicas estéticas en su cuerpo. De la sensación de extrañamiento por el no reconocimiento de la propia imagen en el período preparatorio a la cirugía de mayor impacto -una prótesis pectoral masculina- hasta la asunción de un cuerpo ­ cuya función es de suplencia imaginaria a la forclusión del Nombre-del-Padre­ el joven puede estabilizarse a partir de la organización de una triple externalidad reconocidamente en desorden: social, corporal y subjetiva. Al final del trabajo, se reconoce la necesidad de nuevas investigaciones en torno a los posibles efectos clínicos y metapsicológicos derivados de los intensos procesos de identificaciones necesarias para su estabilización.(AU)

Percepción de estudiantes de pregrado de Medicina de talleres de simulación de procedimientos médico-quirúrgicos / Undergraduate student's perception of clinical simulation workshops: assessment of an instrument

Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.

Causas de cancelación del turno quirúrgico, en un servicio de cirugía general / Causes of cancellation of the surgical turn, in a general surgery service

La cancelación de procedimientos quirúrgicos en una sala de cirugía, afecta la productividad de la misma y ocasiona un impacto emocional en el paciente. Objetivo: determinar las principales causas de cancelación del turno quirúrgico, en el Servicio de Cirugía General del Hospital Dr. Francisco Antonio Rísquez, en el periodo 2006-2015. Métodos: se revisaron las planillas del plan quirúrgico diario de cirugía, en el área de quirófano y los libros de cancelación de acto quirúrgico del departamento de Cirugía del hospital. Resultados: en el Hospital "Dr. Francisco Antonio Risquez", se planificaron para acto quirúrgico del Servicio de Cirugía desde el 2006 al 2015; 2.872 pacientes, de los cuales se suspendieron 1.082 (37,67 %). Las causas específicas de las cancelaciones del turno quirúrgico fueron: ausencia de anestesiólogos: 613 pacientes (56,65%), prolongación del turno quirúrgico: 132 (12,20%), crisis hipertensiva: 81 (7,49%), aire acondicionado dañado: 47 (4,34%), ascensor averiado: 38 (3,51%), "otros": 36 (3,33%), falta de material quirúrgico: 33 (3,05%), ausencia delespecialista en cirugía: 31 (2,87%), maquina anestésica dañada: 27 ( 2,50%), enfermedad aguda del paciente: 20 (1,85%), área quirúrgica contaminada: 14 (1,29%) y exámenes preoperatorios incompletos: 10 (0,92%). Por causas atribuidas al personal médico 666 (61,55 %) casos, seguidas por las inherentes a la institución 306 (28,28 %) personas y 110 (10,17 %) suspensiones atribuibles al paciente. Conclusiones: el índice de suspensión de cirugías en el período evaluado en nuestro centro fue muy alto. Las principales causas de cancelación del turno quirúrgico fueron atribuibles al personal médico(AU)

the cancellation of surgical procedures in a surgery room affects the productivity of the same and causes an emotional impact on the patient. Objective: to determine the main causes of cancellation of surgical interventions in the department of General Surgery of "Dr. Francisco Antonio Rísquez" Hospital, during the period comprised between 2006 and 2015. Methods: the daily surgical schedule formats were revised, located on the fourth floor in the operating room area, as well as the books detailing the cancellation of interventions by the department of Surgery, located in the hospital's office of medical records. Results: in "Dr. Francisco Antonio Rísquez" Hospital, 2.872 patients were scheduled for intervention by the department of surgery between the years 2006 and 2015, of which 1.082 (37, 67%) The specific causes behind the cancellation of the interventions were: absence of anesthesiologist: 613 (56,65%), prolonged surgery times: 132 (12,20%), hypertensive crisis: 81 (7,49%), malfunctioning air conditioning: 47 (4,34%), elevator out of order: 38 (3,51%), others: 36 (3,33%), lack of surgical equipment: 33 (3,05%), absence of attending surgeon: 31 (2,87%), patient with acute illness: 27 (2,50%), non-operative anesthesia machinery: 20 (1,85%), contaminated operating room: 14 (1,29%) and incomplete preoperatory exams: 10 (0,92%). Causes attributed to medical staff predominated by 666 (61, 55%) cases, followed by causes attributed to the hospital in 306 (28, 28%) people, and 110 (10, 17%) suspensions attributed to the patient. Conclusions: the rate of suspension of surgeries in our center was very high and therefore worrisome for all health personnel. The main causes of cancellation of the surgical shift were attributable to medical personnel(AU)

Surgical Safety in Pediatrics: practical application of the Pediatric Surgical Safety Checklist / Cirurgia segura em pediatria: aplicação na prática doChecklist Pediátrico para Cirurgia Segura / Cirugía segura en pediatría: aplicación en la práctica delChecklist Pediátrico para Cirugía Segura

Objectives: to assess the practical application of the Pediatric Surgical Safety Checklist on the preoperative period and to verify family satisfaction regarding the use of the material. Method: exploratory study that aimed to analyze the use of the checklist by children who underwent surgical interventions. The sample was constituted by 60 children (from preschoolers to teens) and 60 family members. The variables related to demographic characterization, filling out the checklist, and family satisfaction, being evaluated through inferential and descriptive statistical analysis. Results: most children (71.7%) were male, with a median age of 7.5 years. We identified the achievement of 65.3% of the checklist items, 30.0% were not filled due to non-performance of the team and 4.7% for children and family reasons. In the association analysis, we found that the removal of accessories item (p = 0.008) was the most checked by older children. Regarding satisfaction, the family members evaluated the material as great (63.3%) and good (36.7%) and believed that there was a reduction of the child's anxiety (83.3%). Conclusion: the use of the checklist in clinical practice can change health services regarding safety culture and promote customer satisfaction.

Objetivos: avaliar a aplicação na prática do Checklist Pediátrico para Cirurgia Segura no período pré-operatório e verificar a satisfação da família quanto ao uso do material. Método: estudo exploratório, no qual se visou analisar o uso dochecklist por crianças que seriam submetidas a intervenções cirúrgicas, sendo a amostra constituída por 60 crianças pré-escolares a adolescentes e 60 familiares. As variáveis relacionaram-se à caracterização demográfica, preenchimento do checklist e satisfação dos familiares, sendo avaliadas por meio da análise estatística descritiva e inferencial. Resultados: a maioria (71,7%) das crianças era do sexo masculino, com mediana de idade de 7,5 anos. Identificou-se consecução do checklist em 65,3% dos itens, 30,0% não foram preenchidos devido à não execução da equipe e 4,7% por motivos das crianças e familiares. Na análise de associação, verificou-se que o item da retirada de adornos (p=0,008) foi mais checado por crianças com maior média de idade. Quanto à satisfação, os familiares avaliaram o material como ótimo (63,3%) e bom (36,7%) e acreditaram que houve redução de ansiedade na criança (83,3%). Conclusão: o uso do checklist na prática clínica pode colaborar para mudanças nos serviços de saúde com relação à cultura de segurança e promover satisfação dos clientes.

Objetivos : evaluar la aplicación en la práctica del ChecklistPediátrico para la Cirugía Segura en el periodo preoperatorio y verificar la satisfacción de la familia con respecto al uso del material. Método : estudio exploratorio, cuyo objetivo fue analizar el uso delchecklist por niños que serían sometidos a intervenciones quirúrgicas, siendo la muestra compuesta por 60 niños en edad preescolar a adolescentes y 60 familiares. Las variables se relacionaron con la caracterización demográfica, llenado del checklist y satisfacción de los familiares, siendo evaluadas por medio del análisis estadístico descriptivo e inferencial. Resultados : la mayoría (71,7%) de los niños eran varones, con una edad media de 7,5 años. Se identificó el cumplimiento del checklist en el 65,3% de los ítems, el 30,0% no ha sido rellenado debido a la falta de ejecución por parte del equipo y el 4,7% por causa de los niños y familiares. En el análisis de asociación, se constató que el ítem de retirada de joyas (p =0,008) fue el más marcado por los niños con una edad media más alta. En cuanto a la satisfacción, los familiares evaluaron el material como óptimo (63,3%) y bueno (36,7%) y acreditaron que hubo una reducción de la ansiedad en los niños (83,3%). Conclusión : el uso del checklist en la práctica clínica puede contribuir a cambios en los servicios de salud con respecto a la cultura de seguridad y promover la satisfacción de los clientes.

Convivendo com a fissura labiopalatina: a experiência da criança e do adolescente / Lip and palate cleft: child and adolecent's experience

A fissura labiopalatal repercute nos ambientes sociais, interferindo na sociabilização, no desenvolvimento da personalidade, no progresso educacional, na qualidade de vida. Como a reabilitação implica hospitalizações, o fissurado tem contato precoce com a enfermagem, que deve garantir assistência humanizada. Torna-se indispensável a atuação de uma equipe interdisciplinar especializada, abrangendo aspectos biopsicossociais do fissurado. Objetivamos compreender a experiência da criança e do adolescente fissurados, conhecer suas necessidades e atuar para seu esclarecimento e orientação. Trata-se de uma pesquisa qualitativa, cujo método foi Análise de Conteúdo. Os sujeitos tinham 7-18 anos. Realizamos nove entrevistas. Apreendemos cinco categorias -Percepção da criança/adolescente frente à fissura; Dificuldades nas interações sociais; Experiência do tratamento da fissura; Entendimento sobre os motivos da fissura e Redes de apoio para superação. O choque emocional de malformações congênitas na saúde infantil/adolescência, na família e na sociedade é complexo, podendo comprometer o ajustamento psicossocial. A correção cirúrgica e o amadurecimento psicológico auxiliam na resiliência. Desvelar a experiência dos fissurados evidencia dificuldades, bem como possibilidades de atuação da Enfermagem junto a eles e suas famílias, aspectos importantes de serem conhecidos/utilizados para a melhora do cuidado prestado.

The craniofacial anomaly affects social environments, influences socialization, personal development and educational progress, interfering in life's quality. Rehabilitation involves hospitalization, so has early contact with nursing that must ensure humanizes care. It's necessary involvement of a specialized interdisciplinary team, spanning the biopsychosocial aspects of cleft. We aimed to understand the experience of the child/adolescent fissured to know their needs, working in the clarification and guidance. This is a qualitative research, whose method was content analysis. Subjects were individuals from 7-18. Nine interviews were conducted. Five categories emerged from the analysis: Perception of child/adolescent about the cleft palate/lip, Difficulties in social interactions, Experience in the treatment of cleft lip/palate, Understanding the reasons for the cleft and Support networks to overcome. The emotional congenital malformation's impact on the health of children/adolescent, family and society is complex. The apparent esthetic difference compromises their psychosocial adjustment. Surgical correction/psychological maturity help to improve the resiliency. The knowledge of the experience's cleft spotlight their difficulties, as well as deficiencies in Nursing action with them and their families, important aspects to be known/used to improve the care provided.

Does a previous surgical experience interfere on psychic stress in patients submitted to major surgery? / A experiência cirúrgica prévia interfere no estresse psíquico em pacientes submetidos à operações de grande porte?

OBJECTIVE: to evaluate the impact of stress in patients undergoing major surgeries under general anesthesia, relating their physical and psychic reactions to the different stages of stress. METHODS: we studied 100 adult patients of both genders, who were divided into two groups: Group 1 - 22 patients without experience with surgery; Group 2 - 78 patients previously submitted to medium and major surgery. To investigate the stress, we used the Inventory of Stress Symptoms for Adults, developed by Lipp, the day before the procedure and two days and seven days after the operation. The comparison of groups with respect to gender, pain, and percentage of stress were performed using the Chi-square test, and for the age variable the Student's t test was used. Differences were considered significant at p<0.05. RESULTS: the groups were not homogeneous as for the overall percentage of stress on the three measurements. G1 had decreased postoperative stress, whilst in G2 it increased. Psychological symptoms of stress prevailed in both groups. CONCLUSION: previous surgery reduced preoperative stress but did not affect postoperative emotional disorders. .

OBJETIVO: avaliar o impacto do estresse em pacientes submetidos à operações de grande porte, sob anestesia geral, relacionando suas reações físicas e psíquicas com as diferentes fases do estresse. MÉTODOS: foram estudados 100 pacientes adultos de ambos os sexos, distribuídos em dois grupos: Grupo 1- 22 pacientes sem experiência com cirurgia; Grupo 2- 78 pacientes submetidos previamente a outras operações de médio e grande porte. Para investigação do estresse, utilizou-se o Inventário de Sintomas de Stress para Adultos, desenvolvido por Lipp, um dia antes, dois dias, e sete dias após a operação. A comparação dos grupos quanto às variáveis sexo, dor, e percentual de estresse, foi realizada pelo teste qui-quadrado e para a variável idade foi utilizado o teste t Student. As diferenças foram consideradas significativas para p<0,05. RESULTADOS: os grupos não foram homogêneos quanto ao percentual geral de estresse nas três mensurações. O G1 diminuiu e o G2 aumentou o estresse no pós-operatório. Prevaleceram sintomas psíquicos do estresse em ambos os grupos. CONCLUSÃO: O fato de ter sido operado previamente reduziu a tensão pré-operatória, porém não interferiu nos distúrbios emocionais pós-operatórios. .

Estresse em procedimentos cirúrgicos / Stress in surgeries

INTRODUÇÃO: Este artigo tem como objetivo rever estudos sobre o estresse psicológico no perioperatório de pacientes adultos submetidos a operações de médio e grande porte, sob anestesia geral. MÉTODOS: Foram estudados trabalhos publicados e catalogados nas bases de dados Medline interface Pubmed, Lilacs e Biblioteca Virtual de Saúde - BVS desde 1984, cruzando-se os descritores estresse, cirurgia, anestesia geral, psicologia Encontraram-se mais de 800 artigos relacionados a estresse e cirurgia, que foram analisados em função de sua pertinência com o tema proposto. Desses, 18 abordaram o estresse psíquico. Os resultados levantados confirmaram a existência do estresse, tanto físico quanto psicológico, no período perioperatório e a relação entre estresse e evolução clínica de pacientes. Após a análise dos estudos observou-se a lacuna existente na literatura consultada, sobre a ação do estresse psíquico nesse período. CONCLUSÃO: O conhecimento mais aprofundado das implicações psicológicas do estresse pode beneficiar pacientes e profissionais de saúde no tratamento cirúrgico.

INTRODUCTION: The purpose of this article was to provide the literature regarding the psychological stress in the peri-operative period of adult patients undergoing operations under general anesthesia. METHODS: The articles were obtained by surveying the papers published and catalogued in the Medline Pubmed interface database, Lilacs and the Biblioteca Virtual de Saúde (BVS) since 1984, crossing the headings stress, surgery, general anesthesia, psychology. Over 800 articles related to stress and surgery were analyzed with regards to their relevance to the considered subject. Eighteen articles were related to psychological stress. Their results confirmed the presence of psychological and physical stress, during the peri-operative period as well as relation between stress and de clinical post-operative recovery. There is a gap regarding in the peri-operative period. CONCLUSION: More studies on psychological influence on stress may benefit patients and help professionals during the surgical treatment.

Estresse em cirurgia de grande porte / Stress in major surgery

Este artigo tem como objetivo rever estudos sobre o estresse psicológico no perioperatório de pacientes adultos submetidos a operações de médio e grande porte, sob anestesia geral. Foram estudados trabalhos publicados e catalogados nas bases de dados Medline interface Pubmed, LILACS e Biblioteca Virtual de Saúde ? BVS desde 1984. Encontraram-se mais de 800 artigos relacionados a estresse e cirurgia, que foramanalisados em função de sua pertinência com o tema proposto. Desses, 18 abordaram o estresse psíquico. Os resultados levantados confirmaram a existência do estresse, tanto físico quanto psicológico, no período perioperatório e a relação entre estresse e evolução clínica de pacientes. Após a análise dos estudos observou-se a lacuna existentena literatura consultada, sobre a ação do estresse psíquico nesse período. O conhecimento mais aprofundado das implicações psicológicas do estresse pode beneficiar pacientes e profissionais de saúde no tratamento cirúrgico.

The purpose of this paper is to review studies on the perioperatory psychological stress in adult patients undergoing large and medium sized surgery, under general anesthesia. Papers published and catalogued in the database Medline interface Pubmed, LILACS and Biblioteca Virtual de Saúde-BVS (Health Virtual Library) were studied since 1984. Over 800 articles related to stress and surgery were found and analyzed due their pertinence with the proposed theme, among which 18 dealt with the psychical stress. The results confirmed the stress existence, either physical or psychological, in the perioperatory period, and the relation between the stress and the patientsï clinical evolution. After the studies analysis, the existing gap in the related literature was observed, concerning the psychical stress action in this period. The deeper information about the stress psychological implications may be beneficial both for patients and health professionals in the surgical treatment.

Anxiety among patients undergoing major general surgery

It has been recognized for more than 40 years that patients experience different levels of anxiety when faced with impending surgery. The degree to which each patient manifests anxiety is related to many factors; this study aims to assess the level of anxiety among patients undergoing major general surgery and to identify the effect of gender on preoperative anxiety. A sample of 300 patients who were admitted from 5th April 2009 to the 10th November 2009; in general surgery units of teaching hospitals [Rezgari and Hawler] in Erbil city were interviewed to assess their level of anxiety before surgery. The instrument used for this purpose was a questionnaire that included socio-demographic information and the State-Trait Anxiety Inventory [STAI] of Spilberger. Most of the patients showed moderate to severe anxiety level; [moderate=50% and severe=38.3%] others showed mild anxiety level [11.7%]. A statistically significant relationship was seen between preoperative anxiety and gender; female patients showed high levels of anxiety [severe anxiety=46.9%] while male patients showed less severe anxiety level [severe anxiety=28.6%]. According to the results of the study patients undergoing major general surgery need to be assessed regarding level of anxiety before surgery. This anxiety should be reduced through appropriate interventions, especially in women who have been found to experience high levels of anxiety

Surgical decision making considering body image in post menopausal breast cancer patients

In most of the developing counties postmenopausal breast cancer cases are offered a radical form of surgery relying on their unawareness about body image. We evaluate the effect of breast cancer surgical choice; Conservative Breast Therapy [BCT] or Modified Radical Mastectomy [MRM]; on body image in Egyptian postmenopausal cases. A prospective randomized trial of 100 postmenopausal women who had stage I and II breast cancer. Half of them had BCT and the other half had MRM. Sociodemographic data were collected and pre and postoperative assessments of body image distress were done using four scales; Breast Impact of Treatment Scale [BITS], Impact of Event Scale [IES], Situational Discomfort Scale [SDS], Body Satisfaction Scale [BSS]. The patients ages ranged from 43-82 years [54.28 +/- 8.84]. Preoperative assessment shows no statistical significant difference as regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects. For the evaluative aspect, there was no statistical significant difference between both groups. Body image is as important for postmenopausal women as for younger women. Even in developing countries, where the concept is ignored, we should not deprive postmenopausal breast cancer cases from their right of a less mutilating option of treatment as BCT

A comunicação da suspensão de cirurgias pediátricas: motivos e sentimentos envolvidos no processo / Communicating pediatric surgery suspension: the motives and feelings involved in the process

A hospitalização é uma experiência complexa e pode apresentar-se como agradável ou não, sendo agravada no caso de necessidade de intervenção cirúrgica, principalmente quando o paciente é criança. Na prática, observa-se todo um movimento de reorganização pessoal do paciente e de seus familiares para enfrentar esse momento. Quando a cirurgia é suspensa, o paciente e seus familiares estão sujeitos a um desconforto maior, que pode gerar sentimentos de insegurança, angústia e ansiedade. Este estudo teve como objetivo identificar e descrever a percepção de quinze mães e/ou responsáveis por crianças de 0 a 18 anos, internadas num hospital de ensino do interior do Estado de São Paulo, após receberem a notícia de que a cirurgia de seu filho (a) seria suspensa. Foi um estudo descritivo com abordagem qualitativa, que utilizou o referencial teórico da Comunicação Interpessoal e o referencial metodológico da Análise de Conteúdo. Os resultados evidenciaram que as suspensões de cirurgias pediátricas são um fato presente na instituição, que trazem repercussões ao paciente e seus familiares e à organização institucional; que a comunicação entre profissionais da equipe de saúde, pacientes e familiares sobre procedimentos a serem realizados ou não, é inadequada; que a atuação da enfermagem no momento da notícia da suspensão da cirurgia precisa ser pontual e efetiva.

[Factors affecting preoprative anxiety]

Tens of milion people undergoing surgery each year in the world. Surgery is a stress that creates physiological responses [endocrine] and psychologic stress [fear, anxiety]. Prolonged anxiety, if unrecognized, creates stress which may subsequently harm the patient and delay recovery. This study was intended to assess factors affecting peroprative anxiey of the patients. This descriptive-analytical study involved 100 patients who admited on the general surgery wards in the hospitals of Mashhad. The patients were selected by objective-bused sampling method and a state- trait Anxiety inventory questionnair was filled for each patient in the evening and morning [immediatelly pre-oprative] prior to surgery. Data analysis was performed using SPSS software. Our result indicated that a significant differnce between the mean evening anxiety [40.6] and mean morning anxiety [43.2][p < 0/001]. In addition, the following factors were found to be affecting preoprative morning anxiety: sex, asleep night prior surgery, waiting more than 2 hours, finacial problems, occupation and companion [R = 0/456]. Given the factors that have influence on preoprative anxiety, and some these factors are preventable, it is suggested that a systematic planning for recognition these factors in order to minimize their effects are prepared in surgery wards