Elaboración de un simulador de trauma torácico a partir de un torso cadavérico utilizando tecnología de imágenes digitales e impresión 3D / Elaboration of a thoracic trauma surgery simulation model from a cadaveric human torso incorporating digital image technology and 3D printing

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Self-confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons / Autoconfiança nas habilidades cirúrgicas adquiridas para lidar com pacientes com trauma grave em cirurgiões recém-formados

ABSTRACT Background: Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.

RESUMO Racional: Trauma é uma das principais causas de morte no mundo e cuidados cirúrgicos adequados são críticos para determinar a mortalidade. No Chile, morte associada a trauma é a primeira causa de mortalidade na população entre 20 e 59 anos. Para lidar com esses pacientes complexos, são necessárias habilidades cirúrgicas precisas para esses procedimentos. Autoconfiança de cirurgiões recentemente graduados na Residência em Cirurgia Geral para práticas de procedimentos de trauma no nosso país não tem sido reportada. Objetivo: Descrever nível de autoconfiança para lidar com procedimentos de trauma em cirurgiões recentemente graduados na residência de cirurgia geral. Método: Estudo transversal. Foi desenhada e aplicada uma enquete em 2015, 2016 e 2017 a cirurgiões recentemente graduados para pesquisar sobre autoconfiança e habilidades cirúrgicas para lidar com cenários de trauma. Foram avaliados 18 procedimentos cirúrgicos de trauma (incluindo procedimentos cervicais, torácicos, abdominais e vasculares) usando a 5-grade Likert Scale. O número total de procedimentos feitos durante a residência foi avaliado. Resultados: Foram incluídos 88 cirurgiões recentemente graduados. O nível de competência foi reportado como alto em procedimentos como trauma intestinal, onde 98% sentiu-se competente ou muito competente em sua reparação. Por outro lado, em traumas complexos como dano vascular maior, até 76% reportaram não se sentirem competentes. A autoconfiança nos procedimentos esteve diretamente associada com o número de procedimentos realizados. Conclusões: Cirurgiões recentemente graduados na residência de cirurgia geral reportam níveis altos de confiança para lidar com traumas de complexidade baixa e média, mas um nível menor de confiança para tratar casos de complexidade alta.

Hábitos alimentarios y funcionalidad familiar en familias de la región metropolitana: un estudio descriptivo / Eating habits and family functionality in families in the metropolitan region: A descriptive study

Existen múltiples estudios acerca del funcionamiento familiar en la población chilena y sobre sus prácticas alimenticias, relacionándose ambas con morbilidades psicológicas o psiquiátricas. A pesar de esto, no logramos encontrar estudios que relacionen específicamente los hábitos alimenticios con el comportamiento a la hora de comer y el funcionamiento familiar en Chile. Definir los hábitos alimentarios no resulta sencillo, ya que existe una diversidad de conceptos, sin embargo, la mayoría converge en que se tratan de manifestaciones recurrentes de comportamiento individuales y colectivas respecto al qué, cuándo, dónde, cómo, con qué, para qué se come y quién consume los alimentos (1). El presente estudio es un estudio descriptivo tipo corte transversal, cuyo objetivo es explorar la relación entre el funcionamiento familiar y el hábito de comer en familia en padres y madres que acuden al policlínico de pediatría. El estudio se aplicó en 5 centros de salud de diferentes comunas de la región Metropolitana: Centro de Salud de San Bernardo (San Bernardo), Policlínico el Salto (Recoleta), Patronato Nacional de la Infancia (Estación central), CESFAM Juan Pablo II (La Reina) y CESFAM Aníbal Ariztía (Las Condes). Todos corresponden a campos clínicos universitarios de la Universidad de Los Andes en el área de pediatría. Todos centros caracterizados por recibir pacientes en su mayoría chilenos, de un nivel socioeconómico medio-bajo (2). Se consideraron como criterios de inclusión el ser padres y/o madres de pacientes que se atendían en los consultorios antes mencionados, mayores de 18 años y que firmaran el consentimiento informado. Los datos fueron obtenidos mediante la auto-aplicación de dos cuestionarios, uno de ellos, de fabricación propia, describe la práctica alimenticia de la familia, el otro, correspondiente al cuestionario APGAR familiar, validado en Chile, fue usado para medir el funcionamiento familiar según la percepción de los padres y/o madres. De un total de 53 encuestas realizadas, 90.6% presentó un APGAR de familia funcional, un 7.5% un APGAR con disfunción familiar moderada y un 1.88% con un APGAR de disfunción familiar severa. El análisis estadístico muestra que este nivel de funcionamiento se explica en un 53% por tres de las variables estudiadas; Comunicación y ambiente a la hora de comer, y si los padres viven juntos o no. Será necesario confirmar estos hallazgos en futuras investigaciones que cuenten con poblaciones de estudio más extensas y variadas en su morfología familiar, para extrapolar estos datos a nivel regional. Palabras clave: APGAR, funcionamiento familiar, comer en familia, hábito alimenticio, trastornos alimenticios

Abstract: There are multiple studies on family functioning in the Chilean population and on their dietary practices, both have been related to psychological or psychiatric morbidities. Despite this, we could not find studies that specifically relate eating habits to eating behaviors and family functioning in Chile. Defining eating habits is not easy, since there is a diversity of concepts, however, most converge in that they are recurrent manifestations of individual and collective behavior with respect to what, when, where, how, with what, and for what purpose we eat and who consumes the food (1). The present study is a descriptive cross-sectional study, whose objective is to explore the relationship between family functioning and the habit of eating as a family in parents who attend the pediatric polyclinic. The study was performed in 5 health centers in different communes of the Metropolitan Region: San Bernardo Health Center (San Bernardo), El Salto Polyclinic (Recoleta), National Children's Trust (Central Station), CESFAM Juan Pablo II (La Reina) and CESFAM Aníbal Ariztía (Las Condes). All correspond to pediatric university clinical campuses of the Universidad de Los Andes. All centers are characterized as receiving mostly Chilean patients, of a medium-low socioeconomic level (2). Inclusion criteria were: fathers and/or mothers of patients who attended the clinics, who were older than 18 years and who signed the informed consent. The data were obtained through the self-administration of two questionnaires, one of them of our own manufacture, describes the family's nutritional practice, the other, corresponding to the family APGAR questionnaire, validated in Chile, was used to measure family functioning according to the perception of fathers and/or mothers. Of a total of 53 surveys conducted, 90.6% presented an APGAR of functional family, 7.5% an APGAR with moderate family dysfunction and 1.88% with an APGAR of severe family dysfunction. The statistical analysis shows that this level of functioning is explained in 53% by three of the studied variables: communication and atmosphere at mealtime, and whether the parents live together or not. It will be necessary to confirm these findings in future investigations that have more extensive and varied study populations in their family morphology to extrapolate these data at a regional level.Key words: APGAR, family functionality, family meal, feeding behavior, eating disorders