Avaliação estética e condutas terapêuticas relacionadas aos principais perfis faciais / Aesthetic evaluation and therapeutic procedures related to main facial profiles

Introdução: A cirurgia ortognática para correções de deformidades dentofaciais proporciona uma face mais harmoniosa, funcional e estética. O objetivo desse estudo foi avaliar a percepção dos cirurgiões bucomaxilofaciais quanto à estética dos perfis faciais padrões I, II e III, relacionada ao sexo, etnia e às principais condutas terapêuticas. Métodos: Foram entrevistados 18 cirurgiões especialistas ou em formação em Cirurgia e Traumatologia Bucomaxilofacial, utilizando uma ficha clínica padronizada para avaliação estética e condutas terapêuticas de 12 imagens manipuladas simulando os perfis faciais, sexo e raças. Resultados: Quanto à estética, destacaram-se os perfis faciais tipo I, que apresentaram as melhores médias, enquanto os perfis faciais tipo III as menores; entretanto, não houve diferenças significativas entre as médias obtidas nos diferentes perfis faciais em relação ao sexo e à raça. As condutas terapêuticas foram homogêneas nos perfis II e III, com maiores percentuais para condutas clássicas no tratamento ortocirúrgico destas deformidades dentofaciais. Conclusão: O perfil facial I foi o considerado mais estético; então, houve influência do sexo e do tipo racial na estética para a amostra estudada. Os perfis faciais I foram os mais difíceis de avaliar quanto às condutas terapêuticas, o que resultou em grande variedade de opções em relação aos perfis II e III.

Introduction: Orthognathic surgery for correction of dentofacial deformities provides a more-symmetrical face, and functional and aesthetic benefits. The aim of this study was to evaluate the perception of buccomaxillofacial surgeons regarding the aesthetics of facial profiles patterns I, II, and III in related to sex, ethnicity, and the main therapeutic procedures. Methods: We interviewed 18 specialist surgeons or surgeons in training in buccomaxillofacial surgery by using a standardized clinical report form for aesthetic evaluation and therapeutic procedures of 12 manipulated images simulating facial profiles, sex, and race. Results: As for aesthetics, the highlights were that facial profile type I had the highest mean values, whereas facial profile type III had the lowest mean values. However, no significant differences were found between the mean values obtained in different facial profiles in relation to sex and race. The therapeutic procedures were homogeneous in profiles II and III, with higher percentages for classical procedures in the orthosurgical treatment of these dentofacial deformities. Conclusion: Facial profile I was considered more aesthetic. Furthermore, sex and racial type effects on aesthetics for the studied sample. Facial profiles I were the most difficult to assess as to therapeutic procedures, which resulted in a wide range of options in relation to profiles II and III.

A survey of healthcare industry representatives' participation in surgery: some new ethical concerns.

OBJECTIVE: To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives. METHODS: A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery. RESULTS: A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon. CONCLUSIONS: HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery.

Modelo y cumplimentacion de alta hospitalaria de la unidad de gestión clínica de cirugía oral y maxilofacial. Cómo mejorarlo / Filling in the hospital discharge report in an oral and maxillofacial surgery clinical management unit. how to improve it

Objetivos. Conocer la calidad y grado de cumplimentación de la información recogida en las altas hospitalarias (IAH) del Servicio de Cirugía Oral y Maxilofacial de nuestro hospital. Material y métodos. Estudio descriptivo transversal de 152 altas hospitalarias. Incluye un total de 35 ítems agrupados. Para la evaluación del IAH valoramos la ausencia y el déficit de información. El criterio de adecuación se fijó por consenso en la cumplimentación del 90% de los ítems de forma correcta. Con el fin de conocer la fiabilidad de los resultados obtenidos se realizó la evaluación por dos revisores de forma independiente y en caso de discordancia se tomó la decisión por consenso tras revisar la historia clínica. Resultados. El 53,94% de los IAH disponen del 90% de los ítems completos y correctos del modelo de alta de nuestro Servicio. El 10,74% presentan alguna ausencia y el 65,79% de IAH presentan algún déficit de información. Se observa una variabilidad importante en la cumplimentación según el tipo de ítem analizado. Conclusiones. Nuestro trabajo valora la calidad de un modelo específico de IAH con ítems previamente seleccionados, considerados útiles y adecuados para reflejar de forma completa, exacta y precisa el proceso asistencial que recibe el paciente y detecta que los ítems: teléfono, residente, fechas de consulta, biopsia y de informe de biopsia, cirugía mayor ambulatoria e intervención urgente deben mejorarse(AU)

Objectives. To determine the quality and compliance to the information contained in the hospital discharge registry (HDR) issued by the Department of Oral and Maxillofacial Surgery in our hospital. Materials and Methods. A cross-sectional descriptive study was conducted to evaluate 152 HDR reports. These reports included a total of 35 items. We observed that there was a lack of information and some mistakes when filling the HDR boxes. Suitability criteria were set up by consensus as the completion of 90% of the items examined. To evaluate the reliability of the results, an assessment was performed by two reviewers independently, and in case of disagreement the decision was made by consensus after reviewing the medical record. Results. Only 53.94% of the HDR had 90% of the items completed appropriately; 10.74% had some items missing when filling in the form, and 65.79% lacked some information. Depending on the type of item there was a significant variation in the completion of the form. Conclusions. In the present work, we assess the quality of a specific hospital discharge form in our hospital, with items previously selected as useful and appropriate to reflect a complete, accurate and precise view of the care process of the patient, and improvements were needed in items such as, telephone, home address, date of consultation, biopsy report and the date it was performed, ambulatory surgery and emergency response(AU)

Evaluación del conocimiento de los cirujanos dentistas brasileños sobre aspectos bioéticos en el tratamiento odontológico / Knowledge evaluation for Brazilian dentist-surgeons on bioethical aspects of the dental treatment

La relación profesional/paciente y su importancia para el buen seguimiento y, suceso del tratamiento odontológico deben ser reflejadas por medio de sus aspectos bioéticos. Nuestro estudio ha tenido como objetivo evaluar el conocimiento de los cirujanos dentistas (n=163) que realizan curso de especialización en la Universidad Estadual Paulista–UNESP, sobre esos aspectos. Entre los investigados, el 88,1% mencionan que la decisión del tratamiento debe ser tomada en común acuerdo entre el profesional y el paciente, sin embargo, el 26,4% relatan que la participación del paciente y/o la de su responsable legal en la decisión puede interferir de manera negativa. La actuación del profesional cuando el paciente opta por un tratamiento menos conveniente, el 95,6% tratan de convencerlo de que no es la mejor opción y cambie para la mejor, manteniendo el modelo paternalístico. Ha sido observado que el 20,3% no supieron relacionar la importancia de la interacción profesional/paciente para el tratamiento odontológico. Se Concluye que muchos cirujanos dentistas no están tomando en cuenta esos aspectos bioéticos en la práctica clínica (AU)

Professional-patient relationship and its importance for a good performance and success of the dental treatment must be reflected upon by means of their bioethical aspects. Our study aimed at evaluating dentist-surgeons’ knowledge (n=163) in conducting specialization courses at São Paulo State University–UNESP, on these aspects. Out of the people surveyed, 88.1% mentioned that a decision for the treatment should be made by mutual agreement between professionals and patients, however, 26.4% report that patients’ or their legal representative’s participation in decision-making can cause negative interference. Professionals’ acting when patients choose a less suitable treatment, 95.6% try to convince patients that it is not the best choice and persuade them for a better one by keeping the paternalistic model. It was noticed that 20.3% did not know how to relate the importance of professional-patient interaction as regards the dental treatment. It was therefore concluded that many dentist-surgeons are not taking these bioethical aspects into account in clinical practice (AU)