Atención quirúrgica en hombres y mujeres ¿Diferente o desigual?

Explorar la posible existencia de sesgos de género en procedimientos quirúrgicos (PQ) frecuentes y en sus estancias medias (EM) postquirúrgicas es objetivo del presente trabajo, mediante su comparación entre sexos en el Servicio de Cirugía General y Digestiva del Hospital General de Alicante (2000-2004). Se intervienen más hombres que mujeres en 4 de los 7 PQ estudiados, apuntando posibles sesgos de género en el patrón quirúrgico, como por apendicectomías agudas (1,36 Hombres/1 Mujer) y complicadas (1,79/1). La estancia postapendicectomías, a igual edad y comorbilidad, es de 2 días más en hombres (9,49) que en mujeres (7,5). No detectar diferencias por sexo en colecistectomías por colecistitis (más frecuentes en mujeres), puede indicar colelitiasis evolucionadas por no sospecha diagnóstica en hombres.

Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.

Modern therapeutics, medical and surgical; including the diseases of women and children. A compendium of recent formulae and therapeutical directions from the practice of eminent contemporary physicians, American and foreign.

Combined ed. of his Modern medical therapeutics, Modern surgical therapeutics, Therapeutics of gynecology and Obstetrics, and Therapeutics of diseases of children.

New York medical journal.

Mode of access: Internet.

Occasional reports /

Title from cover.

American medico-surgical bulletin.

Mode of access: Internet.

Transactions of the Southern Surgical and Gynecological Association.

Description based on: Vol. 18 (Dec. 13, 14, and 15, 1915); title from cover.

The Surgical clinics of Chicago.

Each number has separate title page.

The life of John Collins Warren, M.D. : compiled chiefly from his autobiography and journals /

Added t.p. is engraved.

The Southern medical and surgical journal [serial].

Vols. for 18 - include the Annual announcement of the Medical College of Georgia.

Palliative care training: a survey of physicians in Australia and Europe

The purpose of this paper is to present data about the level and background characteristics of physicians' training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3-10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.

The role of spirituality in transformative learning

The purpose of this phenomenological study was to explore the role of spirituality in Mezirow's (1978, 1990, 1991, 1997, 1998, 2000, 2003) 10-phase process of transformative learning. This study used Mezirow's transformative learning theory as its theoretical framework. Semi-structured interviews were conducted, transcribed, and analyzed for 12 doctoral students and candidates who had a transformative learning experience and who identified themselves as being spiritual. Interview data were analyzed using inductive, deductive, and comparative analyses. Four themes emerged from the inductive analysis of the data: (a) the nature of spirituality, (b) the variety of emotions, (c) the influences of spirituality, and (d) the nature of personal changes. The theory's 10 phases were used as a guide in deductively analyzing data concerning the participants' experiences. The deductive analysis revealed that spirituality played a role in at least 7 of the 10 phases of transformative learning for each participant. Overall, from the participants' perspectives, the role of spirituality was that of a guide in influencing their cognition and behavior, and that of a supporter in influencing their emotions. The comparative analysis revealed that at least three of the four themes from the inductive analysis were reflected in each of the 10 phases of transformative learning used in the deductive analysis. Based on the findings from this study, the researcher proposed a modification of Mezirow's phases of transformative learning. An additional phase was identified: framing and naming the transformed perspective, and two phases were renamed. The findings from this study imply that given the importance of the role participants attributed to spirituality in their transformative learning in influencing their cognition, behavior, and emotions, the role of spirituality should be considered for inclusion in transformative learning theory. Recommendations for further research on the validation and replicability of the proposed modification to transformative learning theory are given.

Açude do cais: uma proposta de aplicação de uma sequência de atividades didáticas em um contexto real

Currently it is expected that science education will enable a more comprehensive conception of the world and of the relationship between scientific knowledge, technology and society. Thus, we seek the science teaching attend around contexts related to science, technology and society (STS). According CTS approaches, the science education should promote learning in the scientific, technological and social fields, from experienced real contexts, generating motivation to students, offering them tools to work as scientifically literate citizens. For this, it becomes crucial to resort to innovative activities and the various methodologies and appropriate teaching materials, and there is a lack of this perspective in general basic education, which drives the practice of an STS approach. Therefore, the aim of this research is the production of an instructional sequence for the exploration of the theme: "The quality of the water in the municipality of Cuité-PB," according to focus CTS in the 2nd year of high school. The choice of this topic is due to the problem caused by the quality of water in this municipality, with the concern to address an issue that came to work the critical / reflective understanding of a real context, in order to sensitize students to the importance of scientific / technological knowledge. The selection criteria of STS subjects were also observed. In this research the materials were produced and applied by the teacher / researcher. For data collection we used the observation and analysis of student records. The results were encouraging in the sense of participation, motivation and skill acquisition. This research contributes to the teaching of science with a focus STS, as well as encourage the use of perspective in new contexts with real questioning

An evaluation of paediatric medicines reconciliation at hospital discharge into the community

OBJECTIVE: A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting. METHODS: Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge. KEY FINDINGS: 142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected. CONCLUSIONS: Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.