Breaking Barriers: A Single-Center Real-World Experience With Recruitment and Administration of COVID-19 Monoclonal Antibodies and Opportunities for Improvement.

We conducted a retrospective exploratory study evaluating factors associated with selection to receive and infusion with coronavirus disease 2019 monoclonal antibodies. While priority was given to high-risk patients, patients with increased Social Vulnerability Index scores were less likely to present for infusion, raising concern that social factors created barriers to treatment.

Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review.

BACKGROUND: Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a 6-item biannual survey querying potential stressors. We reviewed the initial 5-year experience to assess for trends and improve efforts in maintaining resident well-being. STUDY DESIGN: Surgery residents from all postgraduate years were asked to complete a survey of common concerns, prioritizing them in order of importance. The items to be ranked were: needs of family/friends; nonwork time for study; financial concerns; personal well-being needs; concerns for clinical performance; and administrative demands. Changes in ranking were trended across 10 review periods. Results were analyzed using a Kruskal-Wallis test. RESULTS: A completion rate of 96.5% was rendered from the completion of 333 surveys. Rankings changed significantly for nonwork time for study (p = 0.04), personal well-being needs (p = 0.03) and concerns for clinical performance (p = 0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as top two stressors over study period, except for spring 2020. Personal well-being needs ranked highest in spring 2020; 41% of residents placed this as top 2 rankings. A decrease in concerns for clinical performance was observed in spring 2020, corresponding to the coronavirus disease 2019 (COVID-19) pandemic emergency declaration. CONCLUSIONS: Surgery residents generally prioritized time for study and concerns for assessment of clinical performance as highest areas of concern. With the occurrence of a pandemic, increased prioritization of personal well-being was observed. Used routinely with biannual reviews, the survey was able to identify plausible changes in resident concerns. Determination of levels of actual stress and actual association with the pandemic requires additional study.

Spatial Volume Necessary to Perform Open Appendectomy in a Spacecraft.

BACKGROUND: With the increase in crewed commercial spaceflight and expeditions to the Moon and Mars, the risk of critical surgical problems and need for procedures increases. Appendicitis and appendectomy are the most common surgical pathology and procedure performed, respectively. The habitable volume of current spacecraft ranges from 4 m³ (Soyuz) to 425 m³ (International Space Station). We investigated the minimum volume required to perform an appendectomy and compared that to habitable spacecraft volumes.METHODS: The axes of a simulated operating room were marked and cameras placed to capture movements. An expert surgeon, chief surgical resident, junior surgical resident, and a nonsurgeon physician each performed a Focused Assessment with Sonography for Trauma and an appendectomy on a simulated patient. Dimensions and volume needed were collected and compared using unpaired t-tests.RESULTS: Mean volume (± SD) needed was 3.83 m³ ± 0.47 m³ for standing and 3.68 m³ ± 0.49 m³ for kneeling (P = 0.638). Minimal volume needed was 3.20 m³ for standing and 3.26 m³ for kneeling. Minimal theoretical volume was 2.99 m³ for standing and 2.87 m³ for kneeling.DISCUSSION: The unencumbered volume needed for an appendectomy is between 2.87 m³ and 4.3 m³. It may be technically feasible to perform an open appendectomy inside the smallest of currently operating spacecraft, at 4 m³ (Soyuz-MS). Space vessels operating without rapid evacuation to Earth will need to consider this volume for potential surgical emergencies. Additional investigation on microgravity and standardization of procedures for novices must be completed.Kamine TH, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Levin D. Spatial volume necessary to perform open appendectomy in a spacecraft. Aerosp Med Hum Perform. 2022; 93(10):760-763.

Time Cost of Provider Skill: A Pilot Study of Medical Officer Occupied Time By Knowledge, Skill, and Ability Level.

INTRODUCTION: On space missions one must consider the operating cost of the medical system on crew time. Medical Officer Occupied Time (MOOT) may vary significantly depending on provider skill. This pilot study assessed the MOOT Skill Effect (MOOTSkE).METHODS: An expert surgeon (ES), fifth year surgical resident (PGY5), second year surgical resident (PGY2), and an expert Emergency Physician (EP) with only 4 mo direct surgical training each performed two simulated appendectomies. The completion times for endotracheal intubation, appendectomy, and two subprocedures (multilayer tissue repair and single layer tissue repair) were recorded.RESULTS: The ES performed the appendectomy in 410 s, the PGY-5 in 498 s, the PGY-2 in 645 s, and the EP in 973 s on average. The PGY-2 and EP time difference was significant compared to the expert. The PGY-5 was not. The EP's time was significantly longer for the appendectomy and the multilayer repair than either surgical resident. For the single layer repair, only the EP-ES difference was significant. A single intubation attempt by the PGY-2 took 73 s while the EP averaged 27 s. The average recorded MOOTSkE between novice and expert was 2.5 (SD 0.34).DISCUSSION: This pilot study demonstrates MOOTSkE can be captured using simulated procedures. It showed the magnitude of the MOOTSkE is likely substantial, suggesting that a more highly trained provider may save substantial crew time. Limitations included small sample size, limited number of procedures, a simulation that may not reflect real world conditions, and suboptimal camera angles.Levin DR, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Kamine T. Time cost of provider skill: a pilot study of medical officer occupied time by knowledge, skill, and ability level. Aerosp Med Hum Perform. 2022; 93(11):816-821.

Infección diseminada por el bacilo vacunal Calmette-Guerin

RESUMEN Introducción: La infección diseminada por el bacilo vacunal Calmette-Guerin es una rara reacción adversa severa asociada a inmunodeficiencia. Objetivo: Describir una serie de cinco casos con infección vacunal diseminada. Presentación de casos: Se presentan cinco casos vacunados al nacer, predominio masculino 4 (80 %), promedio edad inicio: 8,4 meses 2 (15 %) y de edad al diagnóstico: 17,8 meses 6 (31 %). Cuadro clínico de huella vacunal ulcerada, linfadenitis axilar ipsilateral y en regiones distales, hepatosplenomegalia y afectación de otros órganos, con manifestaciones sistémicas y nutricionales. Existió consanguinidad en tres e historia familiar sospechosa de inmunodeficiencia en otros tres. Todos fallecieron: tres enfermos antes de los 3 años. Se realizaron estudios inmunológicos convencionales a todos los enfermos. Un paciente presentaba Inmunodeficiencia severa combinada, en los otros se sospechó enfermedad granulomatosa crónica en uno y síndrome de susceptibilidad mendeliana a micobacterias en tres. Conclusiones: Aunque la vacuna BCG raramente presenta diseminación del bacilo vacunal, debe sospecharse esta entidad en niños pequeños, con las características severas y sistémicas que se describen, con manifestaciones sugestivas de tuberculosis que no responden al tratamiento antituberculoso de primera línea.

ABSTRACT Introduction: The infection disseminated by the vaccine bacillus Calmette-Guerin is a rare severe adverse reaction associated with immunodeficiency. Objective: Describe a series of five cases with disseminated vaccine infection. Presentation of cases : There are five cases vaccinated at birth: predominance of the male sex in 4 (80%), average age onset: 8.4 months in 2 (15 %) and age at diagnosis: 17.8 months in 6 (31 %); clinical picture of ulcerated vaccine footprint, ipsilateral axillary lymphadenitis and in distal regions, hepatosplenomegaly, involvement of other organs, with systemic and nutritional manifestations. There was consanguinity in three of the patients and suspicious family history of immunodeficiency in three others. All died: three were sick before the age of 3. Conventional immunological studies were performed in all cases. One patient had severe combined immunodeficiency, chronic granulomatous disease was suspected in one, and Mendelian susceptibility syndrome to mycobacteria in three. Conclusions: Although the BCG vaccine rarely presents dissemination of the vaccine bacillus, this entity should be suspected in young children, with the severe and systemic characteristics described, with manifestations suggestive to tuberculosis that do not respond to first-line anti-tuberculous treatment.

Impact of Time Delay on Simulated Operative Video Telementoring: A Pilot Study.

INTRODUCTION: As NASA and private spaceflight companies push forward with plans for missions to cis-lunar and interplanetary space, the risk of surgical emergency increases. At latencies above 500 ms, telesurgery is not likely to be successful, so near-real-time telementoring is a more viable option. We examined the effect of a 700-ms time delay on the performance of first year surgical residents on a simulated task requiring significant feedback from a mentor in a pilot study.METHODS: A simulated surgical task requiring precision and accuracy with built-in error detection was used. Each resident underwent two trials, one with a mentor in the same room and one with the mentor using a teleconference with time delay. Outcomes measured included time to complete task, game pieces successfully removed, number of errors, and scores on the NASA Task Load Index by both mentor and operator. Data were analyzed using paired t-tests.RESULTS: The time delay group removed significantly fewer pieces successfully than the real time group (3.0 vs. 1.6, P = 0.02). There was no difference in the NASA Task Load Index (TLX) scores for the operators between the two groups, but the mentor reported significantly higher scores on Mental Demand (5.6 vs. 12.0, P = 0.04) and Effort (6.2 vs. 11.8, P = 0.05) during the time-delayed trials.DISCUSSION: A 750-ms time delay significantly degraded performance on the task. Though operator TLX scores were not affected, mentor TLX scores indicated significantly increased mental load. Telementoring is viable, but more onerous than in-person mentoring.Kamine TH, Smith BW, Fernandez GL. Impact of time delay on simulated operative video telementoring: a pilot study. Aerosp Med Hum Perform. 2022; 93(2):123-127.

Neumonía adquirida en la comunidad por pacientes entre 1 mes y 18 años de edad / Community-acquired pneumonia by patients from 1 month to 18 years old

Introducción: La neumonía adquirida en la comunidad continúa siendo un problema de salud global. Objetivo: Caracterizar desde la óptica clínico-epidemiológica la neumonía adquirida en la comunidad en la edad pediátrica. Métodos: Estudio descriptivo de corte transversal y prospectivo de pacientes entre 1 mes-18 años, no vacunados con antineumocócica, ingresados en el Hospital Pediátrico Centro Habana, enero 2018-julio 2019 con diagnóstico confirmado por radiología de neumonía adquirida en la comunidad. Los pacientes no presentaban enfermedades crónicas, exceptuando el asma. Los padres o tutores dieron su consentimiento. Se evaluaron variables demográficas y clínicas, factores de riesgo, evolución y complicaciones según grupo de edad. Resultados: Se estudiaron 277 enfermos, predominaron los niños entre 1 a 4 años de edad (39,4 por ciento), superioridad del sexo masculino (55,2 por ciento). Los síntomas más frecuentes fueron: fiebre (98,9 por ciento), disnea (99,3 por ciento), tos (98,9 por ciento) y disminución del murmullo vesicular (96,4 por ciento). Como factores de riesgo predominaron la asistencia a círculos infantiles (31,8 por ciento), lactancia materna inadecuada (23,8 por ciento) y el tabaquismo pasivo (16,6 por ciento). Hubo complicaciones en 110 niños (39,7 por ciento) con predominio de derrame pleural, sobre todo en prescolares y asociación significativa entre complicaciones y edad. No hubo fallecimientos. Conclusiones: Es importante la vigilancia de las neumonías y su desarrollo clínico epidemiológico, para la prevención y diagnóstico en esa etapa previa a la introducción de la vacuna antineumoccócica. En población no vacunada contra el neumococo, es estrategia significativa reducir los factores de riesgo modificables como la insuficiente lactancia materna, el tabaquismo pasivo y la malnutrición(AU)

Introduction: Community-acquired pneumonia continues to be a global health problem. Objective: Characterize from the clinical-epidemiological perspective community-acquired pneumonia in the pediatric ages. Methods: Descriptive cross-sectional and prospective study of patients from 1 month to 18 years old not vaccinated with pneumococcal vaccine, admitted in Centro Habana Pediatric Hospital from January 2018 to July 2019 with diagnosis confirmed by radiology of pneumonia acquired in the community. Patients did not have chronic diseases, except for asthma. Parents or guardians consented. Demographic and clinical variables, risk factors, evolution and complications were assessed according to the age group. Results: 277 patients were studied, children from 1 to 4 years old predominated (39.4 percent); there was male superiority (55.2 percent). The most common symptoms were fever (98.9 percent), dyspnea (99.3 percent), cough (98.9 percent) and decreased vesicular murmur (96.4 percent). As risk factors, attendance to nurseries (31.8 percent), inadequate breastfeeding (23.8 percent) and passive smoking (16.6 percent) predominated. There were complications in 110 children (39.7 percent) with prevalence of pleural effusion, especially in pre-schoolers and significant association among complications and age. There were no deaths. Conclusions: Monitoring of pneumonia and its epidemiological clinical development is important for prevention and diagnosis at this stage prior to the introduction of the pneumococcal vaccine. In populations not vaccinated against pneumococcus, it is a significant strategy to reduce modifiable risk factors such as insufficient breastfeeding, passive smoking and malnutrition(AU)

Tuberculosis infantil en Cuba / Children tuberculosis in Cuba

Introducción: La presencia de tuberculosis infantil constituye una señal de alerta de transmisión en la comunidad. Objetivos: Determinar incidencia y características de la tuberculosis infantil en Cuba en su etapa más reciente. Métodos: Estudio descriptivo, transversal y retrospectivo de los 107 casos diagnosticados 0-18 años, periodo 2013-2017, según datos de la Dirección de Registros Médicos y Estadísticas de Salud, la ficha epidemiológica y datos del Centro de Referencia Nacional de tuberculosis infantil. Se estudiaron variables demográficas, epidemiológicas, clínicas y de estudios que contribuyeron al diagnóstico, así como a la evolución final de los casos. Resultados: Predominó el grupo de edad de 15 - 18 años (52,0 - 48,6 por ciento) , sexo masculino (59,0-55,1 por ciento) y los procedentes de La Habana (43,0 - 40,2 por ciento). La tuberculosis en menores de 19 años representó entre 1,8 y 4,4 por ciento del total de casos en el país. La tasa de incidencia por 100 mil habitantes se comportó en menores de 15 años entre 0,4 y 0,8 con tendencia descendente; en el grupo 15-18 años, entre 0,8 y 3,0 con tendencia ascendente. Predominaron las formas pulmonares (87,0 - 82,6 por ciento) con pobre confirmación bacteriológica (49,0 - 45,7 por ciento). Ningún caso tuvo coinfección VIH-TB ni drogorresistencia. Hubo una fallecida (0,9 por ciento). Conclusiones: Cuba tiene muy baja incidencia de tuberculosis infantil, no es un problema de salud, pero sí un indicador de transmisión de la enfermedad en la comunidad. Para su eliminación, hay que fortalecer las acciones del Programa Nacional de Control, particularmente en La Habana y en el grupo de edad de 15 a 18 años(AU)

Introduction: The presence of children tuberculosis constitutes a transmission alert sign in the community. Objectives: To determine the incidence and characteristics of children tuberculosis in Cuba in its earliest stage. Methods: Descriptive, cross-sectional and restrospective study of 107 diagnosed cases in the ages from 0 to 18 years during the period 2013-2017, according to data provided by the National Division of Medical Records and Health Statistics, epidemiological records and data from the Center of National Reference on Children Tuberculosis. There were studied demographic, epidemiological, clinical and study variables which contributed to the diagnosis as well as to the final evolution of the cases. Results: There was a predominance of the age of group of 15 - 18 years (52.0 - 48.6 percent), masculine sex (59.0 - 55.1 percent) and patients from Havana city (43.0 - 40.2 percent). Tuberculosis in patients under 19 years represented between the 1.8 and 4.4 percent of all the cases in the country. The incidence rate per 100 000 inhabitants in patients under 15 years was 0.4 to 0.8 with a decreasing trend; in the group age of 15 to 18 years it was between 0.8 and 3.0 with an increasing trend. Pulmonary conditions predominated (87.0 - 82.6 percent) with poor bacteriological confirmation (49.0 - 45.7 percent). None of the cases had HIV-TB co-infection nor drugs resistance. There was one deceased girl (0,9 percent). Conclusions: Cuba has a very low incidence of children tuberculosis; it does not represent a health problem but it actually is an indicator of transmission of the disease in the community. For its erradication, it is needed to strenght the actions of the Control´s National Program, particularly in Havana city and the age group of 15 to 18 years(AU)

Perioperative Considerations During Emergency General Surgery in the Era of COVID-19: A U.S. Experience.

The novel coronavirus SARS-CoV-2 (COVID-19) strain has caused a pandemic that affects everyday clinical practice. Care of patients with acute surgical problems is adjusted to minimize exposing health care providers to this highly contagious virus. Our goal is to describe a specific and reproducible perioperative protocol aiming to keep health care providers safe and, simultaneously, not compromise standard of care for surgical patients.

Senior General Surgery Resident Confidence in Performing Abdominal Wall Hernia Repairs.

BACKGROUND: It is expected that graduating general surgery residents be confident in performing common abdominal wall hernia repairs. The objective of our study was to assess the confidence of senior surgical residents in these procedures and to identify factors that correlate with confidence. METHODS: We performed a cross-sectional survey of PGY-4 and PGY-5 general surgery residents at ACGME-accredited programs in the United States in the spring of 2019. Respondents rated their confidence level in 12 hernia procedures on a Likert scale from 1 (not confident) to 5 (extremely confident). Respondents were classified as "Not Confident" (Not Confident, Minimally Confident, Neutral responses) or "Confident" (Confident, Extremely Confident responses). Resident characteristics, program characteristics, and operative experience were collected, and we calculated the area under the curve to screen which factors discriminated between those confident versus not. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) to identify which factors were most predictive. RESULTS: A total of 93 surveys were completed. Respondents reported low confidence rates (25%-60%) in the following hernia repairs: minimally invasive (MIS) inguinal, femoral, tissue (nonmesh) inguinal, pediatric inguinal, and abdominal wall reconstruction. High confidence rates (>80%) were reported for open umbilical, open ventral, and MIS ventral hernia repairs. For MIS inguinal hernia repair, PGY-5 level was associated with a twofold increase in confidence (PR = 2.01; 95% CI = 1.34-3.30), and dedicated research years were associated with low confidence (PR = 0.67; 95% CI = 0.43-1.04). In general, higher operative volumes of a specific repair were associated with increased confidence in that procedure. CONCLUSIONS: Senior surgical residents reported low confidence in performing a variety of essential hernia repairs (particularly MIS inguinal, femoral, and tissue inguinal). Addressing factors associated with low confidence may help increase resident confidence.

Boot Camp in a Box: Initial Experience with Pretraining Skills Preparation for New Interns.

PURPOSE: In order to increase selected skills at onset of training, we provided newly matched PGY-1 trainees with materials and instructions to practice these skills, as well as the opportunity to share video-recorded performance and receive feedback based on these videos. METHODS: Knot tying and suturing kits, instruments and supplies, and video instructions for task performance were sent to newly matched trainees to our program (n = 10), with instructions to practice 4 tasks (1- and 2-handed knot tying, interrupted and running suturing) until self-assessed comfort with each task was achieved or the 8-week time point before start of training was reached. Each trainee returned a video of each task, which was graded by blinded reviewers for time and errors using an itemized evaluation instrument (12 items for suturing and five items for knot-tying). Feedback (annotations of submitted videos) was provided after grading was completed. Task performance was repeated and reassessed at the time of new intern "Boot Camp" and again 8 weeks after start of training. Performance scores were compared for the 3 time points and with scores of PGY 2-4 residents using ANOVA with posthoc tests. RESULTS: Compliance with instruction for practice and return of video recorded tasks in the months before start of PGY-1 training was high, with only 1 of 10 failing to return knot-tying videos. A significant pattern of performance change (p < 0.05) was observed for all tasks with an initial decrease between the pre-employment practice period and the Boot Camp test followed by an increase to the highest level of performance 2 months after start of training. At that point, scores were not significantly different than those of more senior residents. CONCLUSIONS: A high level of compliance was achieved with requested skills practice and video documentation of performance. We attribute the consistently lower scores on the tasks during Boot Camp tests to higher stress test environment which was apt to be less favorable than having the trainee choose to submit their best possible preresidency video recording of performance in a low-stress situation. Subsequent achievement of significantly higher performance even compared to more senior residents may have been helped by incentivized pretraining practice.

Características de los cuidadores principales de niños y adolescentes con fibrosis quística / Characteristics of main caregivers of children and adolescents with cystic fibrosis

Introducción: Las investigaciones sobre los cuidadores han tomado importancia por los efectos negativos que provoca en las esferas físicas, psicológicas y sociales de estas personas, debido a su dedicación prolongada a la atención de enfermos cuyas dolencias les impiden totalmente su autocuidado. Objetivos: Referir las características de los cuidadores principales de pacientes pediátricos con fibrosis quística. Métodos: Estudio descriptivo de corte transversal realizado en el segundo semestre del 2016, con 54 cuidadoras principales de pacientes menores de 19 años, atendidos en los hospitales Pediátrico de Centro Habana, Juan Manuel Márquez, de Marianao, y el William Soler, de Boyeros. Resultados: Las cuidadoras son mujeres, madres en su mayoría, sin vínculo laboral, con nivel educativo medio superior, dedicadas al cuidado de los enfermos a tiempo completo, lo que interfiere su vida personal y social. Ante estas situaciones responden con mediana capacidad de afrontamiento y adaptación ante las situaciones que les generan estrés. Conclusiones: Las estrategias de afrontamiento utilizadas por las cuidadoras están afectadas pues no generan respuestas efectivas que les permita adaptarse y responder a las situaciones de forma óptima, por lo que se requiere reforzar los recursos que están utilizando. La meta de enfermería como ciencia y como disciplina es un factor muy importante para obtener esos recursos necesarios para mejorar la calidad de vida de los niños, adolescentes y sus cuidadores(AU)

Introduction: Research on caregivers has become important because of the negative effects this activity causes in the physical, psychological and social aspects of these people due to their prolonged dedication to the care of patients, whose illnesses prevent them from fully looking for themselves. Objective: To describe the characteristics of the main caregivers of pediatric patients with cystic fibrosis. Methods: A cross-sectional descriptive study conducted in the second semester of 2016, with 54 main caregivers of patients under 19 years old that were attended in Centro Habana Pediatric Hospital, Juan Manuel Márquez (Marianao´s municipality Pediatric Hospital), and William Soler (Boyeros municipality´s Pediatric Hospital). Results: Caregivers are women, mostly mothers, with no employment, with a medium superior level of education, who are devoted to caring for the sick patients full-time, and this interferes with their personal and social life. Given these situations, they respond with a medium capacity for coping and adapting to situations that generate stress. Conclusions: Coping strategies used by caregivers are affected because they do not generate effective responses that allow them to adapt and respond to situations in an optimal way, so it is necessary to reinforce the resources they are using. The goal of nursing as a science and as a discipline is a very important factor in obtaining those necessary resources to improve the quality of life of children, adolescents and their caregivers(AU)

Simulation center best practices: A review of ACS-accredited educational institutes' best practices, 2011 to present.

BACKGROUND: Since the inception of American College of Surgeons' Accredited Educational Institute (ACS-AEI) Consortium, accreditation reviews have identified best practices in simulation-based education and center operations. A review of best practices would support the communication of these best practices, offer recognition of exemplar institutes, and facilitate discussion and sharing of resources amongst AEIs. METHODS: We examined 5 years of ACS AEI accreditation best practices identified across all standards and criteria. The goal was to identify resources that could be shared among AEIs and recognize AEI champions that have promoted best practices in surgical simulation. RESULTS: From 149 site reviews (July 2011-June 2016), reviewers identified 197 best practices across 83 AEIs (52.9% of all sites reviewed received a best practice). A total of 52.5% of best practices were associated with curriculum development, delivery of effective education and assessment, and 25 available resources were identified that could be shared among AEIs. The majority of best practices (n = 117, 59.3%) were identified at 24 AEIs, with the highest number of best practices identified at Banner Simulation Center and New Orleans Learning Center (10 each over 2 reviews). Twenty-two other institutes presented 97 best practices, with between 3 to 8 per institute (mean = 4.4, standard deviation = 1.6). Specific best practices, criteria, and AEI champions are highlighted. CONCLUSION: Review of AEI accreditation best practices identified common themes for surgical simulation programs and identified tools that could be shared to advance all programs and champion AEIs that have promoted best practices in surgical simulation.

Single incision laparoscopic proficiency correlates with residency training level.

BACKGROUND: With experience, certain psychomotor skills should translate from standard laparoscopy to single-incision laparoscopy (SIL). We proposed to compare all surgical postgraduate year (PGY) levels and determine if experience translated to improved SIL skills. METHODS: Surgical residents of all PGY levels (1-5) at our institution were included. Baseline surveys were obtained to determine resident level of exposure to both SIL and standard laparoscopic cases. Participants performed the following tasks: running of the bowel, endoloop placement, extracorporeal suture tying, and intracorporeal suture tying. Tasks were performed on a commercially provided simulated inanimate organ model. Participants were given 5 min to complete each task. Data were collected and analyzed by an impartial-certified Fundamentals of Laparoscopic Surgery proctor. RESULTS: A total of 31 residents participated in the study. Overall, there was minimal SIL exposure among all residents. As expected, PGY level correlated with increased ability to complete assigned tasks within the allotted time. There was a statistically significant difference in the number of individuals able to complete a task based on PGY level for all given tasks (P = 0.005). With increased difficulty, the percentage of higher level residents able to complete the task decreased (100% PGY5 completed running of bowel versus 0% intracorporeal knot tying). CONCLUSIONS: Certain psychomotor skills did appear to translate to SIL skills. However, further dedicated SIL training may help to better develop certain laparoscopic skills devoted to SIL.

Hospitalizaciones por neumonía adquirida en la comunidad / Hospitalizations for community-acquired pneumonia

Introducción: Streptoccocus pneumoniae es la causa más frecuente de neumonía bacteriana adquirida en la comunidad en la edad pediátrica. Objetivo: estimar la proporción de casos hospitalizados y defunciones por neumonía, así como describir la utilización de servicios de atención al paciente grave en niños con neumonía y sepsis. Métodos: se realizó un estudio retrospectivo de series de casos de niños entre 1 mes a 18 años, 2002-2013, así como datos de ingreso por neumonía (confirmada radiológicamente) y sepsis, en la Unidad de Terapia Intensiva 2011-2013, del Hospital Pediátrico Centro Habana. Resultados: se registraron un total de 5 672 ingresos por neumonía, para una media de 469 casos anuales, más frecuente en varones (53,2 por ciento) y niños entre 1 a 4 años (55,1 por ciento). Se registraron 14 fallecidos (0,25 por ciento del total), de los cuales 9 fueron del sexo masculino (64,3 por ciento). Entre 2011-2013, el 6 a 9 por ciento de los niños con neumonía requirieron ingreso en unidades de atención al grave, con predominio también de preescolares. Conclusiones: los datos obtenidos pueden aportar evidencia indirecta de la magnitud de la enfermedad neumocócica en un hospital pediátrico(AU)

Introduction: Streptococcus pneumoniae is the most common cause of community-acquired bacterial pneumonia at pediatric ages. Objective: to estimate the ratio of hospitalized cases and deaths of pneumonia as well as to describe the use of services to severely-ill patients in children with pneumonia and sepsis. Methods: retrospective case-series study performed in children aged one to 18 years from 2002 to 2013 and of hospitalization data for pneumonia (X ray-confirmed) and sepsis in the intensive care unit from 2011 to 2013 in Centro Habana pediatric hospital. Results: a total number of 5 672 admissions for pneumonia were registered, for a mean of 469 cases yearly, more frequent in males (53.2 percent) and children aged one to four years (55.1 percent). There were 14 deaths (0.25 percent of total number) and nine of them were males (64.3 percent). From 2011 to 2013, six to nine percent of children with pneumonia required admission to the severely-ill patient care unit with predominance of pre-school children. Conclusions: the collected data may provide indirect evidence for analysis of the magnitude of pneumococcal disease in a pediatric hospital(AU)