Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis.

BACKGROUND: Short-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective. METHODS: Using a provider perspective, the costs of implementing the surgical trips were collected via Esperança's previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year. RESULTS: Esperança's surgical missions' program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate. CONCLUSIONS: The cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.

Surgery in Brazilian Health Care: funding and physician distribution.

Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.

Objetivo: analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. Métodos: os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a distribuição do trabalho médico e dos estabelecimentos de saúde foram avaliadas, e as regiões geográficas foram analisadas usando o índice de desigualdade público-privado (IDPP). Resultados: o Brasil tem, em média, dois médicos por 1000 habitantes, que são desigualmente distribuídos no país. Tem 22.276 cirurgiões gerais certificados (11,49 por 100.000 habitantes). Existem no país 257 escolas de medicina, com 25.159 vagas por ano, e apenas cerca de 13.500 vagas de residência médica. O índice de desigualdade público-privado é de 3,90 para o país e varia de 1,63 no Rio de Janeiro até 12,06 na Bahia. Conclusão: uma parte significativa da população brasileira ainda encontra muitas dificuldades no acesso ao tratamento cirúrgico, particularmente na região norte e nordeste do país. Médicos e, particularmente, cirurgiões são escassos no sistema público de saúde e incentivos devem ser criados para assegurar uma força médica igual no setor público e no setor privado em todas as regiões do país.

Surgery in Brazilian Health Care: funding and physician distribution / Cirurgia no Sistema Brasileiro de Saúde: financiamento e distribuição de médicos

ABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.

RESUMO Objetivo: analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. Métodos: os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a distribuição do trabalho médico e dos estabelecimentos de saúde foram avaliadas, e as regiões geográficas foram analisadas usando o índice de desigualdade público-privado (IDPP). Resultados: o Brasil tem, em média, dois médicos por 1000 habitantes, que são desigualmente distribuídos no país. Tem 22.276 cirurgiões gerais certificados (11,49 por 100.000 habitantes). Existem no país 257 escolas de medicina, com 25.159 vagas por ano, e apenas cerca de 13.500 vagas de residência médica. O índice de desigualdade público-privado é de 3,90 para o país e varia de 1,63 no Rio de Janeiro até 12,06 na Bahia. Conclusão: uma parte significativa da população brasileira ainda encontra muitas dificuldades no acesso ao tratamento cirúrgico, particularmente na região norte e nordeste do país. Médicos e, particularmente, cirurgiões são escassos no sistema público de saúde e incentivos devem ser criados para assegurar uma força médica igual no setor público e no setor privado em todas as regiões do país.

Potential of a hand transplantation program in Colombia.

The protocols and published results on hand transplantation show acceptable results of this technology. None of the registered groups, however has a sufficient number of patients to allow continuity of the process. In Colombia the main problems are violence, drug traffic, and guerrillas. Thanks to the profitability of drug traffic, guerrillas, who initially were created based on ideologic differences, have become terrorist groups whose main source of income is drug traffic. From that interest comes the use of landmines to protect illicit crops. Colombia is the most mined country in the world, followed by Cambodia and Afghanistan, and the only country in Latin America where there are still landmines. The mines, violence, and trauma produce a large number of people with disabilities and amputations. From 1990 to 2006, the number of victims rose from 21 to 1,041 per year. In Colombia, amputations are more frequently due to trauma than to disease. The fact that 88% of the victims are children and people of working age, affects the political and economic development. These alarming numbers generate a challenge for government, which has led to the creation of policies and laws aimed at comprehensive action against mines. This program under the Presidency has among its objectives assistance to victims, including integrated treatment, prostheses, and other procedures, financed entirely by the government. The number, type of victims, and their motivation to be transplanted, along with government programs directed to their attention, are key factors that we think will enable the continuity of our hand transplantation program at the Fundación Santa Fe de Bogotá, giving Colombia the unfortunate privilege of having the largest number of potential patients for transplantation.

Implementacióndel sistema de gestión por procesos en el área quirúrgica de una institución sanitaria privada de la ciudad de Córdoba / Implementacióndel system of management for processes in the surgical area of a sanitary institution deprived of the city of Cordoba

Para adaptarse a las necesidades de un entorno cambiante las empresas de salud intentan sistematizar la revisión de sus procesos y agregarla a la exigencia de una práctica clínica eficaz. La gestión basada en procesos permite la observación diseño, añálisis, evaluación y mejora de las actividades de cada uno de sus servicios, integrándolos funcionalemnte para alcanzar sus objetivos. El área o bloque quirúrgico, debe gestionar sus procesos como una unidad organizativa para mejorar eficiencia, seguimiento y control.

Web-based learning in undergraduate medical education: development and assessment of an online course on experimental surgery.

In order to increase the number of practical and discussion classes offered to students in the traditional-curriculum scenario, while decreasing the lecture-based ones and to create an online community to share knowledge on surgery, we developed and assessed the first online course for undergraduate medical students on experimental surgery at the Federal University of Sao Paulo-UNIFESP, Brazil. The purposes of the present study are: describe and discuss the process and the lessons learned involved in developing an undergraduate web-based course and analyze the students' attitude towards this educational environment. A group of medical students was taught online during 5 weeks on the theory of experimental surgery through video quizzes, required readings, collaborative activities using discussion board and asynchronous communication. The students' knowledge gain, their web session variables and the results of the course evaluation were used to support our study. The students have significantly improved their knowledge on experimental surgery after the course. Among factors in the online course that could possibly have contributed to this gain, the interactive activities (video quizzes), key element in our online material, seemed to be promising for candidates. The evaluation results demonstrated high levels of course functionality, effectiveness of its online content and acceptance among medical students. This study indicated that a web-based course for undergraduate students may be successfully developed and implemented in medical settings and the students seem to be quite supportive. We encourage undergraduate medical learning strategies involving the Web.

Itinerant Surgery: its effect on local development

The cost of any goods or service is the amount of resources given up in order to obtain it. A service is considered free when the recipient does not give up any resource in exchange for obtaining it, but is free only to the recipient, because someone else pays for it. Itinerant surgery is often justified on the grounds that it is free to the recipient, and this is considered good. But compromises in standards often appear acceptable because the service is free and, after all. "beggars can't be choosers". A discussion of monetary matters borders on the unethical and is traditionally avoided when medical issues are considered, but cost is probably the most limiting factor in the provision of health care in the West Indies. If the itinerant surgeons provides the cost of the surgery it aids the community economically in the short run. In the long run the community will be better able to support its need for surgery and will be more developed if it has its own surgeon. "Give a man fish and he'll eat for a day; teach a man to fish and he'll eat for longtime."(AU) [truncated]

Costo beneficio de una residencia / Cost/Benefit of Residence Program

El costo de las acciones relacionadas con cualquier emprendimiento constituye un factor fundamental en la toma de decisiones. Los ,costos de la salud y de la educación han aumentado aceleradamente, haciendo racional exigir el uso eficiente de los fondos. Los estudios Costo/Beneficio son adecuados para esta misión. Se estudió un programa de Residencia de Clínica Quirúrgica, dependiente de la Provincia de Buenos Aires. El costo por Residente con programa completo se elevó a $50.674. Las residencias son programas de alto costo. Los innegables beneficios de la Residencia, se refieren a la consecución de los objetivos docentes propuestos. Se refieren a la formación de profesionales técnicamente idóneos, con sólida formación en los planos ético, moral y social, capaces de proveer óptima promoción, protección y rehabilitación de la salud, contemplando la prevalecia lesional como uno de sus pilares fundamentales. La medida objetiva de los beneficios es casi imposible de concretar, debiendo definir instrumentos de evaluación que permitan expresarlos. Defender la Residencia como sistema debe ser más que una expresión de deseo. Implica un compromiso racional y creativo, para evitar cristalizaciones definitivas en un mundo donde la inestabilidad y el cambio permanentes obligan a hombres e instituciones a adaptarse para sobrevivir. El análisis Costo/Beneficio provee una medida de la realidad que permite sugerir ajustes y proponer nuevas soluciones

Costo beneficio de una residencia / Cost/Benefit of Residence Program

El costo de las acciones relacionadas con cualquier emprendimiento constituye un factor fundamental en la toma de decisiones. Los ,costos de la salud y de la educación han aumentado aceleradamente, haciendo racional exigir el uso eficiente de los fondos. Los estudios Costo/Beneficio son adecuados para esta misión. Se estudió un programa de Residencia de Clínica Quirúrgica, dependiente de la Provincia de Buenos Aires. El costo por Residente con programa completo se elevó a $50.674. Las residencias son programas de alto costo. Los innegables beneficios de la Residencia, se refieren a la consecución de los objetivos docentes propuestos. Se refieren a la formación de profesionales técnicamente idóneos, con sólida formación en los planos ético, moral y social, capaces de proveer óptima promoción, protección y rehabilitación de la salud, contemplando la prevalecia lesional como uno de sus pilares fundamentales. La medida objetiva de los beneficios es casi imposible de concretar, debiendo definir instrumentos de evaluación que permitan expresarlos. Defender la Residencia como sistema debe ser más que una expresión de deseo. Implica un compromiso racional y creativo, para evitar cristalizaciones definitivas en un mundo donde la inestabilidad y el cambio permanentes obligan a hombres e instituciones a adaptarse para sobrevivir. El análisis Costo/Beneficio provee una medida de la realidad que permite sugerir ajustes y proponer nuevas soluciones

Estudo prospectivo randomizado do uso de um antisséptico tópico no campo operatório / A prospective study about the use of topical antissepsis the skin surgical area

Os autores apresentam um estudo prospectivo da antissepsia do campo operatório. Foram estudados 188 pacientes, divididos em dois grupos. O grupo A, com 98 pacientes, onde foi utilizado uma soluçäo degermante de iodo-iodeto de K (iodo a 1por cento) e um grupo B, com 90 pacientes em que se realizou a antissepsia do campo operatório com a mesma soluçäo utilizada no grupo A, acrescido com álcool iodado a 1por cento. Os resultados näo demonstraram vantagens na utilizaçäo do álcool iodado em relaçäo a incidência de infecçäo de ferida, queimaduras e dermatites