Impact of COVID-19 on the surgical volume of general surgery residents as main surgeons in a National Training Program in Costa Rica: A cross-sectional study.

ABSTRACT: To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents' medical practice in Costa Rica's General Surgery Residency Program.The COVID-19 pandemic has caused a significant disruption in people's lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department's timely measures and pro-resident attitude were the key reasons for the above results.

Impacto del cambio de presentación del trastuzumab para la Seguridad Social de Costa Rica, estudio de minimización de costos / Impact of the change of presentation of the trastuzumab for the Social Security of Costa Rica, cost minimization study

Resumen Objetivo: dado que en este momento está disponible a nivel de la Seguridad Social Costarricense tanto trastuzumab para administración intravenosa como para administración subcutánea, y que la presentación para administración subcutánea ha documentado ser no inferior a la intravenosa, resulta pertinente contar con un estudio de minimización de costes que permita documentar cuál de las formulaciones resulta más conveniente mantener en el sistema público de salud, con base en criterios de eficiencia de la intervención. Métodos: se desarrolló un estudio que evaluó desde la perspectiva financiera de la Seguridad Social de Costa Rica, dos opciones diferentes de aplicación del trastuzumab en pacientes con cáncer de mama. Los procedimientos relacionados fueron identificados y documentados para los dos tipos de aplicación del tratamiento intravenosa y subcutánea. Ambas opciones de tratamiento se basaron en esquemas de diecisiete dosis, con la estimación de los suministros y el tiempo del profesional sanitario para cada posibilidad. El análisis incluyó la evaluación desde la perspectiva del paciente. Resultados: la evaluación económica del procedimiento de administración para ambas alternativas evidenció que la opción subcutánea tenía un costo de aplicación de $ 78,6 y $ 467,34 para la opción intravenosa. Desde la perspectiva financiera, la opción subcutánea constituye la alternativa con un costo menor: $ 4000,00 por tratamiento por paciente, y desde la perspectiva de este, implica un 45,0 % menos de tiempo por sesión de tratamiento por paciente, que en la opción intravenosa. Conclusiones: la formulación de trastuzumab subcutánea evidenció una reducción sustancial de tiempo y costo en comparación con la presentación intravenosa en el sistema de Seguridad Social Costarricense.

Abstract Objective: Given that at this time is available at the Costa Rican Social security both trastuzumab for intravenous as for subcutaneous administration, and that the presentation for subcutaneous administration has documented to be not inferior to the intravenous. It is relevant to have a study of cost minimization to investigate what formulation is more convenient to maintain in the public health system, based on criteria of efficiency of the intervention. Methods: A study was developed to evaluate, from the financial perspective of the Social Security of Costa Rica, two different options of application of trastuzumab in patients with breast cancer. The related procedures were identified and documented for the two types treatment application. Both treatment options were based on seventeen dose schemes, with the estimate of supplies and the time of the health professional for each possibility. The analysis also included the evaluation from the patient's perspective. Results: The economic evaluation of the application procedure for both alternatives evidenced that the subcutaneous option had an application cost of $78.6 and $467.34 for the intravenous option. From the financial perspective the subcutaneous option constitutes the alternative with lower cost, with a cost around $4000.0 by treatment per patient, and from the patient perspective implies a 45.0% less time for session than then intravenous option. Conclusions: Trastuzumab subcutaneous formulation evidenced a substantial time and cost reduction in comparison with the intravenous formulation in the Costa Rican Social Security System.

Epidemiología de la candidemia en el Hospital México / Candidemia and it's Epidemiology at Hospital México

Justificación y objetivos:las infecciones invasivas por Candida son frecuentes y de alta mortalidad en la práctica clínica. Existe poca información publicada al respecto en el país. Estudio retrospectivo y observacional que pretende aportar conocimiento novedoso sobre la epidemiología local de la candidemia.Métodos:se incluyó 136 pacientes mayores de 17 años en su primer episodio de candidemia, internados en el Hospital México, entre 2007 y 2010. Se realizó un análisis descriptivo y temporal, se evaluaron los factores asociados con C. parapsilosis y con la sobrevida a 30 días.Resultados:se detectó en promedio 34 episodios por año (rango 27 a 51), la incidencia acumulada fue de 1,1 casos/1000 admisiones. Las especies de Candida no albicans constituyeron el 62% de las levaduras aisladas. Exceptuando 2009, C. parapsilosis fue la especie predominante en 3 de 4 años estudiados (41%), seguida por C. albicans (38%). Se demostró una fuerte asociación entre la candidemia por C. parapsilosis, la presencia de catéter venoso central (OR=19,6, IC95%: 2,6 a 403,8, p<0,001) y el uso de nutrición parenteral (p=0,014). La mortalidad a 30 días fue del 46%. C. albicans mostró la mortalidad más alta y C. parapsilosis, la más baja. Los pacientes que no recibieron tratamiento antifúngico presentaron una probabilidad significativamente mayor de morir.Conclusiones:la elevada incidencia de candidemia por C. parapsilosisestá directamente relacionada con los catéteres venosos centrales y el uso de nutrición parenteral; su marcada reducción en la frecuencia durante 2009, merece ser investigada para dilucidar los factores que provocaron este cambio.

Background:Invasive Candida infections are frequent and exhibit high mortality in clinical practice. There are few published data in our country. This retrospective observational study intends to provide new knowledge about the local epidemiology of candidemia.Methods:136 patients older than 17 years were included when they had their first episode of candidemia during hospitalization at the Hospital Mexico, in the time period between 2007 and 2010. Descriptive and temporal analysis was performed and the risk factors associated with C. parapsilosis and survival were evaluated.Results:An average of 34 episodes of candidemia were recorded per year (range 27-51) and the cumulative incidence was 1.1 cases/1,000 admissions. The non-albicans Candida species accounted for 62% of the isolated yeasts, C. parapsilosis (41%) was the predominant yeast isolated in 3 out of the 4 years analized, except for 2009, followed by C. albicans (38%). Strong association between C. parapsilosis bloodstream infection, the presence of a central venous catheter (2.6 to 403.8, p <0.001 OR = 19.6, 95% CI) and use of parenteral nutrition (p=0.014) was established. The 30-day mortality was 46%, with C. albicans displaying the highest and C. parapsilosis the lowest. Patients who did not receive antifungal treatment had significantly higher mortality.Conclusions:the unusually high incidence of candidemia due to C. parapsilosis is directly related to the use of central venous catheters and parenteral nutrition; the marked reduction observed in 2009 needs further investigation to find out the causes of this change.