Análisis del coste directo de la atención médica y quirúrgica del cáncer de mama. Estudio comparativo entre etapas temprana y tardía en tercer nivel de atención

BACKGROUND

Management of breast cancer is increased by late diagnoses.

OBJECTIVE

To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute.

METHOD

Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student's t test was used to determinate differences between groups, as well as descriptive statistics.

RESULTS

The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024).

CONCLUSIONS

Cost of medical attention in the initial stage is lower than that of the advanced stage.

Prevalence of pulmonary thromboembolism in patients undergoing abdominopelvic surgery with respiratory distress

Objective

To determine the prevalence of pulmonary thromboembolism (PET) and identify it's risk factors in patients operated on a scheduled basis, in the general surgery service from the High Specialty Medical Unit Hospital de Especialidades de Puebla, of the Mexican Social Security Institute.

Method

Descriptive, retrospective and cross sectional study of 52 patients' records with PET and pulmonary angiotomography whose indication was respiratory distress; from 2612 operated patients from November 2015 to March 2018, the sampling was not probabilistic. The statistics was descriptive, with measures of central tendency and dispersion. Fisher test, and Rho Spearman were used.

Results

There were association between the development of PET and trans-surgical time (p = 0.018), with the D Dimer (p = 0.014), there was correlation between PET and Wells scale (p=0.001) and blood transfusion (p=0.044). Age, gender, body mass index, preoperative diagnosis, thromboprophylaxis, blood transfusion and surgical approach were not risk factors.

Conclusion

The prevalence of postoperative PET in patients with respiratory distress after surgical procedure is 5.7% and the mortality is 33.3%.

[Tecnologías de la información en la formación de evaluadores del Programa Hospital Seguro en México]

Objetivo

Describir el proceso para la formación de evaluadores del Programa Hospital Seguro centrado en el uso de las tecnologías de la información.

Método

Estudio observacional descriptivo en el que se analiza la participación dentro del nuevo curso de evaluadores del Programa Hospital Seguro.

Resultados

Se inscribieron 1323 participantes, de los cuales aprobaron 298 (18%); la calificación media fue de 8.85.

Conclusiones

La plataforma educativa tipo Moodle fue de utilidad para la capacitación del Programa Hospital Seguro. Se tendrían que mejorar los criterios de participación de los alumnos a fin de incrementar la eficiencia terminal.

Objective

To describe the process for the training of evaluators of the safe hospital program in the use of ICT.

Method

Descriptive observational study in which the participation in the new course of appraisers of the safe hospital program is analyzed.

Results

1323 participants registered of which 298 (18%) passed; the average grade was 8.85.

Conclusions

The Moodle type educational platform was useful for the training of the Safe Hospital Program. The criteria for student participation would have to be improved in order to increase terminal efficiency.

[Results of percutaneous discectomy in the management of lumbar disc herniation]

INTRODUCTION

Percutaneous discectomy is a disc decompression technique approved by the FDA that is useful to improve pain caused by a herniated disc. However, its practice is under discussion because the benefits of the technique are controversial.

OBJECTIVES

To describe the clinical course of patients with low lumbar disc herniation (L4-L5, L5-S1) treated by percutaneous surgery within one year of surgery and prove that it is a useful surgical option for the relief of symptoms caused by this pathological entity.

MATERIAL AND METHODS

Cohort study; the clinical course of 21 patients with lumbar disc herniation treated with percutaneous discectomy manually during March 2011-November 2013, is presented. The evaluation was made before surgery and at four, 30, 180 and 365 days after surgery by numerical pain scale (NPS), Oswestry (IDO) and MacNab criteria. We used nonparametric inferential statistics (Wilcoxon) for differences in proportions.

RESULTS

n = 21, six (28.57%) men, 15 (71.42%) women; average age: 37.95, (14-56) ± 10.60 years; the most affected vertebral level was L4-L5 in 57.14% of the patients; the NPS preoperative average was 7.75 (5-9) ± 1.12; at 365 days: average 2.14 (0-7) ± 2.37. The IDO preoperative average was 37% (28-40%) ± 3.06, and at 365 days: 9.52% (0-40%) ± 13.92. The prognosis (IDO) in the presurgical was good to zero (0%) patients and in 15 (71.42%) at 365 days, regular in five (23.80%) and poor in one (4.78%) (p = 0.00, CI 95% 0.00 to 0.13, Wilcoxon); according to MacNab criteria, in 15 (71.42%) patients were excellent and good, poor in four (19.04%) and bad in two (9.52%) (p = 0.00).

CONCLUSIONS

Percutaneous discectomy provides good results for the treatment of lumbar disc herniation (L4-L5, L5-S1) at 365 days after surgery.

[Usefulness of an online education platform for the medical and surgical emergencies specialty in Mexico]

OBJECTIVE

Determine the usefulness of a Moodle-type education platform for knowledge development with residents in the medical and surgical emergencies (MSE) specialty.

METHODS

This quasi-experimental study compared the departmental evaluations of MSE residents in two Mexican hospital units after they did their academic work using different educational strategies. The control group used a traditional format (classroom-style teaching with guided discussion), while the comparison group had access to a variety of resources (forums, chat, wikis, downloaded files) on a Moodle-type platform. Nonparametric statistics were used. The study was conducted during the 2010 - 2011 and 2011 - 2012 academic years. Three versions of the course were made available online, geared to the academic level of the residents (first, second, or third year).

RESULTS

There were statistically significant differences in the mid-year evaluations, and improvements were even greater in the evaluations at the end of the academic year, especially for the third-year residents. In both academic years, the mid-year evaluations reported that only one resident in the control group performed within the average range, while the majority were in the lower range. The resources most used with the platform Moodle were downloaded files (77%) and the forum (63%). Still, 46.4% of the residents said that they encountered some type of limitation when they used the platform, the main one being lack of time (76.9%).

CONCLUSIONS

The Moodle-type education platform appears to be useful and to offer greater opportunities for knowledge development compared with the traditional strategies. It is recommended that educational strategies based on Moodle-type platforms be implemented for MSE and other medical specialties.

Accidental poisoning with "Chinese chalk"

We present a 1.5-year old, 11 kg, female infant with a history of bronchial hyper-responsiveness who accidentally ingested half of a "Chinese chalk". A day later, the infant showed vomiting, cough, fever, drowsiness, and irritability and her clinical conditions progressively worsened. She was admitted to the emergency department with cough, respiratory distress, and hepatomegaly. It has been reported that the chalk may contain deltamethrin and cypermethrin. The patient was successfully treated with supportive therapy. This report identifies "Chinese chalk" as a potential source of accidental poisoning in children and should be considered as part of the differential diagnoses in the emergency rooms since poisoning with these compounds may be misdiagnosed as organophosphate poisoning due to the presentation of similar symptoms.

Reanimation Unit experience of a second-level hospital in Mexico City

OBJECTIVES

The objectives of this study were to determine the clinical characteristics of patients who presented to the Reanimation Unit (RU) of a second-level hospital during one year, and the number and type of emergency procedures performed.

METHODS

A cross-sectional study was designed that enrolled all patients >15 years of age who presented to the RU from 01 January through 31 December 2003. The age, gender, diagnosis, site of origin, and disposition of each patient was recorded, as well as the distribution by time of day, the number and type of emergency procedures performed, complications, and mortality rate.

RESULTS

Of the 3,741 patients enrolled in the study, 57.0% were male; predominantly 41-50 years old (20%). Most patients presented to the RU from their homes during the afternoon. There were 60 different admission diagnoses: more of the emergencies were for medical than for traumatic emergencies. The predominant pathologies were bronchospasm, hypertensive crisis, and upper gastrointestinal bleeding. Initially, patients either were admitted to the observation unit, the consulting office for the emergency department, or the intensive care unit. There were a total of 2,753 emergency procedures performed: orotracheal intubations were the most common, followed by installation of a catheter into the central venous circulation. Of all of the patients admitted to the RU, 31% were not insured.

CONCLUSIONS

There exists a remarkable combination between medical and traumatic emergencies, which is not encountered frequently in other second level-hospitals in Mexico City. A high proportion of the patients who received medical attention were not insured and there were a large number of emergency invasive procedures performed.