ABSTRACT
BACKGROUND: hepatitis C virus (HCV) infection is a global health problem. Chronic infection induces the development of fibrosis and cirrhosis together with all the related complications. The use of direct-acting antiviral (DAA) drugs has proven highly effective. Telemedicine is a present-day resource that brings treatment closer to distant areas and may result in cost savings. OBJECTIVE: to implement a microelimination program for HCV using DAAs with the support of a telemedicine program to minimize expenses. PATIENTS AND METHODS: the program was developed at the Medical Services department of Petróleos Mexicanos (SMPM) with a national coverage; patients diagnosed with chronic hepatitis C were included. These were classified into locals and outsiders. Treatment for foreign patients was indicated, monitored and completed via telemedicine. Thus, avoiding their travel to the country's capital city, in order to save on transportation costs and travel allowances. RESULTS: a total of 136 patients, 74 locals and 62 outsiders, participated in the study. Transfer was avoided for 62 patients (45.5 %), which meant that telemedicine resulted in savings of 3,176.20 USD per patient, with overall savings of 196,924.40 USD from cost minimization. A total of 30 patients remained untreated due to lack of medication, hence the coverage amounted to 86 %. Sustained virological response (SVR) was achieved in 99 % of cases. Only two patients had treatment failure. Adverse events included headache and fatigue in 5 % of the cohort. CONCLUSIONS: with the aid of a telemedicine approach, significant savings were achieved by minimizing costs, since nearly half of patients were outsiders. Coverage reached 86 % and treatment with DAAs was successful for 99 % of our cases.
Subject(s)
Hepatitis C, Chronic , Hepatitis C , Telemedicine , Antiviral Agents/therapeutic use , Hepacivirus , Hepatitis C/drug therapy , Hepatitis C, Chronic/drug therapy , Humans , Sustained Virologic ResponseABSTRACT
Medical specialties' teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.
La enseñanza en las especialidades médicas es un rubro de los sistemas de salud que merece consideraciones especiales de acuerdo con las lecciones aprendidas de la influenza y COVID-19. Deben reevaluarse los programas educativos y las estrategias de capacitación implementadas, ya que la preparación escolar de la mayoría de los alumnos no les permite ser considerados como personal que pueda enfrentar esos problemas globales. Los cursos de especialización han crecido en número, pero su principal amenaza es la suspensión de los programas académicos o que sean parcialmente cubiertos como consecuencia de no implementar estrategias operativas funcionales durante una contingencia.
Subject(s)
Education, Medical/methods , Specialization , Students, Medical , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Influenza, Human/epidemiology , Influenza, Human/therapy , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapyABSTRACT
Resumen Existe la percepción general de que los estudiantes de medicina deben ayudar en caso de situaciones de desastre o en contingencias epidemiológicas; aunque es posible que no hayan sido debidamente educados para hacerlo. En últimas fechas, la participación de estudiantes es importante en actividades de capacitación de personal, triage, atención de actividades burocráticas, voluntariado; pero no son considerados como una primera línea de atención en los sitios de desastre o de manejo de pacientes. Se revisa en la literatura médica la percepción de la participación de los estudiantes de medicina en desastres y pandemias y se establecen algunas de las necesidades para su capacitación y enseñanza, para que realmente puedan convertirse en una opción en los momentos de crisis.
Abstract There is a general perception that medical students should help in case of disaster situations or epidemiological contingencies; although, they may not have been properly educated to do so. In recent dates, the participation of students is important in staff training activities, triage, care of bureaucratic activities, volunteering; but they are not considered a first line of care at disaster sites or patient management. The perception of the participation of medical students in disasters and pandemics is reviewed in the literature and some of the needs for their training and teaching are established, so that they can truly become an option in times of crisis.
Subject(s)
Humans , Students, Medical , Disasters , Triage , PandemicsABSTRACT
Abstract Medical specialties teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.
Resumen La enseñanza en las especialidades médicas es un rubro de los sistemas de salud que merece consideraciones especiales de acuerdo con las lecciones aprendidas de la influenza y COVID-19. Deben reevaluarse los programas educativos y las estrategias de capacitación implementadas, ya que la preparación escolar de la mayoría de los alumnos no les permite ser considerados como personal que pueda enfrentar esos problemas globales. Los cursos de especialización han crecido en número, pero su principal amenaza es la suspensión de los programas académicos o que sean parcialmente cubiertos como consecuencia de no implementar estrategias operativas funcionales durante una contingencia.
Subject(s)
Humans , Specialization , Students, Medical , Education, Medical/methods , Pneumonia, Viral/therapy , Pneumonia, Viral/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Influenza, Human/therapy , Influenza, Human/epidemiology , Pandemics , COVID-19ABSTRACT
There is a general perception that medical students should help in case of disaster situations or epidemiological contingencies; although, they may not have been properly educated to do so. In recent dates, the participation of students is important in staff training activities, triage, care of bureaucratic activities, volunteering; but they are not considered a first line of care at disaster sites or patient management. The perception of the participation of medical students in disasters and pandemics is reviewed in the literature and some of the needs for their training and teaching are established, so that they can truly become an option in times of crisis.
Subject(s)
Disasters , Students, Medical , Humans , Pandemics , TriageABSTRACT
Objetivo. Con el presente estudio se trata de establecer los factores de riesgo para la artroplastía total de la rodilla, su frecuencia de infección y la eficacia del tratamiento para las complicaciones. Material y métodos. Estudio retrospectivo extraído de un total de 447 casos de prótesis total de rodilla (PTR) operados en un periodo de 10 años. Se diseñaron dos grupos comparativos, uno con 19 casos infectados y otro con 237 no infectados, tomados al azar, para un total de 256, con edad promedio de 68 años. Resultados. La edad promedio en mujeres con infección fue de 71 años (no infectadas 60 años, p = 0.002). Para mujeres infectadas con AR fue de 78 años (no infectadas con AR 54 años, p = 0.0001). No hubo diferencia entre mujeres que tenían enfermedades coexistentes, independientemente de artrosis o AR. En hombres con infección, la edad promedio fue 56.9 años para AR y 72.6 para artrosis (p = 0.0001). En todos los casos se resolvió mediante diversos procedimientos, como recambio del componente rotuliano en uno, recambio total en dos, desbridamiento y colgajos en cinco y artrodesis en 10. Conclusión. Los principales riesgos de infección parecen ser, la existencia en la 8a década de la vida para mujeres, independientemente de sufrir o no AR así como la presencia de AR en hombres menos viejos. La sola edad en varones, y la artrosis o las enfermedades coexistentes indistintamente del sexo no parecen ser por sí solas, factores de riesgo significativo.
