Diseño del instrumento de ayuda para la toma de decisiones: “alternativas de tratamiento para el cáncer de mama: ¿qué opción prefiero?”

Purpose: To design a Decision-making Aid within the ‘Breast cancer’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of users and professionals in the mainstream of the SSPA Decision Aid “Breast Cancer” process. 2) Select a Decision Aid from international experiences. 3) Transcultural adaptation of above selected Decision Aid. 4) Decision Aid Validation in the SSPA. Results: The Decision Aid “Alternative treatment for breast cancer: What option do I prefer?” designed for the SSPA includes innovative contents compared to other reviewed experiences. The results of the validation of Decision Aid have shown that the design is attractive for the patient, ideal size and suitable language, and that the clinical information it contains is of quality. The Decision Aid answers your questions (95%) and summarizes the essential information to make the decision (90%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 85.31), facilitates the work in the practice and doctor-patient communication. Conclusion: Patients and professionals agree to recommend the use of Decision Aid and to encourage participation in decisionmaking while recognizing that the time factor is the main obstacle to incorporate its use in the SSPA.Objetivo: Diseñar un Instrumento de Ayuda para la Toma de Decisiones (IATD) en el Proceso Asistencial Integrado ‘Cáncer de mama’ del Sistema Sanitario Público de Andalucía (SSPA) para el abordaje terapéutico de esta enfermedad en estadio inicial. Método: El diseño del IATD se realizó en cuatro fases: 1) Explorar la receptividad de las usuarias y los profesionales del SSPA sobre la incorporación de IATD en el proceso “Cáncer de mama”. 2). Seleccionar un IATD entre las experiencias internacionales.; 3) Adaptar transculturalmente del IATD seleccionado al entorno del SSPA. 4) Validar el IATD en el SSPA. Resultado: El IATD “Alternativas de tratamiento para el cáncer de mama: ¿Qué opción prefiero?” diseñado para el SSPA incluye contenidos innovadores frente a otras experiencias revisadas. Los resultados de la validación del IATD han mostrado que su diseño es atractivo para la paciente, su extensión y lenguaje idóneos, y la información clínica que contiene es de calidad. El Instrumento resuelve sus dudas (95%) y resume la información esencial para tomar la decisión (90%). El IATD ofrece información relevante que prepara a la paciente para la toma de decisiones (ausencia de conflicto decisional: 85,31), facilita la labor en consulta y la comunicación médico-paciente. Conclusiones: Pacientes y profesionales coinciden en recomendar la utilización del IATD y fomentar la participación en la toma de decisiones aunque reconocen que el factor tiempo es el principal obstáculo para incorporar su uso en el SSPA

Design a decision-making aid: "alternative treatment for breast cancer: what option do you prefer?"

Purpose: To design a Decision-making Aid within the ‘Breast cancer’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of users and professionals in the mainstream of the SSPA Decision Aid “Breast Cancer” process. 2) Select a Decision Aid from international experiences. 3) Transcultural adaptation of above selected Decision Aid. 4) Decision Aid Validation in the SSPA. Results: The Decision Aid “Alternative treatment for breast cancer: What option do I prefer?” designed for the SSPA includes innovative contents compared to other reviewed experiences. The results of the validation of Decision Aid have shown that the design is attractive for the patient, ideal size and suitable language, and that the clinical information it contains is of quality. The Decision Aid answers your questions (95%) and summarizes the essential information to make the decision (90%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 85.31), facilitates the work in the practice and doctor-patient communication. Conclusion: Patients and professionals agree to recommend the use of Decision Aid and to encourage participation in decisionmaking while recognizing that the time factor is the main obstacle to incorporate its use in the SSPA

Estudio del efecto mitoxantrone en el desarrollo del embrión de ave

Reducción altaUniv. de Granada, 199

Redox status in the sentinel lymph node of women with breast cancer

Background: Lymphatic metastasis is regulated in multiple steps including the transit of tumor cells via the lymphatic vessels and the successful seeding in draining lymph nodes. Thus, several molecular signals and cellular changes must be involved in this complex process to facilitate tumor cell entry, colonization, and survival in the lymph node. To our knowledge, the present work explores, for the first time in the literature, the redox status (oxidative stress parameters and enzymatic and non-enzymatic antioxidant defense systems) in the sentinel lymph node (SLN) of women with breast cancer. Patients and methods: SLNs from 75 women with breast cancer were identified using the one-step nucleic acid amplification (OSNA) method as negative (n = 43), with micrometastases (n = 13), or with macrometastases (n = 19). It will allow us to gain knowledge about the pro-oxidant/antioxidant mechanisms involved in the processes of distant metastases in breast cancer and also to assess whether these parameters may be alternative techniques for staging. Results: We found different levels of lipid peroxidation in SLNs with micrometastases (increased) and macrometastases (decreased), a decrease in carbonyl group content in SLNs with macrometastases only, and an increase in total antioxidant capacity (TAC) in SNLs with micrometastases and macrometastases. A decrease in the levels of reduced glutathione (GSH) also appears in the SLNs with macrometastases only. Finally, we show increased levels of superoxide dismutase (SOD) and catalase (CAT) activity in SLNs with micrometastases and macrometastases, and decreased levels of glutathione peroxidase (GPx) activity in SNLs with macrometastases but not with micrometastases. Conclusions: Redox status of lymph node microenvironment participates in the progression of metastatic breast cancer

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes

We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding “satisfaction with breasts after surgery” (p = 0.026), “sexual well-being after intervention” (p = 0.010) and “satisfaction with the information received” (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items

Cáncer de mama: proceso asistencial integrado 3ª ed

YesEn el documento se aborda el cáncer de mama desde la gestión por procesos, analizando y ordenando los flujos de trabajo y con la necesidad de actualización del conocimiento científico, planes de cuidados y todos los aspectos de la enfermedad. Por ello, en esta tercera edición, se realiza una revisión y actualización de la anterior, incorporando nuevos aspectos relacionados con dimensiones específicas de calidad, tales como la persona, la evidencia científica, el uso adecuado del medicamento, los cuidados enfermeros y la seguridad del paciente