Breast cancer in girls and adolescents as a vulnerable people

Objetivo: el objetivo principal de esta revisión es identificar las mejores evidencias específicas disponibles en la literatura científica sobre el cáncer de mama en niñas y adolescentes. Metodología: búsqueda avanzada en distintas bases de datos de las que se han recopilado 8 artículos con altos índices de impacto según JCR publicados en los últimos 5 años y disponibles a texto completo. Resultados: existen factores de riesgo modificable y no modificables relacionados con el cáncer de mama en niñas y adolescentes. Es de gran importancia el conocimiento de la enfermedad, las pruebas diagnósticas, la imagen de la mujer con cáncer de mama y su preocupación por el embarazo tras el diagnóstico en este grupo poblacional. Es necesario establecer sistemas enfermeros específicos para las afectadas o en riesgo de presentar cáncer de mama, así como para su familia. Conclusión: La figura de la enfermera cobra aún mayor importancia en este ámbito. Los profesionales de enfermería deben estar perfectamente formados y tener una cartera de servicios para la prevención del cáncer de mama en niñas y adolescentes, pruebas diagnósticas específicas para este grupo vulnerable y el cuidado de la población afectada. El apoyo educativo sería la estrategia de elección para llevarlo a cabo.Objective: The main objective of this review is to identify the best specific evidence available in the scientific literature on breast cancer in girls and adolescents. Methodology: Advanced search in different databases from which 8 articles have been collected with high impact rates according to JCR. These articles have been published in the last 5 years and are available in full text. Results: There are modifiable or non-modifiable risk factors related to breast cancer in girls and adolescents. It is very important to have a good knowledge of the disease, the diagnostic tests, the image of women with breast cancer, and their concern for pregnancy after diagnosis in this population group. It is necessary to set up specific nurse systems for those women affected or who are at risk for developing breast cancer, as well as for their family. Conclusion: The figure of the nurse is even more important in this area. Nursing professionals must be perfectly trained and have available services in terms of breast cancer prevention in girls and adolescents, specific diagnostic tests for this vulnerable group and care of the affected population. Educational support would be the strategy of choice to carry it out

El cáncer de mama en niñas y adolescentes como población vulnerable

Objective: The main objective of this review is to identify the best specific evidence available in the scientific literature on breast cancer in girls and adolescents. Methodology: Advanced search in different databases from which 8 articles have been collected with high impact rates according to JCR. These articles have been published in the last 5 years and are available in full text. Results: There are modifiable or non-modifiable risk factors related to breast cancer in girls and adolescents. It is very important to have a good knowledge of the disease, the diagnostic tests, the image of women with breast cancer, and their concern for pregnancy after diagnosis in this population group. It is necessary to set up specific nurse systems for those women affected or who are at risk for developing breast cancer, as well as for their family. Conclusion: The figure of the nurse is even more important in this area. Nursing professionals must be perfectly trained and have available services in terms of breast cancer prevention in girls and adolescents, specific diagnostic tests for this vulnerable group and care of the affected population. Educational support would be the strategy of choice to carry it out.Objetivo: el objetivo principal de esta revisión es identificar las mejores evidencias específicas disponibles en la literatura científica sobre el cáncer de mama en niñas y adolescentes. Metodología: búsqueda avanzada en distintas bases de datos de las que se han recopilado 8 artículos con altos índices de impacto según JCR publicados en los últimos 5 años y disponibles a texto completo. Resultados: existen factores de riesgo modificable y no modificables relacionados con el cáncer de mama en niñas y adolescentes. Es de gran importancia el conocimiento de la enfermedad, las pruebas diagnósticas, la imagen de la mujer con cáncer de mama y su preocupación por el embarazo tras el diagnóstico en este grupo poblacional. Es necesario establecer sistemas enfermeros específicos para las afectadas o en riesgo de presentar cáncer de mama, así como para su familia. Conclusión: La figura de la enfermera cobra aún mayor importancia en este ámbito. Los profesionales de enfermería deben estar perfectamente formados y tener una cartera de servicios para la prevención del cáncer de mama en niñas y adolescentes, pruebas diagnósticas específicas para este grupo vulnerable y el cuidado de la población afectada. El apoyo educativo sería la estrategia de elección para llevarlo a cabo

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)