Toward optimal implementation of cancer prevention and control programs in public health: A study protocol on mis-implementation

Abstract Background Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes. Methods This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation. Discussion This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas

Características del liderazgo pedagógico del directivo docente de la I.E. de Jesús del municipio de Concordia

Esta investigación abordó el liderazgo pedagógico, específicamente el liderazgo directivo, su papel dentro del proceso pedagógico de la institución educativa está justificado por la relevancia que tiene en la gestión curricular, entre otras funciones, pues permite que las instituciones educativas - I.E marchen adecuadamente y alcancen mayores logros para todos los estudiantes. El objetivo consistió en identificar las características del liderazgo pedagógico del directivo docente de la I.E de Jesús del municipio de Concordia. Para esto se consideró una investigación enmarcada dentro del enfoque cualitativo de tipo descriptivo, el método fue estudio de caso. Los instrumentos que se utilizaron fueron, la entrevista, el diario de campo y el grupo focal. Con base en los resultados obtenidos en las entrevistas se destacan aspectos importantes de la comunicación y el liderazgo, vinculados a la gestión administrativa de la I.E. La investigación muestra la importancia que tiene el liderazgo pedagógico del directivo docente como elemento clave en el desarrollo y funcionamiento pedagógico-curricular de la I.E.This research addressed pedagogical leadership, such as one that focuses on the directive role, specifically on his role in the educational process on the educative institution; the relevance it's justified for this process for function properly on the institutions to and achieve greater achievements for all students. The objective was to identify the pedagogical leadership from the educative director of the Educative Institution of Jesus from the Concordia municipality. For this, was considered an investigation framed within the qualitative approach of descriptive type, the method was a study case. The instruments used were interview, field diaries and focus group. Based on the interview results obtained, important aspects of communication and leadership were highlighted, linked to the development processes on the educative institution. The research shows the importance on a pedagogical leadership of the teaching director as a key element within the institution.Magíster en EducaciónMaestrí

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement : ABRAX international retrospective cohort study

Background: The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. Patients and methods: We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA–IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. Results: The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799–1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458–1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690–1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. Conclusion: We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. Clinical trials identifier: NCT04037124