Sabemos lo suficiente para actuar en consecuencia? La relación volumen de casos y resultados clínicos examinada una vez más

La cirugía es un elemento clave en la estrategia multidisciplinaria del tratamiento oncológico. De hecho, el 80% de los pacientes diagnosticados de cáncer serán tratados quirúrgicamente, lo que supone más de 12 millones de pacientes candidatos a cirugía en el año 2015 en el mundo1. Dado este rol central en la terapia oncológica, no debe extrañar que la evaluación de la calidad y de cómo organizar la prestación de la atención quirúrgica sea un objetivo de investigación muy relevante

L'atenció oncològica a Catalunya

Un dels temes que de manera més recurrent s'ha discutit en l'organització de l'atenció oncològica és quin ha de ser el grau de concentració i d'especialització dels recursos assistencials per assolir els millors resultats clínics. La freqüència de la malaltia, les millores en la supervivència i la complexitat del seu tractament, que requereix un grau d'especialització notable, així com la participació de diferents especialistes, són factors que cal tenir en compte a l'hora d'organitzar l'atenció sanitària en oncologia, juntament amb l'equitat de l'accés dels pacients a una assistència de qualitat com més a prop possible de la seva residència

L'eficàcia del cribratge de càncer de mama mitjançant mamografia

Els resultats disponibles ens indiquen que el cribratge de càncer de mama mitjançant mamografia és eficaç per reduir la mortalitat per aquest càncer en les dones més grans de 50 anys i que per sota d'aquesta edat hi ha més incerteses. Per altra banda, comença a haver-hi estudis que ens suggereixen que, a més d'eficaç, pot ser efectiu quan s'aplica com a programa poblacional

La utilidad de los folletos de información de, medicamentos en pacientes cronicos hospitalizados

ResumenPara conocer cómo los pacientes perciben los folletos informativos sobre medicamentos, se ha realizado un estudio en una muestra de 65 pacientes ingresados en un hospital por enfermedades respiratorias y cardiacas crónicas.El 47,7% de los pacientes declaró que la información principal obtenida de los folletos se refería a la finalidad del fármaco, seguidos por el 18,5%, que resaltó el manejo de situaciones imprevistas y los efectos secundarios. El 63% declaró que no le había aportado información nueva. Una proporción importante de pacientes desconocía el uso correcto de algunos términos empleados con frecuencia en folletos y prospectos (80% de errores con el término «fuera de las comidas»).Se concluye que los folletos informativos pueden ser útiles en el marco de una buena relación médico-paciente, como recordatorio y para reforzar los conocimientos que ya posee el paciente. El momento idóneo para la educación sobre los medicamentos en las enfermedades crónicas es al iniciar su tratamiento.SummaryTo know how patients perceive the information leaflets about medicines, it has been carried out a study in a sample of 65 patients admitted to a hospital for chronic respiratory or cardiac diseases.A 47.7% of patients expressed that the main information provided by the leaflet was such concerning to the purpose of the drug, whereas a 18.5% pointed out such concerning to side effects and management of unexpected circumstances. Sixty three percent of patients expressed that leaflets did not provide them new information. A relevant percentage of patients did not know the meaning of some terms frequently used in leaflets and package-inserts (80% of mistakes in the interpretation of «take the drug on an empty stomach»).It is concluded that the information leaflets can be useful in the framework of a good physician-patient relationship, as a reminder, and to reinforce the knowledge that the patient already has. It is considered that the most appropriate time for the education of chronic patients about drugs is when the treatment is prescribed for the first time

Provision and use of radiotherapy in europe

Radiation therapy is one of the core components of multidisciplinary cancer care. Although ~ 50% of all European cancer patients have an indication for radiotherapy at least once in the course of their disease, more than one out of four cancer patients in Europe do not receive the radiotherapy they need. There are multiple reasons for this underutilisation, with limited availability of the necessary resources - in terms of both trained personnel and equipment - being a major underlying cause of suboptimal access to radiotherapy. Moreover, large variations across European countries are observed, not only in available radiotherapy equipment and personnel per inhabitant or per cancer patient requiring radiotherapy, but also in workload. This variation is in part determined by the country's gross national income. Radiation therapy and technology are advancing quickly; hence, recommendations supporting resource planning and investment should reflect this dynamic environment and account for evolving treatment complexity and fractionation schedules. The forecasted increase in cancer incidence, the rapid introduction of innovative cancer treatments and the more active involvement of patients in the healthcare discussion are all factors that should be taken under consideration. In this continuously changing oncology landscape, reliable data on the actual provision and use of radiotherapy, the optimal evidence-based demand and the future needs are crucial to inform cancer care planning and address and overcome the current inequalities in access to radiotherapy in Europe

Core communication components along the cancer care process: the perspective of breast cancer patients

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n ¼ 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer car

Implementing a Cancer Fast-track programme between primary and specialised care in Catalonia(Spain): amixed methods study

BACKGROUND: The Cancer Fast-track Programme's aim was to reduce the time that elapsed between well-founded suspicion of breast, colorectal and lung cancer and the start of initial treatment in Catalonia (Spain). We sought to analyse its implementation and overall effectiveness. METHODS: A quantitative analysis of the programme was performed using data generated by the hospitals on the basis of seven fast-track monitoring indicators for the period 2006-2009. In addition, we conducted a qualitative study, based on 83 semistructured interviews with primary and specialised health professionals and health administrators, to obtain their perception of the programme's implementation. RESULTS: About half of all new patients with breast, lung or colorectal cancer were diagnosed via the fast track, though the cancer detection rate declined across the period. Mean time from detection of suspected cancer in primary care to start of initial treatment was 32 days for breast, 30 for colorectal and 37 for lung cancer (2009). Professionals associated with the implementation of the programme showed that general practitioners faced with suspicion of cancer had changed their conduct with the aim of preventing lags. Furthermore, hospitals were found to have pursued three specific implementation strategies (top-down, consensus-based and participatory), which made for the cohesion and sustainability of the circuits. CONCLUSION: The programme has contributed to speeding up diagnostic assessment and treatment of patients with suspicion of cancer, and to clarifying the patient pathway between primary and specialised care

Estado de salud, utilización de servicios sanitarios y morbilidad declarada: aplicación del análisis de correspondencias

Fundamento: el análisis de la relación entre la morbilidad declarada y el estado de salud y utilización de los servicios sanitarios estudiados mediante encuestas de salud, plantea problemas metodológicos, debido a la diversidad de enfermedades y condiciones, agudas y crónicas, que puede declarar un mismo individuo. En este artículo se utiliza el análisis de correspondencias múltiples para analizar la relación entre estas variables. Métodos: Sse analizan los datos de la Encuesta Nacional de Salud de 1987, correspondientes a la comunidad catalana. En una primera fase se realiza el análisis de correspondencias múltiples y, posteriormente, sobre los ejes definidos por dicha técnica, se realiza un análisis de conglomerados. Resultados: el primer eje es caracterizado por la percepción de la salud; el segundo, por las limitaciones de la actividad, originadas por problemas de salud; el tercero permite diferenciar entre problemas de salud agudos y crónicos. Los ejes 4 y 5 recogen la variabilidad residual de los ejes anteriores y los valores perdidos. Las enfermedades agudas están asociadas a la percepción de mala salud; las crónicas, a la percepción de un estado de salud regular. Entre los problemas agudos, se puede distinguir las recaídas de enfermedades crónicas de aquellos agudos propiamente dichos. El análisis de conglomerados permite describir 4 grupos. 1) buena salud; 2) problemas agudos y percepción de mala salud; 3) probleas de salud crónicos, limitación de la actividad y percepción de salud regular; y 4) valores perdidos Conclusiones: Este estudio permite mostrar la utilidad del análisis de correspondencias múltiples con variables cualitativas, como las obtenidas en encuestas de salud

The dGLI Cloth Coordinates: A Topological Representation for Semantic Classification of Cloth States

Robotic manipulation of cloth is a highly complex task because of its infinite-dimensional shape-state space that makes cloth state estimation very difficult. In this paper we introduce the dGLI Cloth Coordinates, a low-dimensional representation of the state of a rectangular piece of cloth that allows to efficiently distinguish key topological changes in a folding sequence, opening the door to efficient learning methods for cloth manipulation planning and control. Our representation is based on a directional derivative of the Gauss Linking Integral and allows us to represent both planar and spatial configurations in a consistent unified way. The proposed dGLI Cloth Coordinates are shown to be more accurate in the classification of cloth states and significantly more sensitive to changes in grasping affordances than other classic shape distance methods. Finally, we apply our representation to real images of a cloth, showing we can identify the different states using a simple distance-based classifier.Comment: 24 pages, 34 references, 6 figures, 1 tabl

Assessing predicted age-specific breast cancer mortality rates in 27 Europea countries by 2020

Background: We assessed differences in predicted breast cancer (BC) mortality rates, across Europe, by 2020, taking into account changes in the time trends of BC mortality rates during the period 2000-2010. Methods: BC mortality data, for 27 European Union (EU) countries, were extracted from the World Health Organization mortality database. First, we compared BC mortality data between time periods 2000-2004 and 2006-2010 through standardized mortality ratios (SMRs) and carrying out a graphical assessment of the age-specific rates. Second, making use of the base period 2006-2012, we predicted BC mortality rates by 2020. Finally, making use of the SMRs and the predicted data, we identified a clustering of countries, assessing differences in the time trends between the areas defined in this clustering. Results: The clustering approach identified two clusters of countries: the first cluster were countries where BC predicted mortality rates, in 2020, might slightly increase among women aged 69 and older compared with 2010 [Greece (SMR 1.01), Croatia (SMR 1.02), Latvia (SMR 1.15), Poland (SMR 1.14), Estonia (SMR 1.16), Bulgaria (SMR 1.13), Lithuania (SMR 1.03), Romania (SMR 1.13) and Slovakia (SMR 1.06)]. The second cluster was those countries where BC mortality rates level off or decrease in all age groups (remaining countries). However, BC mortality rates between these clusters might diminish and converge to similar figures by 2020. Conclusions: For the year 2020, our predictions have shown a converging pattern of BC mortality rates between European regions. Reducing disparities, in access to screening and treatment, could have a substantial effect in countries where a non-decreasing trend in age-specific BC mortality rates has been predicted