Autoevaluación de competencias profesionales de enfermería, en un hospital público de tercer nivel en Guanajuato, México / Self-assessment of nursing professional competencies in a tertiary level public hospital in Guanajuato, Mexico

Resumen: Objetivo: Analizar la autoevaluación de las competencias profesionales de enfermería, en un hospital público de tercer nivel de atención, relacionadas con sus características laborales. Material y Métodos: Estudio cuantitativo, descriptivo correlacional, en 162 profesionales de enfermería de los servicios de hospitalización de un hospital público de tercer nivel de atención, se utilizó el instrumento validado "Competencias profesionales para licenciados en enfermería", con una confiabilidad de Alfa de Cronbach de 0.97, el estudio se apegó a lo estipulado en el Reglamento de la Ley General de Salud en Materia de Investigación. Resultados: De los profesionales de enfermería evaluados el 77.2% corresponde al sexo femenino; el rango de edad que predominó fue de 41- 45 años con 50.6%, en su mayoría casados (44.4 %). Destaca la antigüedad laboral de 11 a 14 años (48.1%) y el grado académico de Licenciatura (49.4%). El nivel global de competencias profesionales se ubicó en 164.8 (DE=11.4) de una puntuación máxima de 200, el indicador de ética destaca con una media de 33.85 (DE=2.88), seguido del indicador de atención integral con una media de 33.33 (DE=3.22). No se encontró relación estadísticamente significativa, entre las competencias profesionales del personal de enfermería y las características laborales. Conclusiones: El personal de enfermería, se percibe competente para brindar atención integral con apego ético; no obstante, se demanda fortalecer dimensiones como la educación, investigación y gestión, que contribuyan a la mejora continua de la calidad y seguridad en la atención.

Abstract: Objective: Analyze the self-assessment of the professional competencies of nurses in a tertiary care public hospital related to their work characteristics. Material and Methods: Quantitative, descriptive correlational study of 162 nursing professionals in the hospitalization services of a tertiary care public hospital, using the validated instrument "Professional competencies for nursing graduates", with a Cronbach's Alpha reliability of 0.97, the study complied with the stipulations of the Regulations of the General Law of Health on Research. Results: Of the nursing professionals evaluated, 77.2% were female; the predominant age range was 41-45 years with 50.6%, mostly married (44.4%). The most outstanding characteristics were seniority of 11 to 14 years (48.1 %) and a bachelor's degree (49.4 %). The overall level of professional competencies was 164.8 (SD=11.4) out of a maximum score of 200, the ethics indicator stands out with a mean of 33.85 (SD=2.88), followed by the comprehensive care indicator with a mean of 33.33 (SD=3.22). No statistically significant relationship was found between the professional competencies of the nursing staff and the work characteristics. Conclusions: The nursing staff is perceived as competent to provide comprehensive care with ethical attachment; however, there is a demand to strengthen dimensions such as education, research and management that contribute to the continuous improvement of quality and safety in care.

Prognostic assessment and systemic treatments of invasive local relapses of hormone receptor-positive breast cancer.

The rate of local recurrences, after breast-conserving surgery or mastectomy for hormone receptor-positive (HR+) breast cancer, has dramatically changed in last decades, due to advances in surgical and radiation techniques and a more extensive use of adjuvant systemic treatments. However, the occurrence of local recurrences remains a major predictor for distant metastasis and is responsible for increased cancer-specific death. It has been estimated that 1 in 4 HR+ and HR-ipsilateral breast recurrences leads to widespread metastatic disease, with an annual mortality rate of 10% in the first 5 years. Nevertheless, very few studies have been conducted to evaluate the optimal care of purely HR+ local relapses of breast cancer, after surgical removal. In this review we have highlighted the available knowledge on prognostic assessment and systemic treatment for women experiencing local relapses of HR+ breast cancers, underlying unsolved questions and controversial clinical aspects.

Assessment of the novel online delineation workshop dummy run approach using FALCON within a European multicentre trial in cervical cancer (RAIDs).

BACKGROUND AND PURPOSE: Online delineation workshops (ODW) permit training of geographically dispersed participants. The purpose is to evaluate the methodology of an ODW using FALCON to harmonize delineation within a European multicentre trial on locally advanced cervical cancer (LACC). MATERIAL AND METHODS: Two ODW included 46 clinicians (14 centres). Clinicians completed baseline (C1), guideline (C2) and final contours (C3) for external beam radiotherapy (EBRT) and brachytherapy (BT) for LACC. Interobserver and intraobserver variability was evaluated quantitatively (using the DICE index) and qualitatively compared to expert contours. RESULTS: Nine clinicians submitted for EBRT and BT for C1-C3. Thirty-two sent any contour. Interobserver quantitative comparisons for EBRT showed significant improvement for C2 vs. C1 for bowel, CTV node, CTV-p and GTV node with significant detriment for GTV node (C3 vs. C1; C2), CTV-p (C3 vs. C2) and bowel (C3 vs. C2), showing in general an improvement in C2 vs. C1, with a detriment in C3 vs. C2 for two target volumes and an organ at risk. For BT there was significant improvement for C2 vs. C1 for bladder, GTV, HR-CTV and IR-CTV, with significant detriment for bladder (C3 vs. C2), thus overall improvement in C2 vs. C1, with only a detriment in C3 vs. C2 for bladder. Centres using MRI imaging for BT contouring did significantly better in the BT case for HR-CTV than those which used other techniques (C2 vs. C1: p<0.005; C3 vs. C1: p=0.02). Intraobserver quantitative comparisons showed significant improvement contouring a region of interest between C2 vs. C1, C3 vs. C1 and C3 vs. C2 for EBRT and between C2 and C1 for BT. CONCLUSIONS: ODW offer training, initial contouring harmonization and allow assessment of centres.

The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic.

PURPOSE: Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. PATIENTS AND METHODS: A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. RESULTS: Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. CONCLUSIONS: One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.

Avaliação do desempenho de enfermagem em um programa de previdência social / Evaluation of nursing performance in a social security program

Resumo Objetivo Avaliar o desempenho da enfermagem no controle do diabetes de pacientes ambulatoriais do IMSS (Instituto Mexicano de Seguro Social) - hospital Prospera número 44 em Tamazunchale, San Luis Potosi, México. Métodos Estudo quantitativo, transversal e descritivo, com amostra de 30 enfermeiros recrutados de agosto de 2014 a abril de 2015. Foi utilizado um guia de observação de desempenho que avaliou as funções administrativas, assistenciais, de ensino e de comunicação. O desempenho foi classificado como bom, razoável e ruim por meio de estatísticas descritivas. Resultados Um total de 93.3% da amostra consistiu de mulheres, auxiliares de enfermagem certificadas; 70% com estudo de nível técnico. As medidas globais das funções administração, assistencial, de ensino e de comunicação indicaram que 6,7% apresentaram desempenho bom, 40% desempenho razoável e 53,3% desempenho ruim. Conclusão As funções de cuidar e ensinar mostraram oportunidades significativas para melhorar o autocuidado ao paciente. A avaliação do desempenho de enfermagem forneceu evidências para a gestão dos serviços no programa de diabetes.

Abstract Objective To evaluate nursing performance in the control of diabetic outpatients of the IMSS (Instituto Mexicano del Seguro Social [Mexican Social Security Institute])-Prospera hospital number 44 in Tamazunchale, San Luis Potosi, Mexico. Methods This quantitative, descriptive, cross-sectional study consisted of a sample of 30 nurses recruited from August 2014 to April 2015. A performance observation guide that evaluated administrative, care, teaching, and communication functions was used. Performance was classified as good, fair, and poor by means of descriptive statistics. Results A total of 93.3% of the sample consisted of female certified nurse assistants, 70% with studies at the technician level. The overall measurements of the administrative, care, teaching, and communication functions indicated that 6.7% presented good performance, 40% fair performance, and 53.3% poor performance. Conclusion Care and teaching functions show significant opportunities for improving patient self-care. Nursing performance evaluation provides evidence for the management of services in the diabetes program.

Four years with FALCON - an ESTRO educational project: achievements and perspectives.

Variability in anatomical contouring is one of the important uncertainties in radiotherapy. FALCON (Fellowship in Anatomic deLineation and CONtouring) is an educational ESTRO (European SocieTy for Radiation and Oncology) project devoted to improve interactive teaching, the homogeneity in contouring and to compare individual contours with endorsed guidelines or expert opinions. This report summarizes the experience from the first 4 years using FALCON for educational activities within ESTRO School and presents the perspectives for the future.