ABSTRACT
PURPOSE: Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS: A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS: Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS: Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.
Subject(s)
Delphi Technique , Quality Indicators, Health Care , Urogenital Neoplasms , Humans , Urogenital Neoplasms/therapy , Quality of Health Care , Patient Care Team/standards , Consensus , Medical Oncology/standardsABSTRACT
Gold has been mined at San Antonio-El Triunfo, (Baja California Sur, Mexico) since the 18th century. This area has approximately 5,700 inhabitants living in the San Juan de Los Planes and El Carrizal hydrographic basins, close to more than 100 abandoned mining sites containing tailings contaminated with potentially toxic elements such as arsenic. To evaluate the arsenic exposure of humans living in the surrounding areas, urinary arsenic species, such as inorganic arsenic (iAs) and the metabolites mono-methylated (MMA) and di-methylated arsenic acids (DMA), were evaluated in 275 residents (18-84 years of age). Arsenic species in urine were analyzed by hydride generation-cryotrapping-atomic absorption spectrometry, which excludes the non-toxic forms of arsenic such as those found in seafood. Urinary samples contained a total arsenic concentration (sum of arsenical species) which ranged from 1.3 to 398.7 ng mL(-1), indicating 33% of the inhabitants exceeded the biological exposition index (BEI = 35 ng mL(-1)), the permissible limit for occupational exposure. The mean relative urinary arsenic species were 9, 11 and 80% for iAs, MMA and DMA, respectively, in the Los Planes basin, and 17, 10 and 73%, respectively, in the El Carrizal basin. These data indicated that environmental intervention is required to address potential health issues in this area.
Subject(s)
Arsenic/urine , Environmental Exposure/statistics & numerical data , Environmental Pollutants/urine , Adolescent , Adult , Aged , Aged, 80 and over , Environmental Exposure/analysis , Female , Gold , Humans , Male , Mexico/epidemiology , Middle Aged , Mining , Spectrophotometry, AtomicABSTRACT
Las taquicardias de complejos anchos (TCA) constituyen un problema diagnóstico de importancia, tanto para el médico general como para el especialista en el área, debido a que pueden corresponder a patologías cuyo origen puede ser supraventricular o ventricular. El diagnóstico acertado del tipo de arritmia responsable de esta taquicardia es de vital importancia tanto desde el punto de vista terapéutico como de pronóstico. Un esquema de tratamiento inadecuado basado en un diagnóstico errado, no solamente no corregirá el problema sino que también puede empeorar la situación clínica del paciente incluso llevándolo a su muerte. En el presente artículo se muestra un caso típico de TCA, se interroga el diagnóstico correcto y el tratamiento ideal que debe recibir; además, se hace una revisión del tema resaltando las bases para el adecuado diagnóstico electrocardiográfico.
The wide complex tachycardias are a difficult diagnosis and they are important for the general doctor and the specialist too because they can origin in different level like supraventricular and ventricular. The correct diagnosis of the kind of arrhythmia that produces the wide complex tachycardia is very important for the therapeutic and prognosis of the patients. A bad schedule of treatment in relation with a bad diagnosis wont fi x the clinical problem and it can produce death of the patient. This article shows a typical case of Wide complex tachycardias and ask questions in relation with diagnosis and treatment of this disease. It reviews the electrocardiography diagnosis too.
Subject(s)
Humans , Diagnosis, Differential , Electrocardiography , TachycardiaABSTRACT
Un hombre de 37 años de edad ingresó al Hospital Universitario Ramón González Valencia por presentar pie caído bilateral, debilidad muescular, fasciculaciones y calambres los cuales se presentaron inicialmente en miembros inferiores y luego en los superiores, sugiriendo inicialmente esclerosis lateral amiotrófica. Sin embargo, al efectuar diversos estudios neurofosiológicos se encontraron signos de desmielinización de nervios motores y prominentes bloqueos de conducción, más notorios a la altura del punto de Erb en el nervio cubital izquierdo. El cuadro clínico junto con estos hallazgos neurofisiológicos nos permitieron hacer el diagnóstico de neuropatía multifocal motora, la cual y hasta donde conocemos sería el primer caso descrito en la literatura colombiana