Implementing a mHealth-Based Patient and Nurse Educational Program to Reduce Wound Infection in Rural Philippines.

Background: Surgical site infection (SSI) is a prevalent but preventable complication in low-and-middle income countries (LMIC), with reported incidence varying from 8-30%. In 2018, the MEDIPINAS surgical mission to the Philippines observed a 28.8% rate of SSI despite adherence to WHO intraoperative protocols.The objective of this study was to introduce an educational program for wound care and early identification of wound infection. This program included provision of wound care materials and systematic protocol to ensure adequate and effective follow-up. Barriers to SSI prophylaxis in the Philippines include limited resources in regional hospitals and isolation of patients living in rural areas. The MEDIPINAS mission utilized mobile health software to connect with regional providers and to reinforce the wound care educational program introduced at discharge. Methods: The 2019 MEDIPINAS mission returned to the Philippines and operated on 187 patients in San Antonio de Padua Diocesan Hospital and Santa Maria Josefa Hospital. Before discharge, patients were individually consulted about maintaining the cleanliness of their surgical wound. Each patient was discharged with a wound care infographic and a kit to change dressings. In collaboration with regional care providers, we utilized a secure mobile health software to monitor wound healing 7 and 30 days following the operation. Results: Between the 2018 and 2019 surgical missions, we observed a decrease in SSI from 28.8% to 9.7%. Fourteen patients (7.5%) were lost to follow-up. Postoperative infection was diagnosed using photos provided by hospital-based nurses. Individuals with infections were treated with antibiotics and all but two SSI resolved after 30 days. Conclusions: Patient education, discharge with basic sanitary resources, and development of a mobile health-based follow-up infrastructure may contribute to significant reductions in SSI in LMICs. A limitation to implementation of such a program was integration of the mobile health software into the practice of local healthcare providers.

Training in oncoplastic surgery: an international consensus. The 7th Portuguese Senology Congress, Vilamoura, 2009.

Oncoplastic Breast Surgery (OPBS) is becoming an integral part of breast cancer management, but few surgeons have received formal training in these techniques. An International Symposium has recently debated the key issues which impact on training and specialisation in OPBS, as well as patient access to these procedures. The Symposium concluded that increasing the availability of OPBS is a major challenge, which demands much closer collaboration and cooperation between breast and plastic surgeons, backed up by new training schemes, new curricula and new guidelines.

[Consensus meeting on sentinel lymph node biopsy in breast cancer. Spanish society of mastology and breast disease]. / Reunión de Consenso sobre la Biopsia Selectiva del Ganglio Centinela en el Cáncer de Mama. Socidad Española de Senología y Patología Mamaria.

Sentinel lymph node biopsy is a useful diagnostic technique in the management of breast cancer and is widely used and accepted in clinical practice. The results of this technique allow adequate staging with lower associated morbidity. However, at present, there are numerous methodological issues that remain to be resolved in on-going trials and investigations and Consensus Meetings are required to standardize the methodological variations and indications of this procedure. The conclusions of the Consensus Meeting held in Murcia, Spain, organized by The Spanish Society of Mastology and Breast Disease, are reported in this document.

Reunión de Consenso sobre la Biopsia Selectiva del Ganglio Centinela en el Cáncer de Mama. Sociedad Española de Senología y Patología Mamaria / Consensus Meeting on Sentinel Lymph Node Biopsy. Spanish Society of Mastology and Breast Disease

La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar reuniones de consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria (AU)

Sentinel lymph node biopsy is a useful diagnostic technique in the management of breast cancer and is widely used and accepted in clinical practice. The results of this technique allow adequate staging with lower associated morbidity. However, at present, there are numerous methodological issues that remain to be resolved in on-going trials and investigations and Consensus Meetings are required to standardize the methodological variations and indications of this procedure. The conclusions of the Consensus Meeting held in Murcia, Spain, organized by The Spanish Society of Mastology and Breast Disease, are reported in this document (AU)

Reunión de consenso sobre la biopsia selectiva del ganglio centinela en el cáncer de mama. Sociedad Española de Senología y Patología Mamaria / Consensus meeting about sentinel lymph node selective biopsy in breast cancer. Spanish Society of Senology and Breast Pathology

La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar Reuniones de Consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria

Sentinel lymph node selective biopsy is a diagnostic useful technique in the breast cancer management that has had a good acceptation and diffusion in clinical practice. Its results allow an adequate staging with a lesser associated morbidity. Nevertheless, at present, a lot of methodological variations have been described to do it and they are being studied in several in course assays and research studies. This imply Consensus Meetings are needed to harmonize the methodological aspects and the indications of the technique. In this paper, conclusions of the Spanish Society of Senology and Breast Pathology Consensus Meeting, that was celebrated in Murcia, are described

Reunión de consenso sobre la biopsia selectiva del ganglio centinela en el cáncer de mama. Sociedad Española de Senología y Patología Mamaria / Consensus meeting about sentinel lymph node selective biopsy in breast cancer. Spanish Society of Senology and Breast Pathology

La biopsia selectiva del ganglio centinela es una técnica diagnóstica útil en el manejo del carcinoma de mama que se ha introducido en la práctica clínica con una gran difusión y aceptación. Sus resultados permiten realizar una adecuada estadificación con una menor morbilidad asociada. No obstante, en la actualidad, existen numerosas variaciones metodológicas en su ejecución pendientes de ser contestadas en ensayos e investigaciones en curso. Esto implica realizar Reuniones de Consenso para tratar de homogeneizar los aspectos relacionados con el método y la indicación de la técnica. En este documento se reflejan las conclusiones de la Reunión de Consenso celebrada en Murcia y organizada por la Sociedad Española de Senología y Patología Mamaria

Sentinel lymph node selective biopsy is a diagnostic useful technique in the breast cancer management that has had a good acceptation and diffusion in clinical practice. Its results allow an adequate staging with a lesser associated morbidity. Nevertheless, at present, a lot of methodological variations have been described to do it and they are being studied in several in course assays and research studies. This imply Consensus Meetings are needed to harmonize the methodological aspects and the indications of the technique. In this paper, conclusions of the Spanish Society of Senology and Breast Pathology Consensus Meeting, that was celebrated in Murcia, are described

Infiltrating ductal carcinoma and synchronous malignant phyllodes tumour. Diagnostic and therapeutic approaches.

Simultaneous presentation of breast cancer and malignant phyllodes tumour is rare. A female patient presented with a nodule in her left breast (infiltrating ductal carcinoma). On magnetic nuclear resonance another suspicious lesion (malignant phyllodes) was found in the right breast. Bilateral mastectomy was performed. Thirty two months later the patient is still free of disease. The approach to dealing with synchronous breast tumours should be the same as that normally used.

Valoración de la 5ª edición de la clasificación TNM para el cáncer gástrico en nuestro medio / Appraisal of the fifth edition of the tumor-node-metastasis (TNM) classification for gastric cancer in our environment

Objetivo. Evaluar el número de casos de carcinoma gástrico que pueden ser estadificados con los criterios de la 5.a edición del sistema TNM y analizar qué factores pueden estar relacionados con la obtención de un número suficiente de ganglios. Pacientes y método. En 164 pacientes a los que se resecó un carcinoma gástrico, se estudiaron distintos factores que podían influir en el número de ganglios aislados, como el tamaño tumoral, el tipo de resección gástrica, el grado de diferenciación tumoral, el tipo histológico, la variabilidad entre patólogos que analizaron las piezas y la experiencia del cirujano. Resultados. La media de ganglios linfáticos analizados por los patólogos fue de 11,4 (intervalo de confianza del 95%, 10,12-12,66). Atendiendo a los criterios de la 5.a edición de la clasificación TNM, sólo se pudo clasificar correctamente al 31% de los pacientes. Encontramos una correlación positiva entre el tamaño tumoral y el número de ganglios aislados (p = 0,0018), así como un mayor número de ganglios analizados en las gastrectomías totales respecto de las subtotales (p = 0,034). No se observó una variación significativa en los ganglios analizados en relación con el patólogo que analizó la pieza ni con la experiencia del cirujano que efectuó la resección. Conclusiones. La 5.a edición del sistema TNM es fácilmente reproducible, aunque el número de ganglios necesarios para corroborar la afección ganglionar metastásica es difícil de conseguir en nuestro medio. Nuestros resultados sugieren que es necesario un esfuerzo conjunto por parte de cirujanos y patólogos para aumentar el número de pacientes estadificables con esta edición (AU)

Aim. To estimate the proportion of patients with gastric carcinoma that can be classified using the criteria of the fifth edition of the TNM system and to analyze which factors could be related to the finding of an adequate number of nodes. Patients and method. The influence of distinct factors that could influence the number of lymph nodes isolated was evaluated in 164 patients who underwent resection of gastric carcinoma. These factors included tumor size, surgical resection, grade, histological type, variability among the pathologists who analyzed the surgical specimens, and the surgeon's experience. Results. The mean number of lymph nodes examined by the pathologists was 11.4 (10.12-12.66). Applying the criteria of the fifth edition of the TNM classification, only 31% of the patients could be correctly classified. A positive correlation was found between tumor size and the number of resected nodes (p = 0.0018). In addition, a greater number of lymph nodes were found in total gastrectomies than in subtotal gastrectomies (p = 0.034). No significant association was found with the pathologist who analyzed the surgical specimen or with the experience of the surgeon who performed the resection. Conclusions. The fifth edition of the TNM system is easily reproducible, although the number of lymph nodes required to evaluate metastatic node involvement is difficult to obtain in our environment. Our results suggest that a combined effort between surgeons and pathologists is needed to increase the number of patients that can be reliably staged with this TNM edition (AU)

Adecuación de las unidades de mama españolas a los criterios de EUSOMA / EUSOMA requirements for breast cancer units in Spain

Introducción. El planteamiento multidisciplinario del cáncer de mama en unidades especializadas se considera el más adecuado, tanto en el beneficio para la paciente como en el consumo más racional de recursos materiales. Con estas premisas se han elaborado las recomendaciones de la European Society of Mastology (EUSOMA) encaminadas a dotar a todos los países europeos de equipos multidisciplinarios de alta calidad. Material y método. En este trabajo se presentan y se analizan los resultados obtenidos de la encuesta sobre unidades de mama, promovida por la Sección de Patología de la Mama de la Asociación Española de Cirujanos, en 241 hospitales españoles. Resultados. Destaca la elevada implicación de los servicios de cirugía general (131 hospitales) en la atención de la patología mamaria, así como el gran interés por la formación continuada de los cirujanos españoles (el 41,2% de los servicios posee un título de posgrado). En 95 (73,6%) hospitales se planifica el proceso terapéutico, mediante reunión multidisciplinaria regular. Existen protocolos escritos sobre diagnóstico y tratamiento en 119 (90,8%) de los servicios que se dedican a la patología mamaria y se aplican medios para mantener un adecuado control de la calidad asistencial en 83 (63,4%) hospitales. Conclusiones. Resaltamos la necesidad de una normativa española sobre unidades de mama, preferiblemente adaptada a los criterios de EUSOMA, que son los admitidos por el comité encargado del Parlamento Europeo. La Asociación Española de Cirujanos, a través de la Sección de Patología de la Mama, debe ejercer un destacado papel a la hora de acreditar a los médicos de las unidades de mama y potenciar la formación continuada de éstos (AU)

Introduction. The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams. Material and method. We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons. Results. Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%). Conclusions. We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs (AU)

Aplicación de los criterios de EUSOMA en las unidades funcionales de mama de los países miembros de la Unión Europea / Application of the eusoma criteria in breast units in countries of the European Union

Todos los países de la Unión Europea se enfrentan a retos similares a la hora de ofrecer un tratamiento adecuado y de alta calidad a los pacientes oncológicos. Los “Requisitos de una Unidad de Mama” publicados en 2000 y resultado del trabajo de un grupo de expertos representan la opinión de la European Society of Mastology (EUSOMA) sobre los estándares de composición y funcionamiento necesarios para formar unidades de cáncer de mama de alta calidad. Hemos estudiado la aplicación de las recomendaciones y de los requisitos obligatorios: cantidad crítica o número mínimo de pacientes, composición y formación específica del personal médico, control de calidad, aplicación de protocolos, etc. Los datos se han obtenido a partir de una completa búsqueda bibliográfica, complementada con la información procedente de buscadores médicos, páginas web de sociedades científicas, asociaciones nacionales de lucha contra el cáncer, ministerios de sanidad, etc., de los países miembros de la Unión Europea. Se han actualizado las últimas actuaciones de la Comisión del Parlamento Europeo responsable del informe sobre el cáncer de mama. Hay diversos enfoques de atención multidisciplinaria de la enfermedad mamaria en algunos países europeos, como los desarrollados en el Reino Unido, Suecia, Italia, Francia o España. Sería conveniente disponer de una normativa europea común para poder mejorar el cuidado de nuestras pacientes (AU)

All the countries of the European Union face similar challenges when providing adequate and high quality treatment in oncology. A working party was established to consider what should comprise a specialist service and the “Requirements of a Breast Unit”, published in 2000, represent the opinion of the European Society of Mastology (EUSOMA) on the standards required for creating high quality Breast Cancer Units across Europe. We studied the application of the mandatory requisites and general recommendations of EUSOMA: critical mass, or minimum number of patients, core team (composition and specific training), quality assurance, and application of diagnostic and treatment protocols. A thorough literature search was performed and was completed with information from search tools, the web pages of scientific societies, national associations for the fight against cancer, and health ministries of the countries belonging to the European Union. We also analyzed the latest reports of the European Parliamentary Committee for breast cancer. Distinct approaches to the multidisciplinary management of breast disease can be found in the United Kingdom, Sweden, Italy, France and Spain. A common European standard would be useful to improve the care provided to patients (AU)

[Assessment of the fifth edition of the tumor-node-metastasis (TNM) classification for gastric cancer in our setting]. / Valoración de la 5.a edición de la clasificación TNM para el cáncer gástrico en nuestro medio.

AIM: To estimate the proportion of patients with gastric carcinoma that can be classified using the criteria of the fifth edition of the TNM system and to analyze which factors could be related to the finding of an adequate number of nodes. PATIENTS AND METHOD: The influence of distinct factors that could influence the number of lymph nodes isolated was evaluated in 164 patients who underwent resection of gastric carcinoma. These factors included tumor size, surgical resection, grade, histological type, variability among the pathologists who analyzed the surgical specimens, and the surgeon's experience. RESULTS: The mean number of lymph nodes examined by the pathologists was 11.4 (10.12-12.66). Applying the criteria of the fifth edition of the TNM classification, only 31% of the patients could be correctly classified. A positive correlation was found between tumor size and the number of resected nodes (p = 0.0018). In addition, a greater number of lymph nodes were found in total gastrectomies than in subtotal gastrectomies (p = 0.034). No significant association was found with the pathologist who analyzed the surgical specimen or with the experience of the surgeon who performed the resection. CONCLUSIONS: The fifth edition of the TNM system is easily reproducible, although the number of lymph nodes required to evaluate metastatic node involvement is difficult to obtain in our environment. Our results suggest that a combined effort between surgeons and pathologists is needed to increase the number of patients that can be reliably staged with this TNM edition.

[Application of the EUSOMA criteria in breast units in countries of the European Union]. / Aplicación de los criterios de EUSOMA en las unidades funcionales de mama de los países miembros de la Unión Europea.

All the countries of the European Union face similar challenges when providing adequate and high quality treatment in oncology. A working party was established to consider what should comprise a specialist service and the Requirements of a Breast Unit, published in 2000, represent the opinion of the European Society of Mastology (EUSOMA) on the standards required for creating high quality Breast Cancer Units across Europe. We studied the application of the mandatory requisites and general recommendations of EUSOMA: critical mass, or minimum number of patients, core team (composition and specific training), quality assurance, and application of diagnostic and treatment protocols. A thorough literature search was performed and was completed with information from search tools, the web pages of scientific societies, national associations for the fight against cancer, and health ministries of the countries belonging to the European Union. We also analyzed the latest reports of the European Parliamentary Committee for breast cancer. Distinct approaches to the multidisciplinary management of breast disease can be found in the United Kingdom, Sweden, Italy, France and Spain. A common European standard would be useful to improve the care provided to patients.

[EUSOMA requirements for breast cancer units in Spain]. / Adecuación de las unidades de mama españolas a los criterios de EUSOMA.

INTRODUCTION: The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams. MATERIAL AND METHOD: We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons. RESULTS: Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%). CONCLUSIONS: We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs.