Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru.

To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the Breast Cancer Detection Model (BCDM) in Trujillo, Peru were collected from 2017-2018. Performance was measured against final outcomes derived from regional cancer center medical records, fine needle aspiration results, patient follow-up (sensitivity, specificity, positive, and negative predictive values), and by percent agreement with the retrospective, blinded interpretation of images by a fellowship-trained breast radiologist, and a Peruvian breast surgeon. The diagnostic impact of ultrasound, compared to clinical breast exam (CBE), was calculated for actual practice and for potential impact of two alternative reporting systems. Of the 171 women presenting for breast ultrasound, 23 had breast cancer (13.5%). Breast ultrasound used as a triage test (current practice) detected all cancer cases (including four cancers missed on confirmatory CBE). PCPs showed strong agreement with radiologist and surgeon readings regarding the final management of masses (85.4% and 80.4%, respectively). While the triage system yielded a similar number of biopsies as CBE alone, using the condensed and full BI-RADS systems would have reduced biopsies by 60% while identifying 87% of cancers immediately and deferring 13% to six-month follow-up. Point-of-care ultrasound performed by trained PCPs improves diagnostic accuracy for managing symptomatic women over CBE alone and enhances access. Greater use of BI-RADS to guide management would reduce the diagnostic burden substantially.

Risk-Based Monitoring in Clinical Trials: Past, Present, and Future.

Risk-based monitoring (RBM) is a powerful tool for efficiently ensuring patient safety and data integrity in a clinical trial, enhancing overall trial quality. To better understand the state of RBM implementation across the clinical trial industry, the Association of Clinical Research Organizations (ACRO) conducted a landscape survey among its member companies across 6,513 clinical trials ongoing at the end of 2019. Of these trials, 22% included at least 1 of the 5 RBM components: key risk indicators (KRIs), centralized monitoring, off-site/remote-site monitoring, reduced source data verification (SDV), and reduced source document review (SDR). The implementation rates for the individual RBM components ranged 8%-19%, with the most frequently implemented component being centralized monitoring and the least frequently implemented being reduced SDR. When the COVID-19 pandemic emerged in early 2020, additional data were collected to assess its impact on trial monitoring, focusing specifically on trials switching from on-site monitoring to off-site/remote-site monitoring. These mid-pandemic data show that the vast majority of monitoring visits were on-site in February 2020, but an even higher percentage were off-site in April, corresponding with the first peak of the pandemic. Despite this shift, similar numbers of non-COVID-related protocol deviations were detected from February through June, suggesting little or no reduction in monitoring effectiveness. The pre- and mid-pandemic data provide two very different snapshots of RBM implementation, but both support the need to promote adoption of this approach while also highlighting an opportunity to capitalize on the recent shift toward greater RBM uptake in a post-pandemic environment.

Intususcepción ileocólica en el adulto / Ileocolic intussusception in adults

No disponible

Abordaje videotoracoscopico de tumores toracoabdominales situados en el hiato aórtico / Video-assisted thoracoscopic approach of tumors located in the thoracoabdominal aortic hiatus

No disponible

Caracterización numérica de los trabajos de ascenso del personal docente y de investigación de la Facultad de Ciencias de la Salud de la Universidad de Carabobo durante el período 1954-1999 / Numeric characterization of promotion studies from lecturer and research members of the Health Sciences Faculty of the Carabobo University during the period 1954-1999

El Trabajo de Ascenso (TA) es la modalidad de presentación de investigación científica más difundida entre los profesores universitarios. El presente estudio tiene por finalidad caracterizar objetivamente los TA realizados en la Facultad de Ciencias de la Salud de la Universidad de Carabobo en el período 1954-1999, mediante la aplicación de índices regularmente considerados a la hora de decidir la publicación de un manuscrito en una revista científica acreditada. Para ello, se recolectaron por azar simple 211 TA de la Biblioteca "Dr. Einar Paz Cordero", Valencia, registrándose las variables: número de autores, páginas, figuras, tablas, citas bibliográficas, citas de revistas, citas de libros así como la antigüedad de éstas y el número de consultas realizadas por los lectores al TA en evaluación. El 58,76 por ciento correspondió a revisiones bibliográficas y sólo 15,14 por ciento fueron de tipo experimental. Un 42,65 por ciento fue realizado por dos autores y éstos pertenecían al mismo Departamento en un 78,56 por ciento. La antigüedad promedio de las revistas y libros citados fue 11,62 ± 6,59 años (X ± DE) y 17,41 ± 68,91 años respectivamente. La relación revistas/libros citados fue 7,74 ± 13,63. Existe un incremento significativo del número de páginas con los años (r= +0,28; p<0,0001). Los autores femeninos presentaron sus TA con un número mayor de páginas y de tablas que los masculinos. Apenas 4,58 por ciento de los TA evaluados fueron consultados por los lectores de la Biblioteca. Estos resultados, evaluados a la luz de las exigencias de las revistas científicas indizadas y al margen de las diferencias en los formatos correspondientes, sugieren fuertemente dificultades para que el material presentado en los TA sea aceptado y publicado en medios acreditados y llaman a un intenso esfuerzo a mejorar los indicadores de los TA o a modificar esta modalidad de presentación de la ciencia universitaria