Effectiveness of hexaminolevulinate fluorescence cystoscopy for the diagnosis of non-muscle-invasive bladder cancer in daily clinical practice: a Spanish multicentre observational study.

OBJECTIVE: To assess the sensitivity and specificity of blue-light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white-light cystoscopy (WLC) vs WLC alone for the detection of non-muscle-invasive bladder cancer (NMIBC), in routine clinical practice in Spain. PATIENTS AND METHOD: An intra-patient comparative, multicentre, prospective, observational study. Adults with suspected or documented primary or recurrent NMIBC at eight Spanish centres were included in the study. All patients were examined with WLC followed by BLC with hexaminolevulinate. We evaluated the detection rate of bladder cancer lesions by WLC and BLC with hexaminolevulinate, overall and by tumour stage and compared with histological examination of the biopsied lesions. Sensitivity and specificity was calculated. RESULTS: In all, 1,569 lesions were identified from 283 patients: 621 were tumour lesions according to histology and 948 were false-positives. Of the 621 tumour lesions, 475 were detected by WLC (sensitivity 76.5%, 95% confidence interval [CI] 73.2-79.8) and 579 were detected by BLC (sensitivity 93.2%, 95% CI 91.0-95.1; P < 0.001). There was a significant improvement in the sensitivity in the detection of all types of NMIBC lesions with BLC compared with WLC. Of 219 patients with tumours, 188 had NMIBC [highest grade: carcinoma in situ (CIS), n = 36; Ta, n = 87; T1, n = 65). CIS lesions were identified more with BLC (n = 27) than with WLC [n = 19; sensitivity: BLC 75.0% (95% CI 57.8-87.9) vs WLC 52.8% (95% CI 35.5-69.6); P = 0.021]. Results varied across centres. CONCLUSIONS: This study shows that improvement in diagnosis of NMIBC, mainly CIS and Ta tumours, obtained with BLC with hexaminolevulinate as an adjunct to WLC vs WLC alone can be shown in routine clinical practice.

Evaluation of the administrative management model in a municipality in Peru, incorporating the Intelligent Organization Theory.

Background: This study begins with the analysis of the current management models and their degree of effectiveness in municipal administration. Its aim is to design an administrative management model that enables effective administration in the District Municipality of Nueva Cajamarca, Peru, based on the theory of intelligent organizations. Method: The research type employed in this study is diagnostic-propositional, utilizing both deductive and inductive methods, in alignment with a mixed-method approach and a non-experimental nature of the study. Data was collected from three distinct populations, including the 189 municipal employees engaged in administrative roles, who were subjected to a 50-question survey. This survey aimed to assess their perceptions regarding the current management model and its relationship with administrative effectiveness. Additionally, interviews were conducted with three experts to gain deeper insights into the behavior of the variables under investigation. Results: Finally, documentary information about the management models currently in use was collected. This facilitated the triangulation of data collection, processing, analysis, and inferences from three sources of information. The results reveal a positive, direct, and significant correlation between the management model and administrative effectiveness. It becomes evident that the current management model is deficient, resulting in a low level of administrative effectiveness. Conclusion: The management model based on the theory of intelligent organizations was validated using a rubric by experts in effective management. The main pillars of this model include transformational leadership, structural change, and cultural change.