Conservative treatment modalities in retinoblastoma.

Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub‑tenon, or intra‑arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long‑term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub‑tenon or sub‑conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra‑arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.

Procedimiento para evaluar procesos en los grupos de control de vectores / Procedure to assess the processes in vector control groups

La investigación evaluativa en los servicios es considerada un proceso de indagación sobre avances y obstáculos en una institución, cuyo resultado será un juicio de valor, una decisión. OBJETIVO: Mostrar el proceso de trabajo seguido en la construcción de un procedimiento para evaluar procesos en los grupos de control de vectores. MÉTODOS: Se siguió un algoritmo que se resume en los pasos siguientes: caracterización del trabajo de los grupos de control de vectores, definición de un enfoque y selección de procesos para la evaluación, construcción de criterios y de instrumentos para la obtención de información. En cada uno se apuntaron los elementos teóricos y metodológicos que fundamentaron el resultado mostrado. La revisión documental, las entrevistas a informantes claves, los talleres con expertos y la ejecución de estudios observacionales fueron las fuentes utilizadas en la caracterización. RESULTADOS. Se identificó y se argumentó la conveniencia de un enfoque para la evaluación basado en procesos, a partir de la selección de un proceso operativo y "trazador" del desempeño de los grupos (proceso operativo focal) y de procesos de soporte a este. Se refirieron aspectos sobre la construcción de los criterios evaluativos y los instrumentos para la obtención de información: un cuestionario de clima organizacional con el que se evalúan elementos del ambiente de trabajo y una guía para observar procesos.

Evaluative research in services is considered as an inquiry process on the advances and obstacles in a institution whose result will be value judgment, a decision. OBJECTIVE: To show the working process followed in the creation of a procedure to assess processes in vector control groups. METHODS: Authors followed an algorithm summarized in: working characterization of the vectors control groups, definition of an approach and selection of assessment processes criteria and tools construction to obtain information. In each are signaled the theoretical and methodological elements supported the result showed. RESULTS: The documentary review, interviews to key informants, the workshops with experts and execution of observational studies were sources used in characterization. Authors identified and argued the usefulness of an approach to assessment based on processes, from the selection of a functional process and «tracer¼ of performance of groups (focal operative process) and its supportive processes. Features on the construction of evaluation criteria and the tools to obtain information: a questionnaire of the organizational climate used to assess the elements of the working environment and a guide to observe the processes.