[A review of the scientific evidence concerning the clinical application of digital mammography]. / Revisión de la evidencia científica sobre la aplicación clínica de la mamografía digital.

OBJECTIVE: To review the scientific evidence with respect to the use of digital mammography and compare it with analogical mammography in the clinical context. MATERIAL AND METHOD: We searched Medline and EMbase for studies published between 1989 and 2005 that compared the results of digital and analogical mammography in the same group of patients or in two different groups of patients to evaluate their respective diagnostic accuracy (sensitivity, specificity, area under the ROC curve), recall rate, biopsy rate, and exposure to radiation. We reviewed and compared the different methodologies of the studies published. RESULTS: Eight articles and eight presentations at congresses were found. No statistically significant differences were observed between digital and analogical mammography for the detection of breast cancer. Until the publication of the Oslo II (2004) and Digital Mammographic Imaging Screening Trial (2005) studies, the series presented were small and used a variety of methodologies. This made it impossible to appreciate small differences in diagnostic accuracy between the two techniques and to group the, sometimes, contradictory results. Furthermore, these first series did not include follow-up. CONCLUSION: There are no statistically significant differences between the two techniques for diagnostic accuracy, except in women with dense or heterogeneously dense breasts, in those under 50 years of age, and in peri- or pre-menopausal women, in which cases digital mammography is significantly better. These data should be confirmed in longer term studies to enable the effects on the breast cancer mortality rate to be specifically evaluated. Cost-effectiveness studies are important when considering changing techniques.

Revisión de la evidencia científica sobre la aplicación clínica de la mamografía digital / A review of the scientific evidence concerning the clinical application of digital mammography

Objetivo. Revisar la evidencia científica relativa al uso de la mamografía digital (MD) comparándola con la mamografía analógica (MA) en el contexto clínico.Material y método. Se realizó una búsqueda en Medline y Embase de los estudios publicados entre 1989 y 2005, que comparaban resultados de MD y MA en el mismo grupo o en dos grupos de pacientes, valorando la certeza diagnóstica (sensibilidad, especificidad, área bajo lacurva ROC), tasa de rellamadas, tasa de biopsias y exposición a la radiación.Se revisaron y compararon metodológicamente los trabajos presentados.Resultados. Se encontraron 8 publicaciones y 8 presentaciones a congresos. No se han observado diferencias estadísticamente significativas en la detección de cáncer de mama entre MA y MD. Hasta la publicación de los estudios Oslo II y DMIST (Digital Mammographic Imaging Screening Trial) las series eran cortas, lo que no permitía explotar las pequeñas diferencias de certeza diagnóstica entre ambas técnicas y con gran disparidad metodológica, por lo que no se podían agrupar los resultados, en ocasiones contradictorios. No se incluían seguimientos.Conclusión. No hay diferencias estadísticamente significativas en la certeza diagnóstica entre MA y MD, excepto en mujeres con mamas densas o heterogéneamente densas, menores de 50 años y peri o premenopáusicas, donde la MD tiene mejores resultados en un rango significativo.Estos datos deben ser confirmados en estudios a más largo plazo para valorar específicamente los efectos en la mortalidad por cáncer de mama.Son importantes los estudios de coste-efectividad si se pretende una sustitución de la técnica

Objective. To review the scientific evidence with respect to the use of digital mammography and compare it with analogical mammography in the clinical context.Material and method. We searched Medline and EMbase for studies published between 1989 and 2005 that compared the results of digital and analogical mammography in the same group of patients or in two different groups of patients to evaluate their respective diagnosticaccuracy (sensitivity, specificity, area under the ROC curve), recall rate, biopsy rate, and exposure to radiation. We reviewed and compared the different methodologies of the studies published.Results. Eight articles and eight presentations at congresses were found. No statistically significant differences were observed between digital and analogical mammography for the detection of breast cancer.Until the publication of the Oslo II (2004) and Digital Mammographic Imaging Screening Trial (2005) studies, the series presented were small and used a variety of methodologies. This made it impossible to appreciate small differences in diagnostic accuracy between the two techniques and to grup the, sometimes, contradictory results. Furthermore, these first series did not include follow-up.Conclusion. There are no statistically significant differences between the two techniques for diagnostic accuracy, except in women with dense or heterogeneously dense breasts, in those under 50 years of age, and in peri- or pre-menopausal women, in which cases digitalmammography is significantly better.These data should be confirmed in longer term studies to enable the effects on the breast cancer mortality rate to be specifically evaluated. Cost-effectiveness studies are important when considering changing techniques

[Qualitative analysis of organizational innovations in Spanish public hospitals]. / Análisis cualitativo de las innovaciones organizativas en hospitales públicos españoles.

OBJECTIVE: To determine the opinion of chief executive officers (CEOs) and physicians in public hospitals concerning new managerial trends. METHODS: We performed a qualitative study designed to determine the opinion of CEOs and physicians on the organizational innovations that affect more than one level of health management intervention. In-depth semi-structured interviews were conducted to identify behavior, experiences, opinions, knowledge and other personal and institutional aspects related to the study's aim. Focus groups (two study groups and one control group) were also used. Interaction between groups was used to obtain different types of information on the development of ideas, operational capacity, and the degree of consensus and disagreement on the subjects discussed. RESULTS: Comparison between the control and the study groups revealed that the new management trends added value in the following areas: economy of contracts, delegation, administrative decentralization, incentives, risk avoidance, process re-engineering, heath care continuity, competitiveness, leadership, information systems and client centeredness. CONCLUSIONS: Physicians are showing increased interest in organizational innovations while CEOs are ambivalent about their changing role and respective responsibilities. There is evidence of resistance to change. There is no single institutional model; institutional design depends on internal factors (cohesion and leadership) and external factors (environment, size and technology). The incipient development of innovations reveals the need for changes in the style and characteristics of management structure (composition, functions, responsibilities).

Análisis cualitativo de las innovaciones organizativas en hospitales públicos españoles / Qualitative analysis of organizational innovations in Spanish public hospitals

Objetivo: Conocer la opinión de directivos y clínicos de hospitales públicos sobre los institutos clínicos. Métodos: Estudio cualitativo que trata de responder a preguntas realizadas a gerentes y clínicos sobre las innovaciones organizativas que afectan a más de un nivel de intervención de la gestión sanitaria. Se aplican como técnicas: a) entrevistas en profundidad semiestructuradas con la finalidad de señalar los comportamientos, experiencias, opiniones, conocimientos y otros aspectos personales e institucionales objeto del estudio, y b) grupos de discusión, con un grupo de discusión control y dos grupos de discusión estudio se busca la interacción de los grupos para obtener distintos tipos de información relativos al desarrollo de las ideas, operatividad, grado de consenso y disenso en los temas tratados. Resultados: Realizada la comparación entre el grupo de control y los grupos de estudio, se pone de relieve que las nuevas formas organizativas incrementaron el valor en los siguientes conceptos: economía de contratos, delegación de funciones, descentralización administrativa, incentivación, aversión al riesgo, reingeniería de procesos, continuidad asistencial, competitividad, liderazgo, sistemas de información y orientación al cliente. Conclusiones: Existe un creciente interés de los clínicos por las innovaciones organizativas hospitalarias, postura ambivalente en los gestores clínicos ante los cambios de rol de sus respectivas responsabilidades. Se evidencia la resistencia a los cambios. No existe un modelo único de 'instituto', dependiendo los modelos existentes de influencias particulares en cuanto a factores internos (cohesión y liderazgo) y externos (entorno, tamaño y tecnología). El incipiente desarrollo de innovaciones pone de relieve la necesidad de cambios en el estilo y naturaleza de la estructura directiva (composición, funciones, responsabilidades) (AU)

Objective: To determine the opinion of chief executive officers (CEOs) and physicians in public hospitals concerning new managerial trends. Methods: We performed a qualitative study designed to determine the opinion of CEOs and physicians on the organizational innovations that affect more than one level of health management intervention. In-depth semi-structured interviews were conducted to identify behavior, experiences, opinions, knowledge and other personal and institutional aspects related to the study's aim. Focus groups (two study groups and one control group) were also used. Interaction between groups was used to obtain different types of information on the development of ideas, operational capacity, and the degree of consensus and disagreement on the subjects discussed. Results: Comparison between the control and the study groups revealed that the new management trends added value in the following areas: economy of contracts, delegation, administrative decentralization, incentives, risk avoidance, process re-engineering, heath care continuity, competitiveness, leadership, information systems and client centeredness. Conclusions: Physicians are showing increased interest in organizational innovations while CEOs are ambivalent about their changing role and respective responsibilities. There is evidence of resistance to change. There is no single institutional model; institutional design depends on internal factors (cohesion and leadership) and external factors (environment, size and technology). The incipient development of innovations reveals the need for changes in the style and characteristics of management structure (composition, functions, responsibilities) (AU)