ABSTRACT
OBJECTIVE: To find the view of trainers (tutors and teaching assistants) of third-year family and community medicine (FCM) residents concerning their own teaching activity in areas such as training, the skills and qualities required to be a teacher and the inter-professional relationships that are current and that are needed in a primary care teaching team. DESIGN: Qualitative study developed between June 2000 and May 2002. Sample design with a volunteer population. SETTING: FCM teaching unit under the Primary Care Administration of Murcia. PARTICIPANTS AND/OR CONTEXTS: Tutors and teaching assistants in the FCM residents' programme. METHOD: Semi-structured interview for information gathering. Contents analysis to construct results on the basis of the semiological analysis of the textual discourse. Systematic return of the results. RESULTS: Belonging to the teaching team is the highest motivation for taking part in teaching. It gives the tutors more benefits (affective, care load) than difficulties (organisational adaptation). The tutor profile is sustained by his/her scientific-technical and personal qualities; that of the nurse, by his/her community qualities. Collaboration between nurse and tutor is informal and the teaching strategies most employed by tutors are guidance, guide-lines and encouragement of residents' autonomy. Nurses collaborate with teaching by transmitting a model of professional development and facilitating teamwork. CONCLUSIONS: The complexity of the training process stands out. Postgraduate FCM training is cross-professional, not exclusively circumscribed by the tutor-resident teaching relationship. The qualitative paradigm is shown to be useful for obtaining a vision of the teaching process from the perspective of different actors.
Subject(s)
Attitude of Health Personnel , Family Practice/education , Internship and Residency , Interprofessional Relations , Female , Humans , Interviews as Topic , Male , Models, Educational , SpainABSTRACT
Objetivo. Conocer la opinión de los formadores (tutores y colaboradores docentes) de los residentes de tercer año de medicina familiar y comunitaria (MFyC) sobre su propia actividad como docentes en aspectos relacionados con la formación, las habilidades y las cualidades necesarias para la docencia y las relaciones interprofesionales actuales y necesarias en un equipo de atención primaria con actividad docente. Diseño. Estudio cualitativo desarrollado entre junio de 2000 y mayo de 2002.Realización de un diseño muestral con población voluntaria. Emplazamiento. Unidad docente de MFyC de la Gerencia de Atención Primaria de Murcia. Participantes y/o contextos. Tutores y colaboradores docentes del programa de la residencia de MFyC. Método. Entrevista semiestructurada para la recogida de información. Análisis de contenido para la construcción de resultados a partir del análisis semiológico del discurso textual.Devolución sistemática de los resultados. Resultados. La pertenencia al equipo docente es la mayor motivación para participar en la docencia. Esta última aporta más ventajas para los tutores (afectivas, descarga asistencial) que dificultades (adaptación organizativa).El perfil del tutor se sustenta en las cualidades cientificotécnicas y personales, y el de las enfermeras, en las comunitarias. La colaboración entre enfermera y tutor es informal y las estrategias docentes más empleadas por el tutor son la orientación, la guía y el fomento de la autonomía del residente. La enfermera colabora con la docencia transmitiendo un modelo de desarrollo profesional y facilitando el trabajo en equipo. Conclusiones. Resalta la complejidad existente en el proceso formativo. La formación de posgrado de MFyC es transprofesional y no se circunscribe exclusivamente a la relación docente entre tutores y residentes. El paradigma cualitativo se manifiesta útil para obtener una visión del proceso docente desde la perspectiva de diferentes actores (AU)
Subject(s)
Female , Male , Humans , Internship and Residency , Interprofessional Relations , Attitude of Health Personnel , Interviews as Topic , Models, Educational , Spain , Family PracticeABSTRACT
OBJECTIVE: To evaluate the prognostic value of flow cytometric DNA quantification and immunohistochemical expression of c-erbB-2 and p53, and traditional clinicopathologic variables in stages I-II invasive epithelial ovarian cancer. METHODS: We retrospectively reviewed 77 cases of stages I-II ovarian cancer after comprehensive surgical staging. We recorded anthropometric data (age, menopausal status, weight loss, Karnofsky index) and pathologic variables (tumor size, bilaterality, capsular status, ascites, peritoneal cytology, histologic type, and grade). In 72 cases representative paraffin-embedded samples were available for DNA quantification and immunohistochemical evaluation of c-erbB-2 and p53 overexpression. Most women (87%) had received cisplatin-based adjuvant chemotherapy. RESULTS: The median follow-up was 90 months (range 50-148 months). The 6-year overall disease-free survival rate was 70% (95% confidence interval [CI] 60%, 81%), and overall global survival was 77% (95% CI 67%, 87%). Multivariable analysis using Cox stepwise regression identified DNA content (odds ratio [OR] 12.3; P <.001) and stage (OR 1.4, P =.09) as independent poor prognosis factors for relapse, and DNA content (OR 9.8, P <.001) as the main independent factor for survival. In stepwise discriminant analysis the combination of DNA content and stage provided a correct prediction of relapse in 78% of women. CONCLUSION: Flow cytometric DNA quantification was the main independent prognostic factor of relapse and survival in these women with stages I-II epithelial ovarian cancer.
Subject(s)
Carcinoma/diagnosis , DNA, Neoplasm/analysis , Genes, erbB-2/genetics , Neoplasm Recurrence, Local/diagnosis , Ovarian Neoplasms/diagnosis , Tumor Suppressor Protein p53/genetics , Adult , Aged , Aged, 80 and over , Carcinoma/mortality , Disease-Free Survival , Female , Flow Cytometry , Follow-Up Studies , Gene Expression Regulation, Neoplastic , Humans , Immunohistochemistry , Medical Records , Middle Aged , Neoplasm Staging , Odds Ratio , Ovarian Neoplasms/mortality , Predictive Value of Tests , Prognosis , Retrospective Studies , Spain/epidemiology , Survival AnalysisABSTRACT
PURPOSE: This study was undertaken to assess the antitumor activity and tolerance of chronic oral etoposide (50 mg/m2/d for 21 days every 4 weeks) in metastatic breast cancer (MBC). PATIENTS AND METHODS: Forty-three consecutive metastatic breast cancer patients with at least one site of measurable disease entered the study. All patients had received prior chemotherapy (adjuvant, three patients; adjuvant plus chemotherapy for metastases, 21; chemotherapy for metastases, 19). Twenty-two and 21 patients had also received prior hormonal and radiation therapy, respectively. RESULTS: Thirty-five percent of patients (15 of 43; 95% confidence interval, 21% to 51%) had objective responses, according to an intention-to-treat analysis. Responses were seen in lymph nodes (six of 14), skin and soft tissues (eight of 16), lung (six of 14), lytic lesions of the bone (two of six), liver (four of 23), and peritoneum (one of one). The median duration of response was 7 months (range, 3+ to 12). The main toxic side effects were leukopenia (overall, 65% of patients; World Health Organization [WHO] grade 4, 21%), thrombocytopenia (21%; WHO grade 4, 5%) and anemia (51%; WHO grade 4, 5%). Nine patients (21%) required a 25% dose reduction because of myelosuppression, and one patient abandoned treatment because of gastrointestinal toxicity and severe asthenia. Ninety-one percent of patients developed alopecia, 39.5% had mucositis (WHO grade 3, 9.5%) and 60.5% had some degree of emesis (11.5% nausea, 46.5% transient vomiting, 2.5% intractable vomiting). No toxic deaths occurred. CONCLUSION: Chronic oral etoposide appears to be an active and well-tolerated regimen in MBC patients previously exposed to chemotherapy. This schedule of etoposide administration warrants further studies, alone or in combination, in MBC.
Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Etoposide/therapeutic use , Administration, Oral , Adult , Aged , Drug Administration Schedule , Etoposide/administration & dosage , Etoposide/adverse effects , Female , Humans , Middle Aged , Neoplasm MetastasisABSTRACT
Pure squamous carcinoma is a rare pancreas cancer histological variety. Moreover the association of malign humoral hypercalcemia and neoplasia of the pancreas exocrine portion is extremely rare. The case of a patient with pure squamous pancreas carcinoma and hypercalcemia is discussed. The absence of bone metastasis allowed to classify it within the malign humoral hypercalcemia syndrome. It is the first case described in the spanish scientific literature and the third in the international literature of an epidermoid pancreas carcinoma associated to malign humoral hypercalcemia.