Strengthening breast surgery workforce capacity: implementation of competency-based training programme.

BACKGROUND AND RATIONALE: Quality education is a prerequisite for building a sustainable health system. To address this requirement, it is necessary to strengthen capacity and expand the training opportunities to ensure equitable and efficient development of core professional competencies for specific contexts and educational needs. METHODS AND RESULTS: A competency-based training programme for Breast Surgeons was built and was applied based on the Consolidated Framework for Implementation Research (CFIR). This framework provides a pragmatic structure for approaching complex interactions, multi-level and transient constructs in the real world. CFIR guided the implementation process and verified what works, where and why across each step. CFIR guided implementation was through an adaptable approach of the domains and creating relevant constructs that set up an ideal roadmap to analyse and improve learning needs, the curriculum design and the learning environment. CONCLUSION: The outcomes described in this manuscript demonstrate that evidence-based principles can be implemented in health professionals' training and clinical practice even in resource-constrained settings. Building strong and sustainable healthcare workforce capacity is an urgent need for improved health service delivery and addresses real-life workplace needs in low-middle income countries. This programme integrates training with service to solve problems and develop initiatives to address existing local health priorities. While the article focuses on a training programme development, findings are shared to promote dissemination into other settings.

Mesotelioma papilar: bien diferenciado / Peritoneal mesothelioma: well differentiated

El mesotelioma peritoneal es un tumor raro con problemas diagnósticos y terapéuticos, asociado comúnmente a la exposición de asbesto y amenudo rápidamente fatal. El mesotelioma papilar bien diferenciado es una variedad menos agresiva del tumor, caracterizada por un curso indolente y un buen pronóstico. Presentamos el caso de un paciente masculino de 34 años quien consultó por ascitis sin evidencia de hipertensión portal, de enfermedad hepática o de neoplasia intraabdominal. A través de la laparoscopia diagnóstica fueron encontrados nódulos que cubrían el peritoneo parietal y el epiplón mayor, obteniéndose biopsia cuya inmunohistoquímica resultó positiva para el calretina y los citoqueratinas. El paciente fue tratado con terapia de citos táticos primaria. La ascitis progresiva fue el único síntoma clínico en este paciente, mientras que la enfermedad hepática, la hipertensión portal y las neoplasias intraabdominales gastrointestinales fueron descartadas por clínica, laboratorio e imágenes. La biopsia por laparoscopia reveló mesotelioma papilar bien diferenciado como enfermedad subyacente. La inmunohistoquímica es indispensable para establecer el diagnóstico de esta rara neoplasia que es aún más infrecuente en hombres con ausencia de una historia de exposición al asbesto. El mesotelioma peritoneal, unque es infrecuente, se debe considerar en los pacientes que consultan por ascitis, particularmente en esos donde el diagnóstico inicial no está claro.

The peritoneal mesothelioma is a rare tumour with produce diagnostic and therapeutic problems commonly associated with the asbestos exposure and oftenconsidered rapidly fatal. The well differentiated papillary mesothelioma is a less aggressive variety of the tumour, characterized by an indolent course and good prognosis. We report the case of a 34 year old man patient who presented clinic with ascitis but without evidence of a portal hypertension, liver disease or any abdominal malignancy. True the procedure diagnostic laparoscopy a small tumour nodule was found to cover the parietal peritoneum and the greater omentum. The imunohistochemestry biopsies practice him were positive for calretinin and cytokeratins. The patient was treated with primary cytostatic therapy. The progressive ascitis was the only clinical symptom in this patient, while liver disease, portal hypertension and gastrointestinal malignancies were ruled out by clinical, laboratory and the imaging techniques. Laparoscopic biopsy revealed well differentiated papillary mesothelioma to be the underlying disease. Immunocytochemistry is required to establish the diagnosis of this rare malignant disorder which is even more uncommon in men with the absence of a history of the asbestos exposure. The peritoneal mesothelioma, although uncommon, should be considered in the people presenting ascitis, in particular in those where the initial diagnosis is not clear.