RESUMEN

AIM OF THE STUDY: The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast units to establish minimum standards and ensure specialist multidisciplinary care. In the present study we assess the impact of EUSOMA certification for all breast units for which sufficient information was available before and after certification. MATERIALS AND METHODS: For 22 EUSOMA certified breast units data of 30,444 patients could be extracted from the EUSOMA database on the evolution of QI's before and after certification. RESULTS: On the average of all units, the minimum standard of care was achieved for 12/13 QI's before and after EUSOMA certification (not met for DCIS receiving just one operation). There was a significant improvement of 5 QI's after certification. The proportion of patients with invasive cancer undergoing an axillary clearance containing >9 lymph nodes (91.5% vs 89.4%, p 0.003) and patients with invasive cancer having just 1 operation (83.1% vs 80.4%, p < 0.001) dropped, but remained above the minimum standard. The targeted standard of breast care was reached for the same 4/13 QI's before and after EUSOMA certification. CONCLUSION: Although the absolute effect of EUSOMA certification was modest it further increases standards of care and should be regarded as part of a process aiming for excellence. Dedicated units already provide a high level of care before certification, but continuous monitoring and audit remains of paramount importance as complete adherence to guidelines is difficult to achieve.

Asunto(s)

RESUMEN

This study assessed factors that could predict dentists' knowledge, attitudes and behaviour towards hepatitis B virus (HBV). A total of 300 dentists in Tehran, Islamic Republic of Iran were surveyed and their demographic, educational and office characteristics were analysed in relation to their scores on knowledge about HBV, self-reported attitudes towards treating people infected with HBV and actual behaviour towards treating simulated HBV-positive patients. Having a Master's degree, faculty membership, taking ≥ 3 continuing education courses, wearing eye-shields, spending more time on preparing dental units and higher self-confidence about knowledge predicted better knowledge. A positive attitude was associated with having attended more courses and working in group practice. The number of courses and a shorter dental unit preparation time positively affected dentists' behaviour.

Asunto(s)

RESUMEN

The dental profession has a high risk of hepatitis B virus (HBV) contamination and can play a crucial role in controlling HBV cross-contamination. In this cross-sectional study we used unique methods to assess Tehran dentists' knowledge, attitude and behaviour regarding HBV. Two simulated HBV-positive patients visited 300 general/specialist dentists in their offices and recorded dentists' willingness to treat them. Later, the dentists were interviewed regarding their knowledge about hepatitis B and attitude to HBV-positive patients. The mean knowledge score of dentists was 14.3 (SD 6.9) out of 44 and the mean attitude score was 20.0 (SD 3.6) out of 39. A majority of dentists (55.6%) were willing to treat a patient with HBV, unconditionally or with conditions. Some individual attitude items correlated with knowledge items concerning transmission of the virus and its prevention. Dentists' willingness to treat patients did not correlate with knowledge or attitude, except for the attitude item on concern about becoming infected.

Asunto(s)

RESUMEN

The dental profession has a high risk of hepatitis B virus [HBV] contamination and can play a crucial role in controlling HBV cross-contamination. In this cross-sectional study we used unique methods to assess Tehran dentists’ knowledge,attitude and behaviour regarding HBV. Two simulated HBV-positive patients visited 300 general/specialist dentists in their offices and recorded dentists’ willingness to treat them.Later, the dentists were interviewed regarding their knowledge about hepatitis B and attitude to HBV-positive patients. The mean knowledge score of dentists was 14.3 [SD 6.9] out of 44 and the mean attitude score was 20.0 [SD 3.6] out of 39. A majority of dentists [55.6%] were willing to treat a patient with HBV, unconditionally or with conditions. Some individual attitude items correlated with knowledge items concerning transmission of the virus and its prevention. Dentists’ willingness to treat patients did not correlate with knowledge or attitude, except for the attitude item on concern about becoming infected

La profession dentaire est à haut risque de contamination par le virus de l'hépatite B et peut jouer un rôle crucial dans la lutte contre la contamination croisée par ce virus. Dans cette présente étude transversale, des méthodes uniques ont été adoptée pour évaluer les connaissances,les attitudes et les comportements des dentistes de Téhéran vis-à-vis du virus de l'hépatite B. Deux patients déclarant une infection fictive par le virus de l'hépatite B ont rendu visite à 300 dentistes spécialistes ou généralistes sur leur lieu d'exercice et ont pris note de leur disposition à les traiter.Dans un deuxième temps, les dentistes ont été interrogés sur leurs connaissances en matière d'hépatite B et leur attitude vis-à-vis des patients infectés par le virus. Le score moyen des dentistes pour les connaissances était de 14,3 [ET 6,9] sur 44 tandis que le score moyen pour l'attitude était de 20,0 [ET 3,6] sur 39. La majorité des dentistes [55,6 %] étaient disposés à traiter un patient infecté par le virus de l'hépatite B, avec ou sans conditions. Certains items concernant l'attitude individuelle étaient corrélés aux items concernant les connaissances relatives la transmission du virus et sa prévention. La disposition des dentistes à traiter des patients infectés n'était pas corrélée aux connaissances ni à l'attitude, à l'exception de l'item concernant l'attitude relative à la crainte de contracter l'infection

Asunto(s)

RESUMEN

Myotonic dystrophies, the most common form of adult muscular dystrophy, comprise at least two forms, clinically and genetically heterogeneous. Myotonic dystrophy type 1 and type 2 are both caused by unstable repetitions in untranslated gene regions: a [CTG]n expansion in the 3' region of the DMPK gene on chromosome 19q13 (DM1) and [CCTG]n tetranucleotide repeat located in the first intron of the ZNF9 gene on chromosome 3q21 (DM2). DM clinical features are caused by a gain of functions RNA mechanism in which the CUG and CCUG repeats alter nuclear functions, including alternative splicing of shared genes. Southern blot and/or polymerase chain reaction PCR-based approaches allow the detection of DM mutations in almost 100% of cases, however, the expansion size and the elevated grade of somatic instability make molecular testing for DM a diagnostic challenge. The increased use of DNA testing for DM generates many questions regarding the indications and interpretations of the test which require standardized methods, routinely available in molecular genetic laboratories. Here, we propose Guidelines for the molecular diagnosis of DM1 and DM2 approved by the Italian Ministry of Health in 2005 (Piano Nazionale Linee Guida, PNLG). Best practice for DM molecular analysis in diagnostic application, presymptomatic and prenatal testing, using direct and indirect approaches are described, with particular attention focused on ethical, legal and social issues. Overviews of materials used in the molecular diagnosis, as well as internet resources, are also included.

Asunto(s)

RESUMEN

BACKGROUND: The SRY gene encodes for a testis-specific transcription factor (TDF, testis determining factor) that plays a key role in sexual differentiation and development in males. Several SRY mutations have been described in patients with gonadal dysgenesis, accounting for 10-15% of the sex reversal cases. The reported mutations are both point mutations and deletions, mostly involving the high mobility group (HMG) box domain of SRY, which is a conserved region through the evolution, suggesting that SRY function strictly depends on the HMG box. CASE PRESENTATION: Here we describe the clinical, endocrinological and molecular data of a patient with complete 46, XY gonadal dysgenesis caused by SRY mutation located within the conserved HMG box. Using DNA direct sequencing of the SRY coding region, we identified a single nucleotide insertion at codon 89 with subsequent frameshift of the reading frame sequence, which results in a truncated protein as consequence of an introduction of a stop codon at the position 103. CONCLUSION: A novel SRY mutation has been described in a female with a gonadal dysgenesis associated with a 46, XY karyotype. The described case is of importance for genetic counseling.

Asunto(s)

Asunto(s)