Browsing by Author "Hurtado, Claudia"

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    Lynch syndrome: selection of families by microsatellite instability and immunohistochemistry
    (SOC MEDICA SANTIAGO, 2012) Maria Wielandt, Ana; Zarate, Alejandro J.; Hurtado, Claudia; Orellana, Paulina; Alvarez, Karin; Pinto, Eliana; Contreras, Luis; Corvalan, Alejandro; Kronberg, Udo; Lopez Koestner, Francisco
    Background: Selection of patients with Lynch Syndrome (LS) for a genetic study involves the application of clinical criteria. To increase the rate of identification of mutations, the use of molecular studies as Microsatellite Instability (MSI) and Immunohistochemistry (IHC) in the tumor has been proposed. Aim: To demonstrate the usefulness of MSI and IHC in the detection of mutations in patients with LS. Material and Methods: From our Familial Colorectal Cancer Registry, families suspected of LS were selected according to Amsterdam or Bethesda clinical criteria. Screening of germline mutations of MLH1, MSH2 and MSH6 genes was performed. In addition, analysis of MS I and IHC were performed in colorectal tumors. Results: A total of 35 families were studied (19 met Amsterdam and 16 met Bethesda criteria). Twenty one families harbored a germline alteration in MLH1, MSH2 or MSH6 (18 Amsterdam and 3 Bethesda). In these families, eighteen different alterations were found, 15 of which were mutations and 3 corresponded to variants of uncertain pathogenicity. On the other hand, 80% of the tumors showed positive microsatellite instability (27 MSI-high and 1 MSI-low), and immunohistochemical testing showed that 77% of tumors had the loss of a protein. Correlation between results of tumor molecular studies and the finding of germline nucleotide change showed that IHC and MSI predicted mutations in 81 and 100% of patients, respectively. Conclusions: MSI and IHC can efficiently select patients with a high probability of carrying a mutation in DNA repair genes. (Rev Med Chile 2012; 140: 1132-1139).
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    Process-oriented feedback for ultrasound-guided central venous access training: a randomized controlled trial
    (2025) Fuente Sanhueza, René Francisco de la; Gálvez Yanjarí, Víctor Andrés; Delfino Yurin, Alejandro; Lira, Ricardo; Hurtado, Claudia ; Munoz-Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto
    Background: Process mining is an emerging discipline that allows for the analysis of procedural executions performed in a training context, providing objective information about adherence with a normative procedural model (similarity), the number of repetitions of steps (reworks), and performance metrics, which can be used as objective feedback for trainees to guide learning through a process-oriented feedback approach. The aim of this study was to assess whether interventions based on information derived from process mining analysis improve the attainment of procedural proficiency. Methods: Twenty anaesthesia and emergency medicine residents participated in a training program on ultrasoundguided internal jugular central venous catheter placement that took place in a simulated environment. The participants were randomized into a process-oriented training group (n=10), which received supplementary interventions during training according to the information obtained with process mining tools, and a control group (n=10), for whom the simulation-based training program was unchanged. Video recordings of each student were obtained before and after the training. Two blinded observers evaluated each recording using a global rating scale(primary outcome) and checklist. Procedure execution time and process-oriented metrics (rework and similarity) were measured. The pre- and posttraining performance indicators were compared within groups and between groups. The interrater reliability of the global rating scale scores was calculated using the intraclass correlation coefficient. We used the Wilcoxon signed-rank test for intragroup comparisons and the Mann‒Whitney test for intergroup comparisons. Statistical significance was set at P<.05, adjusted for multiple comparisons. Results: There were no differences between groups in the pretraining measures. During post training, both groups showed improved performance in ultrasound-guided central venous catheter placement compared with their pretraining performance. The global scale results, checklist results, and execution times were not significantly differentbetween the control and process-oriented groups. However, the process-oriented group showed a significant improvement in similarity to the expected performance and a greater reduction in rework than did the control group.