Tutoría clínica de enfermería para el fortalecimiento del aprendizaje de los alumnos en la práctica hospitalaria (papime en223403 / Nursing clinical tutoring to strengthen learning among students in hospital practices (papime en223403)

Entre las problemáticas más preocupantes de las instituciones Educativas de Enfermería es la desvinculación docencia-servicio, situación añeja, que se refleja en el aprendizaje de los alumnos cuando se enfrentan a las contradicciones que existen en los escenarios de práctica. Con base a lo anterior, se propuso un proyecto con el propósito de fortalecer y mejorar el aprendizaje de los estudiantes en el ámbito hospitalario, a través de la formación de Enfermeras tutoras clínicas que compartieran las responsabilidad de la docencia con una metodología innovadora denominada Tutoría Clínica, el cual obtuvo financiamiento por el Programa de Apoyo a la Innovación y Mejoramiento de la Enseñanza (PAPIME- EN223403/UNAM) en la Ciudad de México. Este proyecto se estructuró para ser realizado en tres años, actualmente estamos concluyendo el segundo, y en el tercero esperamos consolidar el modelo de tutoría como estrategia permanente que contribuya a mejorar la calidad de la formación de los estudiantes. Es importante resaltar que el modelo de tutoría como el que hemos iniciado y del cual presentamos los resultados preliminares tiene implicaciones en el logro de los aprendizajes y en la generación de nuevas estrategias de vinculación entre la Escuela y las Instituciones de salud, situación que se verá reflejada cuando en un tiempo determinado el estudiante logre adquirir mayores habilidades sociales y cognitivas que le permitan ser cada vez más autónomo en sus propias decisiones profesionales y como ser humano.

Among the nursing educational intitutions´ are concerning problems is the teaching-service unlinking; this is an old situation that is reflected on students learning when they face contradictions existing in the practice scenes. Based of the previous, a project was proposed that has the purpase to strengthen and enhance students learning within hospital scope, through training clinical tutor nurses to share the responsibility for teaching with an innovative methodology called Clinical Tutoring, and which got sponsoring from the Program for Supparting Teaching Innovation and Betterment (PAPIME EN 223403/UNAM) in Mexico City. This project was structured to be achieved in three years; nawadays we are concluding the secondo year, and in the third year we hoope to brace the tutorial model as a permanent strategy that contributes to enhance students´upbringing quiality. It is important to highlight that the tutorial model as the one we have starded and from which we present the preliminary outcomes, has implications to learning achievernent and in generating new linking strategies between the School and the health institutions; this situation will be reflected when, in a determined time, the student succeeds in acquiring more social and cognitive abilities that would allow him/her to be increasingly autonomous on his/her own professional decisions and as a human being.

[Spontaneous subarachnoid hemorrhage,: is emergency transcranial Doppler sonography useful?]. / Hemorragia subaracnoidea espontánea: ¿ Es útil la ultrasonografía Doppler transcraneal urgente?

OBJECTIVE: To ascertain the value of transcranial Doppler ultrasonography (TCD) in the first 24 hours of hospital admission in patients suffering good-grade spontaneous subarachnoid hemorrhage (SAH) in order to detect a high-risk group for symptomatic vasospasm. METHOD: Forty-nine spontaneous good-grade SAH were included. The first TCD studies were carried out at the Emergency Department. At least one more TCD recording was performed between the 4th and 14th day. Patients were classified according to whether they came to the hospital during the first 72 hours after the haemorrhage (Group 1) or later (Group 2). FINDINGS: Thirty three patients were included in Group 1 and sixteen patients in Group 2. Thirteen patients (26.5%) had sonographic vasospasm. In eight of these patients (61 %), the vasospasm was symptomatic. The initial mean velocity (MV) for Group 1 was normal. The increase in MV/24h (MV/24h) within the first 72 hours after SAH was higher (p< 0.007), in those whose developed sonographic vasospasm. In Group 2, the initial MV was greater (p< 0.001)) in patients who suffered sonographic vasospasm, with or without symptoms. CONCLUSIONS: The ability of TCD recorded in the first 24 hours of hospital admission to detect high-risk vasospasm patients for SAH with low clinical severity helps decide the most efficient patient destination. During the first three days the MV/24h is of value but not the absolute figure of the MV. In contrast, between the 4th and 14th day after SAH, the absolute figure of MV was useful to predict vasospasm.

[The National Survey on Working Conditions: data for reflection]. / Encuesta Nacional de Condiciones de Trabajo: datos para la reflexión.

This work presents some data of relevance from the National Survey on Working Conditions, carried out in Spain in 1993. A cross-section survey was undertaken on a representative sample of the industry and services sectors (3,148 workers), both through an individual interview which took place at their places of work, and a questionnaire. The study revealed that preventive activities are few and far between. Only 11.8% of the companies carried out surveys into the risk of occupational accidents and/or illnesses. This datum contrasts with the high incidence among workers of exposure to the risk of accidents (59%), noise (33%) or the inhaling of chemical substances (32%). Furthermore, approximately 50% of workers spend at least a quarter of their work time in a static posture or making repetitive hand-arm movements. It is estimated that 60% are exposed to high work rates or repetitive tasks of short duration. Where the question of morbidity is concerned, 60% of workers suffer from posture problems associated with their work. In this study, a comparison is made between these findings per activity sector, together with a detailed analysis of morbidity. Finally, it should be borne in mind, that the subjectivity in the responses and answers, which is inherent to any qualitative survey, should not be regarded as a negative aspect. The way in which the worker perceives and experiences his or her work environment, provides essential information for the preventionists.

Diffuse cutaneous leishmaniasis acquired in Peru.

A case of diffuse cutaneous leishmaniasis (DCL) acquired in Peru is described. The causative agent was Leishmania mexicana amazonensis as determined by isoenzyme analysis and species-specific monoclonal antibody binding characteristics. Histological examination of biopsy material showed a large number of intracellular and extracellular amastigotes and few lymphocytes. Treatment with meglumine antimoniate (Glucantime) administered iv at a dosage of 20 mg antimony/kg body weight/day for 60 days resulted in visible improvement of the lesions, but not in clinical or parasitological cure.