Care Pathway at a Cancer Center for the Administration of Radiometabolic Therapy with 177Lu-PSMA in Patients with Metastatic Castration-resistant Prostate Cancer.

Objectives: To present a clinical care model for the administration of 177Lu-labeled prostate-specific membrane antigen (PSMA) in radiometabolic therapy for metastatic castration-resistant prostate cancer (mCRPC) at the National Cancer Institute (NCI) of Bogotá, Colombia. Methods: A care model was designed for patients with mCRPC based on the VISION study, a prospective, phase III, multicenter, open-label, randomized study in patients with positive 68Ga-PSMA positron emission tomography/computed tomography who had progressed to taxane and androgen therapy, to receive 177Lu-PSMA-617 combined with the best standard of care vs. the best standard of care alone. The care pathway provided to patients was developed by the Nuclear Medicine Group of the NCI and is the result of adjustments and improvements in the care process and the updating of the literature. Results: A systematic and efficient care model was formalized and implemented for the administration of 177Lu-PSMA therapy in patients with mCRPC who had previously been treated with at least one androgen receptor pathway inhibitor and one or two taxane regimens, with evidence of disease progression. Conclusion: An optimized process of care based on the determinants of clinical outcomes was developed for patients who received this type of radiometabolic therapy.

Prevalencia de diabetes gestacional en Colombia: una revisión sistemática y estudio comparativo

Introducción: Las mujeres embarazadas con diabetes mellitus gestacional DMG tienen un mayor riesgo de tener resultados adversos materno-infantiles, debido a lo cual es importante estimar la prevalencia de DMG en Colombia de acuerdo con los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo (IADPSG). Materiales y métodos: Se realizó una revisión sistemática mediante búsquedas en las bases de datos PubMed/Medline y Cochrane en inglés y español. La evaluación de la calidad se hizo mediante la metodología GRADE. Resultados: En la revisión sistemática se incluyó un total de 7 estudios con 37 795 participantes colombianas. La prevalencia de DMG en Colombia fue de 8,7 %. Conclusiones: Esta revisión sistemática se constituye en un primer estudio exploratorio en estimar la prevalencia de DMG en Colombia según criterios de la IADPSG. La estimación de la prevalencia global se sitúa cercana a la media mundial, sin embargo, estos resultados deben ser valorados con precaución por limitaciones en la opción de la guía para detección de diabetes gestacional y subregistro. WDF 15-955 Project, Barranquilla, Colombia.

Introduction: Pregnant women with GDM gestational diabetes mellitus have a higher risk of having adverse maternal-infant outcomes. Objective: To estimate the prevalence of GDM in Colombia according to the criteria of the International Association of Diabetes and Pregnancy Study Groups [IADPSG]. Materials and methods: A systematic review was carried out by searching the PubMed / Medline and Cochrane databases in English and Spanish. The quality assessment was done using the GRADE methodology. Results: A total of 7 articles with 37,795 Colombian participants were included in the systematic review. The prevalence of GDM in Colombia was 8.7 %. Conclusions: As far as we know, this systematic review is the first study to estimate the prevalence of GDM in women in Colombia according to criteria of the IADPSG. The results suggest a GDM prevalence in Colombia in the world average. Be careful with these results because there could be un-der-records.

Multi-site, multi-country randomized clinical trial of an acute traumatic brain injury caregiver transition assistance program in Latin America.

BACKGROUND: Individuals with traumatic brain injury (TBI) in Latin America experience high levels of disability and extremely poor functional outcomes, and their informal caregivers play a key role in their rehabilitation and care. OBJECTIVE: To improve TBI rehabilitation through stronger informal caregiving, this study developed and evaluated an evidence-based and culturally appropriate Transition Assistance Program (TAP) for informal caregivers of individuals with TBI in Latin America, specifically targeting the time period before and after the transition from hospital to home. METHODS: A sample of 89 people with a new TBI and their primary informal caregiver (n = 178) was recruited from two hospitals in Mexico City, Mexico, and in Cali, Colombia. Caregivers were randomly assigned to either the TAP group or to a control group receiving the standard care provided by the hospital. Caregivers completed measures of depression and burden, and individuals with TBI completed measures of depression and self-perceived burden on caregivers before hospital discharge and at 2- and 4-month follow ups. RESULTS: Caregivers in the TAP group reported significantly lower burden than those in the control group and marginally lower depression. Individuals with TBI whose caregivers had been in the TAP group reported significantly lower depression than those whose caregivers had been in the control group, and a non-significant but lower self-perceived burden on their caregivers. CONCLUSION: The results suggest that the TAP has strong potential to benefit both TBI caregivers and individuals with TBI during the transition from acute TBI hospitalization to home in Latin America, generally showing small-or medium-sized effects on key outcomes.

Estilos de aprendizaje utilizados por estudiantes de primer año de licenciaturas en Ciencias Médicas. Cienfuegos, 2019-2020

RESUMEN Fundamento: el estilo de aprendizaje está directamente relacionado con las estrategias que utiliza un estudiante para aprender algo. Una manera de entenderlo sería pensar en el estilo de aprendizaje como la media estadística de todas las estrategias que utiliza. Se corresponden, por tanto, las grandes tendencias con las estrategias más usadas. Objetivo: determinar las estrategias y estilos de aprendizaje que utilizaron los estudiantes de primer año de las licenciaturas en Ciencias Médicas, durante el proceso docente-educativo del curso 2019-2020. Métodos: estudio descriptivo acerca de la relación entre estrategias, estilos de aprendizaje y la calidad de la enseñanza. Del universo constituido por 152 estudiantes de primer año de las carreras seleccionadas, se determinó una muestra de 121, que representan el 80,6 %. Se empleó la observación del proceso, el análisis documental, la aplicación de encuestas y el test del aprendizaje de Kolb. Los resultados fueron procesados estadísticamente, aplicando la hoja de cálculo Microsoft Excel y el paquete profesional SPSS para Windows versión 11.0. Resultados: se identificaron las estrategias y estilos de aprendizaje que utilizan los estudiantes, relacionándolos con los resultados académicos del primer año de la carrera. Predominó la estrategia de recirculación de la información y el estilo de aprendizaje visual. Al aplicar la rueda del aprendizaje de Kolb prevaleció el tipo de alumno teórico o convergente. Conclusiones: la calidad de la promoción alcanzada por los estudiantes puede considerarse satisfactoria, porque la mayoría de los resultados evaluativos se ubican en las categorías excelente y bien.

ABSTRACT Background: the learning style is directly related to the strategies that a student uses to learn something. One way to understand it would be to think of the learning style as the statistical mean of all the strategies used. Therefore, the major trends correspond to the most used strategies. Objective: to determine the strategies and learning styles used by first-year students of medical science degrees, during the teaching-educational process of the 2019-2020 academic year. Methods: descriptive and retrospective study about the relationship between strategies, learning styles and the quality of teaching. From the universe of 152 first-year students from the selected careers, a sample of 121 was determined, representing 80.6%. The observation of the process, the documentary analysis, the application of surveys and the Kolb learning test were used. The results were statistically processed, applying the Microsoft Excel spreadsheet and the SPSS professional package for Windows version 11.0. Results: the learning strategies and styles used by the students were identified, relating them to the academic results of the first year of the degree. The information recirculation strategy and the visual learning style predominated. When applying Kolb's wheel of learning, the theoretical or convergent type of student prevailed. Conclusions: the quality of the promotion achieved by the students can be considered satisfactory, because most of the evaluative results are located in the excellent and good categories.

Enterobacterales productores de carbapenemasas en sifones de lavamanos de una Unidad de Paciente Crítico / Carbapenemase-producing Enterobacterales in the sink traps of a Critical Patient Unit

INTRODUCCIÓN: Enterobacterales productores de carbapenemasas (EPC) son una importante causa de infecciones asociadas a la atención en salud (IAAS). El principal reservorio de EPC lo constituyen pacientes infectados y colonizados, sin embargo, también se han identificado reservorios ambientales. OBJETIVO: Detectar la presencia de EPC en los sifones de lavamanos de la unidad de cuidados críticos de pacientes quemados adultos (UPC QMD) y unidad de cuidados críticos de pacientes pediátricos crónicos (UCEP). MÉTODO: Se recolectaron cuatro muestras de sifones de los lavamanos ubicados en el interior de las unidades de pacientes en UCEP y 10 de UPC QMD. A las muestras se les realizó estudio fenotípico y molecular para detección de carbapenemasas en el Instituto de Salud Pública de Chile. RESULTADOS: En los sifones estudiados de UCEP no se aislaron cepas de EPC. En UPC QMD, 50% de los sifones estudiados se aislaron cepas de EPC. CONCLUSIONES: En UPC QMD se objetivó la presencia de EPC en una alta proporción de los sifones de lavamanos testeados, lo que demuestra un reservorio ambiental de bacterias multi-resistentes.

INTRODUCTION: Carbapenemase-producing Enterobacterales (CPE) are an important cause of health care associated infections (HAI). The main reservoir is constituted by infected and colonized patients; however, environmental reservoirs have also been identified. OBJECTIVE: To detect the presence of CPE in the sink traps of the critical care unit for adult burn patients (UPC QMD) and the critical care unit for chronic pediatric patients (UCEP). MATERIAL AND METHOD: Four samples of trap were collected from the sinks located inside the patient units at PICU and 10 at UPC QMD. The samples underwent a phenotypic and molecular study for the detection of carbapenemases at the Institute of Public Health of Chile. RESULTS: In the UCEP no EPC strains were isolated. In UPC QMD, CPE was detected in 50% of the traps. CONCLUSIONS: In UPC QMD, the presence of CPE was observed in a high proportion of the tested sinks traps, which shows an environmental reservoir of multi-resistant bacteria.

Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer / Regulación de los servicios de medicina nuclear: percepción de la problemática y desafíos para el manejo del cáncer en Colombia

Introduction: Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer. Objective: To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia. Materials and methods: We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance. Results: The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors' criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs. Conclusions: Our findings suggest that nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care.

Introducción. La modificación de las normas sobre medicina nuclear en Colombia ha afectado la administración de la terapia de yodo radioactivo en el tratamiento del cáncer de tiroides. Objetivos. Determinar las áreas de acuerdo en torno al problema, los requisitos actuales y los nuevos exigidos en la normativa para el funcionamiento de los servicios de medicina nuclear. Materiales y métodos. Se hizo un estudio Delphi de dos rondas con cada grupo de expertos, 'clínicos' y 'de entidades reguladoras'. En la primera ronda se exploraron los puntos de vista sobre las implicaciones de la normativa en medicina nuclear y, en la segunda, se calificaron las declaraciones de la primera según su relevancia. Resultados. La problemática de los servicios de medicina nuclear está relacionada con la claridad normativa, y la falta de sinergia y coherencia entre los organismos de inspección, vigilancia y control. Las exigencias del sistema de gestión de desechos requieren una alta inversión económica que puede influir en la oferta del servicio y repercutir en el control integral del cáncer de tiroides. Entre las necesidades presentes y futuras, se encuentran la unificación de criterios entre los auditores, la delimitación de funciones de los actuantes, la asistencia técnica para cumplir con la normativa, y la veeduría a los organismos de inspección, vigilancia y control por parte de los entes reguladores. Conclusión. Los hallazgos del estudio sugieren que los servicios de medicina nuclear atraviesan un momento de múltiples desafíos institucionales, normativos y económicos, que ponen en riesgo el desarrollo y mantenimiento de la medicina nuclear en la atención oncológica.

Regulación de los servicios de medicina nuclear: percepción de la problemática y desafíos para el manejo del cáncer en Colombia / Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer

Resumen | Introducción. La modificación de las normas sobre medicina nuclear en Colombia ha afectado la administración de la terapia de yodo radioactivo en el tratamiento del cáncer de tiroides. Objetivos. Determinar las áreas de acuerdo en torno al problema, los requisitos actuales y los nuevos exigidos en la normativa para el funcionamiento de los servicios de medicina nuclear. Materiales y métodos. Se hizo un estudio Delphi de dos rondas con cada grupo de expertos, 'clínicos' y 'de entidades reguladoras'. En la primera ronda se exploraron los puntos de vista sobre las implicaciones de la normativa en medicina nuclear y, en la segunda, se calificaron las declaraciones de la primera según su relevancia. Resultados. La problemática de los servicios de medicina nuclear está relacionada con la claridad normativa, y la falta de sinergia y coherencia entre los organismos de inspección, vigilancia y control. Las exigencias del sistema de gestión de desechos requieren una alta inversión económica que puede influir en la oferta del servicio y repercutir en el control integral del cáncer de tiroides. Entre las necesidades presentes y futuras, se encuentran la unificación de criterios entre los auditores, la delimitación de funciones de los actuantes, la asistencia técnica para cumplir con la normativa, y la veeduría a los organismos de inspección, vigilancia y control por parte de los entes reguladores. Conclusión. Los hallazgos del estudio sugieren que los servicios de medicina nuclear atraviesan un momento de múltiples desafíos institucionales, normativos y económicos, que ponen en riesgo el desarrollo y mantenimiento de la medicina nuclear en la atención oncológica.

Abstract | Introduction: Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer. Objective: To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia. Materials and methods: We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance. Results: The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors' criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs. Conclusions: Our findings suggest that nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care.

Calidad de vida en el adulto mayor con diabetes mellitus tipo II / Quality of life in the elderly with type II diabetes mellitus

RESUMEN Objetivo: Conocer la calidad de vida de una familia de dos adultos mayores que padecen diabetes mellitus tipo II. Material y método: Se realizó un estudio de caso con diseño cualitativo, se aplicó entrevista a profundidad utilizando como referencia los ejes, categorías y subcategorías del Modelo de Valoración Familiar de Calgary y un diario de campo. Los datos se analizaron a través de la técnica de análisis de contenido; se aplicó la estrategia de "triangulación de investigador". Resultados: Las principales categorías que emergieron fueron: la importancia del rol de los padres en la crianza de sus hijos, la educación como base de la superación personal, limitaciones de la edad y secuelas de una vida con diabetes, amor costumbre y dependencia y red de apoyo pilar fundamental para el desarrollo de los adultos mayores. Conclusiones: Las intervenciones del profesional de enfermería están orientadas a favorecer el autocuidado y enseñar a vivir con las nuevas características dadas por las secuelas de su edad y de las complicaciones de las patologías que los aquejan. En caso necesario, se debe fortalecer la red social, buscando recursos familiares y extrafamiliares que participen en la resolución de las crisis que se presenten. Las relaciones con amigos, vecinos y compañeros se consideran también importantes para ofrecer otros tipos de ayuda, estas se establecen a través de intereses comunes y actividades compartidas y son esenciales fuera del contexto del hogar.

ABSTRACT Objective: To know the quality of life of a family of two older adults suffering from Type II Diabetes Mellitus. Material and method: A case study with qualitative design was carried out, an in-depth interview was applied using as reference the axes, categories and subcategories of the Calgary Family Valuation Model and a field diary. The data was analyzed through the technique of content analysis, the strategy of "investigator triangulation" was applied. Results: The main categories that emerged were: the importance of the role of parents in the upbringing of their children, education as a basis for self-improvement, age limitations and sequelae of a life with diabetes, love, habits and dependency and support network, a fundamental support pillar for the development of the elderly. Conclusions: The interventions of the registered nurse are oriented to favor self-care and teach to live with the new characteristics given by the consequences of their age and the complications of the pathologies that afflict them. If necessary, the social network should be strengthened, seeking family and extra-family resources to participate in the resolution of the crises that arise. Relationships with friends, neighbors and colleagues are also considered important to offer other types of help. These are established through common interests and shared activities and are essential outside the home context.

Eficacia de lutecio-177 DOTATATE/TOC en pacientes con tumores neuroendocrinos bien diferenciados en estado avanzado. Ensayo clínico fase II / Efficacy of Lutetium-177 DOTATATE/TOC in Advanced Neuroendocrine Tumors

Resumen Introducción: En 2009, el Instituto Nacional de Cancerología (INC) elaboró el 177Lu-DOTATATE/TOC. El propósito del estudio fue demostrar la eficacia de estos radiopéptidos en el tratamiento paliativo de pacientes con tumores neuroendocrinos (TNE) avanzados inoperables (metastásicos o localmente avanzados) y en progresión. Métodos: Ensayo clínico abierto fase II de un solo brazo en 13 pacientes adultos con TNE grado 1 o 2, con expresión de receptores de somatostatina en lesiones blanco demostrada por captación Krenning 3 o 4 en 99mTc-HYNIC TOC. Los pacientes fueron tratados con 177Lu-DOTATATE o 177Lu-DOTATOC (según disponibilidad) a una actividad acumulativa proyectada de 600-800 mCi dividida en 3-4 dosis cada 6-9 semanas comenzando siempre con una actividad fija de 200 mCi y dosimetría con la primera dosis. El desenlace primario fue la respuesta objetiva calculada 6 y 12 meses después de la última dosis del tratamiento. Resultados: Se incluyeron 13 pacientes (7 mujeres) de 63 ± 11,6 años con TNE avanzado inoperable y en progresión. La actividad final administrada fue de 800 mCi, 600 mCi, 400 mCi y 200 mCi en 4, 7, 1 y 1 pacientes, respectivamente. La tasa de control de enfermedad a 6 y 12 meses fue de 69,2% y 45,5%, respectivamente, logrando únicamente enfermedad estable. Fallecieron 7 pacientes, 2 de ellos en los primeros 6 meses. La mediana de supervivencia global a partir de la última dosis del radiopéptido fue de 15,7 meses. Conclusiones: Se corroboró la eficacia y la seguridad del tratamiento con los radiopéptidos en NETs avanzados.

Abstract Objectives: The National Cancer Institute first elaborated 177Lu-DOTATATE/TOC in 2009. The purpose of this study was to prove the efficacy of these radiopeptides in the palliative treatment of patients with progressive advanced inoperable neuroendocrine tumors (NETs). Methods: A single-phase phase II open clinical trial was conducted in 13 adult patients with grade 1 y 2 NETs, with expression of somatostatin receptors in target lesions proven by Krenning Score 3 or 4 uptake in 99mTc-HYNIC TOC. Patients were treated with 177Lu-DOTATATE or 177Lu-DOTATOC (depending upon availability) at a projected acumulative activitiy of 600-800 mCi divided into 3-4 doses every 6-9 weeks always beginning with a fixed activity of 200 mCi and dosimetry during the first dose. The primary outcome was objective response to therapy. Results: 13 patients (7 women) aged 63 ± 11.6 years with inoperable advanced NETs were included. The final therapeutic administered activity was 800 mCi, 600 mCi, 400 mCi and 200 mCi in 4, 7, 1 and 1 patients, respectively. The disease control rate at 6 and 12 months was 69.2% and 45.5%, respectively, only obtaining stable disease. Six patients died, 2 of them in the first 6 months. Median overall survival was 15.7 months from the last treatment dose. Conclusions: The efficacy of the treatment with 177Lu-DOTATATE or 177Lu-DOTATOC radiopeptides elaborated in-house was confirmed, becoming a management alternative for patients with advanced NETs.

Significados construidos de las prácticas en simulación clínica por estudiantes de enfermería / Significados construidos da práticas em simulação clínica por estudantes de enfermagem / Constructed meanings of clinical simulation practices by nursing students

Resumen: Objetivo: Describir los significados que han construido los estudiantes de enfermería a partir de la experiencia en simulación clínica para satisfacer sus necesidades de aprendizaje. Metodología: La metodología es cualitativa descriptiva, desde un paradigma hermenéutico. El diseño corresponde a un estudio de casos de tipo instrumental. Se aplicó un grupo focal y entrevistas en profundidad a estudiantes de 5° año de la carrera de enfermería de la Universidad Mayor Temuco, Chile, año 2015. La reducción de datos se hizo desde el software Atlas Ti, versión 7.0. La transcripción de la data verbal se desarrolló a partir del convencionalismo de Jefferson, lo que permitió el desarrollar procesos de codificación y análisis de narrativas. Resultados: Surgieron 4 categorías: Características de la simulación clínica, expectativas formativas simulación clínica, competencias movilizadas e importancia de la simulación para la práctica clínica. Dentro de los resultados observados, los estudiantes reconocen que la simulación clínica proporciona un entorno seguro y libre de riesgos, pueden integrar lo aprendido en la teoría a la práctica, sin temor de causar daño a los pacientes, pudiendo cometer errores, logrando así un aprendizaje significativo. Además, permite el desarrollo de competencias como trabajo en equipo, comunicación efectiva, resolución de problemas, manejo del estrés y liderazgo. Todo esto mejora la confianza y seguridad del estudiante al momento de enfrentarse al paciente real, promoviendo la entrega de cuidados enfermeros de calidad, resguardando la seguridad de los usuarios. Conclusión: Los estudiantes valoran desde una perspectiva técnica y personal la simulación clínica como una metodología de aprendizaje que facilita la integración entre teoría y práctica, promoviendo la seguridad del paciente, la autoconfianza y seguridad en el estudiante.

Resumo: Objetivo: Descrever os significados que os estudantes de enfermagem construíram a partir da experiência em simulação clínica para atender as suas necessidades de aprendizagem. Metodologia: Estudo descritivo qualitativo a partir de um paradigma hermenéutico. O design corresponde a um estudo de caso do tipo instrumental. Um grupo focal e entrevistas em profundidade foram aplicados aos alunos do quinto ano da carreira de enfermagem na Universidad Mayor Temuco, Chile, 2015. A redução de dados foi feita a partir do software Atlas Ti, versão 7.0. A transcrição de dados verbais foi desenvolvida a partir do convencionalismo de Jefferson, o que permitiu o desenvolvimento de processos de codificação e análise de narrativas. Resultados: Emergiram quatro categorias: Características da simulação clínica, expectativas formativas, simulação clínica, competências mobilizadas e importância da simulação para a prática clínica. Dentro dos resultados observados, os estudantes reconhecem que a simulação clínica proporciona um ambiente seguro e livre de riscos, eles podem integrar o que aprenderam na teoria à prática, sem medo de causar danos aos pacientes, sendo capazes de cometer erros, alcançando assim a aprendizagem. significativo Também permite o desenvolvimento de habilidades como trabalho em equipe, comunicação eficaz, resolução de problemas, gerenciamento de estresse e liderança. Tudo isso melhora a confiança e a segurança do aluno frente ao paciente real, promovendo a entrega de cuidados de enfermagem de qualidade, resguardando a segurança dos usuários. Conclusão: Os estudantes valorizam, de uma perspectiva técnica e pessoal, a simulação clínica como metodologia de aprendizagem que facilita a integração entre teoria e prática, promovendo a segurança do doente, a autoconfiança e a segurança no estudante.

Abstract: Objective: To describe the meanings that nursing students have built from clinical simulation experience to meet their learning needs. Methodology: The descriptive qualitative study from a hermeneutic paradigm. The design corresponds to an instrumental case study. A focus group and in-depth interviews were applied to 5th year students of the nursing career of Universidad Mayor Temuco, Chile, 2015. Data reduction was done from Atlas Ti software, version 7.0. The transcription of verbal data was developed from Jefferson transcription convention, which allowed the development of codification processes and analysis of narratives. Results: 4 categories emerged: Characteristics of clinical simulation, training expectations of clinical simulation, mobilized competencies and the importance of simulation for clinical practice. Within the observed results, students recognize that clinical simulation provides a safe and risk-free environment, they can integrate what they have learned in theory, into practice, without fear of causing harm to patients, being able to make mistakes, therefore,achieving meaningful learning. In addition, it allows the development of competencies such as teamwork, effective communication, problem solving, stress management and leadership. All this improves the confidence and safety of the student when facing real patients, promoting the delivery of quality nursing care, safeguarding the safety of users. Conclusion: Students value clinical simulation from a technical and personal perspective as a learning methodology that facilitates integration between theory and practice, promoting patient safety, self-confidence and security in the student.

A Multi-Site Study of Traumatic Brain Injury in Mexico and Colombia: Longitudinal Mediational and Cross-Lagged Models of Family Dynamics, Coping, and Health-Related Quality of Life.

Latin America has high rates of traumatic brain injury (TBI), yet reduced mental and physical health outcomes due to limited rehabilitation services. To understand the psychosocial adjustment process in TBI patients in Latin America, the incorporation of cultural values including family-based variables is imperative. The current study examined relations among healthy family dynamics, coping, and mental and physical health related quality of life (HRQL) among a sample of TBI patients across three sites and two countries over the first 4 months post-injury. A sample of 109 acute TBI patients from Mexico and Colombia were recruited, and a series of longitudinal mediation and cross-lag panel analyses were run. Mental and physical HRQL were positively associated with each other, as well as healthy family dynamics and coping. Coping partially mediated the effects of healthy family dynamics on both mental and physical HRQL. Family dynamics showed the strongest cross-lag relationships with coping going from 2 months to 4 months. Similarly, coping showed the strongest cross-lag relationships with both mental and physical HRQL going from baseline to 2 months. Results provide empirical support for the importance of a rehabilitation workforce that has been trained in and can effectively implement family-based interventions for individuals with TBI in Latin America.

Relationship Satisfaction and Depression After Traumatic Brain Injury: An Actor-Partner Interdependence Model of Patients and Caregivers in Mexico and Colombia.

OBJECTIVE: Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship. DESIGN: Dyads (N = 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization. RESULTS: A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients' higher satisfaction at 4 mos. CONCLUSIONS: Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients' and caregivers' depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationship.

Predictors of longitudinal depression trajectories after traumatic brain injury in Latin America: A multi-site study.

BACKGROUND: Latin America has exceptionally high rates of traumatic brain injury (TBI), but very little research has been conducted on longitudinal TBI outcomes in this global region. OBJECTIVE: This study examined whether cognitive dysfunction and social disadaptation in individuals with TBI in Latin America at hospital discharge predict longitudinal trajectories of depression at baseline, 2 months, and 4 months. METHODS: A sample of 109 people with a new TBI was recruited from three hospitals: Mexico City, Mexico, Cali, Colombia and Neiva, Colombia. Participants completed measures of cognitive dysfunction and social disadaptation before hospital discharge and measures of depression at baseline, 2 months, and 4 months. RESULTS: Results suggested that depression scores were found to decrease over time in a quadratic (or U-shaped) fashion, and more significant cognitive dysfunction at hospital discharge was associated with higher longitudinal depression trajectories. Social disadaptation did not exert a unique effect on depression trajectories after controlling for cognitive dysfunction. Depression trajectories changed differentially over time as a function of baseline cognitive dysfunction, such that for those with high cognitive impairment, depression scores started high and then dropped to a moderated range and plateaued, but for individuals with low cognitive dysfunction, depression scores started lower and decreased linearly but moderately. CONCLUSIONS: The results suggest a strong need for neuropsychological assessments and evidence-based cognitive rehabilitation strategies to be implemented immediately after TBI in Latin America, which could exert salubrious effects on depression trajectories over time.

Predictors of Early Reading Acquisition in Children of Low Socioeconomic Status / Preditores da Leitura Inicial em Crianças de Baixa Condição Socioeconômica / Predictores de la Lectura Inicial en Niños de Condiciones Socioeconómicas Bajas

Abstract The aim of the present study was to identify the predictors of early-grade reading acquisition in monolingual speakers of a transparent language. Eighty students attending preschool (M = 5 years, SD = 0.40), first grade (M = 6 years, SD = 0.59) and second grade (M = 7 years, SD = 0.55) in a public institution participated in the study. All were evaluated with the Early Grade Reading Acquisition test, an ad hoc sociodemographic questionnaire and the language domain of the Child Neuropsychological Assessment battery. Multiple regression analysis showed that phonological awareness and years of education are the factors that explain reading performance of children in their early years of school. These findings highlight the importance of improving oral skills prior to early reading acquisition and contribute to enhancing the early reading skills of monolingual children with limited socioeconomic opportunities.

Resumo O presente estudo teve como objetivo identificar os preditores da leitura inicial de uma linguagem transparente em crianças monolíngues. Oitenta alunos pertencentes à educação infantil N3 (M = 5 anos, DE = 0.40), 1ª série (M = 6 anos, DE = 0.59) e 2ª série (M = 7 anos, DE = 0.55) do ensino fundamental participaram do estudo. As crianças foram avaliadas por meio do teste Early Grade Reading Acquisition, por um questionário sociodemográfico ad hoc e apenas pelo Domínio da Linguagem do teste Evaluación Neuropsicológica Infantil. A análise de regressão múltipla mostrou que a consciência fonológica e o nível de escolaridade são os fatores que explicam o desempenho na leitura em crianças nas primeiras séries. Os resultados deste estudo sugerem a importância de promover habilidades orais antes da aquisição da leitura inicial, para melhorar o aprendizado da leitura de crianças monolíngues com limitadas oportunidades socioeconômicas.

Resumen El presente estudio tuvo por objetivo identificar los predictores de la lectura inicial en niños monolingües de un lenguaje transparente. Ochenta estudiantes que cursaban los grados de transición (M = 5 años, DE = 0.40), primero (M = 6 años, DE = 0.59) y segundo de primaria (M = 7 años, DE = 0.55) en una institución pública, participaron en el estudio. Todos fueron evaluados con la prueba Early Grade Reading Acquisition, un cuestionario sociodemográfico ad hoc y el dominio de Lenguaje de la batería Evaluación Neuropsicológica Infantil. Los análisis de regresión múltiple mostraron que la conciencia fonológica y el grado de escolaridad son los factores que explican el desempeño lector de niños de los primeros grados escolares. Estos hallazgos destacan la importancia de promover habilidades orales previas a la adquisición de la lectura inicial, para mejorar el aprendizaje lector de niños monolingües, con limitadas oportunidades socio-económicas.

Herramientas pedagógicas con enfoque interprofesional para la preparación del claustro docente / Pedagogical tools with interprofessional approach for the preparation of the teaching staff

RESUMEN Reflexión sobre la educación interprofesional, tendencia pedagógica a la que organizaciones como la OMS/OPS le otorgan una relevante importancia para la formación de profesionales de la salud. Se consultaron diferentes fuentes bibliográficas, así como documentos rectores y normativos vigentes en la enseñanza de las ciencias médicas, con el objetivo de caracterizar a la educación interprofesional, vertiente educativa que ha tomado auge a nivel mundial y demostrar que, para lograr su desarrollo en Cuba, es necesario preparar los claustros docentes. Se proponen 14 acciones que pueden convertirse en herramientas útiles para lograr dicha preparación. Se llegó a la conclusión de que los equipos interprofesionales de atención de salud optimizan las aptitudes de sus miembros para prestar servicios holísticos, centrados en el paciente y de alta calidad. En este sentido, la educación interprofesional es un paso necesario para preparar la fuerza de trabajo, a fin de que colabore y responda a las necesidades de salud en un entorno dinámico. De ahí su importancia como estrategia destinada a fortalecer la capacidad de los recursos humanos, mejorar los resultados o indicadores y, además, fortalecer los sistemas de salud.

ABSTRACT Reflection on interprofessional education, a pedagogical trend to which organizations such as the WHO / PAHO attach relevant importance to the training of health professionals. Different bibliographic sources were consulted, as well as current and normative documents in force in the teaching of medical sciences, with the aim of characterizing interprofessional education, an educational aspect that has taken boom worldwide and demonstrating that, to achieve its development in Cuba , it is necessary to prepare the teaching staff. Fourteen actions are proposed that can become useful tools to achieve such preparation. It was concluded that interprofessional health care teams optimize their members´ skills to provide holistic, patient-centered and high quality services. In this sense, interprofessional education is a necessary step to prepare the staff, to achieve collaboration and respose to health needs in a dynamic environment. Hence its importance as a strategy aimed at strengthening the capacity of human resources, improving results or indicators and, in addition, strengthening health systems.

Poly(3-hydroxybutyrate) graft copolymer dense membranes for human mesenchymal stem cell growth

Background: The use of novel materials as an artificial extracellular matrix for stem cell growth is a current strategy of increasing interest for regenerative medicine. Here, we prepare thermal-remolded membrane scaffolds from poly(3-hydroxybutyrate) grafted with 2-amino-ethyl methacrylate hydrochloride. However, it is unclear whether these membranes are useful for tissue engineering. Results: The mechanical properties, tribology, and morphology of the dense membranes were assessed. The results show that tensile strain at break and roughness of the compressed membrane decrease with increasing graft degree. Moreover, graft copolymer membranes showed lower resistance to scratching, greater degree of swelling and higher brittleness than un-grafted P(3HB) films. Thus, it effectively supports the growth of dermal fibroblast, as demonstrated by epifluorescence microscopy. Conclusions: It is concluded that the developed membrane can be properly used in is the restoration of skin tissue. How to cite: González-Torres M, Sánchez-Sánchez R, Solís-Rosales SG, et al. Poly(3-hydroxybutyrate) graft copolymer dense membranes for human mesenchymal stem cell growth.

Estadios ninfales de Amnestus rugosus (Hemiptera: Cydnidae) / Immature stages of Amnestus rugosus (Hemiptera: Cydnidae)

ResumenEn México se han registrado 29 especies del género Amnestus, de las cuales, seis se encuentran en el estado de Veracruz. Se describen e ilustran las características morfológicas de los estadios inmaduros de A. rugosus, incluyendo notas sobre su biología y comportamiento. Las ninfas y adultos fueron recolectados en los remanentes de la vegetación riparia del bosque mesófilo en la cuenca del río La Antigua, Veracruz. El muestreo se realizó en la zona montañosa del centro del estado y en la parte media de la cuenca. Se seleccionaron 12 sitios ubicados en cinco municipios, y se realizaron muestreos en época de lluvias (julio) y en secas (abril); las muestras fueron procesadas en embudos de Berlese-Tullgren y Winkler. Se recolectaron y revisaron 419 ejemplares, 320 adultos y 99 ninfas de A. rugosus. El tamaño y coloración del cuerpo y los patrones de puntuación son las principales diferencias entre los estados inmaduros de A. rugosus, A. ficus y A. morelensis.A. rugosus representa un nuevo registro para Veracruz.

Abstract:In Mexico there are 29 species of Amnestus, of which six species are from Veracruz. The morphological features and illustrations of immature stages of A. rugosus are presented. Notes about the biology and behavior were included. The nymphal and adult stages of A. rugosus were found in remnants of riparian vegetation of the mesophilous forest in La Antigua river basin, Veracruz, Mexico. Twelve sites in five localities were selected and the specimens were sampled in rainy (July) and dry (April) seasons of 2012. The samples were processed in Berlese-Tullgren funnel and Winkler. A total of 419 individuals, 320 adults and 99 nymphs of A. rugosus were revised. The size and coloration of the body and punctuation patterns the immature stages of A. rugosus, A. ficus, and A. morelensis are the main differences among these species. A. rugosus is a first record from Veracruz. Rev. Biol. Trop. 65 (1): 31-39. Epub 2017 March 01.

Efectividad de la aplicación de un diplomado para atender la diversidad estudiantil en ciencias médicas / Effectiveness of the application of a diploma course to assist the student´s diversity in medical sciences

Fundamento: el profesor universitario debe estar preparado para responder a las necesidades educativas individuales y grupales que la comunidad educativa requiere. Objetivo: valorar la efectividad de un diplomado para atender la diversidad en los grupos estudiantiles de ciencias médicas. Métodos: se realizó un estudio cuasiexperimental evaluativo, desde febrero 2012 a 2015. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y modelación; empíricos: análisis de documentos, observación de clases, encuesta, experimento pedagógico formativo y registro de información; y matemáticos estadísticos: distribución de frecuencias, porciento y cálculo de la efectividad. El diplomado fue valorado y aceptado por 12 expertos a través del Método Delphi. Su efectividad se valoró en dos etapas: diagnóstico y evaluación. Resultados: el estudio realizado permitió diagnosticar las carencias de los docentes para atender la diversidad estudiantil a partir de indicadores establecidos para las dimensiones currículo, organización y metodología, por lo que se elaboró un diplomado con las temáticas pertinentes para su solución. Antes de su aplicación se constataron niveles muy bajos de conocimientos pedagógicos y después de su aplicación, se observaron saltos de calidad en la preparación del profesorado. Conclusiones: la investigación demostró la efectividad del diplomado como curso de superación posgraduada, para resolver las insuficiencias de los docentes en la atención a la diversidad.

Background: the university professor should be prepared to respond to individual and group educational necessities that the educational community requires. Objective: to value the effectiveness of a diploma course to assist diversity in the group of students of the medical sciences. Methods: it was carried out a cuasie-xperimental assessment study, from February 2012 to 2015. Theoretical methods were used: historical-logical, analytic-synthetic, inductive-deductive and modelling; empiric: analysis of documents, observation of classes, interviews, formative pedagogic experiment and registration of information; and mathematical statistical: distribution of frequencies, percent and calculation of the effectiveness. The diploma course was valued and accepted by 12 experts through the Delphi Method. Its effectiveness was valued in two stages: diagnostic and assessment. Results: the study allowed diagnosing the deficiencies of the professors to assist the student´s diversity through established indicators for the curriculum, organization and methodology dimensions, for that reason a diploma course was elaborated with pertinent topics for its solution. Before its application very low levels of pedagogic knowledge were verified and after its application, a quality increase in the professor's preparation was observed. Conclusions: the investigation demonstrated the diploma course effectiveness as a postgraduate upgrading course, to solve the deficiencies of the professors in the attention to diversity.

[Immature stages of Amnestus rugosus (Hemiptera: Cydnidae)]. / Estadios ninfales de Amnestus rugosus (Hemiptera: Cydnidae).

In Mexico there are 29 species of Amnestus, of which six species are from Veracruz. The morphological features and illustrations of immature stages of A. rugosus are presented. Notes about the biology and behavior were included. The nymphal and adult stages of A. rugosus were found in remnants of riparian vegetation of the mesophilous forest in La Antigua river basin, Veracruz, Mexico. Twelve sites in five localities were selected and the specimens were sampled in rainy (July) and dry (April) seasons of 2012. The samples were processed in Berlese-Tullgren funnel and Winkler. A total of 419 individuals, 320 adults and 99 nymphs of A. rugosus were revised. The size and coloration of the body and punctuation patterns the immature stages of A. rugosus, A. ficus, and A. morelensis are the main differences among these species. A. rugosus is a first record from Veracruz.

[Comparative study of the efficacy of larva therapy for debridement and control of bacterial burden compared to surgical debridement and topical application of an antimicrobial]. / Estudio comparativo de la eficacia de la larvaterapia (LT) para desbridar y controlar la carga bacteriana en úlceras venosas comparado con desbridamiento quirúrgico y aplicación de un antimicrobiano tópico.

Maggot debridement therapy (MDT) is the use of medical grade maggots of the fly Lucilia sericata for wound debridement. Recent observations show that MDT decreases bacterial burden as well. Venous ulcers are the most commonly seen in wound clinics and require, besides adequate treatment of venous hypertension, proper wound bed preparation with debri dement of necrotic tissue and control of potential infections. To evaluate the efficacy of MDT in venous ulcers a randomized controlled trial was designed to compare MDT to surgical debridement and topical application of silver sulfadiazine (SSD) in 19 patients for 4 weeks. The study variables were area reduction, wound bed characteristics, pain, odor, anxiety and bacterial burden using quantitative tissue biopsies. MDT was effective as surgical debridement associated with topical SDD in the debridement of the wound and in reducing its size. A significant difference was observed in the reduction of bacterial burden in favor of the MDT group. Odor and anxiety increased in the MDT group without any difference in the pain intensity between groups. In conclusion, this study suggests that MDT is as effective as surgical debridement for the debridement of necrotic tissue and promote wound healing in venous ulcers and better at reducing bacterial burden.