Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Experiencia formativa de académicos en dos universidades latinas en diplomado de simulación clínica en enfermería / Training Experience with Scholars from two Latin-American Universities during a Diploma Course in Nursing Clinical Simulation

Introducción: Capacitar en simulación clínica asegura calidad de la enseñanza e incrementa conocimientos necesarios para realizar procesos dinámicos que involucren creación de entornos hipotéticos de representaciones auténticas de realidades sanitarias. Esta estrategia reviste importancia para concretar productos e insumos derivados de entrenamientos en simulación, ligados a satisfacción de profesionales que finalizan estas experiencias formativas. Objetivo: Conocer la satisfacción general de académicos y el producto obtenido de una experiencia formativa en modalidad de diplomado en simulación clínica de alta fidelidad. Métodos: Estudio descriptivo, de corte trasversal, con análisis teórico-lógico-reflexivo desde la literatura que respaldó el diseño didáctico del proyecto. Se trabajó con la totalidad de académicos de la Facultad de Enfermería, Universidad de Panamá (N = 146), durante mayo-julio del 2022. Hubo clases sincrónicas y asincrónicas y una semana presencial para exposiciones de escenarios. Se evaluó la estrategia con cuestionario de cinco dimensiones validado por criterios de jueces. El puntaje Alfa de Cronbach final fue 0,89. Se incluyeron profesores con más de 92 por ciento de asistencia a clases, los que tuvieron conexiones inestables a encuentros se excluyeron. Se realizó análisis estadístico descriptivo en programa SPSS. Se siguieron normas éticas y recomendaciones para estudios con seres humanos. Resultados: El 99 por ciento evaluó la capacitación con nivel de satisfacción muy alto. Se obtuvieron productos clave, como reglamentos, consentimientos informados y banco de escenarios validados, como insumos de trabajo para la facultad. Conclusiones: Los resultados configuraron respuestas de un grupo de académicos capacitados en simulación clínica, con valoración de muy alta satisfacción. Los productos obtenidos se encaminaron a normativas y guías para uso de simulación(AU)

Introduction: Clinical simulation training ensures the quality of teaching and increases the knowledge necessary to carry out dynamic processes involving the creation of hypothetical environments of authentic representations of health realities. This strategy is important for the realization of products and inputs derived from simulation training, linked to the satisfaction of professionals who complete these training experiences. Objective: To know the general satisfaction of scholars and the product obtained from a training experience as a diploma course in high-fidelity clinical simulation. Methods: A descriptive and cross-sectional study was carried out, following a theoretical-logical-reflexive analysis from the literature, which supported the didactic design of the project. The working methodology included all the scholars from the Nursing School at University of Panama (N=146), during May-July 2022. There were synchronous and asynchronous classes, as well as a face-to-face week for scenario presentations. The strategy was evaluated with a five-dimension questionnaire validated by judges' criteria. The final Cronbach's alpha score was 0.89. Professors with more than 92 percent of class attendance were included; those with unstable connections to meetings were excluded. A descriptive statistical analysis was performed in the SPSS software. Ethical norms and recommendations for studies with human beings were followed. Results: 99 percent assessed the training with a very high level of satisfaction. Key products were obtained, such as regulations, informed consents and a stock of validated scenario, as working inputs for the school. Conclusions: The outcomes included responses from a group of scholars trained in clinical simulation, with very high satisfaction ratings. The products obtained were directed towards regulations and guidelines for the use of simulation(AU)

Colloidal Synthesis, Characterization, and Photoconductivity of Quasi-Layered CuCrS2 Nanosheets.

The current need to accelerate the adoption of photovoltaic (PV) systems has increased the need to explore new nanomaterials that can harvest and convert solar energy into electricity. Transition metal dichalcogenides (TMDCs) are good candidates because of their tunable physical and chemical properties. CuCrS2 has shown good electrical and thermoelectrical properties; however, its optical and photoconductivity properties remain unexplored. In this study, we synthesized CuCrS2 nanosheets with average dimensions of 43.6 ± 6.7 nm in length and 25.6 ± 4.1 nm in width using a heat-up synthesis approach and fabricated films by the spray-coating method to probe their photoresponse. This method yielded CuCrS2 nanosheets with an optical bandgap of ~1.21 eV. The fabricated film had an average thickness of ~570 nm, exhibiting a net current conversion efficiency of ~11.3%. These results demonstrate the potential use of CuCrS2 as an absorber layer in solar cells.

Invasiveness has no influence on the rate of incidental durotomies in surgery for multisegmental lumbar spinal canal stenosis (≥3 levels) with and without fusion: analysis from the German Spine Registry data (DWG-Register).

BACKGROUND: Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (≥3 levels) is still unclear. The aim of this study was to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in ≥3 levels. METHODS: Retrospective analysis of the data pool of the DWG register based on cases described by 10 clinics between January 2012 and December 2016 was performed. Surgically treated LSS in ≥3 segments were divided into decompression with or without instrumentation and fusion. Cases with intraoperative DT in both subgroups were analysed for risk factor occurrence. The Surgical Invasive Index (SII) was used. RESULTS: DT occurred in 102/941 (10.8%) patients. Difference in DT between groups was non-significant. The likelihood of DT increased by 2.12-fold with previous spinal surgery at the same level and by 1.9-fold for BMI 30-34 and >35 in comparison with BMI 26-29, respectively. Postoperative deep wound infection was increased by 2.39-fold after DT than without. Significance in outcomes between patients with/without DT was not found. The invasiveness index explained 48% of the variation in blood loss and 51% of the variation in surgery duration. CONCLUSIONS: The rate of incidental DT during decompression for LSS with and without fusion in ≥3 levels was associated with BMI and previous surgery at the same spinal level. Invasivness (SII) is valid rather for variables proper to surgery such as bledding and Op-time but no with incidence for DT and subsequent CSF-leackage.

Validación de escala para medir conocimientos pedagógicos del mentor de enfermería en conducción de prácticas / Scale validation to measure pedagogical knowledge of the nursing mentor in conducting practices

Objetivo: Validar una escala para medir conocimientos pedagógicos del mentor de enfermería en conducción de prácticas. Metodología: Estudio metodológico, cuantitativo, periodo 2019-2020. Del constructo teórico y estudio cualitativo surgen reactivos, sometidos a consenso de expertos para validez de contenido. La escala se administró a universo N=172 mentores clínicos. Para concordancia interjueces de la escala, se utilizaron coeficientes estadísticos. Se alcanzó fiabilidad por Alfa de Cronbach. La validez de constructo fue por análisis factorial exploratorio. Resultados principales: La concordancia interjueces obtuvo alta consistencia interna; se eliminaron ítem con correlación <0,5, se incorporan los significativos, p> 0,05. La versión final de la escala fue de 33 ítem, con Cronbach de .897. El análisis factorial exploratorio explicó el 74% de varianza total y aportó cuatro factores. Conclusión principal: La escala tiene validez y fiabilidad, propició diagnóstico de conocimiento pedagógico de mentores para conducir prácticas de enfermería.(AU)

Objective: Validate scale to measure pedagogical knowledge of the nursing mentor in conducting practices. Methods: Methodological, quantitative study, period 2019-2020. From the theoretical construct and qualitative study, reagents arise, submitted to expert consensus for content validity. The scale was administered to a universe of N=172 clinical mentors. For interrater agreement of the scale, statistical coefficients were used. Reliability was achieved by Cronbach's Alpha. Construct validity was by exploratory factor analysis. Results: Interjudge agreement obtained high internal consistency; item with correlation <0.5 were eliminated, significant item were incorporated, p> 0.05. The final version of the scale had 33 item, with Cronbach's score of .897. The exploratory factorial analysis explained 74% of the total variance, contributing four factors. Conclusions: The scale has validity and reliability, propitious diagnosis of pedagogical knowledge of mentors to conduct nursing practices.(AU)

Atributos explorados en tutores clínicos, para conducir el aprendizaje práctico del estudiante de enfermería / Attributes Explored in Clinical Advisors, in View of Conducting Practice Learning of Nursing Students

Introducción: La mentoría en formación de estudiantes de enfermería en ambientes clínicos es reconocida en países como Canadá, Reino Unido (Nursing Midwifery Council) España e Italia, donde es identificada como problemática de la profesión, por debilitarse el tutelaje de estudiantes en escenarios de formación práctica. Objetivo: Describir atributos que perciben tutores clínicos de enfermería para conducir el aprendizaje formativo en prácticas clínicas. Métodos: Estudio descriptivo, exploratorio. Las unidades de análisis fueron tutores de dos unidades académicas de universidades chilenas, temporalidad del estudio: marzo 2018 a noviembre 2019. Para seleccionar los participantes se optó por muestreo homogéneo; activo hasta obtener saturación muestral y suficiencia de información. Se incluyeron al estudio enfermeras asistenciales, contratadas por universidades, con más de tres años como tutores; se excluyeron, académicos supervisores de prácticas, que son parte del cuerpo de escuelas de enfermería de ambas universidades. El trabajo de campo se inició con vagabundeo; se crearon mapas sociales y temporales para primeros acercamientos a los participantes. Para recoger la información, se usó técnica de grupos focales. Se respetaron exigencias y principios éticos de estudios con seres humanos. Resultados: Los tutores percibieron que una buena práctica se inicia con proyección y proximidad de universidad con hospital, destacan necesidad de formación para su acción de mentoría con estudiantes, influenciada por condiciones favorecedoras del clima de aprendizaje del entorno clínico. Conclusiones: Cinco subcategorías configuran atributos de tutores para conducir prácticas clínicas: desarrollo del plan de estudio, planificación de tutoría, entorno de aprendizaje clínico, supervisión de práctica y pensamiento científico-reflexivo(AU)

Introduction: Advisorship in the training of Nursing students in clinical settings is recognized in countries such as Canada, the United Kingdom (Nursing Midwifery Council), Spain and Italy, where it is identified as a problem in the profession, due to the weakening of student tutelage in settings for practice training. Objective: To describe attributes perceived by clinical Nursing advisors concerning the conduction of formative learning in clinical practices. Methods: Descriptive and exploratory study. The analysis units were advisors from two academic units of Chilean universities. The study period was defined from March 2018 to November 2019. To select the participants, homogeneous sampling was chosen, active until sample saturation and information sufficiency were obtained. The study included practicing nurses hired by universities, with more than three years as advisors. The study excluded academic practice advisors who belong to the Nursing school faculties of both universities. Field work began with mind-wandering; social and temporal maps were created for first approaches to the participants. To collect the information, the focus group technique was used. Demands and ethical principles of studies with human beings were respected. Results: The advisors perceived that a good practice begins with a projection and proximity between university and hospital. They highlight their need for training in the work as students' advisors, influenced by conditions that favor the learning environment of the clinical setting. Conclusions: Five subcategories make up the attributes of advisors to conduct clinical practices: development of the study plan, planning of advisorship, clinical learning environment, supervision of practice, and scientific-reflective thinking(AU)

Atributos para caracterizar la satisfacción de estudiantes de enfermería en escenarios clínicos / Attributes for Characterizing Nursing Students' Satisfaction in Clinical Settings

Introducción: La evaluación de satisfacción de estudiantes de enfermería en entornos de aprendizaje clínico está mediada por atributos contextuales del clima de aprendizaje y acción tutorial. Objetivo: Explorar, desde la perspectiva cualitativa, atributos que identifican estudiantes de enfermería para caracterizar la satisfacción en escenarios clínicos. Métodos: Estudio de diseño descriptivo exploratorio. Las unidades de análisis fueron estudiantes de enfermería de dos unidades académicas de universidades chilenas, durante el período lectivo; marzo-noviembre del 2019. Se optó por un muestreo homogéneo. Se incluyeron al estudio alumnos regulares de enfermería, de tercero y cuarto año, que hayan tenido al menos un mes de prácticas clínicas ininterrumpidas y se excluyen, estudiantes de primer, segundo año e internos de enfermería. Para trabajo de campo se inició con vagabundeo y creación de mapas sociales y temporales y como técnica de recogida de información se usó grupo focal, cautelando saturación muestral y suficiencia del dato. Se cumplieron requisitos y principios éticos de investigación en seres humanos. Resultados: los estudiantes distinguen que los atributos para medir su satisfacción en espacios de enseñanza práctica están influenciados o afectados por condiciones del entorno clínico asistencial, profesionalismo del tutor que en su conjunto matizan su satisfacción y por ende el clima de aprendizaje. Conclusiones: Desde la categoría central del constructo de estudio se pudo verificar en los discursos las subcategorías y atributos para medir la satisfacción de los alumnos en los escenarios de prácticas clínicas(AU)

Introduction: Assessment of Nursing students' satisfaction in clinical learning environments is mediated by contextual attributes of the learning climate and tutorial action. Objective: To explore, from a qualitative perspective, attributes identified by Nursing students for characterizing satisfaction in clinical settings. Methods: Study with an exploratory descriptive design. The units of analysis were Nursing students from two academic units of Chilean universities, during school period: March-November 2019. Homogeneous sampling was chosen. Regular third- and fourth-year Nursing students who had had at least one month of uninterrupted clinical practice were included in the study, while first- and second-year students and Nursing interns were excluded. Fieldwork began with wandering and the creation of social and temporal maps, while focus group was used as a data collection technique, ensuring sample saturation and data sufficiency. Requirements and ethical principles for research in humans were met. Results: The students distinguish that the attributes for measuring their satisfaction in practical teaching settings are influenced or affected by conditions of the clinical care environment, as well as by tutor professionalism, which, as a whole, qualify their satisfaction and, therefore, the learning climate. Conclusions: From the central category of the study construct, it was possible to verify, within the discourses, the subcategories and attributes for measuring the students' satisfaction in the clinical practice settings(AU)

Características del proceso enseñanza aprendizaje vinculado al pensamiento crítico desde la mirada de docentes y estudiantes de enfermería / Characteristics of the Teaching-Learning Process Associated to Critical Thinking from the Perspective of Nursing Teachers and Students

Introducción: Enfermería incorpora en su formación de pregrado la competencia genérica y específica de pensamiento crítico y reflexivo, esencial para brindar cuidados holísticos. Objetivo: Describir características del proceso enseñanza aprendizaje vinculado a pensamiento crítico desde la mirada de docentes y estudiantes de la carrera de enfermería. Métodos: Estudio cualitativo descriptivo; realizado en la carrera de enfermería de la Universidad Católica del Norte; Chile, 2017. Las unidades de análisis se conformaron por 8 académicos y 12 estudiantes, seleccionados mediante muestreo por conveniencia, de acuerdo a objetivos, necesidades y alcance metodológico. Se utilizó la técnica de grupo focal. Se realizó análisis de contenido que dieron origen a matrices categoriales que emergen de los discursos. Resultados: El pensamiento crítico para académicos representa un proceso reflexivo complejo, importante para desarrollar habilidades integrales. Desde lo metodológico utilizan estrategias como: aprendizaje basado en problema, estudio de casos, simulaciones de baja y alta fidelidad, trabajo colaborativo, seminarios, clases interactivas, se enfatiza en la indagación; el proceso de evaluación se enmarca en lo oral y escrito, usando pautas y rúbricas. Conclusiones: La enseñanza de pensamiento crítico es compleja, proceso vital en la formación, los docentes y estudiantes construyen una percepción positiva del pensamiento crítico en el desarrollo del proceso enseñanza aprendizaje; emergen categorías: enseñanza del pensamiento crítico, entendida como progreso para favorecer el desarrollo de pensamiento reflexivo, metodologías, para favorecer el aprendizaje consciente de los estudiantes y evaluación del pensamiento crítico-reflexivo, entendido como mecanismos para profundizar logros de aprendizaje(AU)

Introduction: The Nursing major incorporates, in its undergraduate training program, the generic and specific competences of critical and reflective thinking, essential to providing holistic care. Objective: To describe the characteristics of the teaching-learning process associated to critical thinking from the perspective of teachers and students of the Nursing major. Methods: Descriptive and qualitative study carried out, in 2017, in the Nursing major of Universidad Católica del Norte, Chile. The analysis units were made up of eight scholars and twelve students, selected through convenience sampling, according to objectives, needs and methodological scope. The focus group technique was used. Content analysis was carried out, which gave rise to categorical matrices that emerge from the discourses. Results: Critical thinking for scholars represents a complex reflective process, important to developing comprehensive skills. From the methodological point of view, they use strategies such as problem-based learning, case studies, low and high fidelity simulations, collaborative work, seminars and interactive classes, while emphasis is placed on inquiry. The evaluation process is framed within oral and written activities, using guidelines and headings. Conclusions: The teaching of critical thinking is complex, a vital process in training. Teachers and students build a positive perception of critical thinking in the development of the teaching-learning process. Several categories emerge, such as teaching critical thinking, understood as progress to promote the development of reflective thinking; methodologies, to promote the conscious learning of students; and assessment of critical-reflective thinking, understood as mechanisms to deepen learning achievements(AU)

Satisfacción de titulados de enfermería sobre Hospital Simulado de la Universidad Arturo Prat, sede Victoria / Satisfaction of the Nursing Graduates about Simulated Hospital of Arturo Prat University, Vitoria Venue

Introducción: La simulación clínica es una metodología usada ampliamente en ciencias de la salud debido a sus múltiples beneficios, permite un entrenamiento continuo del estudiante, aprender de sus errores y fortalecer sus competencias. La Universidad Arturo Prat, sede Victoria ha desarrollado la simulación de alta fidelidad a través de la implementación de un hospital infantil simulado. Objetivo: Medir el nivel de satisfacción de los titulados de enfermería sobre el hospital clínico infantil simulado como metodología significativa en su formación profesional. Métodos: Estudio descriptivo, de corte transversal. El universo fue de 109 enfermeros titulados de la Universidad Arturo Prat, que contestaron vía online, durante el primer trimestre del año 2019. Se aplicó una encuesta tipo Likert de satisfacción usuaria (SUHCLIS28), previamente validada por criterio de expertos y prueba piloto, con un alfa de Cronbach 0,940 y conformada por 28 ítems agrupados en 6 dimensiones (infraestructura, recurso humano, conocimientos, metodología, evaluación y evaluación global). Resultados: Las preguntas fueron respondidas mayoritariamente de manera positiva para esta metodología, obteniéndose un nivel de satisfacción usuaria global de 4,51 de un total máximo de 5,0, considerada como satisfacción muy alta. Conclusiones: La simulación clínica es una herramienta pedagógica útil, que contribuye al mayor desarrollo de competencias y habilidades, es aceptada de manera favorable por los estudiantes y contribuye finalmente a que ellos entreguen una atención segura y de calidad en el usuario real(AU)

Introduction: Clinical simulation is a methodology widely used in health sciences due to its multiple benefits. It allows continuous training of the student, in order for them to learn from their mistakes and strengthen their skills. Arturo Prat University, at the Victoria venue, has developed high-reliability simulation through the implementation of a simulated children's hospital. Objective: To measure the level of satisfaction of Nursing graduates concerning the simulated children's clinical hospital as a significant methodology in their professional training. Methods: Descriptive and cross-sectional study. The study population consisted of 109 registered nurses from Arturo Prat University, who answered online, during the first quarter of 2019. A Likert survey about user satisfaction (SUHCLIS28) was conducted, previously validated by expert criteria and pilot test, with a Cronbach's alpha of 0.940 and made up of 28 items grouped into six dimensions (infrastructure, human resources, knowledge, methodology, evaluation and global evaluation). Results: The questions were answered mostly positively for this methodology, obtaining an overall user satisfaction level of 4.51 out of a maximum total of 5.0; the result is considered very high satisfaction value. Conclusions: Clinical simulation is a useful pedagogical tool, which contributes to the greater development of competences and skills. It is favorably accepted by students and, finally, contributes to their provision of safe and quality care to the real user(AU)

Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease.

BACKGROUND: The aim of this study is to present midterm results of thoracic endovascular aortic repair (TEVAR) using scalloped or fenestrated custom-made endovascular grafts (CMEGs) in aortic arch Zones 0 and 1. METHODS: A retrospective review of prospectively collected data involving consecutive patients with aortic arch disease treated by scalloped or fenestrated Relay Plus stent grafts (Terumo Aortic, Sunrise, FL) landed in Zones 0 and 1. Patient demographics, operative details, clinical outcomes, and complications were analyzed. RESULTS: Between February 2014 and February 2020, 14 patients (9 male and 5 female) with a median age of 66 years (range 48-84) underwent scalloped or fenestrated TEVAR to preserve flow to the supra-aortic trunks (SATs). In 6 cases the landing zone was Zone 0 and in 8, Zone 1. Target vessels for the scallops were left common carotid artery in 8 cases (Zone 1) and innominate artery (IA) in 1 (Zone 0). All 5 fenestrations were designed to preserve the IA (Zone 0). Technical success was 100% with no endoleaks on completion angiography. One fatal perioperative stroke (7%) occurred in a patient with a fenestration for the IA and atherosclerotic plaques in the arch. During median follow-up of 37.5 (3-72) months, no other patient died, and all the target vessels and cervical revascularizations remained patent. There was no paraplegia, no retrograde dissection, and no other complication. Two patients (14%) with scallops in Zone 1 developed late endoleak: 1 type Ib at 6 months and 1 type Ia endoleak at 12 months. There were no endoleaks at all in the group of fenestrated endografts (Zone 0). CONCLUSIONS: When anatomy allows, endovascular treatment using scalloped or fenestrated CMEGs in Zones 0 and 1 is a feasible technique to treat patients with aortic arch disease involving the SATs.

Sobre la crisis en Chile ante el coronavirus / No disponible

No disponible

Promotores de reserva cognitiva en adultos mayores con alto riesgo de demencia cortical / Promoters of Cognitive Reserve in the Elderly with High Risk of Cortical Dementia

Introducción: La reserva cognitiva constituye un elemento central para entender cómo responde el cerebro a la neuropatología durante el ciclo vital. Objetivo: Comprender los factores promotores de reserva cognitiva desde la experiencia de vida de adultos mayores sin deterioro cognitivo y con alto riesgo de demencia cortical. Métodos: Estudio cualitativo, con base en método Grounded Theory. Se realizan entrevistas semiestructuradas en profundidad a siete adultos mayores. En el análisis, se aplica la técnica de comparación constante según modelo de Glasser y Straus, utilizando Atlas ti/7. Resultados: Desde el análisis axial surgen cinco categorías interrelacionadas: actividad mental, experiencias gratificantes, cuidados, eventos traumáticos y características de personalidad. Se aprecia un patrón constante de experiencias vitales mentalmente estimulantes, relacionado principalmente a actividades de cuidado y experiencias gratificantes, no asociadas a educación formal. Conclusiones: Se distingue un proceso dinámico que involucra experiencias y eventos de vida cotidiana, tanto personales como ambientales, ocupacionales y del estilo de vida, que operan secuencialmente durante el ciclo vital; estos factores podrían incidir significativamente en los mecanismos neurobiológicos y actuar como promotores de reserva cognitiva. Se obtiene un modelo de promotores de reserva cognitiva que podría utilizarse en programas de salud cognitiva para contrarrestar la neuropatología(AU)

Introduction: Cognitive reserve constitutes an element central to understanding how the brain responds to neuropathology during the life cycle. Objective: To understand the factors that promote cognitive reserve from the life experience of the elderly without cognitive deterioration and with high risk of cortical dementia. Methods: Qualitative study, methodologically based on grounded theory. In-depth semi-structured interviews are conducted on seven elderlies. In the analysis, the constant comparison technique is applied according to the model by Glaser and Strauss, using ATLAS-Ti 7. Results: Five interrelated categories emerge from the axial analysis: mental activity, gratifying experiences, care, traumatic events, and personality traits. There is a constant pattern of mentally-stimulating life experiences, mainly related to care activities and gratifying experiences, not associated with formal education. Conclusions: A dynamic process is distinguished that involves experiences and events of daily life, both personal and environmental, occupational and related to lifestyle, which operate sequentially during the life cycle. These factors could significantly influence neurobiological mechanisms and act as promoters of cognitive reserve. A model of cognitive reserve promoters is obtained that could be used in cognitive health programs to counteract neuropathology(AU)

Procesos y estrategias de innovación curricular en la carrera de Enfermería. Universidad Arturo Prat, Chile / Processes and Strategies of Curricular Innovation in the Nursing Major, Arturo Prat University, Chile

Introducción: La educación, en particular la universitaria, hace pertinente las modificaciones curriculares que analicen el trasfondo de los escenarios actuales, los que tensionan y conflictúan los modos tradicionales necesarios para estructurar y configurar la arquitectura curricular. Objetivo: Rediseñar procesos y estrategias de una estructuración curricular basada en competencias en la carrera de Enfermería de la Universidad Arturo Prat, Chile. Métodos: Estudio descriptivo-explicativo, con metodología cuantitativa-cualitativa. Como método teórico se utilizó análisis-síntesis, enfoque sistémico, inducción-deducción, y análisis documental y de contenido de literatura. El universo, estudiado en su conjunto, estuvo constituido por la totalidad de los docentes de la unidad académica. Resultados: Se obtuvo un proyecto curricular de pregrado, que incorporó políticas y lineamientos emanados del Consejo de Rectores de Universidades Chilenas; estrategias y patrones del modelo educativo universitario; y recomendaciones promovidas por la Asociación Chilena de Educación en Enfermería en formación profesional. La propuesta caracterizó un proceso reflexivo y crítico de los académicos participantes. El rediseño siguió los desafíos de la globalización universitaria, al abrir espacios educativo-innovadores, según Tunning, en formación por competencias genéricas. En esta innovación se abordaron 4 como sello institucional y 6 competencias específicas, los cuales tributaron al perfil de egreso del estudiante. Conclusiones: Se logró un nuevo plan de estudio secuenciado, integrado y propicio para formar profesionales de enfermería competentes, con alta calidad, el cual aportó las herramientas para brindar acciones de cuidados, con seguridad y pertinencia. Esta estrategia buscó configurar un nuevo modelo de universidad que, sin descuidar la solvencia cognoscitiva y la competencia profesional, puso énfasis, preferentemente, en la formación de sujetos reflexivos, responsables, críticos, innovadores y versátiles(AU)

Introduction: Education, particularly university education, validates the applicability of the curricular modifications that analyze the background of the current contexts, which stress and conflict with the traditional ways necessary to structure and configure the curricular architecture. Objective: To redesign processes and strategies within acompetence-based curricular structuring in the Nursing major of Arturo Prat University, Chile. Methods: Descriptive-explanatory study, with a quantitative-qualitative methodology. As a theoretical method, we used analysis-synthesis, systemic approach, induction-deduction, and documentary and content analysis of literature. The study population, studied as a whole, was made up of all the teachers in the academic unit. Results: An undergraduate curriculum project was obtained, which incorporated policies and guidelines derived from the Council of Rectors of Chilean universities, strategies and patterns of the university educational model, and recommendations promoted by the Chilean Association of Nursing Education regarding vocational training. The proposal characterized a reflexive and critical process of the participating academics. The redesign followed the challenges of university globalization, by opening educational-innovative spaces, according to Tunning, in training based in generic skills. In this innovation, we addressed four of them an institutional seal and six specific competences, which contributed to the student's working profile. Conclusions: A new sequenced, integrated and conducive study plan was achieved to train competent nursing professionals, with high quality, which gave the tools to provide care actions, with safety and relevance. This strategy sought to configure a new university model that, without neglecting cognitive solvency and professional competence, emphasize, preferably, on the formation of reflective, responsible, critical, innovative and versatile subjects(AU)

Polifarmacia en adulto mayor, impacto en su calidad de vida: revision de literatura / Polypharmacy in older adults and impact on their quality of life: literature review / Polifarmácia em idosos, impacto em sua qualidade de vida: revisão da literatura

RESUMEN: Objetivo: Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud. Métodos: Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet. Resultados: La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida. Conclusiones: Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.(AU)

ABSTRACT: Objective: To know, by analyzing the state of knowledge, the impact of the polypharmacy on the quality of life of older adults and the role of nursing when dealing with this health problem. Materials and Methods: Descriptive review of 62 original articles with multiple methodological designs, in the databases EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS and Dialnet. Results: Polypharmacy in older adults is more frequent in the female sex and people with low level of education, and is associated with socioeconomic factors. A large percentage of older adults present with prescription cascade due to the amount of drugs consumed and the number of doctors consulted, leading to pharmacological interactions that affect functionality and quality of life. Conclusions: More control of drugs consumed by older adults is needed to avoid harmful effects. Nursing professionals should have an educational role in this age group to reduce polypharmacy and promote lifestyles that foster healthy ageing.(AU)

RESUMO: Objetivo: Conhecer, através da análise do estado do conhecimento, o impacto da polifarmácia na qualidade de vida do idoso e qual o papel da enfermagem diante desse problema de saúde. Métodos: Revisão descritiva de 62 artigos originais de vários desenhos metodológicos, nas bases de dados: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS e Dialnet. Resultados: A polifarmácia em idosos ocorre mais frequentemente no sexo feminino, em pessoas com baixa escolaridade, somada a fatores socioeconômicos. Uma grande porcentagem de idosos apresenta efeito cascata no consumo de medicamentos, pela quantidade de medicamentos consumidos e número de médicos consultados, produzindo interações farmacológicas, afetando a funcionalidade e a qualidade de vida. Conclusões: É necessário um maior controle dos medicamentos consumidos por idosos para evitar efeitos nocivos. Os profissionais de enfermagem devem ter papel educativo nessa faixa etária, para diminuir a polifarmácia e promover estilos de vida que promovam o envelhecimento saudável.(AU)

[Polypharmacy in older adults and impact on their quality of life. Literature review]. / Polifarmacia en adulto mayor, impacto en su calidad de vida. Revision de literatura.

OBJECTIVE: To know, by analyzing the state of knowledge, the impact of the polypharmacy on the quality of life of older adults and the role of nursing when dealing with this health problem. MATERIALS AND METHODS: Descriptive review of 62 original articles with multiple methodological designs, in the databases EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS and Dialnet. RESULTS: Polypharmacy in older adults is more frequent in the female sex and people with low level of education, and is associated with socioeconomic factors. A large percentage of older adults present with prescription cascade due to the amount of drugs consumed and the number of doctors consulted, leading to pharmacological interactions that affect functionality and quality of life. CONCLUSIONS: More control of drugs consumed by older adults is needed to avoid harmful effects. Nursing professionals should have an educational role in this age group to reduce polypharmacy and promote lifestyles that foster healthy ageing.

OBJETIVO: Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud. MÉTODOS: Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet. RESULTADOS: La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida. CONCLUSIONES: Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.

2-Thiouracil intersystem crossing photodynamics studied by wavelength-dependent photoelectron and transient absorption spectroscopies.

Single-atom substitution within a natural nucleobase-such as replacing oxygen by sulfur in uracil-can result in drastic changes in the relaxation dynamics after UV excitation. While the photodynamics of natural nucleobases like uracil are dominated by pathways along singlet excited states, the photodynamics of thiobases like 2-thiouracil populate the triplet manifold with near unity quantum yield. In the present study, a synergistic approach based on time-resolved photoelectron spectroscopy (TRPES), time-resolved absorption spectroscopy (TRAS), and ab initio computations has been particularly successful at unraveling the underlying photophysical principles and describing the dissimilarities between the natural and substituted nucleobases. Specifically, we find that varying the excitation wavelength leads to differences between gas-phase and condensed-phase experimental results. Systematic trends are observed in the intersystem crossing time constants with varying excitation wavelength, which can be readily interpreted in the context of ab initio calculations performed both in vacuum and including solvent effects. Thus, the combination of TRPES and TRAS experiments with high-level computational techniques allows us to characterize the topology of the potential energy surfaces defining the relaxation dynamics of 2-thiouracil in both gas and condensed phases, as well as investigate the accessibility of conical intersections and crossings, and potential energy barriers along the associated relaxation coordinates.

Aortic Customized Stent-Graft Treatment of Postnephrectomy Renal Pedicle Arteriovenous Fistula.

A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.

Influence of the State of the Subarachnoid Space of the Cranial Base in Hydrocephalus Resolution after Endoscopy.

Objective To compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS). Material and Methods We conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable. Results We found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference (p < 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88-6.22). Another important factor involved was age that showed a statistically significant difference (p < 0.0018) with HR 3.28 (95% CI, 1.55-6.93). Conclusion The permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.

Utilización de Internet y dependencia a teléfonos móviles en adolescentes / Using Internet and dependence on mobile phones in adolescents / A utilização da Internet e a dependência de celulares dos adolescentes

El objetivo principal del presente trabajo ha sido analizar el uso que los adolescentes realizan de Internet y los teléfonos móviles. Se utilizó un diseño descriptivo, para la muestra se seleccionaron aleatoriamente 10 centros educativos, registrando 874 encuestas. Los adolescentes utilizan masivamente la Red, accediendo a la misma cada vez más a través del teléfono móvil, no aparecen casos llamativos de dependencia en el empleo del teléfono móvil. Otro de los problemas detectados ha sido el del tiempo de conexión a Internet, que aumenta de manera significativa al igual que destacan otros estudios similares. Es fundamental potenciar el papel de familias y centros educativos para dotar a los jóvenes de estrategias que les permitan realizar unos usos adecuados.

The main objective of this study was to analyze the use made of the teenagers Internet and mobile phones. A descriptive design was used, for the sample were randomly selected 10 schools, registering 874 surveys. Teens use Internet massively, increasingly accessed via mobile phone, although do not show a lot of cases of dependency on the use of mobile phone. Another of the problems identified was the Internet connection time, which increases significantly as others similar studies indicates. It is essential to enhance the role of families and schools to equip young people with strategies to do adequate use.

O principal objetivo deste estudo foi analisar o uso da Internet e de celulares pelos adolescentes. Utilizou-se um modelo descritivo. Para a amostra, a seleção ocorreu de forma aleatória em 10 centros educativos, registrando 874 respostas. Os adolescentes utilizam massivamente a Internet e a acessam cada vez mais por meio dos smartphones. Não constam, nesta pesquisa, casos marcantes de dependência no emprego do smartphone. Outro dos problemas detectados tem sido o do tempo de conexão à Internet, que aumenta de maneira significativa, conforme destacam outros estudos similares. É fundamental reforçar o papel das famílias e das escolas na hora de adotar estratégias que permitam aos jovens utilizar a internet de modo adequado, visando a potencialização de suas capacidades cognitivas.

Internal conversion and intersystem crossing pathways in UV excited, isolated uracils and their implications in prebiotic chemistry.

The photodynamic properties of molecules determine their ability to survive in harsh radiation environments. As such, the photostability of heterocyclic aromatic compounds to electromagnetic radiation is expected to have been one of the selection pressures influencing the prebiotic chemistry on early Earth. In the present study, the gas-phase photodynamics of uracil, 5-methyluracil (thymine) and 2-thiouracil-three heterocyclic compounds thought to be present during this era-are assessed in the context of their recently proposed intersystem crossing pathways that compete with internal conversion to the ground state. Specifically, time-resolved photoelectron spectroscopy measurements evidence femtosecond to picosecond timescales for relaxation of the singlet (1)ππ* and (1)nπ* states as well as for intersystem crossing to the triplet manifold. Trapping in the excited triplet state and intersystem crossing back to the ground state are investigated as potential factors contributing to the susceptibility of these molecules to ultraviolet photodamage.