Eficacia del protocolo Start to move en funcionalidad, DA-UCI y delirio: ensayo clínico aleatorizado / Efficacy of the «Start to move» protocol on functionality, ICU-acquired weakness and delirium: Randomized clinical trial

Objetivo Evaluar la eficacia del protocolo Start to move comparado con el tratamiento convencional en sujetos mayores de 15 años hospitalizados en la UCI sobre una mejoría en funcionalidad, disminución de debilidad adquirida en la UCI (DA-UCI), incidencia de delirio, días de ventilación mecánica (VM), estadía en la UCI y mortalidad a los 28 días. Diseño Ensayo clínico controlado aleatorizado. Ámbito Unidad de paciente crítico. Participantes Incluye adultos mayores a 15 años con VMI mayor a 48h, asignación aleatoria. Intervenciones Protocolo «Start to move» y tratamiento convencional. Variables de interés principales Se analizó funcionalidad, incidencia DA-UCI, incidencia delirio, días VM, estadía UCI y mortalidad-28 días, ClinicalTrials.gov número, NCT05053724. Resultados Sesenta y nueve sujetos fueron ingresados al estudio, 33 al grupo Start to move y 36 a tratamiento convencional, comparables clínico y sociodemograficamente. En el grupo Start to move la incidencia DAUCI al egreso de la UCI fue de 35,7 vs. 80,7% grupo tratamiento convencional (p=0,001). La funcionalidad (FSS-ICU) al egreso de la UCI corresponde a 26 vs. 17 puntos a favor del grupo Start to move (p=0,001). La diferencia en Barthel al egreso de la UCI fue del 20% a favor del grupo Start to move (p=0,006). No hubo diferencias significativas en incidencia de delirio, días de VM, estadía UCI y mortalidad-28 días. El estudio no reportó eventos adversos, ni suspensión de protocolo. Conclusiones La aplicación del protocolo Start to move en la UCI se asoció reducción en la incidencia DA-UCI, aumento en funcionalidad y menor caída en puntaje Barthel al egreso. (AU)

Objective To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (IUCD), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. Design Randomized controlled clinical trial. Setting Intensive care unit. Participants Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. Interventions Start to move protocol and conventional treatment. Main variables of interest Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. Results Sixty-nine subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the “Start to move” group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the “conventional treatment” group (P=.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the “Start to move” group (P=.001). The difference in Barthel at ICU discharge was 20% in favor of the “Start to move” group (P=.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. Conclusions The application of the “Start to move” protocol in ICU showed a reduction in the incidence of IUCD, an increase in functionality and a smaller decrease in Barthel score at discharge. (AU)

Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses.

Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.

Número de células CD34+ circulantes como predictor de recolección exitosa de progenitores hematopoyéticos por aféresis en trasplante autólogo / Number of circulating CD34+ cells as a predictor of successful collection of hematopoietic progenitors by apheresis in autologous transplantation

RESUMEN Introducción. El trasplante autólogo de células progenitoras hematopoyéticas es una terapia eficaz en neoplasias malignas hematológicas. El número de células que CD34+ en sangre periférica es el mejor predictor del rendimiento de recolección de células progenitoras hematopoyéticas. Objetivo. Determinar el número de células CD34+ en sangre periférica asociado al éxito de recolección de progenitores hematopoyéticos por aféresis en trasplante autólogo. Métodos. Se evaluó retrospectivamente los datos de 236 procedimientos de aféresis de células progenitoras hematopoyéticas para el trasplante autólogo en el Hospital Edgardo Rebagliati Martins (Lima, Perú) de julio del 2020 a julio del 2023. Se utilizó la curva ROC (características operativas del receptor) para determinar el número de células CD34+ en sangre periférica necesario para lograr una recolección por aféresis ≥ 2 x 106 células CD34+/kg. Resultados. El 61% fueron hombres, con mediana de edad de 58 años, el valor de corte fue de 18,38 células CD34+/μL (sensibilidad de 94,1% y especificidad de 96,9%). Conclusión. El número de células CD34+ sangre periférica para una recolección exitosa de células progenitoras hematopoyéticas para el trasplante autólogo fue de 18,38 células CD34+/μL.

ABSTRACT Introduction. Autologous hematopoietic progenitor cell transplantation is an effective therapy in hematological malignancies, the number of CD34+ cells in peripheral blood is the best predictor of hematopoietic progenitor cell harvesting performance. Objective. To determine the number of CD34+ cells in peripheral blood associated with the successful collection of hematopoietic progenitors by apheresis in autologous transplantation. Methods. The data of 236 hematopoietic progenitor cell apheresis procedures for autologous transplantation at the Edgardo Rebagliati Martins Hospital (Lima, Peru) were retrospectively evaluated from July 2020 to July 2023. The ROC (receiver operating characteristics) curve was used to determine the number of CD34+ cells in peripheral blood necessary to achieve an collection by apheresis ≥ 2 x 106 CD34+ cells/kg. Results. 61% were men, with a median age of 58 years, the cut-off value was 18.38 CD34+ cells/μL (sensitivity of 94.1% and specificity of 96.9%). Conclusion. The number of peripheral blood CD34+cells for successful collection of hematopoietic progenitor cells for autologous transplantation was 18.38 CD34+ cells/μL.

Efficacy of the "Start to move" protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. DESIGN: randomized controlled clinical trial. SETTING: Intensive Care Unit. PARTICIPANTS: Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. INTERVENTIONS: Start to move protocol and conventional treatment. MAIN VARIABLES OF INTEREST: Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. RESULTS: 69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the "Start to move" group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the "conventional treatment" group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the "Start to move" group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the "Start to move" group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. CONCLUSIONS: The application of the "Start to move" protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.

Efecto de la movilización vertebral en rotación de la columna lumbar sobre la actividad electromiográfica del erector espinal / Effects of a rotational spinal mobilization of the lumbar spine on the erector spinae activation patterns

Introducción Este estudio investigó el efecto de la técnica de movilización rítmica lumbar en rotación de grado IV sobre la actividad electromiográfica del erector espinal, así como sobre el rango de movimiento lumbar durante la flexo-extensión de tronco. Metodología Doce participantes adultos asintomáticos realizaron 5movimientos de flexión-extensión antes y después de la intervención. Se registró de manera bilateral la actividad electromiográfica del erector espinal (longissimus thoracis) a nivel de L3 y L5, así como los datos cinemáticos para evaluar los patrones de movimiento de la región lumbo-pélvica. Se compararon las variables registradas antes y después de realizar la movilización rítmica oscilatoria de grado IV de Maitland sobre la región lumbar en el sentido de la rotación izquierda. La movilización fue aplicada en forma unilateral con el paciente en decúbito lateral derecho sobre la camilla. Resultados Hubo una disminución estadísticamente significativa (p<0,01) de la actividad EMG del erector espinal durante la fase de flexión máxima en el lado derecho a nivel de L3 tras la aplicación de la técnica estudiada. No se observó ninguna diferencia a nivel de L5, así como tampoco se observaron diferencias significativas en la cinemática lumbo-pélvica. Conclusión Este estudio demuestra que una movilización rítmica oscilatoria hacia el lado izquierdo en rotación lumbar de grado IV produce una disminución estadísticamente significativa de la actividad electromiográfica del erector espinal en la fase de flexión completa en el lado contralateral (el derecho), en el nivel vertebral de su aplicación (L3) y no en niveles inferiores (L5) (AU)

Introduction This study investigated the effect of the lumbar rotation rhythmic mobilization technique in grade IV on the electromyographic activity of the erector spinae as well as on the lumbar range of motion during trunk flexion-extension. Methodology Twelve asymptomatic adult participants performed 5flexion-extension movements before and after the intervention. The electromyographic activity of the erector spinae (longissimus thoracis) at the level of L3 and L5 was recorded bilaterally, as well as the kinematic data to evaluate the movement patterns of the lumbopelvic region. The variables recorded before and after performing the Maitland grade IV oscillatory rhythmic mobilization on the lumbar region in the direction of left rotation were compared. Mobilization was applied unilaterally with the patient in right lateral decubitus on the stretcher. Results There was a statistically significant decrease (p<0.01) in the EMG activity of the erector spinae during the maximum flexion phase on the right side at the L3 level after the application of the studied technique. No difference was observed at the L5 level, nor were significant differences in lumbopelvic kinematics. Conclusion This study demonstrates that a rhythmic oscillatory mobilization towards the left side in grade IV lumbar rotation produces a statistically significant decrease in the electromyographic activity of the erector spinae in the phase of full flexion on the contralateral (right) side, at the level vertebral column of its application (L3) and not at lower levels (L5) (AU)

Creencias sociales y orientaciones emocionales colectivas sobre la protesta social en ciudadanos de medellín (colombia) y su área metropolitana

Este artículo tiene como objetivo comprender las creencias sociales y orientaciones emocionales colectivas sobre la protesta social en el proceso de construcción de paz en Colombia. Se utilizó una metodología cualitativa con enfoque hermenéutico y se realizó un análisis de contenido sobre lo expresado en entrevistas semiestructuradas por 18 participantes, ciudadanos del común, quienes se asumieron "a favor de la protesta social", "en contra de la protesta social" y "ambivalentes". Como resultados, se contrastaron creencias y orientaciones emocionales colectivas favorables, como empatía y comprensión, con prejuicios y estigmas. Emergieron creencias sobre el "otro" opositor, como enemigo, expresiones de distancia social, discriminación, exclusión y odio. Los medios de comunicación como mecanismos de configuración de estas creencias y orientaciones emocionales colectivas, asociadas al rechazo a los movimientos sociales, por parte de algunos participantes, alimentaron un ambiente de polarización y redujeron las posibilidades del reconocimiento del otro como ser humano.

This research tries to comprehend the societal beliefs and the collective emotions about the social protest in the context of peacebuilding. It was used a qualitative methodology with hermeneutical approach, and it was made an analysis of content about what was said in the semi-structured interviews of 18 participants that were classified in three groups according to their position about the social protest: a group in favor, a group against it, and a third one with an ambivalent position. As a result, there were contrasted the positive societal beliefs and the collective as empathy, understanding against prejudices and stigmata. There were emerged beliefs about the "other" as an opponent and enemy, expressions of social distance between groups, discrimination, exclusion, and hate. The mass media were identified as configuration mechanisms of these societal beliefs and collective emotions, associated to rejection of social movements that feeds the political polarization and reduces the possibility to recognize the other as a human being.

Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system / Análisis de adherencia a un protocolo de movilización precoz en una unidad de cuidados intensivos: datos recopilados prospectivamente durante un periodo de tres años por el sistema de información clínica

Objective To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay. Design Observational and prospective cohort study. Setting Polyvalent ICU over a three-year period (2017–2019). Patients Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol. Interventions None. Main variables of interest Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events. Results We analyzed 3269 stay-days from 388 patients with median age of 63 (51–72) years, median APACHE II 23 (18–29) and median ICU stay of 10.1 (6.2–16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days. Conclusions Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations (AU)

Objetivo Determinar la adherencia y barreras del protocolo de movilización precoz en pacientes que recibieron ventilación mecánica >48 horas en la práctica diaria habitual a través del sistema de información clínica durante toda su estancia en Unidad de Cuidados Intensivos (UCI). Diseño Estudio observacional y prospectivo. Ámbito UCI polivalente durante un periodo de tres años (2017-2019). Pacientes Se incluyeron pacientes adultos en ventilación mecánica > 48 horas que cumplieron los criterios de inclusión del protocolo. Intervenciones Ninguna. Variables principales Se aplicaron variables demográficas, adherencia y adherencia oculta, número total de movilizaciones, barreras, tipo vía aérea artificial/soporte ventilatorio en cada nivel de movilización y eventos adversos. Resultados Analizamos 3.269 días de estancia de 388 pacientes con una mediana de edad de 63 (51-72) años, mediana de APACHE-II 23(18-29) y estancia en UCI mediana de 10,1 (6,2-16,5) días. La adherencia al protocolo fue del 56,6% (1.850 días de estancia), pero los pacientes se movilizaron solo el 32,2% (1.472) de todos los días de estancia. La adherencia oculta fue del 15,6% (509 días de estancia), aumentando la adherencia al 72,2%. Las causas más comunes para la no movilización fueron el incumplimiento de los criterios de estabilidad clínica en 241 (42%) días de estancia y la falta de disponibilidad de fisioterapeutas en 190 (33%) días de estancia. Los eventos adversos ocurrieron en solo 6 (0,4%) días de estancia. Conclusiones Aunque la adherencia fue alta, los pacientes se movilizaron en solo un tercio de todos los días de estancia. Conocer el motivo específico por el cual los pacientes no fueron movilizados permite desarrollar decisiones concretas para incrementar el número de movilizaciones (AU)

Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Impacto de la movilización en pacientes portadores de soporte circulatorio mecánico de corta duración tipo Levitronix® CentriMag como puente a trasplante cardíaco / Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)

Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. The objective of this study is to analyze the impact of mobility on these patients. Methods: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to “Hospital Universitario de Bellvitge” (Barcelona). Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24.5 g/L (IQR: 23-30) vs. 33 g/L (IQR: 26-36); p = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). There were no significant differences in appearance of pressure ulcers, or post-HT infections among mobility groups. Conclusions: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post-HT adverse events.(AU)

Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system.

OBJECTIVE: To determinate the adherence and barriers of our early mobilization protocol in patients who had received mechanical ventilation >48h in routine daily practice through clinical information system during all Intensive Care Unit (ICU) stay. DESIGN: Observational and prospective cohort study. SETTING: Polyvalent ICU over a three-year period (2017-2019). PATIENTS: Adult patients on mechanical ventilation >48h who met the inclusion criteria for the early mobilization protocol. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographics, adherence to the protocol and putative hidden adherence, total number of mobilizations, barriers, artificial airway/ventilatory support at each mobilization level and adverse events. RESULTS: We analyzed 3269 stay-days from 388 patients with median age of 63 (51-72) years, median APACHE II 23 (18-29) and median ICU stay of 10.1 (6.2-16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The putative hidden adherence was 15.6% (509 stay-days) which would increase adherence to 72.2%. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days. CONCLUSIONS: Data form Clinical Information System showed although adherence was high, patients were mobilized in only one-third of all stay-days. Knowing the specific reason why patient were not mobilized in each stay-day allow to develop concrete decisions to increase the number of mobilizations.

Movilización temprana en el paciente sometido a terapia de reemplazo renal continua: ¿el riesgo sobrepasa los beneficios? / Early mobilization in continuous renal replacement therapy: does the risk outweigh the benefits? / Mobilização precoce do paciente em terapia de substituição renal contínua: o risco supera os benefícios?

Resumen: La movilización temprana (MT) del paciente crítico ingresado a la UCI ha demostrado grandes beneficios en poblaciones cada vez más heterogéneas; sin embargo, pacientes que se encuentran vinculados a dispositivos extracorpóreos como la terapia de reemplazo renal continua (TRRC) suelen estar confinados por periodos prolongados a inmovilización en cama debido a la percepción del personal sobre posibles eventos adversos relacionados al paciente (desaturación, inestabilidad hemodinámica, caídas, etc.) o al catéter (desinserción, hemorragia, embolismo) durante la sesión de fisioterapia. Sin embargo, la evidencia actual demuestra que de manera general, si se cuenta con un protocolo de MT adaptado a las necesidades específicas de los pacientes vinculados a TRRC y esto se acompaña de un equipo humano multidisciplinario calificado y coordinado, el paciente podría realizar actividades en cama, sentado, parado e inclusive deambular sin necesidad de interrumpir la TRRC, y aun así, el riesgo de eventos adversos es casi nulo, lo que nos permitiría continuar priorizando la vida del paciente, al mismo tiempo que le permitimos ejercer su derecho de vivirla dignamente a través del movimiento corporal.

Abstract: Early mobilization (EM) of the critically ill patient admitted to the ICU has shown great benefits in increasingly heterogeneous populations, however, patients who are linked to extracorporeal devices such as continuous renal replacement therapy (CRRT) are often confined to prolonged periods of bed immobilization due to the staff's perception of possible adverse events related to the patient (desaturation, hemodynamic instability, falls, etc.) or to the catheter (disinsertion, bleeding, embolism, etc.) during the physical therapy session. However, current evidence shows that, in general, this is an unfounded fear since, if there is a EM protocol adapted to the specific needs of patients linked to CRRT and this is accompanied by a qualified and coordinated multidisciplinary team, the patient could perform activities in bed, sitting, standing and even walking without interrupting CRRT, and even then, the risk of adverse events is almost nil, which would allow us to continue to prioritize the patient's life, while allowing them to exercise their right to live life with dignity through bodily movement.

Resumo: A mobilização precoce (MP) do paciente em estado crítico internado na UTI tem mostrado grandes benefícios em populações cada vez mais heterogêneas, porém, pacientes que estão vinculados a dispositivos extracorpóreos como a terapia renal substitutiva contínua (TRRC) costumam ficar confinados à imobilização no leito por períodos prolongados devido à percepção da equipe sobre possíveis eventos adversos relacionados ao paciente (dessaturação, instabilidade hemodinâmica, quedas, etc.) ou ao cateter (desinserção, hemorragia, embolia) durante a sessão de fisioterapia. No entanto, as evidências atuais mostram que, em geral, se houver um protocolo de MP adaptado às necessidades específicas dos pacientes vinculados a TRRC e este for acompanhado por uma equipe humanizada multidisciplinar qualificada e coordenada, o paciente poderá realizar atividades no leito, sentado, ficar em pé e até andar sem a necessidade de interromper o TRRC, e mesmo assim o risco de eventos adversos é quase zero, o que nos permitiria continuar priorizando a vida do paciente, ao mesmo tempo que permitimos que ele exerça seu direito de viver com dignidade através do movimento corporal.

A mobilização precoce está associada à melhor funcionalidade no pós-operatório de cirurgias abdominais? / Is early mobilization associated with better functionality after abdominal surgery? / ¿Se asocia la movilización temprana con una mejor funcionalidad después de las cirugías abdominales?

Introdução: Pacientes submetidos a grandes cirurgias abdominais apresentam riscos de complicações pós-operatórias. A mobilização precoce vem sendo implementada e cada vez mais aplicada, no intuito de prevenir esses eventos. Objetivo: Demonstrar se a mobilização precoce está associada à melhor funcionalidade no pós-operatório de cirurgias abdominais. Métodos: Revisão integrativa de literatura realizada por meio de uma busca bibliográfica junto aos bancos de dados: BVS, Scielo, PedRO e Pubmed por meio dos descritores: mobilização precoce, deambulação precoce, cuidados pós-operatórios, período pós-operatório, estado funcional, exercício físico, reabilitação, funcionalidade e cirurgia abdominal, nos idiomas inglês, português e espanhol. Resultados: A amostra final foi constituída por 08 artigos científicos, que foram estruturados em forma de quadro para apresentação de suas principais características, dos métodos e os principais resultados. Conclusão: A mobilização precoce está associada ao retorno rápido à funcionalidade da linha de base pré- operatória, as atividades de vida diária, independência funcional, além do tempo de internação mais curto e menor duração dos desagradáveis sintomas pós-operatórios.

Introduction: Patients undergoing major abdominal surgery are at risk of postoperative complications. Early mobilization has been implemented and increasingly applied in order to prevent these events. Objective: to demonstrate whether early mobilization is associated with better functionality in the postoperative period of abdominal surgeries. Methods: an integrative literature review carried out through a literature search in the following databases: BVS, Scielo, PedRO and Pubmed using the descriptors: early mobilization, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, in English, Portuguese and Spanish. Results: The final sample consisted of 08 scientific articles, which were structured in the form of a table to present their main characteristics, methods and main results. Conclusion: Early mobilization interferes with the rapid return to preoperative baseline functionality, activities of daily living, functional independence, in addition to a shorter hospital stay and shorter duration of unpleasant postoperative symptoms.

Introducción: Los pacientes sometidos a cirugías abdominales mayores corren el riesgo de sufrir complicaciones postoperatorias. La movilización temprana se ha implementado y aplicado cada vez más para prevenir estos eventos. Objetivo: Demostrar si la movilización temprana se asocia con una mejor funcionalidad después de la cirugía abdominal. Métodos: Revisión bibliográfica integrativa realizada a través de una búsqueda bibliográfica en las siguientes bases de datos: BVS, Scielo, PedRO y Pubmed utilizando los descriptores: early mobilisation, early ambulation, postoperative care, postoperative period, functional status, physical exercise, rehabilitation, functionality and abdominal surgery, en inglés, portugués y español. Resultados: La muestra final consistió en 08 artículos científicos, que se estructuraron en forma de tabla para presentar sus principales características, los métodos y los principales resultados. Conclusión: La movilización temprana se asocia con un rápido retorno a la funcionalidad de base preoperatoria, a las actividades de la vida diaria, a la independencia funcional, así como a una estancia hospitalaria más corta y a una menor duración de los síntomas postoperatorios desagradables.

Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of 3cases. / [Artículo traducido] Fractura de fémur distal compleja en el paciente frágil y anciano tratada mediante reemplazo femoral distal: reporte de 3 casos.

Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe 3cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement. All the 3patients presented early full weight-bearing mobilization (average time to first ambulation was 5days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of 10days). According to our experience, primary arthroplasty with distal femoral replacement could be a good therapeutic option for complex DFF in elderly patients.

Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of three cases.

Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients.

Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of three cases / Fractura de fémur distal compleja en el paciente frágil y anciano tratada mediante reemplazo femoral distal: reporte de 3 casos

Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients.(AU)

La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianos y frágiles con múltiples comorbilidades que sufrieron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratados con éxito mediante un reemplazo femoral distal (RFD). Los 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos.(AU)

Fractura de fémur distal compleja en el paciente frágil y anciano tratada mediante reemplazo femoral distal: reporte de 3 casos / Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of 3cases

La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianos y frágiles con múltiples comorbilidades que sufrieron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratados con éxito mediante un reemplazo femoral distal (RFD). Los 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos.(AU)

Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients.(AU)

El antifujimorismo y la defensa de la democracia: estudio sobre la conciencia política de jóvenes movilizados contra el fujimorismo en Lima / The anti-fujimorism and the defense of democracy: a study on the political consciousness of young people mobilized against fujimorism in Lima

Resumen El objetivo del presente estudio es explorar las dimensiones de conciencia política en jóvenes que participaron en movilizaciones sociales contra el fujimorismo entre el 2016 y 2018. El grupo de participantes estuvo constituido por 8 jóvenes (6 hombres y 2 mujeres) de entre 21 y 29 años. Para lograr el objetivo se utilizó una guía de entrevista a profundidad semiestructurada basada en las dimensiones de conciencia política de Sandoval (2001). Las entrevistas se realizaron durante el periodo de indulto a Alberto Fujimori y la prisión preventiva a Keiko Fujimori (entre julio y noviembre de 2018). Los resultados muestran que las 7 dimensiones permiten entender el proceso de conciencia política que experimenta el colectivo antifujimorista. La principal dimensión es la de identidad colectiva, dado la alta vinculación de los participantes con el colectivo antifujimorista estos se encuentran altamente identificados con las normas, conductas y objetivos del mismo.

Abstract The objective of this study is to explore the dimensions of political awareness in young people who participated in social mobilizations against fujimorism between 2016 and 2018. The group of participants consisted of 8 young people (6 men and 2 women) between 21 and 29 years old. To achieve the objective, a semi-structured in-depth interview guide was based on the dimensions of political consciousness of Sandoval (2001). The interviews were conducted during the pardon period for Alberto Fujimori and the preventive detention for Keiko Fujimori (between July and November 2018). The results show that the 7 dimensions allow us to understand the process of political consciousness experienced by the anti-Fujimori collective. The main dimension is that of collective identity. Given the high bond of the participants with the anti-Fujimori collective, they are highly identified with its norms, behaviors and objectives.

Closing the knowledge-action gap in conservation with open science.

The knowledge-action gap in conservation science and practice occurs when research outputs do not result in actions to protect or restore biodiversity. Among the diverse and complex reasons for this gap, three barriers are fundamental: knowledge is often unavailable to practitioners and challenging to interpret or difficult to use or both. Problems of availability, interpretability, and useability are solvable with open science practices. We considered the benefits and challenges of three open science practices for use by conservation scientists and practitioners. First, open access publishing makes the scientific literature available to all. Second, open materials (detailed methods, data, code, and software) increase the transparency and use of research findings. Third, open education resources allow conservation scientists and practitioners to acquire the skills needed to use research outputs. The long-term adoption of open science practices would help researchers and practitioners achieve conservation goals more quickly and efficiently and reduce inequities in information sharing. However, short-term costs for individual researchers (insufficient institutional incentives to engage in open science and knowledge mobilization) remain a challenge. We caution against a passive approach to sharing that simply involves making information available. We advocate a proactive stance toward transparency, communication, collaboration, and capacity building that involves seeking out and engaging with potential users to maximize the environmental and societal impact of conservation science.

Cierre de la Brecha entre el Conocimiento y la Acción en la Conservación con Ciencia Abierta 21-311 Resumen La brecha entre el conocimiento y la acción en las ciencias de la conservación y en su práctica ocurre cuando los resultados de las investigaciones no derivan en acciones para proteger o restaurar la biodiversidad. Entre las razones complejas y diversas de esta brecha, existen tres barreras que son fundamentales: con frecuencia el conocimiento no está disponible para los practicantes, es difícil de interpretar o difícil de usar, o ambas. Los problemas con la disponibilidad, interpretabilidad y utilidad son solucionables mediante las prácticas de ciencia abierta. Consideramos los beneficios y los obstáculos de tres prácticas de ciencia abierta para su uso por parte de los científicos y practicantes de la conservación. Primero, las publicaciones de acceso abierto hacen que la literatura científica esté disponible para todos. Segundo, los materiales abiertos (métodos detallados, datos, códigos y software) incrementan la transparencia y el uso de los hallazgos de las investigaciones. Tercero, los recursos educativos abiertos permiten que los científicos y practicantes de la conservación adquieran las habilidades necesarias para utilizar los productos de las investigaciones. La adopción a largo plazo de las prácticas de ciencia abierta ayudaría a los investigadores y a los practicantes a lograr los objetivos de conservación mucho más rápido y de manera eficiente y a reducir las desigualdades que existen en la divulgación de información. Sin embargo, los costos a corto plazo para los investigadores individuales (incentivos institucionales insuficientes para participar en la ciencia abierta y en la movilización del conocimiento) todavía son un reto. Advertimos sobre las estrategias pasivas de divulgación que simplemente hacen que la información esté disponible. Abogamos por una postura proactiva hacia la transparencia, la comunicación, la colaboración y la construcción de las capacidades que incluyen la búsqueda de y la interacción con los usuarios potenciales para maximizar el impacto ambiental y social de las ciencias de la conservación.

Potencialidades da Educação Popular em tempos de pandemia da Covid-19 na Atenção Primária à Saúde no Brasil / The potential of Popular Education in Primary Health Care in Brazil in times of the Covid-19 pandemic / Potencialidades de la Educación Popular en tiempos de pandemia de Covid-19 en la Atención Primaria de la Salud en Brasil

O presente artigo buscou compreender as especificidades e potencialidades da Educação Popular em Saúde (EPS) como orientadora de ações no âmbito da Atenção Primária à Saúde (APS) diante da pandemia da Covid-19 no Brasil. Metodologicamente, esta pesquisa tem caráter exploratório, com abordagem qualitativa dos dados. Foram realizadas, no mês de julho de 2020, entrevistas semiestruturadas com cinco atores sociais integrantes de coletivos nacionais de EPS. Os resultados indicam que têm ocorrido o fortalecimento do trabalho coletivo e a constituição de novas articulações, assim como a EPS se evidencia como prática potente na criação de vínculo com e no território; ademais, as tecnologias da informação e comunicação têm sido consideradas como importantes aliadas. Conclui-se que a EPS continua sendo efetiva no âmbito da APS, tendo o diálogo horizontalizado e a problematização da realidade como pressupostos estruturantes de seu que fazer. (AU)

This study sought to understand the specificities and potential of popular health education (PHE) as a guiding principle for primary health care actions in response to the Covid-19 pandemic in Brazil. We carried out a qualitative exploratory study using data from semi-structured interviews conducted with five social actors who were members of national PHE collectives. The findings show that PHE has strengthened collective working and given rise to new articulations, showing itself to be a powerful practice for creating affiliation with and in the territory. In addition, information and communication technologies are considered important allies. We conclude that PHE, whose underlying premises include horizontal dialogue and the problematization of reality, continues to be effective within primary care. (AU)

El presente artículo buscó comprender las especificidades y potencialidades de la Educación Popular en Salud (EPS) como orientadora de acciones en el ámbito de la Atención Primaria de la Salud (APS) frente a la pandemia de Covid-19 en Brasil. Metodológicamente, esta investigación tiene carácter exploratorio, con abordaje cualitativo de los datos. En el mes de julio de 2020 se realizaron entrevistas semiestructuradas con cinco actores sociales integrantes de colectivos nacionales de EPS. Los resultados indicaron que ha habido el fortalecimiento del trabajo colectivo y la constitución de nuevas articulaciones, así como que la EPS se ha mostrado como una práctica potente en la creación de vínculo con el territorio y en él; además, las tecnologías de la información y comunicación se han considerado importantes aliadas. Se concluye que la EPS continúa siendo efectiva en el ámbito de la APS, teniendo el diálogo horizontalizado y la problematización de la realidad como presuposiciones estructuradoras de su quehacer. (AU)

Elegía psicológica para un país en llamas / Psychological elegy for a country in flames

El presente texto tiene como objetivo realizar una reflexión en torno a los acontecimien-tos que han emergido en Colombia a raíz del paro nacional convocado para el 28 de abril de 2021. El ejercicio está pensado desde el campo de la psicología social y la literatura que sirven como ejes articuladores para adentrarnos al campo de los movimientos so-ciales. Teniendo en cuenta que, es a partir de la expresión literaria y de las contribucio-nes conceptuales, que se puede realizar una aproximación a estos fenómenos sociales. Para esto, se mencionan algunas obras literarias que pueden tener relación con el con-texto actual colombiano; seguido, la reflexión se adentra al área de la psicología, princi-palmente la psicología social y política para entablar un diálogo con la coyuntura que en este momento de efervescencia social está viviendo el país. Finalmente, se exponen las conclusiones referentes al trabajo disciplinar frente a las demandas sociales, políticas y culturales en situaciones como las movilizaciones sociales

The purpose of this text is to reflect on the events that have emerged in Colombia as a result of the national strike called for April 28, 2021. The exercise is thought from the field of social psychology and literature that serve as articulating axes to enter the field of social movements. Taking into account that it is from the literary expression and conceptual contributions that an approach to these social phenomena can be made. For this, some literary works that may be related to the current Colombian context are mentioned; then the reflection enters the area of psychology, mainly social and political psychology to establish a dialogue with the social reality that the country is experiencing at this moment of social effervescence. Finally, conclusions are drawn regarding the disciplinary work in the face of social, political and cultural demands in situations such as social mobilizations