Perfil del paciente ingresado en la Unidad de Cuidados Respiratorios Intermedios del Hospital Clínico Universitario Lozano Blesa de Zaragoza

Introducción: En los últimos años la revolución en VMNI ha abierto nuevos frentes, uno de ellos, dónde tratar a los pacientes. Lejos del binomio inicial, planta de neumología o UCI, surgió el concepto de unidades de cuidados intermedios respiratorios (UCRI). El campo de aplicación de esta técnica es cada vez más amplio, y alberga prácticamente cualquier situación clínica en la que se desarrolle un cuadro de insuficiencia respiratoria, de tal forma que ha aumentado el número de estudios que pretenden mostrar su utilidad en nuevos campos de trabajo. Objetivo: Describir el perfil del paciente con VMNI ingresado en la UCRI del Hospital Clínico Universitario Lozano Blesa, desde julio de 2013 hasta noviembre de 2015. Material y método: Estudio observacional de tipo descriptivo con secuencia temporal transversal, y de carácter retrospectivo en el que se han recogido los datos de los pacientes que han pertenecido a la unidad de cuidados respiratorios intermedios del Hospital Clínico Universitario Lozano Blesa de Zaragoza. Resultados: Se analizaron 103 datos. La mayoría de los pacientes ingresaron en invierno, los cuales eran principalmente hombres fumadores de más de 72 años. Los valores gasométricos fueron prácticamente similares en el grupo EPOC y no EPOC, a excepción de la pCO2 al ingreso. Además, hubo una elevada comorbilidad, y como consecuencia un aumento de la probabilidad de mortalidad de dicha población. Conclusiones: Existieron diferencias en cuanto al valor de la pCO2 al ingreso entre el grupo EPOC y no EPOC, ya que el grupo EPOC tenía esta cifra más elevada

Inclusión educativa diálogos con la psicología en Colombia

Revisar la producción bibliográfica de investigaciones en el área de la psicología en favor de la inclusión educativa en Colombia, entre 2015-2020, cuyos resultados sirvan como sustento en investigaciones futuras.La psicología contribuye mediante pensamientos y experiencias significativas al desarrollo de nuevos modelos y planes de estudio, ajustados a la diversidad del educando; asimismo, actualiza sus saberes desde los diálogos recreados con otras disciplinas. Esta investigación de carácter académico y tipo sistematizada explora la producción bibliográfica de investigaciones desde el área de la psicología realizada en un rango de tiempo entre 2015-2020. Este estudio hizo uso de bases de datos estrictamente electrónicas y de alta confiabilidad (Scielo, Dialnet) para la recolección de la información, orientada específicamente desde la perspectiva psicológica y sus aportes en beneficio de la “inclusión” educativa en Colombia, dirigido desde la definición de una problemática y una pregunta de investigación, que sirvieron como guía en la identificación de estudios previos sobre el tema investigado y todos aquellos aspectos que en el curso de la misma se consideraron relevantes y desconocidos, García-Peñalvo (2017). De esta manera se logró identificar según una georreferenciación realizada, que los 2 departamentos con mayor producción científica entregada frente al tema objeto de estudio esta revisión fueron: Bogotá y Antioquia; en los cuales los profesionales en psicología realizaron aportes significativos respecto al tema de “inclusión” escolar en las diferentes regiones del País, desde múltiples perspectivas territoriales, sociales, familiares, de género, entre otras. La producción científica de alto impacto se tomó de 33 universidades del país, cuyo análisis y reconocimiento de los contenidos hallados permitió evidenciar que el enfoque con mayores aportes en favor de la “inclusión” educativa en Colombia en el marco de esta investigación

Estrategias de gestión de talento humano que permitan el mejoramiento del clima laboral en la panadería ciudad Luz

El presente trabajo de investigación se realizó en la empresa panadería ciudad Luz, donde buscamos orientar en base a un diagnóstico del clima organizacional la empresa para una mejora continua. El principal objetivo es mediante técnicas de recolección de datos en las que puedan participar los empleados de todas las áreas, identificar los factores negativos que tenga la empresa en relación al clima organizacional. Las variables que se tuvieron en cuenta fueron las dimensiones de Likert, así mismo, reevaluar si en cada área de la empresa se cumplen con los recursos necesarios para la realización de labores que faciliten el trabajo de cada uno de los colaboradores de la panadería, con un personal capacitado y motivado a cumplir diariamente con cada una de sus funciones de una manera adecuada, permitiendo el cumplimiento de los objetivos propuestos por la organización.The present research work was carried out in the bakery company Ciudad Luz, where we seek to guide the company based on a diagnosis of the organizational climate for continuous improvement. The main objective is through data collection techniques in which employees from all areas can participate, to identify the negative factors that the company has in relation to the organizational climate. The variables that were taken into account were the Likert dimensions, as well as to reevaluate if in each area of the company the necessary resources for the realization of tasks that facilitate the work of each of the employees of the bakery, with a trained and motivated staff to fulfill each of their daily functions in an appropriate manner, allowing the fulfillment of the objectives proposed by the organization

¿Cómo implementar un programa de Farmacovigilancia para un establecimiento farmacéutico minorista en Colombia?

No aplicaA través de este trabajo se abordarán las problemáticas del caso 1 propuesto para el desarrollo de la actividad, donde se le dará una solución enfocada en la creación de un programa de farmacovigilancia apropiado para el establecimiento farmacéutico minorista; el cual está presentando problemas en los procesos de recepción de pedidos y almacenamiento, abastecimiento de productos, y principalmente en el proceso de dispensación donde fueron entregados medicamentos de diferente componente y concentración a los pacientes, lo cual desencadenó en algunos problemas relacionados con medicamentos (PRM) y eventos adversos. Lo anterior, buscando destacar la importancia en la implementación de un programa de farmacovigilancia en el establecimiento y que como se menciona en la resolución 1403 de 2007, todas las instituciones prestadoras de servicios de salud y empresas administradoras de planes benéficos deben contar con un programa de farmacovigilancia, donde se puedan establecer y prevenir problemas relacionados con la indicación, efectividad y seguridad de los medicamentos (Ítem 5.3 pág. 68); así mismo se menciona que si se sospecha de un evento adverso debe ser reportado al INVIMA dentro de los primeros 5 días usando el formulario (Ítem 5.5 pág. 68). El programa nacional de farmacovigilancia debe enfocar sus esfuerzos en la perspectiva epidemiológica y social de los problemas asociados al uso de medicamentos y sus efectos con el fin de resolverlos. (Resolución 1403 de 2007. Pág. 69) Es de destacar que un programa bien instalado de farmacovigilancia dentro de un establecimiento farmacéutico minorista ayuda a que se prevengan problemas relacionados con la salud de los pacientes, el uso inadecuado de los medicamentos y también ayuda a que se tengan todos los reportes que pueden ser utilizados para aportes científicos de acuerdo con el uso racional de los medicamentos.Through this work we will talk a little more about case 1 presented, where a solution to the problem presented will be given and a pharmacovigilance program will be carried out for the pharmaceutical establishment, which is presenting problems in the part of the process of receiving orders and storage , availability of products , are affected in the same way in the dispensing process where medicines of different concentrations were delivered to the patients and due to this error some problems related to medicines and adverse events arose . For this reason, the importance of implementing a pharmacovigilance program in the establishment and as mentioned in resolution 1403 of 2007 that all institutions providing health services and companies that administer charitable plans must have a pharmacovigilance program wherever possible. establish and prevent problems related to the indication, effectiveness and safety of medications (item 5.3 page 68); It is also mentioned that a suspected adverse event must be reported to INVIMA within the first 5 days using the form (item 5.5 page 68). The national pharmacovigilance program should focus its efforts on the epidemiological and social perspective of the problems associated with the use of drugs and their effects in order to solve them. (Resolution 1403 of 2007. Page 69). It is noteworthy that a well-installed pharmacovigilance program within an IPS helps to prevent problems related to the health of patients, as well as the inappropriate use of medications, it also helps to that all the reports that can be used for scientific contributions are available according to the rational use of medicines

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Utilization of mechanical power and associations with clinical outcomes in brain injured patients. a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

BackgroundThere is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes.MethodsIn this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale <= 12 before intubation) who required mechanical ventilation (MV) >= 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS).ResultsWe included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22).ConclusionsExposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation