Sistema de apoyo a la gestión de salud pública rural: etapas preliminares del proyecto

Con el objetivo de incorporar la tecnología a los Centros de Salud públicos, para optimizar recursos y mejorar la atención al paciente, se expone un proyecto de informatización centrado en el ámbito rural de una Provincia y se abordan con mayor detalle las etapas iniciales del mismo. El trabajo se compone de secciones: la primera introduce el tema de TIC en salud, la segunda la metodología desarrollada. Se presenta, a continuación, los resultados preliminares expuestos mediante el modelado del sistema que esbozan sus principales funcionalidades. Finalmente se sintetizan, las conclusiones y etapas a seguir para concretar el software.Sociedad Argentina de Informática e Investigación Operativ

Apoyo al bienestar socioemocional en contexto de pandemia por COVID19: sistematización de una experiencia basada en el enfoque de Escuela Total 1

: The interruption of face-to-face education caused by the COVID-19 pandemic and the effects of confinement and social distancing have caused multiple socio-educational and socio-emotional implications. Schools have had to resort to different forms of online and hybrid education to maintain the continuity of the educational process, with high concern about the well-being of school communities. This study systematizes and analyzes the educational experience of a basic school that implemented a socio-emotional support plan based on the whole school approach proposed in Chile by the COVID-19 Social Board in the education area. The results show that the school, supported by his Institutional Educational Project with a participatory and inclusive seal, has managed to deliver a comprehensive and systematic educational response that safeguards the conditions for access, permanence and participation of all students, through high-level actions. promotional (selfcare workshops, follow-up and monitoring of students, articulation of the PIE with regular classroom teachers), focused prevention (psychosocial support line through WhatsApp, orientation of social benefits, group pedagogical supports) and individual intervention (conversation with teachers with physical and / or emotional exhaustion, individual tutoring for students, referral to networks). The possibilities of the total school approach are discussed to overcome the logic of psychological wellbeing associated with individual interventions, moving towards more collective and community ways of understanding, planning and implementing actions to support the well-being of educational communities.: La interrupción de la educación presencial provocada por la pandemia por COVID-19 y los efectos del confinamiento y distanciamiento social han provocado múltiples implicancias socioeducativas y socioemocionales. Las escuelas han debido recurrir a distintas formas de educación en línea e híbrida para mantener la continuidad del proceso educativo, con alta preocupación sobre el bienestar de las comunidades escolares. Este estudio sistematiza y analiza la experiencia educativa de una escuela básica que implementó un plan de apoyo socioemocional basado en el enfoque de escuela total (whole school approach) propuesto en Chile por la Mesa Social COVID-19 en el área educación. Los resultados muestran que la escuela, sustentada en un Proyecto Educativo Institucional con sello participativo e inclusivo, ha logrado entregar una respuesta educativa integral y sistemática que resguarda las condiciones para el acceso, permanencia y participación de todos los estudiantes, a través de acciones de nivel promocional (talleres de autocuidado, seguimiento y monitoreo de estudiantes, articulación del PIE con docentes de aula regular), de prevención focalizada (línea de apoyo psicosocial por WhatsApp, orientación de beneficios sociales, apoyos pedagógicos grupales) e intervención individual (conversatorio con docentes con desgaste físico y/o emocional, tutorías individuales a estudiantes, derivación a redes). Se discuten las posibilidades del enfoque de escuela total para superar la lógica de bienestar psicológico asociada a intervenciones individuales, avanzando hacia formas más colectivas y comunitarias de entender, planificar e implementar acciones de apoyo al bienestar de las comunidades educativas

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease