TRIBUNAL ARBITRAL DE COLOMBIA TELECOMUNICACIONES S.A. E.S.P. VS. MUNICIPIO DE COTA

546

TRIBUNAL ARBITRAL DE PROMOTORA COMERCIAL DE LA SABANA S.A.S (PROCOMSA S.A.S.) VS. EDOSPINA S.A.S. - EN REORGANIZACION

460

Systematization of experiences of a team of interviewers during a pilot test in humanized childbirth

Introducción: esta sistematización recoge las riquezas de notas de campo escritas por siete encuestadoras de siete ciudades de Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga, Manizales y Pasto), realizadas durante una prueba piloto, en donde se reconocieron sus dinámicas y aprendizajes. Objetivo: sistematizar las experiencias de los traslados hacia los terrenos de campo y de las experiencias del parto de mujeres entrevistadas, a través de las voces de las encuestadoras. Métodología: se plantearon tres fases para seguir la metodología de la sistematización de experiencias: fase de reconstrucción, fase de la interpretación y fase de la potenciación de la experiencia. Resultados: se evidenciaron tres categorías de análisis: el trayecto y el entorno, las convergencias en la maternidad y la experiencia del parto. Conclusiones: las notas de campo de las encuestadoras se convirtieron en fuente primordialde informaciones no homogéneas y muy diversas. Se hizo imprescindible analizar sus experiencias durante sus traslados a los terrenos de campo y, de esta forma, aplicar un enfoque intersectorial para entender e interpretar lo que ellas escucharon de parte de las madres encuestadas, por ejemplo: circunstancias cálidas y respetuosas a la hora de recibir la atención clínica del parto, así como situaciones de maltrato en la asistencia obstétrica, donde han sido culturalmente jerarquizadas por la medicalización del parto, lo que constituye una posición de subordinación hacia la paciente.Introduction: This systematization gathers the richness of the field notes written by seven interviewers from sevencities in Colombia (Bogotá, Medellin, Cali, Barranquilla, Bucaramanga, Manizales and Pasto), carried out during atest pilot, where their dynamics and learning were recognized. Objective: To systematize experiences of itineraries to the territories, as well as childbirth from the voices of the interviewers. Methods: The methodological process presented three phases designed to follow the methodology of systematization of experiences. Reconstruction phase; interpretation phase and experience empowerment phase. Results: Three categories of analysis were evidenced: the journey and the environment, the convergences in motherhood and the experience of childbirth. Conclusions: The field notes of the pollsters became a primary source of inhomogeneous and highly diverse information. It became essential to analyze their experiences during their transfers to the fields and thus apply an intersectoral approach to understand and interpret what they heard from the surveyed mothers: warm and respectful circumstances when receiving clinical care of childbirth, as well as situations of abuse in obstetric care that are and have been culturally hierarchical by the medicalization of childbirth, constituting a subordinate position towards the patient.Introducción: esta sistematización recoge las riquezas de notas de campo escritas por siete encuestadoras de siete ciudades de Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga, Manizales y Pasto), realizadas durante una prueba piloto, en donde se reconocieron sus dinámicas y aprendizajes. Objetivo: sistematizar las experiencias de los traslados hacia los terrenos de campo y de las experiencias del parto de mujeres entrevistadas, a través de las voces de las encuestadoras. Métodología: se plantearon tres fases para seguir la metodología de la sistematización de experiencias: fase de reconstrucción, fase de la interpretación y fase de la potenciación de la experiencia. Resultados: se evidenciaron tres categorías de análisis: el trayecto y el entorno, las convergencias en la maternidad y la experiencia del parto. Conclusiones: las notas de campo de las encuestadoras se convirtieron en fuente primordialde informaciones no homogéneas y muy diversas. Se hizo imprescindible analizar sus experiencias durante sus traslados a los terrenos de campo y, de esta forma, aplicar un enfoque intersectorial para entender e interpretar lo que ellas escucharon de parte de las madres encuestadas, por ejemplo: circunstancias cálidas y respetuosas a la hora de recibir la atención clínica del parto, así como situaciones de maltrato en la asistencia obstétrica, donde han sido culturalmente jerarquizadas por la medicalización del parto, lo que constituye una posición de subordinación hacia la paciente

Caracterización biológica de Paz de Ariporo. Identificación de especies claves para establecer límites de humedales.

Se exponen los resultados y evaluaciones en campo de la ventana piloto de humedales de Paz de Ariporo- Hato Corozal en el marco del convenio 005 (13-014) entre el Instituto Humboldt y el Fondo Adaptación.BogotáSubdirección de Servicios Científicos y Proyectos Especiale

ABORDAJE FISIOTERAPÉUTICO EN USUARIO DE LA CLÍNICA DE LA POLICÍA REGIONAL CARIBE CON PARÁLISIS DE LOS NERVIOS FACIAL Y MOTOR OCULAR. REPORTE DE CASO

Introducción: La parálisis facial es un trastorno neuromuscular relativamente frecuente generado por la lesión de las vías centrales o periféricas del nervio facial como consecuencia de una lesión, se presenta con asimetría, disfunción  y disminución en el desempeño de los músculos de la expresión facial. A nivel mundial se estima una incidencia anual de 23/100.000 habitantes afectando a ambos géneros por igual entre los 10 y los 45 años. Resumen del caso: El objetivo de este artículo es la presentación del caso clínico de un paciente que presentó este trastorno por secuela de fractura ósea del occipital y del peñasco a causa de traumatismo craneoencefálico, con un periodo de evolución de 9 meses. Discusión: Se justifica la importancia y pertinencia de las modalidades cinéticas en la recuperación de la funcionalidad del paciente con este tipo de trastorno. Conclusiones: La parálisis facial genera un impacto funcional y psicológico importante para la persona que la padece, por tanto la intervención fisioterapéutica debe enfocarse desde la rehabilitación integral tanto funcional como de integración social

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Innovaciones y mejoras en el proyecto tutoría entre compañeros. Curso 2015-2016

Memoria ID-0137. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission