Enseñanza centrada en el aprendizaje e implicación del estudiante en estudiantes universitarios

Los datos que se presentan son un avance de resultados de una investigación de tres años que pretende evaluar el impacto de metodologías innovadoras, centradas en el aprendizaje, sobre el modo de aprender de los estudiantes universitarios y sobre su rendimiento

Experiencia en el uso de las trayectorias clínicas estudio electrofisiológico eef/ablación

• Objective: To analyze the degree of compliance with the Clinical Trajectory (CT) used to plan for medical care in patients undergoing electrophysiological study (EPS) and/or ablation, by comparing the previous paper form (PF) to the actual electronic form (EF). We further aimed to determine the degree of satisfaction of nurses carrying out both methods. • Methods: We included patients undergoing EPS/ablation during the data collection period. We retrospectively analyzed the CT of these patients by reviewing the clinical pre-procedural, intra-procedural and post-procedural reports. Those nurses involved in the procedures underwent a voluntary and anonymous satisfaction questionnaire (scoring from 0 to 10). • Results: We finally reviewed a total number of 104 CT, 45 (43%) of which were EF and 59 (57%) PF. We noted a higher degree of fulfillment of pre-procedural and post-procedural medical care variables among those patients whose data was noted in EF as opposed to those in PF. No differences were noted in the fulfillment of intra-procedural variables between both groups. A fairly high mean score in the satisfaction questionnaire for both EF and PF (8) was obtained. • Conclusions: Clinical Trajectory computerization helps improve the registering of data on procedural-related medical care. PF does not span the whole nursing pre-procedural and post-procedural activity as fully. Completion of the EF requires nurses to fill in a larger number of mandatory fields in the patient’s CT. The nursing staff who served as a pilot unit (Cardiology) for the study are more used to the medical care given during these procedures• Objetivos: Evaluar el grado de cumplimiento de los registros de la trayectoria clínica (TC) utilizada para planificar los cuidados de los pacientes sometidos a un estudio electrofisiológico (EEF) / ablación, comparando un primer formato en papel (TCP), con el actual formato electrónico (TCI). Paralelamente, analizar el grado de satisfacción de los profesionales que las utilizan. • Material y Métodos: Serie consecutiva de procedimientos de EEF/ablación del periodo seleccionado, se realizó un estudio observacional retrospectivo de las TC. Análisis estadístico descriptivo, jerarquizando según los tres tiempos del procedimiento (pre, intra y post intervencionismo). Fuente de información: la historia clínica. Paralelamente se solicitó de manera voluntaria y anónima a las enfermeras implicadas en este proceso que respondieran a un cuestionario. • Resultados: Se disponen para análisis 104 TC, 45 (43%) son TCI, y 59 (57%) son TCP. Observamos que la cumplimentación de variables pre y post procedimiento en la TCI respecto al formato papel es mayor. En la fase asistencial intra procedimiento no existen diferencias significativas de cumplimentación. El resultado del cuestionario destaca un grado de satisfacción bastante alto, con una media de 8 (valorado entre 0-10). • Conclusiones: La informatización de la TC favorece la cumplimentación de los registros. El formato papel no recoge toda la práctica enfermera. La TCI tiene un abanico más amplio de cumplimentación obligatoria. El personal de enfermería de la unidad piloto (cardiología) está más habituado al cuidado del paciente sometido a este procedimiento

Documentación de enfermería en una unidad de arritmias

• Introduction: In 1995 a clinical trajectory protocol was initiated in our center. The Unit of Cardiac Electrophysiology and Arrhythmias has incorporated this clinical tool in order to improve the nursing care of our patients. We have previously developed an informative form regarding the indication and usefulness of the electrophysiological study, including patient’s personal cares needed after hospital discharge. • Aim: We aimed to assess the quality and continuation of the patient’s clinical assistance during hospital admission. We further aimed to elaborate an advisory written protocol including medical self-care after hospital discharge for the patients and their relatives. • Methods: We first evaluated previous clinical trajectories performed in our Cardiology Department. In order to assess for quality of nursing cares, the Marjory Gordon patterns were used. The NANDA (North American Nursing Diagnosis Association) classification was used in order to label the nursing diagnoses. • Results: The nursing team of the Electrophysiology Unit has developed 3 written forms, including a trajectory sheet during the electrophysiological study; an informative form for the patient, with a detailed explanation of the procedure before the electrophysiological study/ablation is performed; and an informative form with clinical care recommendations after discharge. • Conclusions: The written forms we have developed are a guarantee for continuation of adequate medical cares during and after an electrophysiological study and ablation. These documents also enhance the learning process of new professionals in an electrophysiology unit, as well as an adequate patient’s self-care after discharge.• Introducción: En el año 1995 se inició en nuestro centro un proceso de implantación de trayectorias clínicas. La unidad de arritmias ha incorporado dicha herramienta con el fin de mejorar los cuidados de enfermería, además de una hoja informativa en la que se explica en qué consiste un estudio electrofisiológico y unas recomendaciones sobre el autocuidado del paciente tras el alta hospitalaria. • Objetivo: Garantizar la calidad y continuidad del proceso asistencial. Ofrecer soporte escrito para la implicación del paciente y su familia en la continuidad de los cuidados. • Material y método: Se ha realizado una revisión de las trayectorias ya existentes en la unidad de cardiología. Como método de valoración enfermera del paciente se han seguido los patrones funcionales de Marjory Gordon, utilizando la taxonomía de la NANDA (North American Nursing Diagnosis Association) para los diagnósticos de enfermería. • Resultados: Se ha realizado una trayectoria propia del Estudio Electrofisiológico, una hoja informativa del procedimiento para entregar al paciente, previo a la intervención, así como un documento con recomendaciones al alta para el paciente. • Conclusiones: La documentación elaborada asegura la continuidad de los cuidados, favorece el aprendizaje de los nuevos profesionales que se incorporan a las distintas unidades que intervienen en el proceso y facilita el autocuidado del paciente tras el alta hospitalaria

GLI2-specific Transcriptional Activation of the Bone Morphogenetic Protein/Activin Antagonist Follistatin in Human Epidermal Cells*S⃞

Hedgehog (HH) signaling in the epidermis is primarily mediated by the zinc finger transcription factors GLI1 and GLI2. Exquisite regulation of HH/GLI signaling is crucial for proper specification of the epidermal lineage and development of its derivatives, whereas dysregulation of HH/GLI signaling disrupts tissue homeostasis and causes basal cell carcinoma (BCC). Similarly, bone morphogenetic proteins (BMPs) and activins have been described as key signaling factors in the complex regulation of epidermal fate decisions, although their precise interplay with HH/GLI is largely elusive. Here we show that, in human epidermal cells, expression of the activin/BMP antagonist follistatin (FST) is predominantly up-regulated by the HH effector GLI2. Consistently, we found strong FST expression in the outer root sheath of human hair follicles and BCC. Detailed promoter analysis showed that two sequences with homology to the GLI consensus binding site are required for GLI2-mediated activation. Interestingly, activation of the FST promoter is highly GLI2-specific, because neither GLI1 nor GLI3 can significantly increase FST transcription. GLI2 specificity requires the presence of a 518-bp fragment in the proximal FST promoter region. On the protein level, sequences C-terminal to the zinc finger are responsible for GLI2-specific activation of FST transcription, pointing to the existence of GLI-interacting cofactors that modulate GLI target specificity. Our results reveal a key role of GLI2 in activation of the activin/BMP antagonist FST in response to HH signaling and provide new evidence for a regulatory interaction between HH and activin/BMP signaling in hair follicle development and BCC