Jornada Nacional de Escuelas y Carreras de Obstetricia de Chile, un espacio para la reflexión y el fortalecimiento de la profesión.

El día 4 de noviembre en la ciudad de Copiapó se desarrolló la Jornada anual de Escuelas y Carreras de Obstetricia de Chile, que en este año por primera vez tuvo como anfitrión al Departamento de Obstetricia y Puericultura de la Universidad de Atacama. Este año después de dos versiones virtuales se pudo concretar una reunión presencial que contó con la participación de 35 directivos, académicos y académicas de 13 universidades públicas y privadas que forman parte de la red de instituciones formadoras de matronas y matrones de Chile. Las jornadas anuales de Escuelas y carreras de Obstetricia realizadas desde el año 2017, se han convertido en un espacio de reflexión y análisis de la realidad actual de la formación profesional, como también del escenario que vive la matronería a nivel nacional y mundial. Este espacio también ha contribuido a fortalecer la colaboración entre las diversas casas de estudio y a generar espacios de sinergia entre las instituciones que conforman la red. A casi tres años del inicio de la Pandemia Covid 19, el mundo, el país y naturalmente la formación de profesionales han sufrido vertiginosos y forzados cambios que han repercutido directamente el en quehacer de las unidades académicas. Durante este periodo, estas unidades debieron realizar adaptaciones macro y microcurriculares que permitieron, en el contexto de una formación de calidad y las disposiciones reglamentarias, continuar con el desarrollo de competencias de los y las estudiantes a pesar de las restricciones de presencialidad en los espacios de aula, laboratorio y campo clínico. Es por esto, que las dos versiones anteriores trataron sobre los desafíos académicos de las escuelas de Obstetricia en tiempos de pandemia y lo que la pandemia nos ha enseñó respecto de las formas de aprender. En este año habiendo superado en parte las problématicas generadas por la pandemia, la jornada se abocó en observar la situación nacional en relación a las políticas en materia de salud sexual y reproductiva, como también en aportar el  futuro de la matronería desde la ciencia, la innovación y el desarrollo sostenible. Las principales “ideas fuerza”, desafíos observados y propuestas realizadas por las y los asistentes a la jornada se detallan a continuación. Desarrollo. Durante la jornada los asistentes se reunieron en equipos de trabajo para responder preguntas orientadoras dirigidas a reflexionar sobre los principales desafíos para la formación profesional en las áreas de docencia, investigación y vinculación con el medio. Para finalizar, a todos los grupos de trabajos que les solicitó que redactaran propuestas en relación a los desafíos identificados en cada área. En el área misional de la docencia se identificaron los siguientes desafíos: 1) la formación de profesionales integrales, comprometidos socialmente y con un rol transformador, 2) cuidar la salud mental de los estudiantes y 3) instaurar la docencia remota. Las propuestas que surgieron a la formación integral fueron: desarrollar estrategias para reforzar la formación en competencias genéricas, fijar estándares mínimos para el desarrollo de competencias específicas y trabajar en potenciar en el enfoque de inclusión en las carreras de Obstetricia en Chile. En salud mental se pretende visibilizar y crear estrategias para trabajar la salud mental de los estudiantes y fortalecer el desarrollo de las habilidades blandas en los estudiantes a través del currículum. Mientras que en docencia remota se plantea capacitar a los académicos en competencias digitales. En el área de la investigación, se identificaron como desafíos: 1) potenciar la práctica de la matronería basada en la evidencia y ampliar mirada más allá de la salud sexual/ reproductiva y 2) generar recursos humanos y económicos para cumplir la tarea. Dentro de las propuestas del punto 1, destacaron: hacer investigación en torno a la profesión, sus prácticas e impacto en la sociedad, direccionar la búsqueda de evidencia científica y el desarrollo del pensamiento crítico desde primer año del pregrado y determinar competencias para el pre y postgrado. Mientras que para atraer recursos, se planteó potenciar y fortalecer la red de escuelas y trabajo con el Ministerio de Salud y Colegio de Matronas, vincularse con el ámbito clínico a través del trabajo colaborativo e incorporar de manera permanente y sistemática a los estudiantes en actividades investigativas. Finalmente en el área de la vinculación con el medio, se presentó como desafío principal la tarea de realizar vinculación efectiva con diferentes instituciones y organizaciones de la sociedad civil. Para cumplir con esto, las propuestas serían: 1) incluir  dentro de la elaboración de propuestas de vinculación, la participación de la comunidad a intervenir y al estudiantado, idealmente a través de diagnósticos participativos, 2) definir claramente las políticas de vinculación a ejecutar en cada unidad académica, 3) explorar nuevos espacios para realizar la extensión y vinculación con el medio que pudieran implicar retribuciones de recursos, 4) crear una coordinación entre las distintas escuelas de Obstetricia de la red para elaborar actividades consorciadas, 5) ampliar la mirada para intervenir más allá de la salud sexual y reproductiva y explorar áreas no abordadas tradicionalmente y 6) postular iniciativas de vinculación con el medio a fondos concursables de interés público como ciencia abierta, fondos privados u otros. Conclusiones. Se debe fortalecer la red de instituciones formadoras de matronas y matronas de Chile, inclusive a nivel de asociación académica u otra similar. Con el fin de poder realizar un trabajo conjunto que permita enfrentar los desafíos en materia de docencia de pregrado, investigación y vinculación con el medio. El trabajo de fortalecimiento de la red permitirá también, ser un aporte y transformarse en un referente académico ante el Ministerio de Salud, Educación y asociaciones gremiales. La red de instituciones formadoras debe estructurarse con una directiva que permita una coordinación efectiva, elecciones frecuentes de sus miembros y estatutos que regulen su funcionamiento y orgánica

Consideraciones para la provisión de servicios de regulación de fertilidad para mujeres durante la pandemia por COVID-19

Introduction. The sexual and reproductive health (SRH) constitutes a universal human right. Due the consequences generated by the pandemic Virus SARS-COV-2 sexual and reproductive health benefits have been deprioritized in different countries. In Chile, a loss in access and continuity of benefits has been observed due to the reorientation of primary health care resources. The consequences of these decisions affected the preventive benefits in SRH and the discontinuation of contraceptive controls. The latter becomes more serious if it is observed that this level solves 95 % of the contraceptive benefits of the entire public network. Objectives. Describe the main international recommendations available regarding the management of contraception in pandemic times and generate proposals for our country. Material and Methods. It was done a literature review in Pubmed, the Cochrane Library and the websites of the main international Spanish and English-speaking scientific societies. Results. 6 documents were identified that systematize the recent and updated information so that the countries can face better the problems in contraception. The results were organized into the following categories: implementation of a non-face-to-face consultation system, suggestions for access to information / services and management of different types of contraception. Conclusions. The adoption of all or some of the proposed measures implies that the health system can prevent the consequences derived from the loss of access and continuity in contraceptive and SRH services.Introducción. La salud sexual y reproductiva (SSR) constituye un derecho humano universal. Debido a las consecuencias generadas por la pandemia del Virus SARS-COV-2 las prestaciones en salud sexual y reproductiva han sido postergadas en diferentes países. En Chile, debido a las medidas de distanciamiento social y reorganización de los servicios, se ha observado una pérdida en el acceso y continuidad de las prestaciones a causa de la reorientación de los recursos de atención primaria de salud. Las consecuencias de estas decisiones afectan a las prestaciones preventivas en SSR y descontinuación de los controles de anticoncepción. Esto último se torna más grave si se observa que este nivel resuelve el 95 % de las prestaciones de anticoncepción de toda la red pública. Objetivos. Describir las principales recomendaciones internacionales disponibles respecto del manejo de la anticoncepción en tiempos de pandemia y generar propuestas generales aplicables a nuestro país. Material y métodos. Se realizó una revisión de literatura en Pubmed, Biblioteca Cochrane y sitios web de las principales sociedades científicas internacionales de habla hispana e inglesa. Resultados. Se identificaron 6 documentos que sistematizan la información reciente y actualizada para que los países puedan enfrentar de la mejor manera las problemáticas en anticoncepción. Los resultados fueron organizados en: implementación de sistema de consultas no presenciales, sugerencias para el acceso a información/ servicios y manejo de los distintos tipos de anticoncepción. Conclusiones. La adopción de la totalidad o algunas de las medidas propuestas supone que un sistema de salud pueda prevenir las consecuencias derivadas de la pérdida de acceso y continuidad en los servicios de anticoncepción y SSR

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Family functioning in students of health sciences in four Latin American countries: a study of the structure and factorial invariance of the FACES III scale. A cross-sectional study

Abstract Background Psychometric studies of the FACES III scale in Spanish-speaking countries show a lack of agreement on the factorial structure of the scale. In addition, most of the studies have only performed exploratory analyses of its factorial structure. Objective The objective of the present study was to confirm the structure and factorial invariance of the FACES III scale in nursing and obstetric students from Chile, Colombia, Peru, and Mexico. Methods A total of 3303 students from the four countries participated in this study (Colombia = 1559, Chile = 1224, Peru = 215, Mexico = 305). Results The results of the study showed that the Bi-factor model presents the best-fit indexes to the data from Colombia, Chile, and Mexico, but not from Peru. In addition, it was found that this model showed evidence of being strictly invariant among the three countries in the sequence of the invariance models proposed: metric invariance (ΔRMSEA = .000), scalar (ΔRMSEA = .008), and strict (ΔRMSEA = .008). The bi-factor model also showed adequate reliability indexes in the three countries. Conclusion It is concluded that the FACES III scale shows adequate psychometric performance under a bi-factor model in nursing and obstetric students from Colombia, Chile, and Mexico. The lack of fit of the model in Peru could be associated with the small sample size

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury