La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia. Departamento Cundinamarca

Es el desarrollo de las temáticas estudiadas durante la realización del Diplomado de Acompañamiento psicosocial en escenarios de violencia, mediante el análisis y evaluación de eventos psicosociales traumáticos desde una mirada psicológica, por consiguiente, utilizamos para este propósito las historias narradas en el libro Voces. Relatos de violencia y esperanza en Colombia, en este sentido, cumpliendo con los requerimientos de la guía, tratamos de abordar psicosocialmente y aproximarnos a estos desarrollos conceptuales y con ellos realizar, desde un aspecto aplicado, un ejercicio de análisis de los relatos para el desarrollo de subjetividades inmersas en contextos de violencia. Democráticamente escogimos la historia de “CAMILO” un joven afrocolombiano que salió de su tierra por amenazas de paramilitares y de milicianos de las FARC, teniendo en cuenta y gracias a la deliberación en el foro colaborativo propusimos las tres preguntas estratégicas, tres circulares, tres reflexivas, orientadas hacia un acercamiento psicosocial ético y proactivo en la superación de las condiciones de victimización debidamente justificada desde su pertinencia, con el propósito de unificar la presentación de las 9 preguntas solicitadas. Seguidamente desarrollamos el caso Pandurí, se trata de una historia que dibuja marcas y un escenario de violencia que es repetitivo y en nuestro país trata de la historia de 200 personas, tratando de sobrevivir lejos de la protección del estado, es aterrorizada en medio de la noche cuyos habitantes sufrieron las pérdidas de sus vidas a manos de terroristas, sin antes sufrir torturas, narración que nos ayudó a establecer un escenario de reflexión para los propósitos de la actividad, nuestro grupo analizo el caso y sobre él generamos reflexiones sobre su abordaje y propusimos tres estrategias de acompañamiento psicosocial.The development of the topics studied during the completion of the diplomaed in: Psychosocial Accompaniment in violence scenarios, through the analysis and evaluation of traumatic psychosocial events from a psychological perspective, therefore, for this purpose we use the stories narrated in the book “Voices Stories of violence and hope in Colombia”, complying with the requirements of the guide, we try to psychosocially approach these conceptual developments and with them carry out, from an applied aspect, an exercise of analysis of stories for development of subjectivities immersed in violence contexts. We, chose the story of “CAMILO”, a young Afro-Colombian who left his land due to threats from paramilitaries and FARC warfare, we proposed three strategic questions, three circular questions , three reflective questions, oriented towards an ethical and proactive psychosocial approach to overcome the conditions of victimization, justified from its relevance, with the purpose of unifying the presentation of the 9 questions requested. Then, we develop the Pandurí case, it is a repetitive story that draws marks and a scene of violence in our country. This history it is about 200 people, trying to survive without the protection of the state, they are terrified in the middle of the night, the habitants suffered the loss of their lives at the hands of terrorists, suffering torture, this history helped us to establish a reflection scenario for the purposes of the activity, our group analyzed the case and on it, we generated reflections about this approach and We proposed three strategies for psychosocial support

Catàleg de logotips per a commemorar el 50 aniversari de la fundació d’EINA

Catàleg de logotips dissenyats per a commemorar el 50 aniversari de la fundació d’EINA

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used