La imagen y la narrativa como herramienta para el abordaje psicosocial en escenarios de violencia. Departamento del Magdalena

Se considera violencia el uso de la fuerza física para causar daño a otra persona con el fin de lograr un objetivo. Actualmente existen diversos tipos de violencia en diferentes contextos, el presente artículo, se enmarcará en el conflicto armado, violencia sexual, violencia física y violencia basada en género, todas estas como consecuencia a la problemática del conflicto armado o grupos ilegales. En los últimos dos siglos, Colombia ha experimentado múltiples incidentes de violencia, causando daño psicosocial irreparable en el tejido familiar y social del individuo y la comunidad, sin embargo, se evidencia la resiliencia de estas poblaciones, buscan la manera de transformar la realidad que les tocó vivir y presenciar en sus territorios. Conocer la perspectiva que tienen las víctimas, acerca de los procesos estratégicos que se implementan mediante leyes es de gran importancia; saber que consideraciones tienen ellos acerca de las posibles soluciones que buscan mejorar la calidad de vida. Las condiciones particulares del conflicto en Colombia demandan, la creatividad para la formulación de mecanismos de justicia que permitan la defensa y promoción de los derechos de las víctimas y, de ninguna manera, la mera postergación de esta agenda en nombre de circunstancias particulares. Uribe, M (2009) p.8 Las múltiples estrategias que se aplican en la actualidad han contribuido a que los afectados tengan un mayor interés en participar en los programas de construcción de memoria colectiva para ellos es muy importante ser escuchados y comprendidos.Violence is considered the use of physical force to cause harm to another person in order to achieve an objective. Currently we manage to visualize various types of violence in different contexts every day, but, in this article, we are going to focus on the armed conflict, sexual violence, physical violence and gender-based violence, all of these as a consequence of the problem of armed conflict or illegal groups. In the last two centuries, our country has experienced multiple incidents of violence. All this violence causes irreparable psychosocial damage to the family and social fabric of these communities, however, these communities are very resilient and every day they look for a way to transform that reality that they had to live and witness in their territories. Knowing the thinking of the affected people about the strategies that are implemented through laws is of great importance, knowing what consideration they have about those possible solutions that seek to improve the quality of life of the victims. The particular conditions of the conflict in Colombia demand creativity for the formulation of justice mechanisms that allow the defense and promotion of the rights of victims and, in no way, the mere postponement of this agenda." in the name of particular circumstances. Uribe, M (2009) (p.8) The multiple strategies that are currently applied have contributed to those affected having a greater interest in participating in programs for the construction of collective memory. For them, it is very important to be heard and understood

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates