Estilos de Liderazgo del Directivo y la Gestión Educativa de las II.EE. de Primaria Polidocentes de Chimbote, 2017.

La presente investigación explica la relación entre los estilos de liderazgo de los directivos y la gestión educativa de las Instituciones Educativas de primaria polidocentes del Distrito de Chimbote. Es un tipo de investigación básica de tipo descriptivo y con el diseño correlacional; como técnica de recolección de datos fue la encuesta y como instrumento la escala valorativa que fue aplicada a una muestra de 19 directores, cuya información permitió realizar el análisis estadístico bajo la correlación de Pearson. En el estudio se determinó, que la correlación de los estilos de liderazgo del directivo y la gestión educativa fue de manera significativa, obteniendo como resultado que la correlación es de 0,867; concluyéndose, que el estilo de liderazgo y la gestión educativa tienen estrecha relación, por cuanto, el tipo de liderazgo mayor asumido de parte de los directivos es el transformacional

HELMINTOS DEL GÉNERO DIDELPHIS (DIDELPHIMORPHIA: DIDELPHIDAE) DE CUATRO REGIONES DEL PERÚ

La helmintofauna en marsupiales del Perú es uno de los grupos menos investigados y conocidos. Por ello, en este trabajo se investiga la helmintofauna del género Didelphis Linnaeus, 1758, en base a cuatro especímenes recientemente colectados en el norte del Perú (tres ejemplares de Didelphis marsupialis Linnaeus, 1758 de San Felipe de Vichayal, Piura, Perú y uno de Didelphis pernigra J. A. Allen, 1900 del Bosque de Cachil, La Libertad, Perú) y muestras de la Colección de Protozoología, Helmintología e Invertebrados Relacionados del Museo de Historia Natural UNMSM, Lima, Perú. Se identificaron un total de 997 helmintos encontrándose que los nemátodos fueron el grupo más diverso con seis especies (85, 7%) mientras que los tremátodos estuvieron representados por solo una especie (14.3%). Se agregan seis registros nuevos y una especie de nemátodo [Travassostrongylus sp.] a los trabajos publicados sobre helmintofauna en marsupiales del país. Además, los nemátodos Aspidodera raillieti Travassos, 1913, Cruzia tentaculata (Rudolphi, 1819) Travassos, 1917 y Physaloptera mirandai Lent & Freitas, 1937 y el tremátodo Rhopalias caballeroi Kifune & Uyena, 1982 representan los primeros reportes como parásitos de D. pernigra en Perú. Finalmente, Cruzia tentaculata (Rudolphi, 1819) Travassos, 1917 fue el más abundante (78, 03%, n= 778 individuos), mientras que Turgida turgida (Rudolphi, 1819) Travassos, 1919 fue el nemátodo con menor frecuencia parasitaria (1%, n=10). Se encuentra que la helmintofauna entre ambas especies es diferente

Adverse clinical events in the hospital: characterization from the point of view of the health worker.

Introducción: un evento adverso es un incidente que ha producido daño en un paciente y que puede o no estar asociado a un error clínico. Un porcentaje elevado de profesionales de la salud se encuentran implicados en este tipo de eventos anualmente. Gran parte de los profesionales desconocen la existencia de los sistemas implantados en sus centros de trabajo para una comunicación correcta de los eventos adversos. Objetivos: identificar las características de los profesionales hospitalarios afectados por algún evento adverso y evaluar su conocimiento de los sistemas de notificación. Metodología: estudio observacional descriptivo transversal. Se evaluaron variables demográficas, laborales y relacionadas con los eventos adversos y los sistemas de notificación. Resultados: participaron 207, 45,4% enfermeros y 54,6% médicos, de 39,24±10,07 años y con una experiencia de 14,43±9,9 años.  El 71,8% resultaron afectados por algún evento adverso.  El primer evento adverso ocurrió a los 6,45±6,18 años. El 42,1% conocía algún sistema de notificación; pero sólo el 24,61% de éstos, afectados por un evento adverso, lo notificaron. Los médicos fueron más afectados por un evento adverso, además, más precozmente (p < 0,001); y también conocían los sistemas de notificación (p= 0,001). Discusión: muchos sanitarios, con escasa experiencia, fueron afectados por eventos adversos. Pocos conocían los sistemas de notificación y muchos menos los utilizaban. Los médicos resultaron más afectados, y más precozmente, por los eventos adversos y conocían mejor los sistemas de notificación.Introduction: an adverse event is an incident that has caused harm to a patient and that may or may not be associated with a clinical error. A high percentage of health professionals are involved in this type of event annually. A large part of the professionals are unaware of the existence of the systems implemented in their work centers for a correct communication of adverse events. Objectives: to identify the characteristics of hospital professionals affected by an adverse event and to evaluate their knowledge of the notification systems. Methods: cross-sectional descriptive observational study. Demographic, labor and related variables with adverse events and notification systems were evaluated. Results: 207, 45.4% nurses and 54.6% doctors, participated, 39.24 ± 10.07 years and with an experience of 14.43 ± 9.9 years. 71.8% were affected by some adverse event. The first adverse event occurred at 6.45 ± 6.18 years. 42.1% knew of some notification system; but only 24.61% of these, affected by an adverse event, reported it. Physicians were more affected by an adverse event, moreover earlier (p <0.001) and they were also more aware of notification systems (p = 0.001). Discussion: many health workers, with little experience, were affected by adverse events. Few knew notification systems and far fewer used them. Doctors were more affected, and earlier, by adverse events and were better acquainted with notification systems

Development and validation of an HIV risk exposure and indicator conditions questionnaire to support targeted HIV screening

The aim of our study was to develop a Spanish-structured HIV risk of exposure and indicator conditions (RE&IC) questionnaire. People attending to an emergency room or to a primary clinical care center were offered to participate in a prospective, 1 arm, open label study, in which all enrolled patients filled out our developed questionnaire and were HIV tested. Questionnaire accuracy, feasibility, and reliability were evaluated. Valid paired 5329 HIV RE&IC questionnaire and rapid HIV tests were performed, 69.3% in the primary clinical care center, 49.6% women, median age 37 years old, 74.9% Spaniards, 20.1% Latin-Americans. Confirmed hidden HIV infection was detected in 4.1%, while HIV RE&IC questionnaire was positive in 51.2%. HIV RE&IC questionnaire sensitivity was 100% to predict HIV infection, with a 100% negative predictive value. When considered separately, RE or IC items sensitivity decreases to 86.4% or 91%, and similarly their negative predictive value to 99.9% for both of them. The majority of people studied, 90.8% self-completed HIV RE&IC questionnaire. Median time to complete was 3 minutes. Overall HIV RE&IC questionnaire test-retest Kappa agreement was 0.82 (almost perfect), likewise for IC items 0.89, while for RE items was lower 0.78 (substantial). A feasible and reliable Spanish HIV RE&IC self questionnaire accurately discriminated all non–HIV-infected people without missing any HIV diagnoses, in a low prevalence HIV infection area. The best accuracy and reliability were obtained when combining HIV RE&IC items

Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure

Background and aimsHeart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. Methods and resultsWe designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75 +/- 9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. ConclusionA new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented

Post-Transplant Cyclophosphamide and Tacrolimus–Mycophenolate Mofetil Combination Prevents Graft-versus-Host Disease in Allogeneic Peripheral Blood Hematopoietic Cell Transplantation from HLA-Matched Donors

Abstract Allogeneic hematopoietic cell transplant (HCT) remains the only curative therapy for many hematologic malignancies but it is limited by high nonrelapse mortality (NRM), primarily from unpredictable control of graft-versus-host disease (GVHD). Recently, post-transplant cyclophosphamide demonstrated improved GVHD control in allogeneic bone marrow HCT. Here we explore cyclophosphamide in allogeneic peripheral blood stem cell transplantation (alloPBSCT). Patients with high-risk hematologic malignancies received alloPBSCT from HLA-matched unrelated/related donors. GVHD prophylaxis included combination post-HCT cyclophosphamide 50 mg/kg (days +3 and +4) and tacrolimus/mofetil mycophenolate (T/MMF) (day +5 forward). The primary objective was the cumulative incidence of acute and chronic GVHD. Between March 2011 and May 2015, 35 consecutive patients received the proposed regimen. MMF was stopped in all patients at day +28; the median discontinuation of tacrolimus was day +113. Acute and chronic GVHD cumulative incidences were 17% and 7%, respectively, with no grade IV GVHD events, only 2 patients requiring chronic GVHD immunosuppression control, and no deaths from GVHD. Two-year NRM, overall survival, event-free survival, and chronic GVHD event-free survival rates were 3%, 77%, 54%, and 49%, respectively. The graft-versus-tumor effect was maintained as 5 of 15 patients (33%) who received HCT with evidence of disease experienced further disease response. A post-transplant cyclophosphamide + T/MMF combination strategy effectively prevented acute and chronic GVHD after alloPBSCT from HLA-matched donors and achieved an unprecedented low NRM without losing efficacy in disease control or impaired development of the graft-versus-tumor effect. This trial is registered at clinicaltrials.gov as NCT02300571

Comunidades, territorios y turismo en América Latina

Este libro es una suerte de regreso al futuro en la medida que intenta explicar la historia reciente del desarrollo turístico como parte de los males del capitalismo neoliberal globalizado, y al mismo tiempo tornar palpable las ventajas y oportunidades de ese otro turismo, enraizado en los paisajes naturales y culturales de las comunidades locales