The importance of organizational variables in treatment time for patients with ST-elevation acute myocardial infarction improve delays in STEMI

Background: The time between arrival at the emergency department (ED) and balloon (D2B) in STEMI is one of the best indicators of the quality of care. Our aim is to describe treatment times and evaluate the causes of delay. Methods: This is an observational retrospective study, including all consecutive STEMI code patients ≥18 years old treated in the ED from 2013 to 2016.All the patients were stratified into two groups: delayed group with D2B > 70 min and non-delayed ≤70. The primary variable was D2B time. Findings: In total 327 patients were included, stratified according to their D2B as follows: 166 (67·48%) in the delayed group and 80 (32·52%) in the non-delayed group. The delayed group was older (p = 0·005), with more females (p = 0·060) and more atypical electrocardiogram (ECG) STEMI signs or symptoms (p = 0·058) (p = 0·087). Predictors of shorter D2B time were: typical STEMI ECG signs and short training sessions for nurses on identifying STEMI patients. Interpretation: There are delays particularly in specific groups with atypical clinical presentations. Short training sessions aimed at emergency nurses correlate with shorter delay. This suggests that continuing training for emergency nurses, along with organizational strategies, can contribute to increasing the quality of care. Clinical trial number: NCT0433338

Psicoterapia de Vittorio Guidano y sus influencias epistemológicas

Este artigo encontra-se estruturado basicamente em três partes. Na primeira, contextualizamos as concepções de Vittorio Guidano face às correntes psicoterapêuticas do século XX, nomeadamente quanto ao comportamentalismo, ao cognitivismo e ao construtivismo. Fazemos notar que as várias tendências da psicoterapia dessa época se autorrotulavam a partir de conceitos advindos de outras áreas, sem terem o cuidado de indagar sobre os fundamentos epistemológicos nos quais elas se alicerçavam. Num segundo momento detemo-nos no embasamento epistemológico de sua teoria e metodologia psicoterapêuticas, focalizando-nos no papel que o cognitivismo cibernético teve no seu pensamento (nomeadamente, quanto à questão da observação), bem como na teoria biológica da autopoiesis, na qual nosso autor explicitamente se inspirou. Por fim, nos debruçamos com algum pormenor sobre o seu modelo sobre o conhecimento e experiência humana, que se traduz numa nova teoria da personalidade (organização pessoal, noção de si mesmo) e um novo sistema psicoterapêutico que enfatiza o papel do vínculo afetivo como modelador da identidade pessoal.This article is structured in three parts. At first, we contextualize the concepts of Vittorio Guidano in relation to psychotherapeutic currents of the twentieth century, particularly regarding behaviorism, cognitivism constructivism and others. We note that the various trends of psychotherapy labeled themselves according to concepts coming from other areas of study, without regard to their epistemological origins. Secondly we reflect on the epistemological foundation of Guidano’s theory and psychotherapeutic methodology, focusing on the role that cyber cognitivism had in his thinking (namely, the question of observation, and self-observation), as well as the biological theory of autopoiesis, in which our author explicitly inspired himself. Finally, we center our attention on his model of knowledge and human experience that translates into a new theory of personality (regarding personal organization, as well as the notion of the self) and into a new system, that emphasizes the psychotherapeutic role of bonding in shaping personal identity.Este artículo se estructura básicamente en tres partes. Al principio, contextualizamos los conceptos de Vittorio Guidano con respecto a las corrientes psicoterapéuticas del siglo XX, sobre todo en relación con el comportalismo, el cognitivismo y el constructivismo. Tomamos nota de que las diversas tendencias de la psicoterapia en ese momento si se llamaban a sí mismos nombres provenientes de conceptos otras áreas, sin la precaución de preguntar acerca de las bases epistemológicas sobre la que se fundaban. En segundo lugar estamos reflejando el fundamento epistemológico de su teoría y metodología psicoterapéutica, centradas en el papel que el cognitivismo cibernético tenía en su mente (es decir, la cuestión de la observación), así como en la teoría biológica de la autopoiesis, en ella que nuestro autor se ha inspirado explícitamente Finalmente, nos detenemos en algunos detalles sobre su modelo en el conocimiento y la experiencia humana, que se traduce en una nueva teoría de la personalidad (organización personal, la noción del yo) y un nuevo sistema que destaca en psicoterapia el papel de la vinculación en la unión y en la formación de la identidad personal.(undefined