La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia Departamento del Cauca (Popayán) y Norte de Santander (Cúcuta).

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia Departamento del Cauca (Popayán) y Norte de Santander (Cúcuta).Este trabajo propone un tema personal expuesto por una de las Víctimas, de la Violencia, con una solución a toda adversidad a la que se vio expuesta la persona elegida en el trabajo colaborativo, para manifestar las diferentes fases por las que debe enfrentarse este paciente ya tomado por las personas involucradas como tal para así tener una mejor Calidad de Vida, y también para enseñar a las personas involucradas en el trabajo propuesto la Subjetividad, de los acontecimientos tomando las voces de las personas que pasan por estos sucesos macabros en la sociedad. También se dará a conocer lo trabajado desde la unidad 1 hasta la 10 en donde se evidencian enfoques narrativos teniendo como base estrategias en el abordaje de algunos casos planteados dentro de la unidad. Esto produce un análisis para una posterior interpretación por parte de cada uno de los participantes de este diplomado. A lo largo de este trabajo se desplegaron varias fases iniciando por el análisis de un caso propuesto en el anexo 1 del entorno de aprendizaje, luego se responden las preguntas orientadoras que la tutora propuso en el foro, las cuales dan cuentan de la interiorización y apropiación de los diferentes conocimientos, posteriormente se realizan unas preguntas estratégicas, circulares y reflexivas sobre el caso de José Ignacio. Por último se abordó el caso de las comunidades de Cacarica en donde se hace un análisis de la problemática para luego darle respuesta a las preguntas orientadoras como lo son: estrategias psicosociales que se pueden trabajar con los pobladores de Cacarica, que faciliten la Potenciación; de recursos de Afrontamiento; a la situación expresada, qué impactos genera para la población ser estigmatizada como cómplice de un actor armado, qué emergentes Psicosociales; considera están latentes después de la incursión y el hostigamiento militar. También da una perspectiva nueva de cómo se pueden desenvolver las personas que pasan por estas Adversidades, y tener una mentalidad uniforme y con el deseo de salir adelante para enseñar a los que se encuentran en la misma situación a reintegrarse y aprovechar de la nueva calidad de vida que se les brinda.This work proposes a personal theme exposed by one of the Victims, of Violence, with a solution to all adversity to which the chosen person was exposed in the collaborative work, to manifest the different phases that this patient must face. Taken by the people involved as such in order to have a better Quality of Life, and also to teach the people involved in the proposed work the Subjectivity, of the events taking the voices of people who go through these macabre events in society. It will also be known what worked from unit 1 to 10 where narrative approaches are evidenced based on strategies in the approach of some cases raised within the unit. This produces an analysis for subsequent interpretation by each of the participants of this diploma. Throughout this work several phases were unfolded, starting with the analysis of a case proposed in annex 1 of the learning environment, then answering the guiding questions that the tutor proposed in the forum, which explain the internalization and appropriation of the different knowledge, later some strategic, circular and reflective questions are asked about the case of José Ignacio. Finally, the case of the communities of Cacarica is addressed, where an analysis of the problematic is made to then answer the guiding questions as they are: psychosocial strategies that can be worked with the Cacarica settlers, that facilitate the Potentiation; of Coping resources; to the situation expressed, what impacts it generates for the population to be stigmatized as an accomplice of an armed actor, what psychosocial emergencies; considers they are dormant after the military incursion and harassment. It also gives a new perspective on how people who go through these Adversities can develop, and have a uniform mentality and with the desire to move forward to teach those who are in the same situation to reintegrate and take advantage of the new quality of life. Life that is offered to them

Death messengers

Mandeep R Mehra and colleagues dissect doctors’ attitudes to dyin

Relationship among epicardial coronary disease, tissue myocardial perfusion, and survival in heart transplantation

Background: Cardiac allograft vasculopathy continues to represent the major limitation to long-term cardiac allograft survival. Routine angiography and intravascular ultrasound fall short in their ability to detect microcirculatory aberrations. Thrombolysis in myocardial infarction (TIMI) myocardial perfusion grades (TMPG) have been used as a measure of microvascular circulation in patients treated for acute myocardial infarction. We studied the correlation of epicardial coronary anatomy with microvascular flow as determined by TMPG and correlated it with patient outcome. Methods: We enrolled 66 consecutive cardiac transplant recipients (49 men; mean age 52 ± 13 years; range 15-70 years) undergoing surveillance coronary angiogram during a 9-month period. All angiograms were interpreted for epicardial coronary anatomy by an independent investigator. Another investigator, blinded for clinical data and angiogram interpretation, interpreted TMPGs. TMPG 0 was defined as no apparent tissue-level perfusion; TMPG 1 indicated presence of myocardial blush but no clearance from the microvasculature; TMPG 2 blush cleared slowly; and TMPG 3 indicated that blush began to clear during washout (blush is minimally persistent after 3 cardiac cycles of washout). Cardiac deaths served as the primary outcome variable. Results: Fifty-eight of 66 patients had an abnormal TMPG. Mean TMPG in all these patients was 4.2 ± 3 (normal is 9). Forty-four patients (Group A) with no angiographic coronary narrowing had TMPG 4.81 ± 3.1, and 22 patients (Group B) with epicardial coronary narrowing 40% of lumen diameter had TMPG 3.0 ± 2.5 (p = 0.007). There was no difference in TMPG related to the coronary territory involved. At a mean follow-up of 30 ± 2.5 months, 6 (13.6%) of 44 patients in Group A had died, and 7 (31.8%) of 22 in Group B had died (p < 0.03). Conclusions: Microcirculatory aberrations as assessed by tissue TMPG is abnormal across all coronary territories in cardiac transplant recipients and associated with poor survival, suggesting a generalized microvascular involvement even in the presence of a normal angiogram. Patients with focal epicardial coronary narrowing have significantly greater decline in tissue perfusion, independent of the coronary territory involved, and exhibit poor survival compared with patients without epicardial coronary disease