Estrategias didácticas para el desarrollo de las competencias comunicativas en niños de 5 años del nivel inicial de una institución educativa privada del distrito de Miraflores

El presente trabajo de suficiencia profesional contempla una propuesta de estrategias didácticas para el desarrollo de las competencias comunicativas en niños de 5 años del nivel inicial de una Institución privada del distrito de Miraflores, cuyo diseño está alineado a los fundamentos del paradigma sociocognitivo humanista y las teorías pedagógicas que han impactado el campo educativo como la teoría del desarrollo cognitivo impulsado por Piaget, la teoría del aprendizaje significativo representado por David Ausubel, la teoría sociocultural impulsado por Lev Vygotsky, entre otros. La propuesta de intervención considera la planificación anual cuyas competencias capacidades y destrezas del área de comunicación han sido seleccionadas del currículo nacional. Las sesiones de aprendizaje se han diseñado de tal manera que el estudiante sea el protagonista, constructor de su propio aprendizaje, al interactuar con sus pares a partir de la movilización de recursos que facilita el docente mediador para promover la comunicación oral, la lectura y escritura de textos asimismo la creación de proyectos desde los lenguajes artísticos.The present work of professional sufficiency contemplates a proposal of didactic strategies for the development of communication skills in 5-year-old children of the initial level of a private institution in the district of Miraflores, whose design is aligned with the fundamentals of the humanist socio-cognitive paradigm and theories pedagogical that have impacted the educational field such as the theory of cognitive development promoted by Piaget, the theory of significant learning represented by David Ausubel, the sociocultural theory promoted by Lev Vigotsky, among others. The intervention proposal considers the annual planning whose competencies, abilities and skills in the area of communication have been selected from the national curriculum. The learning sessions have been designed in such a way that the student is the protagonist, builder of their own learning, when interacting with their peers based on the mobilization of resources facilitated by the mediator teacher to promote oral communication, reading and writing texts similar to the creation of projects from artistic languages.Trabajo de suficiencia profesiona

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease