LA NUEVA PATOLOGÍA DE LA POSTMODERNIDAD: LA AUSENCIA DE LA DIMENSIÓN PROFUNDA

En este artículo investigativo, resultado del ejercicio hermenéutico delestudio cualitativo y cuantitativo surgido de la investigación denominada“Caracterización de la dimensión profunda-espiritual-trascendentey sus expresiones religiosas, en estudiantes de la Universidad de SanBuenaventura y de La Salle, regionales de Medellín y Caldas, Antioquia-Colombia”, se dilucida una serie de consideraciones antropológica, filosóficasy psicológicas, que van a aportar a la academia, los síntomas por losque atraviesa el ethos universitario, revelando las razones por las cualesse afirma que se está viviendo un estado existencial identificado comoausencia de sentido

LA NUEVA PATOLOGÍA DE LA POSTMODERNIDAD: LA AUSENCIA DE LA DIMENSIÓN PROFUNDA

En este artículo investigativo, resultado del ejercicio hermenéutico del estudio cualitativo y cuantitativo surgido de la investigación denominada “Caracterización de la dimensión profunda-espiritual-trascendente y sus expresiones religiosas, en estudiantes de la Universidad de San Buenaventura y de La Salle, regionales de Medellín y Caldas, Antioquia- Colombia”, se dilucida una serie de consideraciones antropológica, filosóficas y psicológicas, que van a aportar a la academia, los síntomas por los que atraviesa el ethos universitario, revelando las razones por las cuales se afirma que se está viviendo un estado existencial identificado comoausencia de sentido

Towards the interdisciplinary construction of an anthropology of pain in franciscan perspective

El propósito general de este trabajo investigativo ha sido realizar un estudio sistemático en torno al sentido del dolor en perspectiva interdisciplinaria, con el fin de hacer aproximaciones a una nueva visión que favorezca el significado del dolor. Se presenta la validez y la vigencia de la mirada evangélica del dolor en Francisco de Asís a través de un estudio hermenéutico y de análisis documental. Discusión: el dolor nos hace tomar conciencia de nuestro existir en el mundo, de la individualidad, de los límites y de la corporeidad. Todo ser humano ha experimentado alguna vez el dolor, por ello se afirma que es algo inherente e intrínseco a la condición humana, aunque no se apetezca, no se busque, se le quiera huir o evadir, a pesar de ser, en algunos casos, algo inevitable. El método a seguir es el documental, guiado por la hermenéutica, con el fin de congregar las diversas verdades construidas desde las diferentes disciplinas que acuden al estudio de este tópico. Conclusión: el dolor no se puede reducir a un hecho neurológico ni orgánico exclusivamente. El dolor humano requiere de un tratamiento interdisciplinar si lo que se busca es aportar un valor antropológico en favor de una mirada integral con la que se reconozca el aporte de múltiples intencionalidades epistemológicas y de las ciencias humanas que acuden al estudio del dolor.The general purpose of the research work, which is presented below, is intended to conduct a systematic study around the sense of pain in an interdisciplinary perspective, in order to make approaches to a new vision that favors the meaning and meaning of pain by presenting the validity and validity of the evangelical sense of the latter in Francis of Assisi, through a hermeneutical study and documentary analysis. Discussion: Pain makes us aware of our existence in the world of individuality, limits and corporeality. Every human being has ever experienced pain, so it is said that it is something inherent and intrinsic to the human condition, even if you don't want to, don't look for it, you want to run away or evade it, despite being in some cases something inevitable. The method to follow is the documentary, guided by hermeneutics, in order to congregate the different truths constructed from the different disciplines that go to the study of this topic. Conclusion: pain cannot be reduced to a neurological or organic fact exclusively. Human pain requires an interdisciplinary treatment, if what is sought is to provide for an integral view, recognizing the contribution of multiple epistemological intentions and human sciences that come to the study of pain

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Aportes bioéticos y franciscanos en torno a una antropología de la muerte y una hermenéutica del dolor

ForthcomingNext, we want to put for the reader’s consideration the reflection carried out around two related topics both to Bioethics and to Franciscan Humanism: pain and death. The double horizon of thought proposes the discursive debate based on two questions: How can the meaning of pain and death be understood in the proposed double perspective? And how does pain influence, build, rebuild the subject in contemporary society? Likewise, it is proposedto detect some of the most outstanding conceptions of the phenomenon of death among students and the attentive care that both teachers and curricula will take into account, to work on the meaning and meaning of life in the subjects-objects of study. From our belonging and identity as a Bonaventurian university, these hermeneutics, which were carried out from a pluralistic and interdisciplinary perspective, also sought to highlight the horizon of Franciscan meaning, for this reason questions such as: What does Franciscan spirituality contribute to topics such as these: pain from an anthropological perspective and death as an anthropological-existential category

Hacia la construcción interdisciplinaria de una antropología del dolor en perspectiva franciscana

El propósito general de este trabajo investigativo ha sido realizar un estudio sistemático en torno al sentido del dolor en perspectiva interdisciplinaria, con el fin de hacer aproximaciones a una nueva visión que favorezca el significado del dolor. Se presenta la validez y la vigencia de la mirada evangélica del dolor en Francisco de Asís a través de un estudio hermenéutico y de análisis documental. Discusión: el dolor nos hace tomar conciencia de nuestro existir en el mundo, de la individualidad, de los límites y de la corporeidad. Todo ser humano ha experimentado alguna vez el dolor, por ello se afirma que es algo inherente e intrínseco a la condición humana, aunque no se apetezca, no se busque, se le quiera huir o evadir, a pesar de ser, en algunos casos, algo inevitable. El método a seguir es el documental, guiado por la hermenéutica, con el fin de congregar las diversas verdades construidas desde las diferentes disciplinas que acuden al estudio de este tópico. Conclusión: el dolor no se puede reducir a un hecho neurológico ni orgánico exclusivamente. El dolor humano requiere de un tratamiento interdisciplinar si lo que se busca es aportar un valor antropológico en favor de una mirada integral con la que se reconozca el aporte de múltiples intencionalidades epistemológicas y de las ciencias humanas que acuden al estudio del dolor.The general purpose of the research work, which is presented below, is intended to conduct a systematic study around the sense of pain in an interdisciplinary perspective, in order to make approaches to a new vision that favors the meaning and meaning of pain by presenting the validity and validity of the evangelical sense of the latter in Francis of Assisi, through a hermeneutical study and documentary analysis. Discussion: Pain makes us aware of our existence in the world of individuality, limits and corporeality. Every human being has ever experienced pain, so it is said that it is something inherent and intrinsic to the human condition, even if you don't want to, don't look for it, you want to run away or evade it, despite being in some cases something inevitable. The method to follow is the documentary, guided by hermeneutics, in order to congregate the different truths constructed from the different disciplines that go to the study of this topic. Conclusion: pain cannot be reduced to a neurological or organic fact exclusively. Human pain requires an interdisciplinary treatment, if what is sought is to provide for an integral view, recognizing the contribution of multiple epistemological intentions and human sciences that come to the study of pain

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous