La experiencia de la aplicación de un modelo de acreditación de carreras en Chile (2000 – 2007)

This work is made from the academics views considered "key players" in five higher education institutions in the region of Valparaiso (Chile), for having participated with different degrees of responsibility in accreditation processes of degree careers in education, both public and private universities. After a brief contextualization of the development and characterization of the accreditation model adopted in Chile at the level of institutions and courses, analyses their views from different experiences and views about studied institutions accreditation processes, evaluation criteria, the concept of quality used and the expectations concerning the improvement of the teaching careers. Finally, raised some proposals in order to refine this evaluative process, in response to the reality of our institutions. Keywords Accreditation; careers evaluation; quality; higher educationEste trabajo se elabora a partir de las opiniones de académicos considerados “actores claves” dentro de cinco instituciones de educación superior de la región de Valparaíso (Chile), por haber participado con diferentes grados de responsabilidad en procesos de acreditación de carreras de Licenciatura en educación, tanto en universidades públicas y privadas. Luego de una breve contextualización del desarrollo y caracterización del Modelo de Acreditación adoptado en Chile a nivel de instituciones y de carreras, se analizan sus opiniones desde distintas experiencias y visiones acerca de los procesos de acreditación en las instituciones estudiadas, los criterios de evaluación, la concepción de calidad utilizada y las expectativas respecto al mejoramiento de las carreras pedagógicas. Finalmente, se plantean algunas propuestas en orden a perfeccionar este proceso evaluativo, atendiendo a la realidad de nuestras institucione

La experiencia de la aplicación de un modelo de acreditación de carreras en Chile (2000 – 2007)

Aquest treball s’elabora a partir de les opinions d’acadèmics considerats «actors claus» dins de cinc institucions d’educació superior de la regió de Valparaíso (Xile), per haver participat amb diferents graus de responsabilitat en processos d’acreditació de carreres de llicenciatura en Educació, tant en universitats públiques com privades. Després d’una breu contextualització del desenvolupament i caracterització del Model d’Acreditació adoptat a Xile en l’àmbit d’institucions i de carreres, s’analitzen les seves opinions des de diferents experiències i visions sobre els processos d’acreditació en les institucions estudiades, els criteris d’avaluació, el concepte de qualitat utilitzada i les expectatives respecte a la millora de les carreres pedagògiques. Finalment, es plantegen algunes propostes amb vista a perfeccionar aquest procés avaluatiu, atenent a la realitat de les nostres institucions.This work is made from the academics views considered "key players" in five higher education institutions in the region of Valparaiso (Chile), for having participated with different degrees of responsibility in accreditation processes of degree careers in education, both public and private universities. After a brief contextualization of the development and characterization of the accreditation model adopted in Chile at the level of institutions and courses, analyses their views from different experiences and views about studied institutions accreditation processes, evaluation criteria, the concept of quality used and the expectations concerning the improvement of the teaching careers. Finally, raised some proposals in order to refine this evaluative process, in response to the reality of our institutions.Este trabajo se elabora a partir de las opiniones de académicos considerados “actores claves” dentro de cinco instituciones de educación superior de la región de Valparaíso (Chile), por haber participado con diferentes grados de responsabilidad en procesos de acreditación de carreras de Licenciatura en educación, tanto en universidades públicas y privadas. Luego de una breve contextualización del desarrollo y caracterización del Modelo de Acreditación adoptado en Chile a nivel de instituciones y de carreras, se analizan sus opiniones desde distintas experiencias y visiones acerca de los procesos de acreditación en las instituciones estudiadas, los criterios de evaluación, la concepción de calidad utilizada y las expectativas respecto al mejoramiento de las carreras pedagógicas. Finalmente, se plantean algunas propuestas en orden a perfeccionar este proceso evaluativo, atendiendo a la realidad de nuestras instituciones

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

La educación superior en Chile: continuidades y desafíos

The objective of this paper is to offer an overview of higher education reforms in Chile from the 1980s to the present. With the political institutional bias of Augusto Pinochet¿s regime (1973-1990), a number of State reforms were implemented, being the legal changes in higher education organization one of them. The main characteristics of this model are a wide institutional differentiation, assessment procedures based on exams and accreditation, and diversification of funding sources for public higher education institutions, putting the emphasis on tuition fees (arancelamiento).El objetivo del presente trabajo es ofrecer un panorama de las reformas de la educación superior en Chile desde la década de 1980. A partir de la orientación político institucional establecida con el régimen militar del general Augusto Pinochet (1973-1990), se implementaron una serie de reformas del Estado, entre las cuales se destacan los cambios legales en la organización de la educación superior. El modelo fue reorganizado presentando como características principales: una amplia diferenciación institucional, el establecimiento de procedimientos de evaluación (examinación y acreditación) y la diversificación de las fuentes de financiamientopara la educación superior pública, con énfasis en el arancelamiento

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave : the global UNITE-COVID study

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality