La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia departamento Cundinamarca

When conducting phase No. 4 of the Diploma course psychosocial accompaniment in scenarios of violence based on the life stories taken from the book VOCES; Stories of violence and hope in Colombia, edited by the World Bank in 2009, the narrative is taken from the life experiences of the conflict, punctually the story of José Ignacio Medina. Based on the role of the psychologist, the emerging emergencies that are visible in the case chosen for this exercise are analyzed reflexively, such as fear, the change of identity, the confrontation of beliefs and values, the imposition of criminal acts, the uprooting, which It impelled the protagonist to renew and build social ties in the community as an action plan that allows to address and make known the rights that each person has to rebuild their identity from their life experience, with the purpose of improving social relations. To deepen the case nine circular, reflexive and strategic questions are constructed, which provide information regarding the effects of the experience to transform and dignify the scenarios of violence in a resilient manner in all aspects of their lives. Afterwards, the case of the "Cacarica" communities is deepened in order to know the psychosocial emergencies that are latent and the psychosocial scopes that take over the community; In this way, it is possible to define the impacts it generates for the population, where stigmatization arises as an accomplice of an armed actor, support actions in the crisis situation and coping techniques that facilitate the empowerment of this community's resources, promoting strategies Comprehensive reparation to mitigate emotional suffering, impacts on moral integrity, psychological and actions that contribute to the repair of human dignity where this community is able to demand rights and return to be independent persons who have control of their lives, recognizing their potential, capacities to recover and realize their life projects. In order to have a direct experience, a blog is built with the activity called "foto voz" that allows from the metaphor a critical and narrative approach on the armed conflict in Colombia. Keywords: Psychosocial emergent, Armed conflict, Psychosocial accompaniment.Al realizar la fase No. 4 del curso Diplomado acompañamiento psicosocial en escenarios de violencia basados en los relatos de vida tomado del libro VOCES; Relatos de violencia y esperanza en Colombia, Editado por el Banco mundial en el 2009, se toma la narrativa desde las experiencias de vida del conflicto, puntualmente el relato de José Ignacio Medina. A partir del rol del psicólogo se analiza de forma reflexiva los emergentes que son visibles en el caso escogido para este ejercicio, como el temor, el cambio de identidad, la confrontación de creencias y valores, la imposición de actos delictivos, el desarraigo, que impulsó al protagonista a renovar y construir lazos sociales en la comunidad como plan de acción que permite abordar y dar a conocer los derechos que tiene cada persona para reconstruir su identidad desde su experiencia de vida, con el propósito de mejorar las relaciones sociales. Para profundizar el caso se construyen nueve preguntas circulares, reflexivas y estratégicas las cuales proporcionan información en cuanto a los efectos de la experiencia para transformar y dignificar los escenarios de violencia de manera resiliente en todos los aspectos de su vida. Posteriormente se profundiza el caso de las comunidades de “Cacarica” para conocer los emergentes psicosociales que se encuentran latentes y los ámbitos psicosociales que se apoderan de la comunidad; de tal forma se logra definir los impactos que genera para la población, donde surge la estigmatización como cómplice de un actor armado, las acciones de apoyo en la situación de crisis y técnicas de afrontamiento que faciliten la potenciación de los recursos de esta comunidad promoviendo estrategias de reparación integral para atenuar el sufrimiento emocional, los impactos contra la integridad moral, psicológica y realizando acciones que contribuyan a la reparación de la dignidad humana en donde esta comunidad este en la capacidad de exigir derechos y volver a ser personas independientes que tengan el control de sus vidas , reconociendo sus potencialidades, capacidades para recuperarse y realizar sus proyectos de vida. Para tener una experiencia directa, se construye un blog con la actividad denominada “foto voz” que permite desde la metáfora un abordaje crítico y narrativo sobre el conflicto armado en Colombia. Palabras clave: Emergente psicosocial, Conflicto armado, Acompañamiento psicosocial

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society