Parent-provider communication dynamics during the pediatric oncology diagnostic process in Guatemala: A qualitative study.

BACKGROUND: Effective communication is founded on bidirectional participation from families and healthcare providers. In adult medicine, bidirectional communication promotes treatment adherence and builds the family-provider relationship. However, the relationship between communication styles in pediatrics remains poorly understood, particularly in culturally diverse settings. This study aims to investigate parent-provider communication dynamics and parental involvement during diagnostic cancer communication in Guatemala. PROCEDURE: This qualitative study included 20 families of children with cancer and 10 providers at Unidad Nacional de Oncología Pediátrica in Guatemala. Psychoeducation and diagnostic conversations between parents, psychologists, and oncologists were recorded and thematically analyzed using a priori and novel codes exploring communication behaviors, parental engagement, and interpersonal dynamics. RESULTS: Participating parents had children with various diagnoses. Only 15% of fathers and 5% of mothers reported education beyond primary school. Providers spoke 68% of words during psychoeducation and 85% of words during diagnosis conversations. Providers used supportive communication behaviors providing explanations, demonstrating verbal attentiveness, and soliciting questions and non-supportive behaviors including paternalistic talk. Parental participation was considered active when they asked questions, expressed hopes or concerns, or asserted their opinions, and non-active when participation was limited to brief responses to closed-ended questions. Supportive provider communication often encouraged active participation; non-supportive communication did not. Furthermore, active parental participation prompted supportive communication from providers, while non-active participation did not. CONCLUSIONS: Our findings highlight the bidirectional nature of effective communication, establishing that provider communication styles both influence and are influenced by parental participation, and emphasizing the importance of supportive provider communication for patient-centered care.

Critical Thinking, Formation, and Change.

In this paper, we propose an application of critical thinking (CT) to real-world problems, taking into account personal well-being (PB) and lifelong formation (FO). First, we raise a substantial problem with CT, which is that causal explanation is of little importance in solving everyday problems. If we care about everyday problems, we must treat the identification of causal relationships as a fundamental mechanism and action as a form of solution once the origin of the problem is unequivocally known. Decision-making and problem-solving skills should be the execution of the causal explanations reached. By acting this way, we change reality and achieve our goals, which are none other than those imposed by our PB. However, to achieve changes or results, we must have these fundamental competencies in CT, and these are not innate; we must acquire and develop them, that is, we must train ourselves to have CT competencies according to the demands of today's world. Finally, in this paper we propose a causal model that seeks to identify and test the causal relationships that exist between the different factors or variables that determine the CT-PB-FO relationship. We present some results on the relevance of causality and how to effectively form and address real-world problems from causality. However, there are still questions to be clarified that need to be investigated in future studies.

Critical Thinking: The ARDESOS-DIAPROVE Program in Dialogue with the Inference to the Best and Only Explanation.

In our daily lives, we are often faced with the need to explain various phenomena, but we do not always select the most accurate explanation. For example, let us consider a "toxic" relationship with physical and psychological abuse, where one of the partners is reluctant to end it. Explanations for this situation can range from emotional or economic dependency to irrational hypotheses such as witchcraft. Surprisingly, some people may turn to the latter explanation and consequently seek ineffective solutions, such as visiting a witch doctor instead of a psychologist. This choice of an inappropriate explanation can lead to actions that are not only ineffective but potentially harmful. This example underscores the importance of inference to the best explanation (IBE) in everyday decision making. IBE involves selecting the hypothesis that would best explain the available body of data or evidence, a process that is crucial to making sound decisions but is also vulnerable to bias and errors of judgment. Within this context, the purpose of our article is to explore how the IBE process and the selection of appropriate explanations impact decision making and problem solving in real life. To this end, we systematically analyze the role of IBE in the ARDESOS-DIAPROVE program, evaluating how this approach can enhance the teaching and practice of critical thinking.

Relation between metacognitive strategies, motivation to think, and critical thinking skills.

Critical thinking is a complex reasoning skill, and even though it is hard to reach a consensus on its definition, there is agreement on it being an eminently cognitive skill. It is strongly related with reflective and metacognitive skills, as well as attitudinal or motivational aspects, although no model has yet been able to integrate these three elements. We present herein the preliminary results of a study seeking to establish these relations, in a sample of Chilean university students. 435 students from three universities participated, of which 88 were men, 333 were women, and 14 did not indicate their gender. Their ages ranges between 18 and 51 years old (M = 21, SD = 3.09). Three instruments were applied, one to measure metacognitive strategies, one to measure motivation to critical thinking, and a third to measure critical thinking skills. The relation was analyzed via structural equations. The results show a positive, strong, and significant relation between metacognition and motivation to think. However, only a weak significant relation was observed between motivation to think and critical thinking, and no direct relation was found between metacognition and critical thinking. We hypothesize a significant but moderate relation between the variables, where metacognition influences motivation to think, which in turn influences critical thinking skills. Factors are discussed which could negatively affect the studied relations, as well as the importance of generating integrated models between the three variables, as they would show a theoretical and empirical link.

¿Puede ser evaluado el pensamiento crítico de forma breve? / Pode o pensamento crítico ser avaliado de forma breve? / Can critical thinking be briefly assessed?

El objetivo de la investigación ha sido validar una versión breve de la prueba completa de pensamiento crítico (PC) PENCRISAL, en español y portugués. Aquí se presenta la primera. Esta versión breve consta de 2 factores, con 3 ítems cada uno. Un factor evalúa argumentación general, y el otro las formas de razonamiento más empleadas a diario. Además, ambos factores evalúan indirectamente la toma de decisiones y la solución de problemas, gracias a la naturaleza de los ítems, en los que se plantean problemas cotidianos que se deben resolver y, en ocasiones, hay que tomar decisiones. El análisis factorial confirmatorio nos ofrece índices de ajuste adecuados que avalan la estructura de la versión breve del test presentado. Los coeficientes de fiabilidad y validez son razonablemente robustos, lo que hace que esta prueba sirva a los objetivos de investigación establecidos (AU).

O objetivo do nosso estudo foi validar uma versão breve do Teste Completo de Pensamento Crítico (PC) PENCRISAL, em espanhol e português. Aqui apresentamos o primeiro. Esta versão resumida consiste em 2 fatores, com 3 itens cada. Um fator avalia a argumentação geral e o outro as formas de raciocínio mais utilizadas no dia a dia. Além disso, ambos os fatores avaliam indiretamente a tomada de decisão e a resolução de problemas, graças à natureza dos itens, nos quais se levantam problemas diários que devem ser resolvidos e para os quais, às vezes, devem ser tomadas decisões. A análise fatorial confirmatória nos oferece índices adequados de ajustamento que sustentam a estrutura da versão resumida do teste apresentado. Os coeficientes de confiabilidade e validade são razoavelmente robustos, o que faz com que este teste sirva para os objetivos de investigação declarados (AU).

The aim of our study was to validate a short version of the PENCRISAL complete critical thinking test, in Spanish and Portuguese. Here we present the first. This short version consists of 2 factors, with 3 items each. One factor assesses general argumentation, and the other the forms of reasoning most used on a daily basis. In addition, both factors indirectly evaluate decision-making and problem solving, thanks to the nature of the items, in which daily problems are raised that must be solved and for which decisions must sometimes be made. The confirmatory factor analysis offers us solid and consistent indices that support the structure of the short version of the test presented. The reliability and validity coefficients are reasonably robust, as to make this test serve very well for the stated objectives (AU).

Propiedades psicométricas de la adaptación peruana de la prueba de pensamiento crítico PENCRISAL / Psychometric properties of Peruvian adaptation of the critical thinking test PENCRISAL / Propriedades psicométricas da adaptação peruana de pensamento crítico teste PENCRISAL

El objetivo principal de este estudio fue estudiar, en población peruana, las propiedades psicométricas de la prueba de pensamiento crítico, PENCRISAL, desarrollada y validada originalmente en población española. Participaron respondiendo voluntariamente la prueba 422 estudiantes de Ciencias e Ingeniería de una universidad peruana. Se analizó el nivel de fiabilidad con el alfa de Cronbach; la fiabilidad interjueces con coeficientes de concordancia Kappa de Cohen para cada uno de los ítems; la validez de constructo con Análisis Factorial de Componentes Principales, método Varimax y la validez divergente mediante el estudio de correlaciones con otras pruebas a través del coeficiente de Pearson. Los resultados obtenidos permiten concluir que el test PENCRISAL reúne los requisitos psicométricos necesarios para la evaluación de habilidades de pensamiento crítico en población peruana...

The main objective of this study was to study, in Peruvian population, the psychometric properties of the critical thinking test, PENCRISAL, originally developed and validated in Spanish population. 422 students of Science and Engineering of a Peruvian university participated voluntarily answering the test. Reliability was analyzed with Cronbach's alpha; interrater reliability was studied by mean of Cohen's Kappa coefficients for each of the items; construct validity was analyzed with Factor Analysis of Principal Components, Varimax method. Finally, divergent validity was studied by mean of the correlations with other tests through Pearson coefficient. It is concluded that PENCRISAL test fits with the psychometric requirements for the assessment of critical thinking skills in Peruvian population...

O objetivo principal deste trabalho foi estudar, em população peruana, as propriedades psicométricas do teste de pensamento crítico, PENCRISAL, originalmente desenvolvida e validada na população espanhola. Respondendo o teste participaram voluntariamente 422 estudantes de Ciência e Engenharia de uma universidade peruana. O nível de confiabilidade foi analisada com alfa de Cronbach; a confiabilidade inter-juizes foi analisada com coeficientes Kappa de Cohen para cada um dos itens; a validade do construto foi analisada por meio da análise fatorial de componentes principais, método Varimax. Finalmente, a validade divergente foi analisada por meio do estudo de correlações com outros testes utilizando o coeficiente de Pearson. Concluí-se que o teste PENCRISAL tem os requisitos psicométricos necessários para a avaliação de habilidades de pensamento crítico na população peruana...

Clasificación de las indicaciones de transfusión sanguínea en un Departamento de Pediatría / Blood transfusion indications and classifications

Objetivo.Clasificar las transfusiones sanguíneas efectuadas en Pediatría de un Hospital Nacional como necesarias o innecesarias según recomendaciones internacionales.Diseño. Retrospectivo, descriptivo. Población . 715 expedientes para un total de 8,099 transfusiones efectuadas en 3 años. Metodología. La variable nominal: indicación necesaria o innecesaria de transfusión se difinió en base a protocolos ya establecidos internacionalmente.Resultados. Las principales indicaciones clínicas para transfusión fueron anemia y sepsis m s di tesis hemorr gica y en neonatología para exanguinotransfusión. Los servicios con mayor número de transfusiones innecesarias fueron neurocirugía y traumatología, seguidas por sala de operaciones y cirugía pedi trica II. El 21/100 de los niños requirió dos transfusiones. El grupo et reo m s transfundido fue el de menores de un año (60/100), siendo m s frecuente en el sexo masculino. El derivado sanguíneo mayormente utilizado fue el de glóbulos rojos empacados, seguido por plasma fresco congelado. Se clasificó al 46/100 de las transfusiones sanguíneas como innecesarias.De este porcentaje, el hemoderivado que m s se utilizó incorrectamente fue la sangre completa, seguida por células empacadas.Conclusiones. La mitad de las transfusiones indicadas fueron innecesarias de acuerdo a referencias internacionales de transfusión de hemoderivados

Linfoma de órbita y párpados. Manifestaciones clínicas, clasificación clínico-patológica y tratamiento / Lymphoma of the orbit and eyelid. Clinical manifestations, clinical-patologycal clasification and treatment

Se estudiaron nueve pacientes que presentaban linfoma de órbita y/o párpados, entre el 1o. de marzo de 1987 y el 31 de agosto de 1988, en los Servicios de Oftalmología y Hematología del Hospital General de México, S.S. En todos se llegó al diagnóstico por medio de biopsia de un ganglio comprometido o de la lesión extraganglionar; los cortes, teñidos con hematoxilina y eosina, fueron revisados por el mismo patólogo quien los describió y agrupó de acuerdo a la clasificación internacional para linfomas no Hodgkin. También se practicaron pruebas de inmunohistobioquímica para corroborar la estirpe y funcionalidad de los linfomas. A los pacientes les fué practicado examen ocular y en el Servicio de Hematología se les realizó examen físico completo y se les ordenaron estudios de extensión. Con ésto se clasificó clínico-patológicamente cada caso y se les trató de acuerdo a los esquemas seguidos en el Servicio de Hematología del Hospital General de México, S.S. Se hizo una revisión bibliográfica sobre los linfomas en general y la afección orbitaria en particular, se presenta un resumen de cada caso, luego se muestran los resultados y finalmente se hace una discusión y se establecen las conclusiones pertinentes.

Hemangioendotelioma maligno / Malignant hemangioendothelioma

Se presenta el caso de un hemangioendotelioma, valorado inicialmente como un angioma cavernoso, cuya evolución clínica agresiva y su falta de respuesta a las terapéuticas empleadas, hizo que se interpretara como un proceso maligno. La paciente posteriormente fallece, se comprueba entonces la existencia de este tumor maligno mediante el estudio necrópsico realizado

Atrofia cutánea secundaria debido a inyección intramuscular de corticoide / Secondary cutaneous atrophy due to intramuscular injection of corticoids

Se establecen conceptos acerca de los efectos beneficiosos de los corticoides, tanto desde el punto de vista local como sistémico. Se presenta el caso de un paciente del sexo femenino de 25 años de edad con antecedentes de asma desde hace alrededor de 8 años, por lo que en varias ocasiones utilizó como tratamiento inyección intramuscular de Kanelog-40; con posterioridad a la administración del mismo notó alteraciones en la piel de la región glútea, y asiste al Servicio de Dermatología de nuestro hospital, donde se decide realizar biopsia de piel con la impresión diagnóstica de atrofia residual medicamentosa, lo cual fue corroborado con dicho estudio

Sífilis maligna precoz y enfermedad de Hodgkin / Early malignant syphilis and Hodgkin's disease

Se realiza una revisión bibliográfica sobre la sífilis maligna precoz, forma clínica muy rara en nuestros días, que aparece en aquellas personas que adquieren la sífilis y padecen, además, de otras afecciones crónicas, como tuberculosis, desnutrición, alcoholismo, paludismo, adicción a drogas, etcétera. Se presenta un paciente que, con el diagnóstico previo de una enfermedad de Hodgkin, adquirió una sífilis reciente confirmada por los resultados de laboratorio y epidemiológicos y con manifestaciones clínicas que corresponden a una sífilis maligna precoz

Sarcoidosis: a propósito de un caso interesante / Sarcoidosis: apropos of an interesting case

La sarcoidosis es una enfermedad granulomatosa, sistémica, de origen indeterminado. Se realiza una revisión del tema, tanto del tipo transitorio o subagudo como del tipo persistente o crónico. Se ilustra con un paciente diagnosticado de sarcoidosis en el Servicio de Dermatología del Hospital Docente Clinicoquirúrgico "10 de Octubre" con manifestaciones sistémicas en ganglios, hilios pulmonares y piel. Se trata de un paciente de 49 años de edad, de la raza negra, con antecedentes de padecer drepanocitemia y asma bronquial. El diagnóstico se sospecha por la clínica de las lesiones cutáneas y se confirma con el estudio histopatológico. Como dato de interés está el hecho de que hace unos 4 años fue diagnosticado de padecer de un linfoma folicular gigante y posteriormente como una enfermedad de Hodgkin. Recibió tratamiento basado en dichos diagnósticos