Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease.

BACKGROUND: The aim of this study is to present midterm results of thoracic endovascular aortic repair (TEVAR) using scalloped or fenestrated custom-made endovascular grafts (CMEGs) in aortic arch Zones 0 and 1. METHODS: A retrospective review of prospectively collected data involving consecutive patients with aortic arch disease treated by scalloped or fenestrated Relay Plus stent grafts (Terumo Aortic, Sunrise, FL) landed in Zones 0 and 1. Patient demographics, operative details, clinical outcomes, and complications were analyzed. RESULTS: Between February 2014 and February 2020, 14 patients (9 male and 5 female) with a median age of 66 years (range 48-84) underwent scalloped or fenestrated TEVAR to preserve flow to the supra-aortic trunks (SATs). In 6 cases the landing zone was Zone 0 and in 8, Zone 1. Target vessels for the scallops were left common carotid artery in 8 cases (Zone 1) and innominate artery (IA) in 1 (Zone 0). All 5 fenestrations were designed to preserve the IA (Zone 0). Technical success was 100% with no endoleaks on completion angiography. One fatal perioperative stroke (7%) occurred in a patient with a fenestration for the IA and atherosclerotic plaques in the arch. During median follow-up of 37.5 (3-72) months, no other patient died, and all the target vessels and cervical revascularizations remained patent. There was no paraplegia, no retrograde dissection, and no other complication. Two patients (14%) with scallops in Zone 1 developed late endoleak: 1 type Ib at 6 months and 1 type Ia endoleak at 12 months. There were no endoleaks at all in the group of fenestrated endografts (Zone 0). CONCLUSIONS: When anatomy allows, endovascular treatment using scalloped or fenestrated CMEGs in Zones 0 and 1 is a feasible technique to treat patients with aortic arch disease involving the SATs.

2-Thiouracil intersystem crossing photodynamics studied by wavelength-dependent photoelectron and transient absorption spectroscopies.

Single-atom substitution within a natural nucleobase-such as replacing oxygen by sulfur in uracil-can result in drastic changes in the relaxation dynamics after UV excitation. While the photodynamics of natural nucleobases like uracil are dominated by pathways along singlet excited states, the photodynamics of thiobases like 2-thiouracil populate the triplet manifold with near unity quantum yield. In the present study, a synergistic approach based on time-resolved photoelectron spectroscopy (TRPES), time-resolved absorption spectroscopy (TRAS), and ab initio computations has been particularly successful at unraveling the underlying photophysical principles and describing the dissimilarities between the natural and substituted nucleobases. Specifically, we find that varying the excitation wavelength leads to differences between gas-phase and condensed-phase experimental results. Systematic trends are observed in the intersystem crossing time constants with varying excitation wavelength, which can be readily interpreted in the context of ab initio calculations performed both in vacuum and including solvent effects. Thus, the combination of TRPES and TRAS experiments with high-level computational techniques allows us to characterize the topology of the potential energy surfaces defining the relaxation dynamics of 2-thiouracil in both gas and condensed phases, as well as investigate the accessibility of conical intersections and crossings, and potential energy barriers along the associated relaxation coordinates.

Internal conversion and intersystem crossing pathways in UV excited, isolated uracils and their implications in prebiotic chemistry.

The photodynamic properties of molecules determine their ability to survive in harsh radiation environments. As such, the photostability of heterocyclic aromatic compounds to electromagnetic radiation is expected to have been one of the selection pressures influencing the prebiotic chemistry on early Earth. In the present study, the gas-phase photodynamics of uracil, 5-methyluracil (thymine) and 2-thiouracil-three heterocyclic compounds thought to be present during this era-are assessed in the context of their recently proposed intersystem crossing pathways that compete with internal conversion to the ground state. Specifically, time-resolved photoelectron spectroscopy measurements evidence femtosecond to picosecond timescales for relaxation of the singlet (1)ππ* and (1)nπ* states as well as for intersystem crossing to the triplet manifold. Trapping in the excited triplet state and intersystem crossing back to the ground state are investigated as potential factors contributing to the susceptibility of these molecules to ultraviolet photodamage.

Invasiveness has no influence on the rate of incidental durotomies in surgery for multisegmental lumbar spinal canal stenosis (≥3 levels) with and without fusion: analysis from the German Spine Registry data (DWG-Register).

BACKGROUND: Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (≥3 levels) is still unclear. The aim of this study was to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in ≥3 levels. METHODS: Retrospective analysis of the data pool of the DWG register based on cases described by 10 clinics between January 2012 and December 2016 was performed. Surgically treated LSS in ≥3 segments were divided into decompression with or without instrumentation and fusion. Cases with intraoperative DT in both subgroups were analysed for risk factor occurrence. The Surgical Invasive Index (SII) was used. RESULTS: DT occurred in 102/941 (10.8%) patients. Difference in DT between groups was non-significant. The likelihood of DT increased by 2.12-fold with previous spinal surgery at the same level and by 1.9-fold for BMI 30-34 and >35 in comparison with BMI 26-29, respectively. Postoperative deep wound infection was increased by 2.39-fold after DT than without. Significance in outcomes between patients with/without DT was not found. The invasiveness index explained 48% of the variation in blood loss and 51% of the variation in surgery duration. CONCLUSIONS: The rate of incidental DT during decompression for LSS with and without fusion in ≥3 levels was associated with BMI and previous surgery at the same spinal level. Invasivness (SII) is valid rather for variables proper to surgery such as bledding and Op-time but no with incidence for DT and subsequent CSF-leackage.

Colloidal Synthesis, Characterization, and Photoconductivity of Quasi-Layered CuCrS2 Nanosheets.

The current need to accelerate the adoption of photovoltaic (PV) systems has increased the need to explore new nanomaterials that can harvest and convert solar energy into electricity. Transition metal dichalcogenides (TMDCs) are good candidates because of their tunable physical and chemical properties. CuCrS2 has shown good electrical and thermoelectrical properties; however, its optical and photoconductivity properties remain unexplored. In this study, we synthesized CuCrS2 nanosheets with average dimensions of 43.6 ± 6.7 nm in length and 25.6 ± 4.1 nm in width using a heat-up synthesis approach and fabricated films by the spray-coating method to probe their photoresponse. This method yielded CuCrS2 nanosheets with an optical bandgap of ~1.21 eV. The fabricated film had an average thickness of ~570 nm, exhibiting a net current conversion efficiency of ~11.3%. These results demonstrate the potential use of CuCrS2 as an absorber layer in solar cells.

[Polypharmacy in older adults and impact on their quality of life. Literature review]. / Polifarmacia en adulto mayor, impacto en su calidad de vida. Revision de literatura.

OBJECTIVE: To know, by analyzing the state of knowledge, the impact of the polypharmacy on the quality of life of older adults and the role of nursing when dealing with this health problem. MATERIALS AND METHODS: Descriptive review of 62 original articles with multiple methodological designs, in the databases EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS and Dialnet. RESULTS: Polypharmacy in older adults is more frequent in the female sex and people with low level of education, and is associated with socioeconomic factors. A large percentage of older adults present with prescription cascade due to the amount of drugs consumed and the number of doctors consulted, leading to pharmacological interactions that affect functionality and quality of life. CONCLUSIONS: More control of drugs consumed by older adults is needed to avoid harmful effects. Nursing professionals should have an educational role in this age group to reduce polypharmacy and promote lifestyles that foster healthy ageing.

OBJETIVO: Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud. MÉTODOS: Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet. RESULTADOS: La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida. CONCLUSIONES: Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.

Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Experiencia formativa de académicos en dos universidades latinas en diplomado de simulación clínica en enfermería / Training Experience with Scholars from two Latin-American Universities during a Diploma Course in Nursing Clinical Simulation

Introducción: Capacitar en simulación clínica asegura calidad de la enseñanza e incrementa conocimientos necesarios para realizar procesos dinámicos que involucren creación de entornos hipotéticos de representaciones auténticas de realidades sanitarias. Esta estrategia reviste importancia para concretar productos e insumos derivados de entrenamientos en simulación, ligados a satisfacción de profesionales que finalizan estas experiencias formativas. Objetivo: Conocer la satisfacción general de académicos y el producto obtenido de una experiencia formativa en modalidad de diplomado en simulación clínica de alta fidelidad. Métodos: Estudio descriptivo, de corte trasversal, con análisis teórico-lógico-reflexivo desde la literatura que respaldó el diseño didáctico del proyecto. Se trabajó con la totalidad de académicos de la Facultad de Enfermería, Universidad de Panamá (N = 146), durante mayo-julio del 2022. Hubo clases sincrónicas y asincrónicas y una semana presencial para exposiciones de escenarios. Se evaluó la estrategia con cuestionario de cinco dimensiones validado por criterios de jueces. El puntaje Alfa de Cronbach final fue 0,89. Se incluyeron profesores con más de 92 por ciento de asistencia a clases, los que tuvieron conexiones inestables a encuentros se excluyeron. Se realizó análisis estadístico descriptivo en programa SPSS. Se siguieron normas éticas y recomendaciones para estudios con seres humanos. Resultados: El 99 por ciento evaluó la capacitación con nivel de satisfacción muy alto. Se obtuvieron productos clave, como reglamentos, consentimientos informados y banco de escenarios validados, como insumos de trabajo para la facultad. Conclusiones: Los resultados configuraron respuestas de un grupo de académicos capacitados en simulación clínica, con valoración de muy alta satisfacción. Los productos obtenidos se encaminaron a normativas y guías para uso de simulación(AU)

Introduction: Clinical simulation training ensures the quality of teaching and increases the knowledge necessary to carry out dynamic processes involving the creation of hypothetical environments of authentic representations of health realities. This strategy is important for the realization of products and inputs derived from simulation training, linked to the satisfaction of professionals who complete these training experiences. Objective: To know the general satisfaction of scholars and the product obtained from a training experience as a diploma course in high-fidelity clinical simulation. Methods: A descriptive and cross-sectional study was carried out, following a theoretical-logical-reflexive analysis from the literature, which supported the didactic design of the project. The working methodology included all the scholars from the Nursing School at University of Panama (N=146), during May-July 2022. There were synchronous and asynchronous classes, as well as a face-to-face week for scenario presentations. The strategy was evaluated with a five-dimension questionnaire validated by judges' criteria. The final Cronbach's alpha score was 0.89. Professors with more than 92 percent of class attendance were included; those with unstable connections to meetings were excluded. A descriptive statistical analysis was performed in the SPSS software. Ethical norms and recommendations for studies with human beings were followed. Results: 99 percent assessed the training with a very high level of satisfaction. Key products were obtained, such as regulations, informed consents and a stock of validated scenario, as working inputs for the school. Conclusions: The outcomes included responses from a group of scholars trained in clinical simulation, with very high satisfaction ratings. The products obtained were directed towards regulations and guidelines for the use of simulation(AU)

Validación de escala para medir conocimientos pedagógicos del mentor de enfermería en conducción de prácticas / Scale validation to measure pedagogical knowledge of the nursing mentor in conducting practices

Objetivo: Validar una escala para medir conocimientos pedagógicos del mentor de enfermería en conducción de prácticas. Metodología: Estudio metodológico, cuantitativo, periodo 2019-2020. Del constructo teórico y estudio cualitativo surgen reactivos, sometidos a consenso de expertos para validez de contenido. La escala se administró a universo N=172 mentores clínicos. Para concordancia interjueces de la escala, se utilizaron coeficientes estadísticos. Se alcanzó fiabilidad por Alfa de Cronbach. La validez de constructo fue por análisis factorial exploratorio. Resultados principales: La concordancia interjueces obtuvo alta consistencia interna; se eliminaron ítem con correlación <0,5, se incorporan los significativos, p> 0,05. La versión final de la escala fue de 33 ítem, con Cronbach de .897. El análisis factorial exploratorio explicó el 74% de varianza total y aportó cuatro factores. Conclusión principal: La escala tiene validez y fiabilidad, propició diagnóstico de conocimiento pedagógico de mentores para conducir prácticas de enfermería.(AU)

Objective: Validate scale to measure pedagogical knowledge of the nursing mentor in conducting practices. Methods: Methodological, quantitative study, period 2019-2020. From the theoretical construct and qualitative study, reagents arise, submitted to expert consensus for content validity. The scale was administered to a universe of N=172 clinical mentors. For interrater agreement of the scale, statistical coefficients were used. Reliability was achieved by Cronbach's Alpha. Construct validity was by exploratory factor analysis. Results: Interjudge agreement obtained high internal consistency; item with correlation <0.5 were eliminated, significant item were incorporated, p> 0.05. The final version of the scale had 33 item, with Cronbach's score of .897. The exploratory factorial analysis explained 74% of the total variance, contributing four factors. Conclusions: The scale has validity and reliability, propitious diagnosis of pedagogical knowledge of mentors to conduct nursing practices.(AU)

Aortic Customized Stent-Graft Treatment of Postnephrectomy Renal Pedicle Arteriovenous Fistula.

A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.

Influence of the State of the Subarachnoid Space of the Cranial Base in Hydrocephalus Resolution after Endoscopy.

Objective To compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS). Material and Methods We conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable. Results We found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference (p < 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88-6.22). Another important factor involved was age that showed a statistically significant difference (p < 0.0018) with HR 3.28 (95% CI, 1.55-6.93). Conclusion The permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.

Endoscopic transventricular exploration with biopsy of the basal cisterns and the role of endoscopic third ventriculostomy in patients suffering with basal cistern meningitis and consecutive hydrocephalus.

OBJECTIVES: The purpose of this work is to elucidate the efficacy of endoscopic basal cisterns exploration, biopsy, and third ventriculostomy (ETV) in patients with basal cistern meningitis and arachnoiditis. MATERIALS AND METHODS: The cases and videos of all patients in whom flexible neuroendoscopy was performed during the period of January 2005-June 2012 at the University Hospital 'Dr. Ignacio Morones Prieto' in San Luis Potosí, México. A group of 47 patients with radiological diagnosis of basal meningitis, arachnoiditis, and negative cerebrospinal fluid analysis were included. RESULTS: From the 28 (60%) patients with histological diagnosis, 22 (47%) were made from biopsy from the arachnoid membranes of the basal cisterns only, 4 (9%) only from the cerebral cortex, and 2 (4%) from both sites. There were no complications related to the endoscopic procedure. In 23 patients from the 42 with hydrocephalus, ETV was successful. The grade of diagnostic accuracy of both biopsies in detect etiology was 68% (28 of 47 patients), the diagnostic accuracy of arachnoid biopsy was 60%, and diagnostic accuracy of convexity brain biopsy was 21% with 24 and 6 patients, respectively. DISCUSSION: Endoscopic transventricular biopsy of the basal cisterns seems to be a safe and a relatively accurate procedure. As longs as frozen subarachnoid space was not seen, the possibilities of performing ETV in hydrocephalus condition are elevated depending on the causal micro-organism.

Atributos explorados en tutores clínicos, para conducir el aprendizaje práctico del estudiante de enfermería / Attributes Explored in Clinical Advisors, in View of Conducting Practice Learning of Nursing Students

Introducción: La mentoría en formación de estudiantes de enfermería en ambientes clínicos es reconocida en países como Canadá, Reino Unido (Nursing Midwifery Council) España e Italia, donde es identificada como problemática de la profesión, por debilitarse el tutelaje de estudiantes en escenarios de formación práctica. Objetivo: Describir atributos que perciben tutores clínicos de enfermería para conducir el aprendizaje formativo en prácticas clínicas. Métodos: Estudio descriptivo, exploratorio. Las unidades de análisis fueron tutores de dos unidades académicas de universidades chilenas, temporalidad del estudio: marzo 2018 a noviembre 2019. Para seleccionar los participantes se optó por muestreo homogéneo; activo hasta obtener saturación muestral y suficiencia de información. Se incluyeron al estudio enfermeras asistenciales, contratadas por universidades, con más de tres años como tutores; se excluyeron, académicos supervisores de prácticas, que son parte del cuerpo de escuelas de enfermería de ambas universidades. El trabajo de campo se inició con vagabundeo; se crearon mapas sociales y temporales para primeros acercamientos a los participantes. Para recoger la información, se usó técnica de grupos focales. Se respetaron exigencias y principios éticos de estudios con seres humanos. Resultados: Los tutores percibieron que una buena práctica se inicia con proyección y proximidad de universidad con hospital, destacan necesidad de formación para su acción de mentoría con estudiantes, influenciada por condiciones favorecedoras del clima de aprendizaje del entorno clínico. Conclusiones: Cinco subcategorías configuran atributos de tutores para conducir prácticas clínicas: desarrollo del plan de estudio, planificación de tutoría, entorno de aprendizaje clínico, supervisión de práctica y pensamiento científico-reflexivo(AU)

Introduction: Advisorship in the training of Nursing students in clinical settings is recognized in countries such as Canada, the United Kingdom (Nursing Midwifery Council), Spain and Italy, where it is identified as a problem in the profession, due to the weakening of student tutelage in settings for practice training. Objective: To describe attributes perceived by clinical Nursing advisors concerning the conduction of formative learning in clinical practices. Methods: Descriptive and exploratory study. The analysis units were advisors from two academic units of Chilean universities. The study period was defined from March 2018 to November 2019. To select the participants, homogeneous sampling was chosen, active until sample saturation and information sufficiency were obtained. The study included practicing nurses hired by universities, with more than three years as advisors. The study excluded academic practice advisors who belong to the Nursing school faculties of both universities. Field work began with mind-wandering; social and temporal maps were created for first approaches to the participants. To collect the information, the focus group technique was used. Demands and ethical principles of studies with human beings were respected. Results: The advisors perceived that a good practice begins with a projection and proximity between university and hospital. They highlight their need for training in the work as students' advisors, influenced by conditions that favor the learning environment of the clinical setting. Conclusions: Five subcategories make up the attributes of advisors to conduct clinical practices: development of the study plan, planning of advisorship, clinical learning environment, supervision of practice, and scientific-reflective thinking(AU)

Características del proceso enseñanza aprendizaje vinculado al pensamiento crítico desde la mirada de docentes y estudiantes de enfermería / Characteristics of the Teaching-Learning Process Associated to Critical Thinking from the Perspective of Nursing Teachers and Students

Introducción: Enfermería incorpora en su formación de pregrado la competencia genérica y específica de pensamiento crítico y reflexivo, esencial para brindar cuidados holísticos. Objetivo: Describir características del proceso enseñanza aprendizaje vinculado a pensamiento crítico desde la mirada de docentes y estudiantes de la carrera de enfermería. Métodos: Estudio cualitativo descriptivo; realizado en la carrera de enfermería de la Universidad Católica del Norte; Chile, 2017. Las unidades de análisis se conformaron por 8 académicos y 12 estudiantes, seleccionados mediante muestreo por conveniencia, de acuerdo a objetivos, necesidades y alcance metodológico. Se utilizó la técnica de grupo focal. Se realizó análisis de contenido que dieron origen a matrices categoriales que emergen de los discursos. Resultados: El pensamiento crítico para académicos representa un proceso reflexivo complejo, importante para desarrollar habilidades integrales. Desde lo metodológico utilizan estrategias como: aprendizaje basado en problema, estudio de casos, simulaciones de baja y alta fidelidad, trabajo colaborativo, seminarios, clases interactivas, se enfatiza en la indagación; el proceso de evaluación se enmarca en lo oral y escrito, usando pautas y rúbricas. Conclusiones: La enseñanza de pensamiento crítico es compleja, proceso vital en la formación, los docentes y estudiantes construyen una percepción positiva del pensamiento crítico en el desarrollo del proceso enseñanza aprendizaje; emergen categorías: enseñanza del pensamiento crítico, entendida como progreso para favorecer el desarrollo de pensamiento reflexivo, metodologías, para favorecer el aprendizaje consciente de los estudiantes y evaluación del pensamiento crítico-reflexivo, entendido como mecanismos para profundizar logros de aprendizaje(AU)

Introduction: The Nursing major incorporates, in its undergraduate training program, the generic and specific competences of critical and reflective thinking, essential to providing holistic care. Objective: To describe the characteristics of the teaching-learning process associated to critical thinking from the perspective of teachers and students of the Nursing major. Methods: Descriptive and qualitative study carried out, in 2017, in the Nursing major of Universidad Católica del Norte, Chile. The analysis units were made up of eight scholars and twelve students, selected through convenience sampling, according to objectives, needs and methodological scope. The focus group technique was used. Content analysis was carried out, which gave rise to categorical matrices that emerge from the discourses. Results: Critical thinking for scholars represents a complex reflective process, important to developing comprehensive skills. From the methodological point of view, they use strategies such as problem-based learning, case studies, low and high fidelity simulations, collaborative work, seminars and interactive classes, while emphasis is placed on inquiry. The evaluation process is framed within oral and written activities, using guidelines and headings. Conclusions: The teaching of critical thinking is complex, a vital process in training. Teachers and students build a positive perception of critical thinking in the development of the teaching-learning process. Several categories emerge, such as teaching critical thinking, understood as progress to promote the development of reflective thinking; methodologies, to promote the conscious learning of students; and assessment of critical-reflective thinking, understood as mechanisms to deepen learning achievements(AU)

Atributos para caracterizar la satisfacción de estudiantes de enfermería en escenarios clínicos / Attributes for Characterizing Nursing Students' Satisfaction in Clinical Settings

Introducción: La evaluación de satisfacción de estudiantes de enfermería en entornos de aprendizaje clínico está mediada por atributos contextuales del clima de aprendizaje y acción tutorial. Objetivo: Explorar, desde la perspectiva cualitativa, atributos que identifican estudiantes de enfermería para caracterizar la satisfacción en escenarios clínicos. Métodos: Estudio de diseño descriptivo exploratorio. Las unidades de análisis fueron estudiantes de enfermería de dos unidades académicas de universidades chilenas, durante el período lectivo; marzo-noviembre del 2019. Se optó por un muestreo homogéneo. Se incluyeron al estudio alumnos regulares de enfermería, de tercero y cuarto año, que hayan tenido al menos un mes de prácticas clínicas ininterrumpidas y se excluyen, estudiantes de primer, segundo año e internos de enfermería. Para trabajo de campo se inició con vagabundeo y creación de mapas sociales y temporales y como técnica de recogida de información se usó grupo focal, cautelando saturación muestral y suficiencia del dato. Se cumplieron requisitos y principios éticos de investigación en seres humanos. Resultados: los estudiantes distinguen que los atributos para medir su satisfacción en espacios de enseñanza práctica están influenciados o afectados por condiciones del entorno clínico asistencial, profesionalismo del tutor que en su conjunto matizan su satisfacción y por ende el clima de aprendizaje. Conclusiones: Desde la categoría central del constructo de estudio se pudo verificar en los discursos las subcategorías y atributos para medir la satisfacción de los alumnos en los escenarios de prácticas clínicas(AU)

Introduction: Assessment of Nursing students' satisfaction in clinical learning environments is mediated by contextual attributes of the learning climate and tutorial action. Objective: To explore, from a qualitative perspective, attributes identified by Nursing students for characterizing satisfaction in clinical settings. Methods: Study with an exploratory descriptive design. The units of analysis were Nursing students from two academic units of Chilean universities, during school period: March-November 2019. Homogeneous sampling was chosen. Regular third- and fourth-year Nursing students who had had at least one month of uninterrupted clinical practice were included in the study, while first- and second-year students and Nursing interns were excluded. Fieldwork began with wandering and the creation of social and temporal maps, while focus group was used as a data collection technique, ensuring sample saturation and data sufficiency. Requirements and ethical principles for research in humans were met. Results: The students distinguish that the attributes for measuring their satisfaction in practical teaching settings are influenced or affected by conditions of the clinical care environment, as well as by tutor professionalism, which, as a whole, qualify their satisfaction and, therefore, the learning climate. Conclusions: From the central category of the study construct, it was possible to verify, within the discourses, the subcategories and attributes for measuring the students' satisfaction in the clinical practice settings(AU)

Biopsy of Brainstem Gliomas Using Flexible Endoscopes.

OBJECTIVES: To describe our experience and the results obtained in performing transventricular brainstem biopsy with the use of flexible neuroendoscops. METHODS: We identified patients who underwent a neuroendoscopic procedure with brainstem lesion biopsy to obtain histopathologic diagnosis and to treat obstructive hydrocephalus. All patients had follow-up examinations at months 1, 3, 6, and 12 postsurgery and then annually. RESULTS: Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3-26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally. CONCLUSION: The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors.

Promotores de reserva cognitiva en adultos mayores con alto riesgo de demencia cortical / Promoters of Cognitive Reserve in the Elderly with High Risk of Cortical Dementia

Introducción: La reserva cognitiva constituye un elemento central para entender cómo responde el cerebro a la neuropatología durante el ciclo vital. Objetivo: Comprender los factores promotores de reserva cognitiva desde la experiencia de vida de adultos mayores sin deterioro cognitivo y con alto riesgo de demencia cortical. Métodos: Estudio cualitativo, con base en método Grounded Theory. Se realizan entrevistas semiestructuradas en profundidad a siete adultos mayores. En el análisis, se aplica la técnica de comparación constante según modelo de Glasser y Straus, utilizando Atlas ti/7. Resultados: Desde el análisis axial surgen cinco categorías interrelacionadas: actividad mental, experiencias gratificantes, cuidados, eventos traumáticos y características de personalidad. Se aprecia un patrón constante de experiencias vitales mentalmente estimulantes, relacionado principalmente a actividades de cuidado y experiencias gratificantes, no asociadas a educación formal. Conclusiones: Se distingue un proceso dinámico que involucra experiencias y eventos de vida cotidiana, tanto personales como ambientales, ocupacionales y del estilo de vida, que operan secuencialmente durante el ciclo vital; estos factores podrían incidir significativamente en los mecanismos neurobiológicos y actuar como promotores de reserva cognitiva. Se obtiene un modelo de promotores de reserva cognitiva que podría utilizarse en programas de salud cognitiva para contrarrestar la neuropatología(AU)

Introduction: Cognitive reserve constitutes an element central to understanding how the brain responds to neuropathology during the life cycle. Objective: To understand the factors that promote cognitive reserve from the life experience of the elderly without cognitive deterioration and with high risk of cortical dementia. Methods: Qualitative study, methodologically based on grounded theory. In-depth semi-structured interviews are conducted on seven elderlies. In the analysis, the constant comparison technique is applied according to the model by Glaser and Strauss, using ATLAS-Ti 7. Results: Five interrelated categories emerge from the axial analysis: mental activity, gratifying experiences, care, traumatic events, and personality traits. There is a constant pattern of mentally-stimulating life experiences, mainly related to care activities and gratifying experiences, not associated with formal education. Conclusions: A dynamic process is distinguished that involves experiences and events of daily life, both personal and environmental, occupational and related to lifestyle, which operate sequentially during the life cycle. These factors could significantly influence neurobiological mechanisms and act as promoters of cognitive reserve. A model of cognitive reserve promoters is obtained that could be used in cognitive health programs to counteract neuropathology(AU)

Satisfacción de titulados de enfermería sobre Hospital Simulado de la Universidad Arturo Prat, sede Victoria / Satisfaction of the Nursing Graduates about Simulated Hospital of Arturo Prat University, Vitoria Venue

Introducción: La simulación clínica es una metodología usada ampliamente en ciencias de la salud debido a sus múltiples beneficios, permite un entrenamiento continuo del estudiante, aprender de sus errores y fortalecer sus competencias. La Universidad Arturo Prat, sede Victoria ha desarrollado la simulación de alta fidelidad a través de la implementación de un hospital infantil simulado. Objetivo: Medir el nivel de satisfacción de los titulados de enfermería sobre el hospital clínico infantil simulado como metodología significativa en su formación profesional. Métodos: Estudio descriptivo, de corte transversal. El universo fue de 109 enfermeros titulados de la Universidad Arturo Prat, que contestaron vía online, durante el primer trimestre del año 2019. Se aplicó una encuesta tipo Likert de satisfacción usuaria (SUHCLIS28), previamente validada por criterio de expertos y prueba piloto, con un alfa de Cronbach 0,940 y conformada por 28 ítems agrupados en 6 dimensiones (infraestructura, recurso humano, conocimientos, metodología, evaluación y evaluación global). Resultados: Las preguntas fueron respondidas mayoritariamente de manera positiva para esta metodología, obteniéndose un nivel de satisfacción usuaria global de 4,51 de un total máximo de 5,0, considerada como satisfacción muy alta. Conclusiones: La simulación clínica es una herramienta pedagógica útil, que contribuye al mayor desarrollo de competencias y habilidades, es aceptada de manera favorable por los estudiantes y contribuye finalmente a que ellos entreguen una atención segura y de calidad en el usuario real(AU)

Introduction: Clinical simulation is a methodology widely used in health sciences due to its multiple benefits. It allows continuous training of the student, in order for them to learn from their mistakes and strengthen their skills. Arturo Prat University, at the Victoria venue, has developed high-reliability simulation through the implementation of a simulated children's hospital. Objective: To measure the level of satisfaction of Nursing graduates concerning the simulated children's clinical hospital as a significant methodology in their professional training. Methods: Descriptive and cross-sectional study. The study population consisted of 109 registered nurses from Arturo Prat University, who answered online, during the first quarter of 2019. A Likert survey about user satisfaction (SUHCLIS28) was conducted, previously validated by expert criteria and pilot test, with a Cronbach's alpha of 0.940 and made up of 28 items grouped into six dimensions (infrastructure, human resources, knowledge, methodology, evaluation and global evaluation). Results: The questions were answered mostly positively for this methodology, obtaining an overall user satisfaction level of 4.51 out of a maximum total of 5.0; the result is considered very high satisfaction value. Conclusions: Clinical simulation is a useful pedagogical tool, which contributes to the greater development of competences and skills. It is favorably accepted by students and, finally, contributes to their provision of safe and quality care to the real user(AU)

Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury.

OBJECTIVES: Our main objective was to evaluate whether serum hypocalcaemia (defined as <2.1 mmol/L [8.5 mg/dL]) and ionized serum calcium (defined as <1.10 mmol/L [4.5 mg/dL]) is a prognostic factor for mortality and morbidity (defined as Glasgow outcome score [GOS] ≤3) in early moderate and severe traumatic brain injury (TBI). MATERIALS AND METHODS: We developed a retrospective study and evaluated clinical profiles from included patients from January 2004 to December 2012. Patients were between 16 and 87 years old and had a Glasgow coma scale of 3-13 points following TBI, with demonstrable intracranial lesions in cranial computed tomography. RESULTS: We found a significant statistical difference (P < 0.008) in the ionized serum calcium levels on the 3(rd) day of admission between the groups: GOS ≤3 and >3 (disability/death). According with the receiving operative curves analysis, we found that the best level of higher sensitivity (83.76%) and specificity (66.66%) of hypocalcaemia of serum ionized calcium on 3(rd) day was the value of 1.11 mmol/L, with an odds ratio value of 6.45 (confidence intervals 95%: 2.02-20.55). CONCLUSIONS: The serum levels of ionized calcium on day 3 could be useful for the prediction of mortality and disability in patients with moderate and severe TBI.

Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury.

OBJECTIVES: Our main objective was to evaluate whether serum hypocalcaemia on the third day [defined as < 2.1 mmol/l (8.5 mg/dl)] is a prognostic factor for early mortality after moderate and severe traumatic brain injury (TBI). METHODS: We developed an ambispective comparative case control study. We evaluated clinical profiles from included patients from January 2005 to July 2009 and we prospectively recruited additional patients from August 2009 to July 2011. Patients were between 1 and 89 years old and had a Glasgow Coma Scale of 3-12 points following TBI. RESULTS: We calculated an Odds Ratio of 5.2 (Confidence Intervals 95%: 4.48 to 6.032) for hypocalcaemia on day three, which was associated with death. Retrospectively (January 2005 to July 2009) we compiled data from 81 patients. Prospectively (August 2009 to July 2011) we recruited 41 patients. The adjusted variables in the logistic regression final model were: serum calcium on day three (Odds Ratio 3.5, Confidence Intervals 95%: 1·12 to 13·61, P < 0·028) and anisocoria (Odds Ratio 8·24, Confidence Intervals 95%: 1·3 to 67·35, P < 0·019) obtaining an adjusted R2 of 0·22 (P < 0·005). DISCUSSION: The serum levels of calcium on day three could be useful for the prediction of mortality in patients with moderate and severe TBI.