Representaciones sociales sobre seguridad y salud en el trabajo en universitarios / Social representations on safety and health at work in universities

Antecedentes y objetivo La seguridad y salud en el trabajo corresponde a una de las competencias específicas, que deben desarrollar los profesionales de fisioterapia en Colombia, pero también se puede profundizar en él, como un campo de acción profesional que debe certificarse a través de formación de posgrado. El objetivo del presente estudio buscó describir las representaciones sociales sobre seguridad y salud en el trabajo en estudiantes de fisioterapia en una universidad pública en la ciudad de Cali (Colombia). Métodos Estudio cualitativo de la teoría de las representaciones sociales, los datos se recogieron con la técnica de listados de palabras de asociación libre, aplicada a 37 estudiantes antes del inicio y transcurridas 12 semanas de la práctica de seguridad y salud en el trabajo. El análisis se realizó con el software libre Anthropac. Resultados El concepto de seguridad y salud en el trabajo se configuró en el núcleo central a través del lexema pausa activa. Las categorías emergentes fueron ergonomía y movimiento. Conclusiones Las representaciones sociales evocadas hacen parte de las competencias establecidas en el perfil profesional y competencias del fisioterapeuta en Colombia, mientras otras representaciones sociales son imaginarios que el estudiante considera debería conocer el fisioterapeuta sobre SST (AU)

Background and objective Occupational safety and health corresponds to one of the specific competencies that physiotherapy professionals in Colombia must develop, but it can also be deepened, as a professional field of action to be certified through postgraduate training. The objective of this study was to describe the social representations on safety and health at work in physiotherapy students at a public university in the city of Cali (Colombia). Methods Qualitative study of the theory of social representations, the data were collected with the free association word lists technique, applied to 37 students before the beginning and 12 weeks of the practice of safety and health at work. The analysis was performed with the free software Anthropac. Results The concept of occupational safety and health was configured in the core through the active pause lexema. Emerging categories were ergonomics and movement. Conclusions The social representations mentioned are part of the competencies established in the professional profile and competencies of the physiotherapist in Colombia, while other social representations are imaginary that the student considers should know the physiotherapist about OSH (AU)

Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room.

BACKGROUND: Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance. AIMS: The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access. METHODS: We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors. RESULTS: 12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement. CONCLUSIONS: Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.

Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices.

PURPOSE: To determine institutional practice requirements for personal protective equipment (PPE) in cross-sectional interventional radiology (CSIR) procedures among a variety of radiology practices in the USA and Canada. METHODS: Members of the Society of Abdominal Radiology (SAR) CSIR Emerging Technology Commission (ETC) were sent an eight-question survey about what PPE they were required to use during common CSIR procedures: paracentesis, thoracentesis, thyroid fine needle aspiration (FNA), superficial lymph node biopsy, deep lymph node biopsy, solid organ biopsy, and ablation. Types of PPE evaluated were sterile gloves, surgical masks, gowns, surgical hats, eye shields, foot covers, and scrubs. RESULTS: 26/38 surveys were completed by respondents at 20/22 (91%) institutions. The most common PPE was sterile gloves, required by 20/20 (100%) institutions for every procedure. The second most common PPE was masks, required by 14/20 (70%) institutions for superficial and deep procedures and 12/12 (100%) institutions for ablation. Scrubs, sterile gowns, eye shields, and surgical hats were required at nearly all institutions for ablation, whereas approximately half of institutions required their use for deep lymph node and solid organ biopsy. Compared with other types of PPE, required mask and eye shield use showed the greatest increase during the SARS-CoV-2 pandemic. CONCLUSION: PPE use during common cross-sectional procedures is widely variable. Given the environmental and financial impact and lack of consensus practice, further studies examining the appropriate level of PPE are needed.

Assessment of organizational dynamics in a Psychosocial Care Center from the multidisciplinary team's perspective / Evaluación de la dinámica organizacional en un Centro de Atención Psicosocial desde la perspectiva del equipo multidisciplinario / Avaliação da dinâmica organizacional em Centro de Atenção Psicossocial na perspectiva da equipe multidisciplinar

ABSTRACT Objectives: to assess organizational dynamics in a Psychosocial Care Center for Alcohol and Drugs from the multidisciplinary team's perspective. Methods: an evaluative, qualitative study, supported by the Fourth Generation Assessment theoretical-methodological framework. It was carried out in a Psychosocial Care Center for Alcohol and Drugs from September 2019 to March 2020. Data collection took place through observation, individual open-ended interviews and negotiation sessions. The informants were 12 professionals. Analysis was based on Constant Comparative Method. Results: it was highlighted as potential of organizational dynamics, being an outpatient service, trying to address the deficiencies of RAPS and understanding the importance of matrix support. Among the challenges are the fragility of teamwork, reception, insufficient training, worker profile and overload. Final Considerations: the importance of understanding the work process and the care flow is highlighted, in order to strengthen the Psychosocial Care Network.

RESUMEN Objetivos: evaluar la dinámica organizacional en un Centro de Atención Psicosocial por Alcohol y Drogas desde la perspectiva del equipo multidisciplinario. Métodos: estudio evaluativo, cualitativo, sustentado en el marco teórico-metodológico de la Evaluación de Cuarta Generación. Realizado en un Centro de Atención Psicosocial por Alcohol y Drogas, de septiembre de 2019 a marzo de 2020. La recolección de datos se realizó mediante observación, entrevistas individuales abiertas y sesión de negociación Los informantes fueron 12 profesionales y el análisis se basó en el Método Comparativo Constante. Resultados: se destacó el potencial de la dinámica organizacional como un servicio ambulatorio, tratando de abordar las deficiencias del RAPS y entendiendo la importancia del soporte matricial. Entre los retos se encuentran la fragilidad del trabajo en equipo, la acogida, la formación insuficiente, el perfil y la sobrecarga del trabajador. Consideraciones Finales: se destaca la importancia de comprender el proceso de trabajo y el diagrama de flujo de la atención, con el fin de fortalecer la Red de Atención Psicosocial.

RESUMO Objetivos: avaliar a dinâmica organizacional em um Centro de Atenção Psicossocial Álcool e Drogas na perspectiva da equipe multidisciplinar. Métodos: estudo avaliativo, qualitativo, apoiado no referencial teórico-metodológico da Avaliação de Quarta Geração. Realizado em um Centro de Atenção Psicossocial Álcool e Drogas, de setembro de 2019 a março 2020. A coleta de dados ocorreu por meio da observação, entrevista aberta individual e sessão de negociação. Os informantes foram 12 profissionais, e a análise se baseou no Método Comparativo Constante. Resultados: foram destacadas como potencialidades da dinâmica organizacional ser um serviço ambulatorial, tentar suprir as deficiências da RAPS e entender a importância do matriciamento. Dentre os desafios, estão a fragilidade do trabalho em equipe, do acolhimento, a insuficiência de capacitações, o perfil e sobrecarga do trabalhador. Considerações Finais: salienta-se a importância de compreender o processo de trabalho e o fluxograma de atendimentos, a fim de fortalecer a Rede de Atenção Psicossocial.

Resistance to interprofessional collaboration in in-service training in primary health care / Resistencias a la colaboración interprofesional en la formación en servicio en la atención primaria a la salud / Resistências à colaboração interprofissional na formação em serviço na atenção primária à saúde

ABSTRACT Objective: to analyze the resistance to interprofessional collaboration in the professional practices of residents in primary health care. Method: Social and clinical qualitative research with 32 residents of a Multiprofessional Residency, carried out from 2017 to 2018. Data production included Institutional Analysis of Professional Practices, document analysis; investigator's diary; and observation. Data were analyzed based on Institutional Analysis concepts. Results: There were contradictions between the reproduction of uniprofessional education with a focus on the specialty and interprofessional collaborative practices. The resistance analysis pointed to two axes: not-knowing as an analyzer of resistance to collaboration; interprofessional interference and knowledge-power relations. Residents' practices were characterized as resistant to interprofessional collaboration. Conclusion: The resistance analysis in the Multiprofessional Residency showed integrative movements of assimilation and disputes with physician-centered power, with damage to the sharing of care and interprofessional communication. The collective analysis questioned health professionals education, revisiting the perspective of comprehensive care guided by the users' needs.

RESUMEN Objetivo: Hacer un análisis por medio de las resistencias a la colaboración interprofesional en las prácticas profesionales de residentes médicos en la atención primaria a la salud. Método: Investigación cualitativa socio clínica con 32 residentes de una Residencia Multiprofesional, realizada entre 2017 y 2018. La producción de datos incluyó Análisis Institucional de las Prácticas Profesionales, análisis documental; apuntes diarios del investigador; y observación. Los datos fueron analizados a partir de conceptos del Análisis Institucional. Resultados: Se revelaron contradicciones entre la reproducción de la educación uniprofesional con énfasis en la especialidad y prácticas colaborativas interprofesionales. El análisis de la resistencia destacó dos ejes: el no saber cómo método de análisis de resistencias a la colaboración; interferencias interprofesionales y relaciones de saber y de poder. Las prácticas de los residentes fueron caracterizadas por la resistencia a la colaboración interprofesional. Conclusión: El análisis de resistencia en la Residencia Multiprofesional evidenció movimientos integrativos de asimilación y disputas con el poder médico centrado, con daños a la división del cuidado y a la comunicación interprofesional. El análisis colectivo cuestionó la formación de profesionales de salud, revisitando la perspectiva del cuidado integral orientado por las necesidades de los pacientes.

RESUMO Objetivo: fazer uma análise pelas resistências à colaboração interprofissional nas práticas profissionais de residentes na atenção primária à saúde. Método: Pesquisa qualitativa Sócio-clínica com 32 residentes de uma Residência Multiprofissional, realizada de 2017 a 2018. A produção de dados incluiu Análise Institucional das Práticas Profissionais, análise documental; diário do pesquisador; e observação. Os dados foram analisados a partir de conceitos da Análise Institucional. Resultados: Revelaram-se contradições entre a reprodução da educação uniprofissional com foco na especialidade e práticas colaborativas interprofissionais. A análise resistencial apontou dois eixos: não-saber como analisador de resistências à colaboração; interferências interprofissionais e relações de saber-poder. As práticas dos residentes foram caracterizadas pela resistência à colaboração interprofissional. Conclusão: A análise resistencial na Residência Multiprofissional evidenciou movimentos integrativos de assimilação e disputas com o poder médico-centrado, com prejuízos ao compartilhamento do cuidado e à comunicação interprofissional. A análise coletiva questionou a formação de profissionais de saúde, revisitando a perspectiva do cuidado integral orientado pelas necessidades dos usuários.

Formación del talento humano en enfermería en Colombia / Treinamento de talento humano em enfermagem na Colômbia / Training of human talent in nursing in Colombia

Introducción: la formación del talento humano en enfermería requiere de la articulación, de manera imprescindible, con las Instituciones Prestadoras de Servicios de Salud (IPS). Objetivo: analizar la relación docencia-servicio para la formación de talento humano en enfermería en Colombia. Materiales y métodos: estudio de tipo descriptivo. Se envió una encuesta electrónica con preguntas estructuradas y semiestructuradas a 53 Instituciones de Educación Superior (IES). Se incluyeron instituciones con programas de enfermería y con convenios docencia-servicio para prácticas formativas. Resultados: participaron 48 programas de enfermería de IES privadas (60,4 %) y públicas (39,6 %). El 62,5 % no contaban con una IPS propia para el desarrollo de prácticas formativas en salud, situación que deriva en estructuración de convenios docencia-servicio y pagos en dinero o servicios por las IES. Las principales modalidades de contraprestación fueron capacitación del recurso humano, educación continuada y dotación tecnológica. Conclusiones: la integración docencia-servicio de universidades públicas y privadas con diferentes instituciones es necesaria en la formación integral de profesionales de enfermería. Las IES se ven abocadas a ofrecer actividades de compensación y contraprestación según su capacidad y valoración de las necesidades conjuntas. Un bajo porcentaje cuenta con IPS propias, cuya mayoría es de carácter privado. La relación docencia-servicio mejora la atención, educación, orientación a los pacientes y familiares y la credibilidad por la presencia de la academia en las unidades asistenciales.

Introdução: para a formação do talento humano em enfermagem, é essencial articular-se com as instituições prestadoras de serviços de saúde (IPS). Objetivo: analisar a relação ensinoserviço para a formação do talento humano em enfermagem na Colômbia. Materiais e métodos: estudo descritivo, o qual utilizou enquete eletrônica com perguntas estruturadas e semiestruturadas enviadas a 53 Instituições de Ensino Superior (IES). Foram incluídas instituições com programas de enfermagem e convênios docentes para as práticas de formação. Resultados: participaram 48 programas de enfermagem de IES privadas (60,4 %) e públicas (39,6 %). 62,5 % não contavam com IPS própria para o desenvolvimento de estágios em saúde; essa situação leva à estruturação de convênios de prestação de serviços docentes e pagamentos em dinheiro ou serviços pelas IES. As principais formas de contraprestação foram treinamento do recurso humano, educação continuada e dotação tecnológica. Conclusões: a integração ensinoserviço de universidades públicas e privadas com diferentes instituições é necessária na formação integral dos profissionais de enfermagem. As IES são forçadas a oferecer atividades de compensação e remuneração de acordo com sua capacidade e avaliação de necessidades conjuntas. Uma porcentagem baixa tem suas IPS, e a maioria é privada. A relação ensinoserviço melhora o atendimento, a educação, a orientação e a credibilidade do paciente e da família, devido à presença da academia nas unidades de atendimento.

Introduction: The training of human talent in nursing requires the articulation with the health services institutions (IPS, in Spanish) as an essential feature. Objective: To analyze the teachingservice relationship for the training of human talent in nursing in Colombia. Materials and methods: Descriptive study using an electronic survey with structured and semi-structured questions sent to 53 higher education institutions (IES, in spanish). Institutions with nursing programs and teaching service agreements for training practices were included. Results: 48 nursing programs from private (60.4 %) and public (39.6 %) IES participated in this study. 62.5 % of these did not have an IPS in charge of providing their own health services for the development of training practices. This situation leads to the structuring of teaching service agreements and payments in money or services by IES. The main forms of compensation were human resource training, continuing education, and technological endowment. Conclusions: The teachingservice integration of public and private universities with different institutions is necessary for the comprehensive training of nursing professionals. IES are forced to offer compensation activities according to their capacity and assessment of joint needs. A low percentage have their own IPS, whose majority are private institutions. The teaching-service relationship improves care, education, patient and family orientation and credibility due to the presence of the academy in health care units.

Escenarios de práctica formativa en el modelo de salud colombiano / Training practice settings in the Colombia health model

Introducción: La formación del talento humano en salud requiere de la articulación de actividades teóricas y prácticas, por lo cual necesita de manera imprescindible la interacción con instituciones prestadoras de servicios de salud. Objetivo: Evaluar la situación de los escenarios de práctica formativa en el modelo de salud colombiano. Métodos: Estudio evaluativo de corte cualitativo. Se realizó la revisión de la normativa y del contexto de universidades colombianas sobre la relación docencia-servicio. Para el análisis se utilizó el Software Atlas Ti versión 8.0, licenciado por la Universidad de Caldas. Resultados: Se identificaron 161 instituciones de educación superior en Colombia. Se obtuvo respuesta de 32 universidades públicas y 6 privadas. De la revisión normativa se resaltó el Decreto 2376 de 2010, que regula la relación docencia-servicio para la formación del talento humano en salud. Las principales modalidades de contraprestación reportadas fueron: cupos en programas de posgrados, descuentos en matrículas, cupos en educación continuada, pago de facturas de bienes y suministros. La fuente de financiamiento de las instituciones de educación superior, en su mayoría, ha sido los recursos propios. Conclusiones: En el modelo de salud colombiano existe una normativa que sustenta el proceso de relación docencia-servicio. Se requieren los aportes, el apoyo y la interacción de instituciones prestadoras de servicios de salud y de instituciones de educación superior para ofrecerle a los estudiantes las diferentes posibilidades que lo llevarán a lograr las competencias generales y específicas de su profesión(AU)

Introduction: The training of human talent in health requires the articulation of theoretical and practical activities, a reason why interaction with healthcare institutions is essential. Objective: To evaluate the situation of training practice settings in the Colombian health model. Methods: Qualitative evaluation study. A review of the setting of Colombian universities and the regulations on the teaching-service relationship was carried out. For the analysis, the software Atlas Ti (version 8.0) was used, licensed by the University of Caldas. Results: 161 higher education institutions were identified in Colombia. A response was obtained from 32 public universities and from six private universities. The regulatory review highlighted Decree 2376 of 2010, which regulates the teaching-service relationship for the training of human talent in health. The main compensation forms reported were places in postgraduate programs, enrollment discounts, places in continuing education, payment of bills for goods and supplies. The source of financing for higher education institutions, for the most part, has been their own resources. Conclusions: In the Colombian health model, there is a regulation that supports the teaching-service relationship process. The contributions, support, and interaction between healthcare institutions and higher education institutions are required to offer students the different possibilities that will lead them to achieve the general and specific competences of their profession(AU)

Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark.

Inequity in immigrants' health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.

eHealth initiatives; the relationship between project work and institutional practice.

BACKGROUND: Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives? METHODS: Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions. RESULTS: The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools. CONCLUSION: The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.

A national survey of approaches to manage the ICU patient with opioid use disorder.

PURPOSE: Opioid associated admissions to the Intensive Care Unit (ICU) are increasing, but how institutions manage the care of these patients is unknown. We studied the availability of protocols and guidelines in Intensive Care Units (ICUs) for the management of the critically ill patient with opioid use disorder. MATERIALS AND METHODS: A survey was sent to a random sampling of ICU clinicians at acute care hospitals in the United States. RESULTS: Of the 300 hospitals contacted, 118 agreed to participate and 58 submitted surveys (49%, 58/118 response rate). While a majority of ICUs has a guideline to titrate sedative analgesics, only 7% reported a guideline that addresses the sedation needs of patients with opioid use disorder. Only one respondent identified a guideline for the continuation of medication-assisted treatment such as methadone. Most respondents did not have, or were unaware of, a guideline to manage opioid withdrawal or to prevent over-reversal with naloxone. Outpatient resources were offered to patients by 36% of institutions, while even fewer reported the use of a dedicated addiction care team. CONCLUSIONS: Few institutional guidelines exist to provide clinicians with the tools necessary to prevent harm and promote recovery for this growing and vulnerable ICU population.

Appropriateness of blood culture: A comparison of practices between the emergency department and general wards.

BACKGROUND: The decision to perform a blood culture is influenced by factors, such as the pretest probability of bacteremia, resource availability and individual clinician's preference. The lack of formal guidelines results in inconsistencies in practices and an inappropriate or overuse of blood cultures. The primary aim of this study is to compare the rate of positive blood cultures in the emergency department (ED) and general ward. The secondary aim of this study is to analyze factors associated with a positive blood culture. METHODS: We compared 200 consecutive patients in the ED with 200 consecutive patients with first blood cultures done within 24 h of admission from ED to the general ward. We analyzed the clinical characteristics, proportion of positive blood cultures, and variables associated with a positive blood culture. RESULTS: The percentage of positive blood cultures was 13.5% (n = 27) in the ED group, compared with 6.0% (n = 12) in the general ward group. Contamination rates were higher in the ED compared to general ward (4% vs 0.5%). Heart rate and rigors were independently associated with a positive blood culture in a multivariate logistic regression model. CONCLUSION: There was a lower rate of positive blood cultures in the general ward group. Reasons may include a lower threshold for performing blood cultures in the general ward, and prior antibiotics in the ED reducing the sensitivity of blood cultures taken in the general ward. Adherence to clinical decision rules and education of junior staff are needed to improve the efficiency of blood culture taking practices.

Práctica del psicoanalista en la institución: ¿análisis o sugestión? / Practice of the psychoanalyst at the institutional level: analysis or suggestion?

Resumen En el marco de la investigación titulada: Práctica de los psicoanalistas en las instituciones de salud mental en el contexto latinoamericano. Un estado del arte (2000-2013), se mantuvo como eje la pregunta por la presencia del psicoanalista en contextos diferentes al dispositivo analítico clásico, el cual se enmarca en el ámbito de lo privado. Una referencia obligada en esta vía es aquella frase freudiana que evoca la aleación entre el oro puro del análisis y el cobre de la sugestión directa. El presente texto es una elaboración al respecto y sus consecuencias para una praxis psicoanalítica en el ámbito institucional. Para ello se revisaron distintas fuentes en la obra de Freud y en la enseñanza de Lacan, que, junto con otros autores, intentan dar cuenta de las dificultades y posibilidades para que ello sea viable. Se evidencia que los detractores de esta opción se concentran en lo imaginario del dispositivo, mientras que otros más orientados por la estructura del mismo y la función deseo del analista señalan la pertinencia de esta praxis por fuera del dispositivo clásico.

Abstract Within the framework of the research entitled: "Practice of psychoanalysts in mental health institutions in the Latin American context. A state of art (2000-2013) ", the question of the presence of psychoanalysts in contexts different from the classic analytical device, which is framed in the private sphere, was kept as the axis. An obligatory reference in this way is the Freudian phrase that evokes the alloy between the pure gold of the analysis and the copper of the direct suggestion. The present text is an elaboration on this and its consequences for a psychoanalytic praxis at the institutional level. For this, different sources were reviewed in the work of Freud and the lessons of Lacan, which together with other authors attempt to account for the difficulties and possibilities for this to be viable. It is evident that the detractors of this option concentrate on the imaginary of the device, while others are more oriented by the structure of the device and the desired function that the analyst points out.

Clínica institucional: abrigar o desamparo / Institutional practice: giving shelter to helplessness / Clínica institucional: abrigar el desamparo / Clinique institutionnelle: abriter le désarroi

Por ser demasiado humana, a clínica institucional envolve sempre pares em oposição: a força da vida institucional e a força de erupção da desmedida; o enquadre e sua aparente imobilidade e os movimentos vitais em direção ao futuro; os espaços físicos e simbólicos e os processos; as intermináveis repetições e o novo; a preservação e a criação (nela incluída a destruição necessária). É intrigante o movimento de construção e desenvolvimento de projetos de vida. Não se trata de mediações que eliminem as oposições ou que cedam a elas, deixando-se paralisar em um dos polos. Retomando Bleger e fazendo-o conversar com Winnicott, abordamos o vínculo paradoxal entre o imóvel do enquadre analítico e a mobilidade necessária aos processos implicados no tratamento. Nossa proposta é que a correlação positiva entre vida e projetos compartilhados é uma construção que vale a pena ser feita. Favorecer e articular projetos que têm valor de vida é nossa meta clínica institucional.

Because of its excessive humanity, institutional (clinical) practice always involves opposed pairs: the strength of institutional life and the strength of the eruption of excess; framing and its apparent stillness and the vital movements towards the future; the physical and symbolic spaces and the processes; the endless repetitions e the new; the preservation and the creation (which includes the necessary destruction). The movement of construction and development of life projects is intriguing. It is not about mediations which either remove oppositions or surrender to them, and then, let themselves paralyze in one of the poles. Back to Bleger's work, the author connects it with Winnicott's in order to deal with the paradoxical bound between the stillness of the analytic framing and the mobility that is needed to the processes the treatment implies. The author proposes that the positive correlation between life and shared projects is a construction that is worth being done. Favoring and articulating projects with value of life is our goal with institutional practice.

Por ser demasiado humana, la clínica institucional involucra siempre pares opuestos: la fuerza de la vida institucional y la fuerza de erupción desmedida; encajar y su aparente inmovilidad y los movimientos vitales en dirección al futuro; los espacios físicos y simbólicos y los procesos; las interminables repeticiones y lo nuevo; la preservación y la creación (incluida en ella la destrucción necesaria). Es intrigante el movimiento de construcción y desarrollo de proyectos de vida. No se trata de mediaciones que eliminen las oposiciones o que cedan a ellas, dejándose paralizar por uno de los polos. Retomando a Bleger y haciendo que converse con Winnicott, abordamos el vínculo paradójico entre lo inmóvil del encaje analítico y la movilidad necesaria para los procesos implicados en el tratamiento. Nuestra propuesta es que la correlación positiva entre vida y proyectos compartidos es una construcción que vale la pena realizar. Favorecer y articular proyectos que tienen valor de vida es nuestra meta clínica institucional.

En étant trop humaine, la clinique institutionnelle concerne toujours des paires en opposition: la force de la vie institutionnelle et la force de l'éruption de la démesure; le cadre analytique et son apparente immobilité et les mouvements vitaux vers l'avenir; les espaces physiques et symboliques et les processus ; les répétitions interminables et le nouveau ; la préservation et la création (y compris la destruction nécessaire). Ce qui est intrigant, c'est le mouvement de construction et de développement de projets de vie. Il ne s'agit pas de médiations qui éliminent les oppositions ou qui cèdent à elles, en se laissant paralyser sur un des pôles. En reprenant Bleger et le faisant dialoguer avec Winnicott, nous abordons le lien paradoxal entre l'immobilité du cadre analytique et la mobilité nécessaire aux processus impliqués dans la cure. Ce que nous voulons proposer, c'est que la corrélation positive entre la vie et les projets partagés est une construction qui vaut la peine d'être accomplie. Favoriser et articuler des projets qui ont une valeur de vie, voici notre but institutionnel.

A new look at the supposed risks of early institutional rearing.

The main focus is on the assessment of the effects of early institutional care and compares three longitudinal studies from Romania, Greece and Hong Kong/China. The findings have been strikingly contrasting. The review asks if the risks are dependent on whether or not the institutional rearing is accompanied by gross pervasive deprivation (as it was in Romania) and investigates the methodological issues to explore the causal influence of the outcomes. Evidence is considered on changing institutional practices and the benefits of doing so. Comparison is made between institutions with major deprivation and those without global deprivation. A small number of studies are discussed that look at direct comparisons between institutional and community care. The empirical and conceptual implications of the findings are discussed.

La Medicina Veterinaria en el contexto del municipio colombiano: conversaciones con la ruralidad desde la práctica académica profesionalizante de pregrado Administración en Salud Animal de la Universidad de Antioquia (2005-2015) / Veterinary Medicine in the context of the Colombian municipality: Conversations with rurality from the professionalizing undergraduate academic practice in Animal Health Administration at the Universidad de Antioquia, 2005-2015 / A Medicina Veterinária no contexto do município colombiano: conversações com a ruralidade desde a prática acadêmica profissionalizante de graduação em Administração em Saúde Animal da Universidade de Antioquia, 2005-2015

Resumen La sistematización es un proceso investigativo, reflexivo, crítico y propositivo, mediante el cual se pretende estudiar, comprender, criticar, cuestionar y aprender de las prácticas. Este estudio pretendió sistematizar la experiencia de la práctica académica profesionalizante de pregrado Administración en Salud Animal (ASA) de la Universidad de Antioquia (UdeA), la cual se desarrolla en municipios antioqueños. La ruta metodológica comprendió tres etapas: la construcción histórica de la práctica desde la memoria colectiva, el análisis crítico de la práctica y aprender desde la práctica para mejorarla. Se utilizaron los dispositivos de flujo del proceso, la entrevista semiestructurada, la conversación, el relato, la entrevista de salida a los expracticantes, el taller, la revisión e interpretación de documentos y el diario de campo. En total se visitaron 17 municipios y se entrevistaron 74 personas. Dentro de los resultados están la construcción del marco contextual de ASA, el listado y ubicación de municipios con presencia histórica de ASA, la construcción de la línea de tiempo con red de actores y sucesos, la construcción y análisis del discurso ordenador, la identificación de las fortalezas, las limitaciones y carencias de la práctica en los ámbitos universitario y municipal y las contribuciones para trascender las carencias y fortalecer la práctica. La práctica de ASA representa la materialización del potencial de la Universidad para propiciar el diálogo entre la Universidad y la sociedad por medio del apoyo a la función de los municipios en salud animal y salud pública, aunque requiere profundas intervenciones para explotar al máximo su potencial transformador y formativo.

Abstract Systematization is an investigative, reflexive, critical and purposeful process, which seeks to study, understand, criticize, and question practices, and learn from them. This study systematized the experience of the undergraduate professionalizing academic practice in Animal Health Administration (AHA) at the Universidad de Antioquia, which is developed in municipalities of the department of Antioquia. The methodological route involved three stages: historical construction of the practice from collective memory, critical analysis of the practice, and learning from the practice to improve it. Process flow devices were used, such as semi-structured interview, conversation, storytelling, exit interview with former participants, workshop, document review and interpretation, and field diary. In total, 17 municipalities were visited and 74 people were interviewed. Results included the construction of the contextual framework of AHA, listing and location of municipalities with AHA historical presence, construction of a timeline with a network of agents and events, construction and analysis of the guiding discourse, identification of strengths, limitations, and shortcomings of the practice in university and municipal environments, as well as contributions to transcending shortcomings and strengthening the practice. The AHA practice represents the materialization of the University's potential to foster dialogue between the University and society by supporting the role of municipalities in animal health and public health, although it requires profound interventions to exploit its transformative and educational potential.

Resumo A sistematização é um processo de pesquisa, reflexivo, crítico e propositivo, mediante o qual se pretende estudar, compreender, criticar, questionar e aprender das práticas. Este estudo sistematizou a experiência da prática acadêmica profissionalizante de graduação Administração em Saúde Animal (ASA) da Universidade de Antioquia, que se desenvolve em municípios da região de Antioquia. A rota metodológica compreendeu três etapas: a construção histórica da prática desde a memória coletiva, a análise crítica da prática e aprender com a prática para melhorá-la. Se utilizaram os dispositivos de fluxo do processo, a entrevista semiestruturada, a conversação, o relato, a entrevista de saída aos ex-praticantes, a oficina, a revisão e interpretação de documentos e o diário de campo. Em total foram visitados 17 municípios e entrevistadas 74 pessoas. Dentro dos resultados estão a construção do marco contextual de ASA, a lista e localização de municípios com presença histórica de ASA, a construção da linha de tempo com rede de atores e sucessos, a construção e análises do discurso ordenador, a identificação das fortalezas, as limitações e carências da prática nos âmbitos universitário e municipal e as contribuições para transcender as carências e fortalecer a prática. A prática de ASA representa a materialização do potencial da Universidade para propiciar o diálogo entre a Universidade e a sociedade por meio do apoio da função dos municípios em saúde animal e saúde pública, embora requeira de profundas intervenções para explorar ao máximo o seu potencial transformador e formativo.

Fatores associados à ocorrência de violência obstétrica institucional: uma revisão integrativa da literatura / Factors associated with obstetric violence: An integrative review of the literature

Objective To perform an integrative review of the literature on the factors associated with obstetric violence and to present the main pieces of evidence found in the selected articles. Methods Data were collected from 20 articles published in the databases MedLine, LILACS, SciELO, and Google Scholar between the years 2010-2016. Results The professionals described as promoters of obstetric violence were physicians, nursing staff, and medical students. The results were systematized and discussed by five categories: (1) health professional education; (2) episiotomy without clinical recommendation; (3) excessive labor medication; (4) taking away the right to a companion; and (5) institutional unpreparedness and an estranging work pace associated with inadequate resources. The women's right to be the protagonists of their own story should not be denied to them by not providing proper, safe, qualified, respectful, and science-based health care. Conclusion In conclusion this study may help to sensitize professionals to change violent practices. Once the factors associated with obstetric violence are identified, it is possible to intervene directly and encourage managers and institutions to implement humane teaching practices and improve the quality of public health services.

Objetivo Realizar revisão integrativa da literatura sobre os fatores associados à ocorrência de violência obstétrica institucional e apresentar as principais evidências encontradas nos artigos selecionados. Métodos Os dados foram adquiridos através da seleção de artigos nas bases: MedLine, LILACS; SciELO e Google Acadêmico. A amostra foi composta por 20 artigos publicados entre os anos de 2010 e 2016. Resultados Diante da análise dos estudos, constatou-se que os profissionais descritos como promotores da violência obstétrica foram os médicos, equipe de enfermagem e estudantes de medicina. Os resultados encontrados foram sistematizados e discutidos por meio de cinco categorias: (1) formação dos profissionais de saúde; (2) prática de episiotomia sem recomendação clínica; (3) medicalização excessiva do parto; (4) anulação do direito ao acompanhante; (5) despreparo institucional e ritmo de trabalho alienante associado à precariedade de recursos. Não se deve tirar o direito da mulher de ser protagonista de sua história, com acesso a uma assistência à saúde adequada, segura, qualificada, respeitosa, humanizada e baseada em evidências científicas. Conclusão Conclui-se que esta pesquisa pode contribuir para a sensibilização no processo de mudança das práticas violentas. A partir da identificação dos fatores associados à ocorrência de violência obstétrica, é possível intervir de forma diretiva e possibilitar o incentivo aos gestores e instituições para implementação de práticas de ensino humanizado e melhorias na qualidade dos serviços de saúde pública.

Inovações em Psicologia Escolar: o contexto da educação superior / Innovations in School Psychology: The context of higher education

A educação superior, tanto no Brasil quanto no exterior, tem sido alvo de inúmeras políticas educacionais contemporâneas. O sistema brasileiro ampliou-se velozmente na última década, ocasionando transformações institucionais no âmbito político-pedagógico e acadêmico, bem como no perfil dos estudantes. As mudanças têm como foco o direito de acesso acadêmico e a democratização de oportunidades. A expansão do ensino tornou-se uma urgente meta orientadora de decisivas ações governamentais. A consequente massificação agudizou, no espaço educativo das Instituições de Ensino Superior, as tensões e contradições, mas, também, as potencialidades para o desenvolvimento pessoal e as emancipações inerentes a esse contexto. Defendendo que a educação superior apresenta-se como fértil campo para a ação da Psicologia Escolar, apresenta-se, neste artigo, um modelo de atuação baseada em cinco eixos principais: 1) Mapeamento Institucional; 2) Escuta Psicológica; 3) Gestão de Políticas, Programas e Processos Educacionais; 4) Propostas Pedagógicas e Funcionamento de Cursos; 5) Perfil do Estudante. Essas reflexões e propostas para pesquisa e intervenção na área, fundamentadas pela Psicologia Histórico-cultural do desenvolvimento humano, enfatizam a mediação intencional do psicólogo no desenvolvimento dos atores educacionais. Como conclusão, destaca-se que a intervenção institucional e coletiva do psicólogo escolar deva estar voltada tanto à conscientização e ao empoderamento dos sujeitos, como às transformações sociais emancipadoras e ao sucesso acadêmico.(AU)

The higher education, both in Brazil and abroad, has been targeted by countless contemporary educational policies. Brazil's educational system has improved considerably over the past decade, causing institutional changes both in the political-pedagogical and in the academic scope, as well as in the students' profiles. The changes aim at the right to academic access and at the democratization of opportunities. The expansion of the education has become a top-priority compelling goal guiding decisive governmental actions. The subsequent massification in the educational scope of Higher Education Institutions has sharpened the tensions and contradictions, but it has also increased the potentialities for personal development and emancipation inherent to this context. Understanding that higher education is itself fertile ground for School Psychology to take action, this article presents an action plan based on five main axes: 1) Institutional Mapping; 2) Psychological Listening; 3) Policies, Programs and Educational and Processes Management; 4) Pedagogical Proposals and Course Scheme; 5) Student Profile. These considerations and proposals of research and intervention in this field, based on the Cultural-historical Psychology of human development, emphasize the psychologist's intentional mediation in the development of the educational actors. As a conclusion, we highlight that the institutional and collective intervention of the school psychologist should not only be turned toward the awareness and empowerment of the subjects, but also to the emancipating social changes and academic success.(AU)

Inovações em psicologia escolar: o contexto da educação superior / Innovations in school psychology: the context of higher education

A educação superior, tanto no Brasil quanto no exterior, tem sido alvo de inúmeras políticas educacionais contemporâneas. O sistema brasileiro ampliou-se velozmente na última década, ocasionando transformações institucionais no âmbito político-pedagógico e acadêmico, bem como no perfil dos estudantes. As mudanças têm como foco o direito de acesso acadêmico e a democratização de oportunidades. A expansão do ensino tornou-se uma urgente meta orientadora de decisivas ações governamentais. A consequente massificação agudizou, no espaço educativo das Instituições de Ensino Superior, as tensões e contradições, mas, também, as potencialidades para o desenvolvimento pessoal e as emancipações inerentes a esse contexto. Defendendo que a educação superior apresenta-se como fértil campo para a ação da Psicologia Escolar, apresenta-se, neste artigo, um modelo de atuação baseada em cinco eixos principais: 1) Mapeamento Institucional; 2) Escuta Psicológica; 3) Gestão de Políticas, Programas e Processos Educacionais; 4) Propostas Pedagógicas e Funcionamento de Cursos; 5) Perfil do Estudante. Essas reflexões e propostas para pesquisa e intervenção na área, fundamentadas pela Psicologia Histórico-cultural do desenvolvimento humano, enfatizam a mediação intencional do psicólogo no desenvolvimento dos atores educacionais. Como conclusão, destaca-se que a intervenção institucional e coletiva do psicólogo escolar deva estar voltada tanto à conscientização e ao empoderamento dos sujeitos, como às transformações sociais emancipadoras e ao sucesso acadêmico.

The higher education, both in Brazil and abroad, has been targeted by countless contemporary educational policies. Brazil's educational system has improved considerably over the past decade, causing institutional changes both in the political-pedagogical and in the academic scope, as well as in the students' profiles. The changes aim at the right to academic access and at the democratization of opportunities. The expansion of the education has become a top-priority compelling goal guiding decisive governmental actions. The subsequent massification in the educational scope of Higher Education Institutions has sharpened the tensions and contradictions, but it has also increased the potentialities for personal development and emancipation inherent to this context. Understanding that higher education is itself fertile ground for School Psychology to take action, this article presents an action plan based on five main axes: 1) Institutional Mapping; 2) Psychological Listening; 3) Policies, Programs and Educational and Processes Management; 4) Pedagogical Proposals and Course Scheme; 5) Student Profile. These considerations and proposals of research and intervention in this field, based on the Cultural-historical Psychology of human development, emphasize the psychologist's intentional mediation in the development of the educational actors. As a conclusion, we highlight that the institutional and collective intervention of the school psychologist should not only be turned toward the awareness and empowerment of the subjects, but also to the emancipating social changes and academic success.

Mapeamento da atuação do terapeuta ocupacional nos Centros de Atenção Psicossocial Álcool e Drogas (CAPS ad) do interior do estado de São Paulo / Mapping of occupational therapy practice in the psychosocial Care Centers of Alcohol and Drugs In Sao Paulo state

O uso de drogas e o desafio de encontrar respostas no âmbito da assistência para o chamado uso prejudicial é uma temática atual que interpela os profissionais, serviços e gestores. O presente trabalho objetivou mapear características, profissionais e atividades realizadas pelos terapeutas ocupacionais dos Centros de Atenção Psicossocial Álcool e Drogas (CAPS ad), do interior do estado de São Paulo, por meio da aplicação de um questionário autorrespondível. Durante a coleta de dados, foram encontrados 45 CAPS ad no interior paulista, sendo que 19 profissionais colaboraram com a pesquisa; desses, 15 eram terapeutas ocupacionais. Como resultado, encontrou-se que os CAPS ad apresentam propostas regulamentadas segundo as diretrizes do Ministério da Saúde, porém a complexidade da demanda e suas múltiplas facetas com a dimensão social requerem maior discussão acerca do tipo de intervenção que tem sido empregada, assim como sobre sua eficácia. Quanto ao perfil das terapeutas ocupacionais, em sua maioria elas possuem pelo menos cinco anos de formação, pós-graduação e não optaram pela área de saúde mental e drogas. As terapeutas ocupacionais têm uma visão diferenciada de suas ações, utilizam recursos e estratégias diversas, sobretudo em atendimentos grupais e por meio de oficinas, assim como significam suas ações de formas distintas, promovendo novos projetos de vida, filiando-se a proposições de tratamento desde a abstinência até a redução de danos. Conclui-se que a assistência aos usuários dos CAPS ad é de extrema complexidade por envolver temática de caráter social com determinantes macrossociais e que necessitam de maior integração entre setores, áreas e recursos.

Comparison of Aseptic Compounding Errors Before and After Modified Laboratory and Introductory Pharmacy Practice Experiences.

OBJECTIVE: To determine whether aseptic compounding errors were reduced at the end of the third professional year after modifying pharmacy practice laboratories and implementing an institutional introductory pharmacy practice experience (IPPE). DESIGN: An aseptic compounding laboratory, previously occurring during the third-year spring semester, was added to the second-year spring semester. An 80-hour institutional IPPE was also added in the summer between the second and third years. Instructors recorded aseptic compounding errors using a grading checklist for second-year and third-year student assessments. Third-year student aseptic compounding errors were assessed prior to the curricular changes and for 2 subsequent years for students on the Oklahoma City and Tulsa campuses of the University of Oklahoma. ASSESSMENT: Both third-year cohorts committed fewer aseptic technique errors than they did during their second years, and the probability was significantly lower for students on the Oklahoma City campus. The probability of committing major aseptic technique errors was significantly lower for 2 consecutive third-year cohorts after the curricular changes. CONCLUSION: The addition of second-year aseptic compounding laboratory experiences and third-year institutional IPPE content reduced instructor-assessed errors at the end of the third year.