Abstract Background The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes. Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021. Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66–11.5, p = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44–10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02–1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96–0.99; p < 0.003) remained significant. Conclusions Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes. (IVT timedependent. timedependent dependent. dependent time-dependent doortoneedle door needle (DTN (SNs nonstroke non (NSNs EPs . (EPs) Additionally 2 201 2021 30 433 43 3 43. 236 23 23. seventythree seventy three 57.4% 574 57 4 (57.4% 12 40.5% 405 40 5 (40.5% 2.1% 21 1 (2.1% 408 8 40. 247 24 7 24.7 225 22 22. Doortoneedle Door 15 15% 4% 0 0% odds OR [OR] 4.3 95 95%CI 95CI CI [95%CI] 166115 66 11 1.66–11.5 0.004. 0004 0.004 004 0.004) 0.002, 0002 0.002 , 002 0.21, 021 0.21 ER (ER 0.142, 0142 0.142 142 0.142) 0.007, 0007 0.007 007 0.007) 0.09, 009 0.09 09 0.09) (NIHSS 0.001, 0001 0.001 001 0.001) 0.143 0143 143 pressures ASPECTS (ASPECTS 0.05, 005 0.05 05 0.05) 0.18, 018 0.18 18 0.18) 0.13, 013 0.13 13 0.13) 0.001. (OR 3.95 395 1.44–10.8 144108 44 10 1.07 107 07 1.02–1.12 102112 02 0.98 098 98 0.96–0.99 096099 96 99 0.003 0003 003 significant (EPs 202 57.4 (57.4 40.5 (40.5 2.1 (2.1 24. [OR 4. 9 [95%CI 16611 1.66–11. 000 0.00 00 0.2 014 0.14 14 0.0 01 0.1 3.9 39 1.44–10. 14410 1.0 1.02–1.1 10211 0.9 0.96–0.9 09609 57. (57. (40. 2. (2. 1661 1.66–11 0. 3. 1.44–10 1441 1. 1.02–1. 1021 0.96–0. 0960 (57 (40 (2 166 1.66–1 1.44–1 144 1.02–1 102 0.96–0 096 (5 (4 ( 16 1.66– 1.44– 1.02– 0.96– 1.66 1.44 1.02 0.96 1.6 1.4

Resumen Antecedentes La respuesta a la trombólisis intravenosa (TIV) es dependiente del tiempo. Objetivo Comparar los tiempo puerta-aguja (TPAs) de neurólogos vasculares (NVs) contra los de neurólogos no vasculares (NNVs) y médicos emergencistas (MEs), y determinar los elementos asociados a un PTA ≤ 20 minutos. Métodos Análisis observacional prospectivo de pacientes con TIV tratados en Clínica Alemana entre junio de 2016 y septiembre de 2021. Resultados En total, 301 pacientes con TIV fueron tratados. El TPA promedio fue de 43,3 ± 23,6 minutos. Un total de 173 (57,4%) pacientes fueron evaluados por NVs, 122 (40,5%), por NNVs, y 6 (2,1%), por MEs; los TPAs promedios fueron de 40,8 ± 23; 46 ± 24,7 y 58 ± 22,5 minutos, respectivamente. Los TPAs ≤ 20 minutos fueron más frecuentes en pacientes tratados por NVs versus NNVs y MEs: 15%, 4% y 0%, respectivamente (odds ratio [OR]: 4,3; intervalo de confianza del 95% [IC95%]: 1,66–11,5; p = 0,004). El análisis univariado demostró que TPA ≤ 20 minutos se asoció con: tratamiento por NVs (p = 0,002), periodo de la pandemia de enfermedad por coronavirus 2019 (COVID-19; p = 0,21), tiempo a urgencia (p = 0,21), diabetes (p = 0,142), hipercolesterolemia (p = 0,007), fibrilación auricular (p < 0,09), puntaje en la National Institutes of Health Stroke Scale [NIHSS] (p = 0,001), presión arterial sistólica (p = 0,143) y diastólica menores (p = 0,21), Alberta Stroke Program Early CT Score (ASPECTS ; p = 0,09), oclusión de vasos cerebrales (p =0,05), uso de tecneteplase (p = 0,18), trombectomía (p = 0,13) y años de experiencia del médico (p < 0,001). El análisis multivariado demostró que ser tratado por NVs (OR: 3,95; IC95%: 1,44–10,8; p = 0,007), el puntaje en la NIHSS (OR: 1,07; IC95%: 1,02–1,12; p < 0,002) y la presión arterial sistólica (OR: 0,98; IC95%: 0,96–0,99; p < 0,003) se asociaron a TPA ≤ 20 minutos. Conclusões El tratamiento por NVs resultó en un TPA menor y en una mayor probabilidad de tratamiento ≤ 20 minutos. (TIV puertaaguja puerta aguja (TPAs (NVs (NNVs MEs, MEs , (MEs) 2 201 2021 30 433 43 3 43, 236 23 23, 17 57,4% 574 57 4 (57,4% 12 40,5%, 405 40,5% 40 5 (40,5%) 2,1%, 21 2,1% 1 (2,1%) 408 8 40, 247 24 7 24, 225 22 22, 15 15% 0 0% odds OR [OR] 4,3 95 IC95% IC95 IC [IC95%] 1,66–11,5 166115 66 11 0,004. 0004 0,004 . 004 0,004) 0,002, 0002 0,002 002 COVID19 COVID 19 (COVID-19 0,21, 021 0,21 0,21) 0,142, 0142 0,142 142 0,142) 0,007, 0007 0,007 007 0,007) 0,09, 009 0,09 09 0,09) [NIHSS 0,001, 0001 0,001 001 0,001) 0,143 0143 143 ASPECTS =0,05, 005 =0,05 05 =0,05) 0,18, 018 0,18 18 0,18) 0,13 013 13 0,001. (OR 3,95 395 1,44–10,8 144108 44 10 1,07 107 07 1,02–1,12 102112 02 0,98 098 98 0,96–0,99 096099 96 99 0,003 0003 003 (MEs 202 57,4 (57,4 40,5 (40,5% 2,1 (2,1% [OR 4, 9 IC9 [IC95% 1,66–11, 16611 000 0,00 00 COVID1 (COVID-1 0,2 014 0,14 14 0,0 =0,0 01 0,1 3,9 39 1,44–10, 14410 1,0 1,02–1,1 10211 0,9 0,96–0,9 09609 57, (57, (40,5 2, (2,1 [IC95 1,66–11 1661 (COVID- 0, =0, 3, 1,44–10 1441 1, 1,02–1, 1021 0,96–0, 0960 (57 (40, (2, [IC9 1,66–1 166 (COVID =0 1,44–1 144 1,02–1 102 0,96–0 096 (5 (40 (2 [IC 1,66– 16 1,44– 1,02– 0,96– ( (4 1,66 1,44 1,02 0,96 1,6 1,4

ABSTRACT Objective: To analyze the relationship between academic profile, perception of competence in nursing students, with their performance in the final exam, based on high-fidelity simulation. Material and Method: A quantitative, cross-sectional, and correlational study following the STROBE guidelines. The study measured academic profile variables (number of semesters completed, failed subjects, internship grade and 8th semester grade) and the perception of competence in a probabilistic sample of 101 nursing students, prior to the final exam, based on high-fidelity clinical simulation. They were then related to the final exam grades. Results: 36.6% of students took 14 or more semesters to graduate, and 52.4% had failed more than 5 subjects. In the 8th semester, 58.4% obtained a sufficient grade. During the internship, 55.4% received a very good grade. 94% of students perceived their competence as good or excellent before the final exam, and in the final exam, 67.1% had a very good grade, and 6.9% had an excellent grade. Significant relationships were found between students' perceptions of competence and final exam grades (p= 0.012), and between internship grades and final exam grades (p= 0.029). There were no significant relationships between semesters completed, failed subjects, and 8th semester grade with the final exam grade. Conclusion: Before the final exam, nursing students perceive their competence as excellent or good. This perception is related to their performance in the exam and during the internship. The final exam grade is not related to the number of semesters completed, the 8th semester grade or the failed subjects.

RESUMO Objetivo: Analisar a relação entre o perfil académico, a percepção de competências dos estudantes de enfermagem e seu desempenho no exame de graduação, com base na simulação de alta fidelidade. Material e Método: Estudo quantitativo, transversal e correlacional que seguiu o guia STROBE. O estudo mediu variáveis de perfil académico (número de semestres cursados, disciplinas reprovadas, nota do estágio e nota do 8° semestre) e a percepção de competência em uma amostra probabilística de 101 estudantes de enfermagem, antes do exame de graduação, com base em simulação clínica de alta fidelidade. Em seguida, essas variáveis foram relacionadas com a nota do exame de graduação. Resultados: 36,6% dos estudantes levaram 14 semestres ou mais para concluir o programa de estudos, e 52,4% tiveram mais de 5 disciplinas reprovadas. No 8° semestre, 58,4% obtiveram uma nota suficiente. Durante o estágio, 55,4% receberam uma nota muito boa. 94% dos estudantes perceberam suas competências como boas ou excelentes antes do exame de graduação. No exame de graduação, 67,1% obtiveram uma nota muito boa e 6,9% uma nota excelente. Foram encontradas relações significativas entre a percepção de competência do estudante e a nota do exame de graduação (p= 0,012), e entre a nota do estágio e o exame de graduação (p= 0,029). Não houve relações significativas entre semestres cursados, disciplinas reprovadas e a nota do 8° semestre com a nota do exame de graduação. Conclusão: Antes do exame de graduação, os estudantes de enfermagem percebem suas competências como excelentes ou boas. Isso está relacionado com a nota neste exame e no estágio. A nota do exame de graduação não está relacionada com os semestres cursados, a nota no 8° semestre ou as disciplinas reprovadas.

RESUMEN Objetivo: Analizar la relación entre perfil académico y la percepción de competencias en estudiantes de enfermería, con su desempeño en el examen de grado basado en simulación de alta fidelidad para la obtención del título de enfermera/o. Material y Método: Estudio cuantitativo, transversal y correlacional que siguió la guía STROBE. Midió variables del perfil académico (número de semestres cursados, asignaturas reprobadas, calificación de internado y al 8vo semestre) y la percepción de competencias en una muestra probabilística de 101 estudiantes de enfermería previo al examen de grado basado en simulación clínica de alta fidelidad. Luego se relacionaron con la calificación obtenida en el examen de grado. Resultados: El 36,6% de los estudiantes tardó 14 o más semestres en completar la carrera, y 52,4% tuvo más de 5 asignaturas reprobadas. En el 8vo semestre, el 58,4% obtuvo calificación suficiente. Durante el internado, el 55,4% tuvo calificación muy buena, el 94% percibió sus competencias como buenas o excelente antes del examen de grado y en el examen de grado, el 67,1% obtuvo calificación muy buena y 6,9% sobresaliente. Se encontraron relaciones significativas entre percepción de competencias del estudiante y calificación del examen de grado (p= 0,012), y entre calificación del internado y examen de grado (p= 0,029). No hubo relaciones significativas entre semestres cursados, asignaturas reprobadas y promedio al 8vo semestre con calificación del examen de grado. Conclusiones: Antes del examen de grado, los estudiantes de enfermería perciben su competencia como excelente o buena. Esto se relaciona con calificación en este examen y del internado. La calificación del examen de grado no se relaciona con los semestres cursados, nota al 8vo semestre, ni asignaturas reprobadas.

Abstract Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion-weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.

RESUMEN Antecedentes: Los patrones topográficos pueden correlacionarse con las causas del accidente cerebrovascular isquémico. Objetivo: Investigar la asociación entre imágenes ponderadas por difusión por resonancia nuclear magnética (dRNM) y el ensayo de Org 10172 en la clasificación de tratamiento agudo de accidentes cerebrovasculares (TOAST). Métodos: Fueron incluidos 1.019 pacientes con accidente cerebrovascular isquémico. Las dRNM fueron clasificadas como: i) negativa; ii) dRNM lesión única (cortico-subcortical, cortical, subcortical ≥20 mm, o subcortical <20 mm); iii) lesiones disgregadas un territorio vascular (pequeñas lesiones dispersas o confluentes con lesiones adicionales); y iv) lesiones múltiples (unilaterales de circulación anterior [MAC], de circulación posterior [MPC], bilaterales de circulación anterior [MBAC] y de circulación anterior y posterior [MAP]). Resultados: Existió relación entre los patrones de dRNM y la clasificación TOAST (p<0,001). La aterosclerosis de las arterias grandes se asoció con lesiones pequeñas y disgregadas en un territorio vascular (Odds Ratio [OR] 4,22, intervalo de confianza del 95% [IC95%] 2,61–6,8), MPC (OR 3,52; IC95% 1,54–8,03), y lesiones subcorticales <20 mm (OR 3,47; IC95% 1,76–6,85). Cardioembolias se relacionaron con MAP (OR 4,3; IC95% 1,64–11,2), lesiones cortico-subcorticales (OR 3,24; IC95% 1,9–5,5) y dRNM negativas (OR 2,46; IC95% 1,1–5,49). Los accidentes cerebrovasculares criptogénicos se relacionaron con dRNM negativas (OR 4,1; IC95% 1,84–8,69), accidentes cerebrovasculares corticales (OR 3,3; IC95% 1,25–8,8), MAP (OR 3,33; IC95% 1,25–8,81) y lesiones subcorticales ≥20 mm (OR 2,44; IC95% 1,04–5,73). Los accidentes cerebrovasculares lacunares se correlacionaron con lesiones subcorticales de diámetro <20 mm (OR 42,9; IC95% 22,7–81,1) y dRNM negativas (OR 8,87; IC95% 4,03–19,5). Finalmente, MBAC (OR 9,25; IC95% 1,12–76,2), MAP (OR 5,54; IC95% 1,94–15,1) y MPC (OR 3,61; IC95% 1,5–8,7) se relacionaron con accidentes cerebrovasculares de otras etiologías. Conclusiones: Existe relación entre dRNM y subtipo de accidente cerebrovascular.

Abstract Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs. Background Lowdose Low dose (LrtPA standarddose standard SrtPA (SrtPA deathdisability death disability death/disability Objective dosage Methods 201 2018 Results 16 50 female 654185 65 4 18 5 65.4±18. years these 30 (30% analysis s p=0.000, p0000 p p=0.000 , 0 000 (mRS p<0.000, p<0.000 (p<0.000) p=0.076, p0076 p=0.076 076 (p=0.076) p=0.021, p0021 p=0.021 021 (p=0.021) p=0.19, p019 p=0.19 19 (p=0.19) p=0.06, p006 p=0.06 06 (p=0.06) p=0.10, p010 p=0.10 10 (p=0.10) RatioINR Ratio INR p=0.18, p018 p=0.18 (p=0.18) p=0.045, p0045 p=0.045 045 (p=0.045) p<0.003, p0003 p<0.003 003 (p<0.003) (p=0.000 p=0.027. p0027 p=0.027 . 027 (p=0.027) p=0.02 p002 02 (p=0.02 OR (OR 2.21 221 2 21 95CI CI 95 1.37‒14.19, 1371419 1.37‒14.19 1 37 14 1.37‒14.19) 11.41 1141 11 41 3.98‒32.70, 3983270 3.98‒32.70 3 98 32 70 3.98‒32.70) 56.10 5610 56 8.81‒357.80, 88135780 8.81‒357.80 8 81 357 80 8.81‒357.80) 4.41 441 1.37‒14.10 1371410 0.22 022 22 0.10‒0.40 010040 40 Conclusions drugs 20 65418 6 65.4±18 (30 p000 p=0.00 00 p<0.00 (p<0.000 p007 p=0.07 07 (p=0.076 (p=0.021 p01 p=0.1 (p=0.19 p00 p=0.0 (p=0.06 (p=0.10 (p=0.18 p004 p=0.04 04 (p=0.045 (p<0.003 (p=0.00 (p=0.027 (p=0.0 2.2 9 137141 1.37‒14.1 11.4 114 398327 3.98‒32.7 7 56.1 561 8813578 8.81‒357.8 35 4.4 44 0.2 0.10‒0.4 01004 6541 65.4±1 (3 p<0.0 (p<0.00 (p=0.07 p0 p=0. (p=0.1 (p=0.04 (p=0. 2. 13714 1.37‒14. 11. 39832 3.98‒32. 56. 881357 8.81‒357. 4. 0. 0.10‒0. 0100 654 65.4± ( p<0. (p<0.0 p=0 (p=0 1371 1.37‒14 3983 3.98‒32 88135 8.81‒357 0.10‒0 010 65.4 p<0 (p<0. p= (p= 137 1.37‒1 398 3.98‒3 8813 8.81‒35 0.10‒ 01 65. p< (p<0 (p 13 1.37‒ 39 3.98‒ 881 8.81‒3 0.10 (p< 1.37 3.98 88 8.81‒ 0.1 1.3 3.9 8.81 1. 3. 8.8 8.

RESUMEN Introducción: Dosis reducidas de trombolitico (LrtPA) podrían no ser inferiores en muerte/discapacidad. Objetivo: Evaluar el porcentaje de pacientes tratados con LrtPA en nuestro centro después del ensayo ENCHANTED, y los factores asociados con el uso de esta dosis. Métodos: Estudio prospectivo de pacientes consecutivos con infarto cerebral ingresados entre junio de 2016 y noviembre de 2018. Resultados: 160 pacientes fueron tratados con trombólisis intravenosa, 50% mujeres; edad media 65,4±18,5 años. 48 casos (30%) recibieron LrtPA. En el análisis univariado, LrtPA se asoció con la edad del paciente (p=0,000), escala de Rankin modificadas (mRS) (p<0,000), hipertensión arterial (p=0,076), diabetes mellitus (p=0,021), hipercolesterolemia (p=0,19), tabaquismo (p=0,06), fibrilación auricular (p=0,10), antecedentes de enfermedad coronaria (p=0,06), tratamiento previo con antiplaquetarios (p<0,000), International Normalized Ratio-INR (p=0,18), recuento de plaquetario (p=0,045), leucoaraiosis en neuroimagen (p<0,003), contraindicaciones para el tratamiento trombolítico (p=0,000) y tratamiento endovascular (p=0,027). Las hemorragias previas relevantes fueron determinantes para el tratamiento con LrtPA. El diagnóstico al alta de imitador de accidente cerebrovascular fue significativo (p=0,02) para el tratamiento con dosis estándar. El análisis multivariado demostró que mRS (OR: 2,21; IC95% 1,37‒14,19), tratamiento antiplaquetario previo (OR: 11,41; IC95% 3,98‒32,7), contraindicaciones para trombólisis (OR: 56,1; IC95% 8,81‒357,8), leucoaraiosis (OR: 4,41; IC95% 1,37‒14,1) y un diagnóstico de imitador de accidente cerebrovascular (OR: 0,22; IC95% 0,1‒0,40) fueron asociados con la dosis recibida. Conclusiones: LrtPA está restringido al 30% de nuestros pacientes. Los criterios para tomar esta decisión se basan en variables que podrían aumentar el riesgo de hemorragia cerebral/sistémica o excluir al paciente del tratamiento con fármacos líticos. Introducción (LrtPA muertediscapacidad muerte discapacidad muerte/discapacidad Objetivo ENCHANTED Métodos 201 2018 Resultados 16 intravenosa 50 mujeres 654185 65 4 18 5 65,4±18, años 30 (30% univariado p=0,000, p0000 p p=0,000 , 0 000 (mRS p<0,000, p<0,000 (p<0,000) p=0,076, p0076 p=0,076 076 (p=0,076) p=0,021, p0021 p=0,021 021 (p=0,021) p=0,19, p019 p=0,19 19 (p=0,19) p=0,06, p006 p=0,06 06 (p=0,06) p=0,10, p010 p=0,10 10 (p=0,10) RatioINR Ratio INR p=0,18, p018 p=0,18 (p=0,18) p=0,045, p0045 p=0,045 045 (p=0,045) p<0,003, p0003 p<0,003 003 (p<0,003) (p=0,000 p=0,027. p0027 p=0,027 . 027 (p=0,027) p=0,02 p002 02 (p=0,02 estándar OR (OR 2,21 221 2 21 IC95 IC 1,37‒14,19, 1371419 1,37‒14,19 1 37 14 1,37‒14,19) 11,41 1141 11 41 3,98‒32,7, 398327 3,98‒32,7 3 98 32 7 3,98‒32,7) 56,1 561 56 8,81‒357,8, 8813578 8,81‒357,8 8 81 357 8,81‒357,8) 4,41 441 1,37‒14,1 137141 0,22 022 22 0,1‒0,40 01040 40 recibida Conclusiones cerebralsistémica sistémica líticos 20 65418 6 65,4±18 (30 p000 p=0,00 00 p<0,00 (p<0,000 p007 p=0,07 07 (p=0,076 (p=0,021 p01 p=0,1 (p=0,19 p00 p=0,0 (p=0,06 (p=0,10 (p=0,18 p004 p=0,04 04 (p=0,045 (p<0,003 (p=0,00 (p=0,027 (p=0,0 2,2 IC9 11,4 114 39832 3,98‒32, 9 56, 881357 8,81‒357, 35 4,4 44 1,37‒14, 13714 0,2 0,1‒0,4 0104 6541 65,4±1 (3 p<0,0 (p<0,00 (p=0,07 p0 p=0, (p=0,1 (p=0,04 (p=0, 2, 11, 3983 3,98‒32 88135 8,81‒357 4, 1,37‒14 1371 0, 0,1‒0, 010 654 65,4± ( p<0, (p<0,0 p=0 (p=0 398 3,98‒3 8813 8,81‒35 1,37‒1 137 0,1‒0 01 65,4 p<0 (p<0, p= (p= 39 3,98‒ 881 8,81‒3 1,37‒ 13 0,1‒ 65, p< (p<0 (p 3,98 88 8,81‒ 1,37 0,1 (p< 3,9 8,81 1,3 3, 8,8 1, 8,

Background: Intravenous thrombolysis (IT) in acute ischemic stroke (AIS) is time dependent. The time elapsed from hospital admission to the thrombolytic bolus is named door to needle time (DNT) and is recommend to be of less than 60 min. Aim: To describe the DNT in our center and determine those factors associated with a DNT longer than 60 min. Material and Methods: Prospective analysis of patients treated with IT at a private hospital between June 2016 and June 2019. The percentage of patients with DNT exceeding 60 min, and the causes for this delay were evaluated. Results: IT was used in 205 patients. DNT was 43.6 ± 23.8 min. Forty patients (19.5% (95% CI, 14.4-25.7), had a DNT longer than 60 min. Uni-varied analysis demonstrated that AIS with infratentorial symptomatology (ITS), was significantly associated with DNTs exceeding 60 min. A history of hypertension, a higher NIH Stroke Scale score, the presence of an hyperdense sign in brain tomography (p = 0.001) and the need for endovascular therapy (p = 0.019), were associated with DNT shorter than 60 min. Multivariate analysis ratified the relationship between ITS and DNT longer than 60 min (Odds ratio: 3.19, 95% confidence intervals 1.26-8). Conclusions: The individual elements that correlated with a DNT longer than 60 min were the failure to detect the AIS during triage and doubts about its diagnosis.

Background: Sequelae after a stroke are common and may lead to disability. Aphasia - defined as an acquired language disturbance - can cause important limitations in quality of life. Aim: To describe the epidemiological features of patients who had an aphasia after a first episode of ischemic stroke and their functional outcome at six months. Material and Methods: Review of a database of a population study on the incidence, 30-day case fatality rate, and prognosis of stroke performed in a northern Chilean city between 2000 and 2002. Results: Aphasia was diagnosed in 28 of 142 patients in whom the disorder was sought (20%). The projected incidence rate in the city where the study was carried out is 7.06 per 100,000 inhabitants. The mean age of these 28 patients was 66 ± 20 years and 53% were women. The main risk factor for stroke was hypertension in 62%. The etiology of stroke was undetermined in 64% of these patients. Partial anterior circulation infarction was the most common stroke location in 61%. Conclusions: Twenty percent of patients with a first episode of ischemic stroke have aphasia

Violence among peers has a negative effect on students' mental health. The literature indicates that life satisfaction is one of the factors on which peer violence could have a major effect. Nevertheless, some factors may attenuate this negative impact. This study analyzed the influence of teacher and peer support on the relation between students' peer victimization and life satisfaction. The sample included 5,527 students from grades 4 through 8 attending municipal schools in one district of the Region of Valparaíso, Chile. Using self-report questionnaires taken from the survey “Coexistence in my School”, whose data was analyzed with structural equation modeling, it was observed that teacher social support has a greater effect than peer social support as a mediator in the inverse relationship between students' peer victimization and life satisfaction. These findings are discussed in terms of the mediating role of teachers in reducing the effects of peer victimization.

La violencia entre pares afecta negativamente la salud mental de los estudiantes. La literatura señala que la satisfacción con la vida es uno de los factores que puede verse mayormente afectado. No obstante, pueden existir factores que atenúen estos efectos negativos. La presente investigación indagó en la influencia que tiene el apoyo de profesores y pares en la escuela sobre la satisfacción con la vida en estudiantes que reportan agresiones de sus pares. El estudio censal incluyó a 5.527 estudiantes de 4° a 8° grado de educación básica de 44 establecimientos municipales de una comuna de la Región de Valparaíso, Chile. Usando cuestionarios autoaplicados de la encuesta “La Convivencia en mi Escuela”, cuyos datos se analizaron usando modelos de ecuaciones estructurales, se encontró que el apoyo social de los profesores tiene un efecto más importante que el de los pares como mediador en la relación inversa entre victimización entre pares y satisfacción con la vida de los estudiantes. Estos hallazgos son discutidos respecto del papel mediador de los profesores en la victimización entre pares.

Background: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM. Aim: To describe the frequency and prognosis of SM treated with IVT. Material and Methods: Prospective analysis of all patients evaluated in a Chilean private clinic between December 2004 and July 2015 with a suspected acute ischemic stroke (AIS). We calculated the number of SM that were treated with IVT. In these patients, we analyzed the presence of symptomatic cerebral hemorrhage defined as the presence of a neurological deterioration of four points or more on the National Institute of Health Stroke Scale, the presence of extracranial bleeding according to Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries criteria and the patient’s functional status at three months by modified Rankin scale (MRS). Results: We evaluated 1,417 patients with suspected AIS, of which 240 (16.9%) were finally diagnosed as SM. A total of 197 patients were treated with IVT, of these 10 (5%) corresponded to SM. All SM patients treated with thrombolytic drugs were functionally independent at 3 months and showed no bleeding complications. Conclusions: Occasionally SM patients were treated with IVT. This treatment was not associated with bleeding complications and the prognosis of these patients at three months was favorable.

Students' and teachers' mental health is negatively affected by school violence, and positively affected by teachers' social wellbeing in school. We analyzed the mediating effect of teachers' perceived need to receive training in school violence prevention, as well as teachers' perceived magnitude of violence in their schools, on the negative association between the frequency of student maltreatment and teachers' perception of social coherence in their school. 397 elementary school teachers participated in this study. The mediating model theorized proved significant and improved the predictive power of the frequency of student maltreatment on teachers' social coherence in school. However, only teachers' perceptions of the need to receive teacher training on school violence had a mediating effect. Findings are discussed in terms of the need to strengthen and improve teacher training programs in school violence and school wellbeing, both for in-service as well as for teachers in formation.

La violencia escolar afecta negativamente, y el bienestar social escolar positivamente, la salud mental de los estudiantes y de sus profesores. En este estudio se analizó el efecto mediador de la necesidad de contar con capacitación en violencia escolar y de la magnitud de violencia escolar, en 397 profesores de escuelas básicas, sobre la asociación entre la frecuencia percibida de maltrato entre estudiantes y la coherencia social con que observan su contexto escolar. El modelo de mediación resultó significativo y mejoró el poder predictivo de la frecuencia de conductas de maltrato entre estudiantes sobre la coherencia social de la escuela. Sin embargo, es solo la percepción que los profesores tienen sobre su necesidad de capacitación en violencia escolar la variable que actúa como mediadora. Se discuten estos hallazgos en relación a la necesidad de fortalecer y mejorar los programas de capacitación y formación inicial y continua de los docentes.

This purpose of this study was to characterize the social well-being of teachers working in public-municipal schools with different levels of autonomy in their school management (emergent and autonomous schools) and school size (large and small). 78 schools and 899 teachers working as school leaders, classroom teachers and teacher assistants, participated in this study. Results show no significant differences between teachers' global social well-being in autonomous versus emergent schools. However, the social well-being of teachers working in small autonomous schools was higher. Results also support the notion that a higher level of teacher participation in school management is associated with good levels of social well-being. We discuss that these organizational variables -autonomy in school management, school size, and teacher participation- have a significant impact on teachers' mental health.

El presente estudio tuvo por objetivo conocer el bienestar social en la escuela de profesores adscritos a establecimientos educacionales municipales que presentan niveles distintos de autonomía en su gestión administrativa (escuelas emergentes y autónomas) y distintos tamaños (escuelas grandes y pequeñas). Se trabajó con una muestra de 78 escuelas y 899 profesores distribuidos en cargos de directivos, docentes y asistentes. Los resultados globales indican que no existen diferencias significativas entre el bienestar social en la escuela de establecimientos autónomos y emergentes. No obstante, es mayor el nivel de bienestar social de los profesores adscritos a escuelas autónomas pequeñas. Por otro lado, los resultados avalan que una alta participación de los docentes en la gestión escolar está altamente relacionada con buenos niveles de bienestar social. Se discute que estas variables organizacionales -autonomía en la gestión, tamaño y participación de profesores- sí inciden en la salud mental de los profesores.

Based on theoretical debate and empirical evidence, both raised in the context of State Reform and Modernization of Public Management processes, this paper proposes a model of synthesis and analysis that allows characterizing such processes. Using a case study methodology, this research demonstrates the usefulness of such a model to the Chilean case, during the 1990-2006 period. There is evidence of particular features of these processes of reform and modernization in the Chilean experience. Said conclusion is based on data collected through the application and analysis of 37 interviews to key actors involved in those processes as well as the collection and analysis of official documents. This article identifies, describes and explains the variables that define the Policy of Modernization of Public Management in the Chilean experience.

A partir del debate teórico y de las evidencias empíricas surgidas en el ámbito de los procesos de reforma del Estado y de modernización de la gestión pública, este paper propone un modelo de síntesis y análisis que permite caracterizar dichos procesos. Mediante el estudio de caso, se demuestra la aplicabilidad de este modelo al caso chileno para el periodo 1990-2006. La evidencia muestra que existen rasgos propios que han definido un proceso con características particulares. Esta información se recoge a partir de la aplicación y análisis de entrevistas a 37 actores claves de estos procesos así como del análisis de documentos oficiales. El artículo identifica, describe y explica las variables que definen la política de modernización para el caso chileno.

Analyzing the public management modernization policy, from 1990 to 2006, the article identifies the model which might explain how policies are formulated in the country. This model has been identified from evidence collected through 37 interviews to key actors of the process, official documents, and media analysis. The model diverges from Kingdon and IABS's approaches, which are commonly used to explain the policy formulation process in Latin America. The article explains which might be the reasons of the divergence.

El artículo analiza el proceso de formulación de políticas públicas en Chile, basado en el caso de la política de modernización de la gestión pública (PMHP), en el periodo 1990-2006. El trabajo construye una matriz analítica que permite analizar las distintas etapas, así como caracterizar sus énfasis y estrategias de aprobación. A partir de la evidencia recogida, mediante entrevistas aplicadas a 37 actores clave del proceso, análisis de documentos oficiales e información de prensa, el artículo explica por qué la PMGP se instaló en la agenda del gobierno, por qué fue retirada y luego se reinstaló, por qué adoptó los énfasis que tuvo y el papel que desempeñaron diferentes actores a lo largo del proceso.