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Resumen La Práctica Basada en Evidencia (PBE) es un proceso que inicia con el conocimiento de las evidencias disponibles y concluye con la selección de la mejor intervención para su implementación en escenarios clínicos lo cual impacta la efectividad de las intervenciones. Objetivo. Caracterizar el perfil de los terapeutas que laboran en 17 centros de tratamiento ambulatorio en adicciones del noroeste de México, además de sus conocimientos y habilidades en el uso de la PBE (fuentes de consulta, uso de manuales) y percepción de su autoeficacia. Método. Participaron 102 terapeutas, se contemplaron dos etapas: cuantitativa basada en la aplicación del CUTEA y cualitativa con aplicación de entrevista semi-estructurada, buscando contrastar las respuestas. Resultados. La mayoría de los participantes tuvo dificultad para describir el concepto de PBE, solo el 37.25% logró una adecuada definición sin embargo, reportaron altos niveles (95.91%) de autoeficacia para implementarla. En relación a las fuentes de consulta el 50% reportó utilizar cualquier buscador comercial en internet, mientras que el 46.08% referían usar los manuales de la institución. Al ingreso a su trabajo, no contaban con capacitación en adicciones ni en el área clínica. Discusión. Se aborda la necesidad del entrenamiento en la PBE y no solo en la implementación de tratamientos específicos.

Abstract Introduction. Evidence-Based Practice (EBP) is a process which starts with the knowledge of available evidence and concludes with the evaluation and selection of the best intervention for the implementation in clinical settings, this process impact the efficacy of the interventions. The variables which can impact on the EBP could be: personal and institutional variables and therapist skills and variables of the interventions. However, to make decisions in the clinical context, it has prevailed a position based on the risks and needs of the clients, which would justify using any treatment, regardless of its effectiveness, which makes the professional psychologist a passive subject who is dedicated only to implementing interventions that institutions request. Therefore, EBP demands that the psychologist be critical of the research and this allows the identification of the best evidence available and also must have the skills to adapt that evidence to their particular context. The objective is to characterize the profile of therapists working in 17 outpatient treatment centers in Mexico, as well as the skills related to the use of EBP (sources of consultation and use of manuals, transfer of knowledge to the population and other therapists) and perception of their self-efficacy. Method. This is a cross-sectional research in which 102 therapists participated. Two stages were considered: quantitative, based on the application of a questionnaire, and the second was qualitative, seeking to contrast the responses. Results. Most of the participants had difficulties in explaining EBP, but reported high levels of self-efficacy to implement it. At the beginning of their work, they had no training in addictions or in the clinical area. Discussion. The need for training in EBP from undergraduate studies is addressed so that future therapists will find it more natural to implement it in clinical settings, through the analysis of scientific articles and, if possible, its application.

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Introdução: As atitudes dos estudantes de enfermagem frente ao álcool, alcoolismo e alcoolista tem sido descritas de maneira geral como negativas, isso é atribuído a pouca atenção dada à educação dos estudantes de enfermagem frente a temática de adições durante sua graduação. Essas atitudes negativas refletem negativamente no cuidado gerado pelo futuro profissional a indivíduos com problemas associados ao uso do álcool. Embora não haja consenso, estudos têm sugerido que a experiência clínica em serviços especializados no tratamento de uso e abuso de substâncias exercerem influência nas atitudes dos estudantes frente ao álcool, alcoolismo e alcoolista. Objetivo : Identificar, analisar e sintetizar as melhores evidências sobre a efetividade da experiência clínica em serviços de tratamento especializados em álcool e outras drogas nas atitudes dos estudantes de enfermagem frente ao álcool, alcoolismo e ao alcoolista. Método: Trata-se de uma revisão sistemática de efetividade, baseada no modelo proposto pelo Instituto Joanna Briggs (JBI). A primeira etapa foi realizada em duas bases de dados para coletar mais descritores para a estratégia de busca, a segunda foi realizada a seleção das publicações por meio do título e resumo e, a terceira, foi realizada análise das referências dos artigo que preencheram os criteros de inclusão. Tanto a busca, extração e síntese foi realizada por dois revisores independentes. A busca contemplou artigos publicados e nas línguas inglesa, portuguesa e espanhola, sem limitação de período. Utilizou-se a ferramenta SUMARI, para a extração e avaliação crítica dos artigos selecionados. Resultado: Foram identificadas 4655 publicações, oito artigos foram incluídos de acordo com critérios previamente estabelecidos. Estes são apresentados em um artigo. Artigo 1: Efetividade da experiência clínica em serviços especializados no tratamento de álcool e outras drogas nas atitudes dos estudantes de enfermagem frente ao álcool, alcoolismo e alcoolista: revisão sistemática e meta-análise A maioria dos estudos mostrou mudanças positivas nas atitudes dos estudantes em relação ao álcool, alcoolismo e alcoolismo, além de uma maior motivação dos estudantes para trabalhar com esse paciente após a experiência clínica. Conclusão: Conclui-se que a experiência clínica em serviços especializados no tratamento de dependentes de álcool e outras drogas possibilita atitudes mais positivas dos estudantes de enfermagem frente ao alcoolismo e ao alcoolista, contribuindo também para motivar os estudantes a trabalhar com essa clientela. Contudo, esse estudo necessita de uma análise quantitativa com mais estudos para reforçar o efeito presente no resultado e contornar as limitações apresentadas.

Introduction: Nursing students\' attitudes towards alcohol, alcoholism and alcoholics have been generally described as negative, this is attributed to the little attention given to the education of nursing students regarding the theme of addictions during their graduation. These negative attitudes reflect negatively on the care provided by the future professional to individuals with problems associated with alcohol use. Although there is no consensus, studies have suggested that clinical experience in specialized services in the treatment of substance use and abuse has an influence on students\' attitudes towards alcohol, alcoholism and alcoholics Objective: To identify, analyze and synthesize the best evidence on the effectiveness of clinical experience in specialized treatment services on alcohol and other drugs in nursing students\' attitudes towards alcohol, alcoholism and alcoholics. Method: This is a systematic review of effectiveness, based on the model proposed by the Joanna Briggs Institute (JBI). The first step was carried out in two databases to collect more descriptors for the search strategy, the second was the selection of publications by means of the title and summary and the third was carried out an analysis of the references of the articles that met the inclusion criteria. Both search, extraction and synthesis were performed by two independent reviewers. The search included published and unpublished articles in English, Portuguese and Spanish, with no period limitation. The SUMARI tool was used to extract and critically evaluate the selected articles Result: A total of 4655 publications were identified, and eight articles were included according to previously established criteria. These are presented in an article. Article 1: Effectiveness of clinical experience in specialized treatment services on alcohol and other drugs in nursing students\' attitudes towards alcohol, alcoholism and alcoholics: Systematic review and meta-analysis. Most studies showed positive changes in students\' attitudes towards alcohol, alcoholism and alcoholism, as well as a greater motivation of students to work with this patient after clinical experience. Conclusion : It is concluded that clinical experience has the potential to change nursing students\' attitudes towards the studied theme, besides helping to motivate students to work with it. However, this study needs a quantitative analysis with more studies to reinforce the effect present in the result and to overcome the limitations presented.

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Resumen El surgimiento de la experiencia clínica en la medicina europea posee hoy numerosos estudios que han abordado su proceso de emergencia desde comienzos del siglo XIX. Con respecto a la indagación acerca de dicho proceso en el espacio del Río de la Plata, la historiografía ha brindado mayor atención al análisis del desarrollo institucional de la práctica médica, que a la elaboración que los médicos del escenario local llevaron a cabo sobre las obras más relevantes de la ciencia médica. Por lo tanto, la presente edición de la Disertación de la manía aguda (1827), del médico Diego Alcorta, busca arrojar nuevos indicios que permitan profundizar en el registro del desarrollo de la experiencia clínica, en el espacio rioplatense.

Abstract The rise of clinical experience in European medicine has by now been the subject of numerous studies dealing with the process of its emergence since the beginning of the nineteenth century. As regards research on this process in the River Plate area, the historiography has devoted more attention to analysis of the institutional development of medical practice than to local physicians' creation of the most important works of medical science. Therefore, this edition of the Disertación de la manía aguda (1827), by physician Diego Alcorta, seeks to shed new light on records of the development of clinical medicine in the River Plate área.

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Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

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El análisis de los diarios reflexivos forman parte de la investigación "La tutoría clínica como estrategia de enseñanza aprendizaje en Enfermería Fundamental" a través de la implementación de un Modelo de Tutoría Clínica Reflexiva donde los diarios reflexivos se aplican como estrategia de enseñanza aprendizaje e investigación. Objetivo: Identificar los significados que le asignan los tutorados a la práctica clínica de Fundamentos de Enfermería ll, a través de los diarios en un modelo de tutoría clínica reflexiva. Metodología: Análisis del contenido y significado de los diarios reflexivos desde la interpretación cualitativa de los textos en tres etapas: Codificación, categorización e interpretación y el establecimiento de los vínculos y relaciones en el proceso de categorización.¹ El grupo de estudio lo integran catorce tutorados, tres tutoras clínicas y 138 registros durante cuarenta días. Resultados: Del análisis del discurso se derivaron las siguientes categorías: Temor vs confianza, percepción sobre las enfermeras, identidad profesional, el ser enfermera, percepción sobre la tutoría y relación entre la teoría y la práctica, mismas que dan cuenta de las reflexiones clínicas. Discusión y conclusiones: Las categorías muestran las experiencias significativas que vive el tutorado en el entorno de práctica hospitalaria, favorecen el aprendizaje reflexivo y una relación humanizada entre el tutor-tutorado. Permiten individualizar la tutoría, la reflexión en la acción coloca en el centro del proceso al tutorado y tutor. Resultados: 96% tuvo riesgo medio para la edad (15 a 19 años); aunque 9 tuvieron mayor riesgo debido a tenían 15 años o menos; 27% eran solteras, 23% correspondían a un nivel socioeconómico bajo, dos terceras partes reportó una escolaridad de 9 años o menos. Respecto a los factores biológicos cuatro de cada 10 tuvieron riesgo medio o alto en función de su peso (35% entre 41 a 50 kgs. y 6.1% con menos de 40 kgs); la gran mayoría eran nuliparas; 12% con tabaquismo positivo; 16% tuvo amenaza de aborto; 11% con amenaza de parto pretermino; el problema de salud más importante fue la infección de vías urinarias 28% la tenía controlada y 10% activa. Discusión y Conclusión: Los resultados coinciden con otras investigaciones, pero el número de embarazadas de 15 años o menos es superior a la media nacional que es de 6 en mil; el perfil obstétrico es en mayor medida de mediano riesgo; falta conocer los riesgos y daños en el posparto y recién nacido para completar este perfil.

"Clinical Tutoring as a Teaching Learning Strategy in Fundamental Nursing" is a study in which, by implementing a Reflective Clinical Tutoring Model, reflective diaries are used. Objective: to identify the meanings given by the mentored to clinical practice in Nursing Fundamentals II, through diaries in a model of reflective clinical tutoring. Methodology: Analysis of the contents and meanings of reflective diaries following a qualitative interpretation in three stages; codification, categorization and interpretation, and establishment of links and relations within the process of categorization. 1 The study group is integrated by 14 mentored, 3 clinical tutors, and 138 registers taken during 40 days. Results: from the discourse analysis, the following categories were derived; fear vs. confidence, perceptions about nurses, professional identity, being a nurse, perceptions about the tutoring process, and relationships between theory and practice. Discussion and conclusions: the derived categories show the significant experiences which mentored live within the hospital practice. They favor reflective learning and a human relationship between mentor and mentored, showing that reflection allows the individualization of tutoring.

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