File "contentv3.xml"
Full path: /var/www/vhosts/msproyectoscloud.cl/siadrecursos.msproyectoscloud.cl/RECURSOS/recursos.siadspsminsal.cl/Insuficiencia cardiaca/u3/contentv3.xml
File size: 259.26 KiB (265480 bytes)
MIME-type: text/xml
Charset: utf-8
<?xml version="1.0" encoding="utf-8"?>
<instance xmlns="http://www.exelearning.org/content/v0.3" reference="1" version="0.3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemalocation="http://www.exelearning.org/content/v0.3 content.xsd" class="exe.engine.package.Package">
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium; line-height: 1.5;"><span>En los siguientes apartados se abordarán los estadios de la IC, sus tratamientos y recomendaciones. </span>Los tratamientos disponibles para la IC en la actualidad, se resumen en la tabla a continuación.</span></p>
<table border="0" align="center" style="width: 650px;">
<tbody>
<tr>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="font-size: medium; color: #ffffff;">Tratamientos disponibles en la ICFER</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;">
<p><span style="font-size: medium;">Terapias no farmacológicas: prevención, tratamiento adecuado de factores de riesgo CV (FRCV),alimentación saludable, ejercicio regular.</span></p>
</td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Terapia farmacológica recomendada en las dosis óptimas.</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Dispositivos utilizados en la IC (Terapia de resincronización cardíaca, desfibrilador automático implantable).</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Tratamiento etiológico si está indicado (cirugía coronaria, cirugía valvular).</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Asistencia circulatoria mecánica (ACM), trasplante de corazón.</span></td>
</tr>
</tbody>
</table>
<p style="text-align: center;"><span style="font-size: medium; color: #000000;">Tabla 10: Tratamientos disponibles en IC.</span></p>"></unicode>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">En base a los estadios evolutivos y niveles de complejidad se establecen distintas recomendaciones particulares para el tratamiento de IC. A continuación observaremos dos tablas referidas a esta información.<br /></span></p>
<p style="text-align: justify;"><span style="font-size: medium;">Según los estadios evolutivos de la IC (vistos en el apartado de Progresión de la enfermedad / Estadios IC en la primera unidad ), se señalan necesidades de tratamiento según los niveles I y II de complejidad. <br style="clear: both;" /><br style="clear: both;" /></span></p>
<table border="0" align="center" style="width: 650px; height: 168px;">
<tbody>
<tr>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Estadio </span></td>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Nivel I</span></td>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Nivel II</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><img src="resources/aa.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, mayoritariamente</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Casos seleccionados</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><img src="resources/bb.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, mayoritariamente</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, algunos casos</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><img src="resources/cc.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, sólo terapia farmacológica</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si<span>, terapia completa</span></span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><img src="resources/dd.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, cuidados paliativos</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si, terapia completa</span></td>
</tr>
</tbody>
</table>
<p style="text-align: center;"><span style="font-size: medium; color: #000000;">Tabla 11: Tratamiento de la IC según estadios evolutivos y niveles de complejidad</span></p>
<p style="text-align: center;"></p>
<p style="text-align: justify;"><span style="font-size: medium; color: #000000;">Según tipo de tratamiento, se establecen las siguiente indicaciones para cada <span>nivel de complejidad: <br style="clear: both;" /></span></span></p>
<p style="text-align: left;"></p>
<table border="0" align="center" style="border: 0px solid #0066ad; width: 650px; background-color: #ffffff;">
<tbody>
<tr>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="font-size: medium;"><span style="color: #ffffff;">Tipo de tratamiento</span> </span></td>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Nivel I</span></td>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Nivel II</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">No farmacológico</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Farmacológico</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Eléctrico</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">No, conocer indicaciones y proceso de derivación</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Quirúrgico</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">No, conocer indicaciones y proceso de derivación</span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Si</span></td>
</tr>
</tbody>
</table>
<p style="text-align: center;"><span style="font-size: medium; color: #000000;">Tabla 12: Diferentes tipos de tratamiento en IC, según niveles de complejidad</span></p>
<p></p>
<p></p>
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<string role="key" value="exe.engine.galleryidevice.GalleryImage.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="makeThumbnail"></string>
<bool value="0"></bool>
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</instance>
</list>
<string role="key" value="idevice"></string>
<reference key="6"></reference>
</dictionary>
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<string role="key" value="intlinks_to_anchors"></string>
<dictionary></dictionary>
<string role="key" value="nextImageId"></string>
<int value="38"></int>
<string role="key" value="parentNode"></string>
<reference key="4"></reference>
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<string role="key" value="icon"></string>
<unicode value="objectives"></unicode>
<string role="key" value="id"></string>
<unicode value="13"></unicode>
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<bool value="0"></bool>
<string role="key" value="nextFieldId"></string>
<int value="3"></int>
<string role="key" value="originalicon"></string>
<unicode value="objectives"></unicode>
<string role="key" value="parentNode"></string>
<reference key="4"></reference>
<string role="key" value="systemResources"></string>
<list>
<string value="common.js"></string>
</list>
<string role="key" value="undo"></string>
<bool value="1"></bool>
<string role="key" value="userResources"></string>
<list>
<reference key="7"></reference>
<reference key="8"></reference>
<reference key="9"></reference>
<reference key="10"></reference>
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<string role="key" value="version"></string>
<int value="0"></int>
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</list>
<string role="key" value="_id"></string>
<unicode value="0"></unicode>
<string role="key" value="_package"></string>
<reference key="1"></reference>
<string role="key" value="anchor_fields"></string>
<list></list>
<string role="key" value="exe.engine.node.Node.persistenceVersion"></string>
<int value="2"></int>
<string role="key" value="last_full_node_path"></string>
<string value="exe-node:Tratamientos"></string>
<string role="key" value="parent"></string>
<none></none>
<string role="key" value="top_anchors_linked_from_fields"></string>
<list></list>
<string role="key" value="children"></string>
<list>
<instance class="exe.engine.node.Node" reference="13">
<dictionary>
<string role="key" value="_title"></string>
<unicode value="Objetivos de los tratamientos"></unicode>
<string role="key" value="idevices"></string>
<list>
<instance class="exe.engine.freetextidevice.FreeTextIdevice" reference="11">
<dictionary>
<string role="key" value="_title"></string>
<unicode value="Free Text"></unicode>
<string role="key" value="_author"></string>
<unicode value="University of Auckland"></unicode>
<string role="key" value="_purpose"></string>
<unicode value="The majority of a learning resource will be
establishing context, delivering instructions and providing general information.
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<string role="key" value="_tip"></string>
<string value=""></string>
<string role="key" value="childs"></string>
<list></list>
<string role="key" value="content"></string>
<instance class="exe.engine.field.TextAreaField" reference="12">
<dictionary>
<string role="key" value="_id"></string>
<int value="85"></int>
<string role="key" value="_idevice"></string>
<reference key="11"></reference>
<string role="key" value="_instruc"></string>
<unicode value="Use this field to enter text. This
iDevice has no emphasis applied although limited formatting can be applied to
text through the text editing buttons associated with the field."></unicode>
<string role="key" value="_name"></string>
<unicode value="Free Text"></unicode>
<string role="key" value="anchor_names"></string>
<list></list>
<string role="key" value="anchors_linked_from_fields"></string>
<dictionary></dictionary>
<string role="key" value="buttonCaption"></string>
<string value=""></string>
<string role="key" value="content_w_resourcePaths"></string>
<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">El tratamiento de la IC debe considerar una serie de variables: estadio de la IC, etiología, ICFER o ICFEP, clase funcional, síntomas predominantes, variables de laboratorio (función renal, electrolitos), hallazgos del ECG y expectativas de sobrevida.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;">Los objetivos del tratamiento de la IC incluyen:</span></p>
<ul>
<li style="text-align: justify;"><span style="font-size: medium;">Controlar factores de riesgo y desencadenantes.</span></li>
<li style="text-align: justify;"><span style="font-size: medium;">Prevenir la aparición y la progresión de la enfermedad.</span></li>
<li style="text-align: justify;"><span style="font-size: medium;">Reducir las tasas de mortalidad y hospitalizaciones.</span></li>
<li style="text-align: justify;"><span style="font-size: medium;">Aliviar los síntomas y mejorar la calidad de vida. </span></li>
</ul>"></unicode>
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<int value="4"></int>
<string role="key" value="exe.engine.field.FieldWithResources.persistenceVersion"></string>
<int value="2"></int>
<string role="key" value="exe.engine.field.TextAreaField.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="htmlTag"></string>
<string value="div"></string>
<string role="key" value="images"></string>
<instance class="exe.engine.galleryidevice.GalleryImages">
<dictionary>
<string role="key" value=".listitems"></string>
<list></list>
<string role="key" value="idevice"></string>
<reference key="12"></reference>
</dictionary>
</instance>
<string role="key" value="intlinks_to_anchors"></string>
<dictionary></dictionary>
<string role="key" value="nextImageId"></string>
<int value="0"></int>
<string role="key" value="parentNode"></string>
<reference key="13"></reference>
</dictionary>
</instance>
<string role="key" value="edit"></string>
<bool value="0"></bool>
<string role="key" value="emphasis"></string>
<int value="0"></int>
<string role="key" value="exe.engine.freetextidevice.FreeTextIdevice.persistenceVersion"></string>
<int value="7"></int>
<string role="key" value="icon"></string>
<string value=""></string>
<string role="key" value="id"></string>
<unicode value="14"></unicode>
<string role="key" value="lastIdevice"></string>
<bool value="0"></bool>
<string role="key" value="originalicon"></string>
<string value=""></string>
<string role="key" value="parent"></string>
<none></none>
<string role="key" value="parentNode"></string>
<reference key="13"></reference>
<string role="key" value="systemResources"></string>
<list></list>
<string role="key" value="type"></string>
<none></none>
<string role="key" value="undo"></string>
<bool value="1"></bool>
<string role="key" value="userResources"></string>
<list></list>
<string role="key" value="version"></string>
<int value="0"></int>
</dictionary>
</instance>
<instance class="exe.engine.freetextidevice.FreeTextIdevice" reference="14">
<dictionary>
<string role="key" value="_title"></string>
<unicode value="Free Text"></unicode>
<string role="key" value="_author"></string>
<unicode value="University of Auckland"></unicode>
<string role="key" value="_purpose"></string>
<unicode value="The majority of a learning resource will be
establishing context, delivering instructions and providing general information.
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delivered."></unicode>
<string role="key" value="_tip"></string>
<string value=""></string>
<string role="key" value="childs"></string>
<list></list>
<string role="key" value="content"></string>
<instance class="exe.engine.field.TextAreaField" reference="15">
<dictionary>
<string role="key" value="_id"></string>
<int value="85"></int>
<string role="key" value="_idevice"></string>
<reference key="14"></reference>
<string role="key" value="_instruc"></string>
<unicode value="Use this field to enter text. This
iDevice has no emphasis applied although limited formatting can be applied to
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<string role="key" value="_name"></string>
<unicode value="Free Text"></unicode>
<string role="key" value="anchor_names"></string>
<list></list>
<string role="key" value="anchors_linked_from_fields"></string>
<dictionary></dictionary>
<string role="key" value="buttonCaption"></string>
<string value=""></string>
<string role="key" value="content_w_resourcePaths"></string>
<unicode content="true" value="<p><span class="Cuerpodeltexto2" style="font-size: medium;"><span lang="ES">Recordemos que la clasificación funcional de la IC es la siguiente:</span></span></p>
<p><sup> </sup></p>
<table border="0" style="width: 680px; height: 264px; margin-left: auto; margin-right: auto;">
<tbody>
<tr>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Clase funcional</span></td>
<td style="border: 1px solid #0066ad; text-align: center; background-color: #0066ad;"><span style="color: #ffffff; font-size: medium;">Limitaciones de la actividad física</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;"><img src="resources/uno.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></span></td>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;">Sin limitaciones para la actividad física. Actividad física habitual no causa síntomas.</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;"><img src="resources/dos.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></span></td>
<td style="border: 1px solid #0066ad; text-align: justify; background-color: #ffffff;"><span style="font-size: medium;">Limitación leve de la actividad física. Actividad física habitual provoca síntomas de IC, fundamentalmente disnea.</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;"><img src="resources/tres.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></span></td>
<td style="border: 1px solid #0066ad; text-align: justify; background-color: #ffffff;"><span style="font-size: medium;">Limitación marcada de la actividad física. Actividad física menor a la habitual (esfuerzos menores) provoca síntomas.</span></td>
</tr>
<tr>
<td style="border: 1px solid #0066ad; background-color: #ffffff;"><span style="font-size: medium;"><img src="resources/cuatro.png" width="30" height="30" style="display: block; margin-left: auto; margin-right: auto;" /></span></td>
<td style="border: 1px solid #0066ad; text-align: justify; background-color: #ffffff;"><span style="font-size: medium;">Incapaz de realizar actividad física sin síntomas, o síntomas en reposo.</span></td>
</tr>
</tbody>
</table>
<div style="text-align: center;"><span style="font-size: medium;">Tabla 13: Clasificación Funcional de la IC de la Asociación de Cardiología de Nueva York (NYHA).</span></div>"></unicode>
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<string role="key" value="exe.engine.field.FieldWithResources.persistenceVersion"></string>
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<string role="key" value="exe.engine.field.TextAreaField.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="htmlTag"></string>
<string value="div"></string>
<string role="key" value="images"></string>
<instance class="exe.engine.galleryidevice.GalleryImages">
<dictionary>
<string role="key" value=".listitems"></string>
<list>
<instance class="exe.engine.galleryidevice.GalleryImage">
<dictionary>
<string role="key" value="_caption"></string>
<instance class="exe.engine.field.TextField">
<dictionary>
<string role="key" value="_id"></string>
<int value="290"></int>
<string role="key" value="_idevice"></string>
<none></none>
<string role="key" value="_instruc"></string>
<string value=""></string>
<string role="key" value="_name"></string>
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<string role="key" value="content"></string>
<string value=""></string>
<string role="key" value="exe.engine.field.Field.persistenceVersion"></string>
<int value="4"></int>
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</instance>
<string role="key" value="_id"></string>
<unicode value="15_85.22"></unicode>
<string role="key" value="_imageResource"></string>
<instance class="exe.engine.resource.Resource" reference="16">
<dictionary>
<string role="key" value="_idevice"></string>
<reference key="14"></reference>
<string role="key" value="_package"></string>
<reference key="1"></reference>
<string role="key" value="_storageName"></string>
<string value="cuatro.png"></string>
<string role="key" value="_userName"></string>
<string value="c:\\users\\pelussa\\appdata\\local\\temp\\tmpclksdw\\cuatro.png"></string>
<string role="key" value="checksum"></string>
<string value="27f744172e7c14bd5eeae6a695486a80"></string>
<string role="key" value="exe.engine.resource.Resource.persistenceVersion"></string>
<int value="2"></int>
<string role="key" value="exe.engine.resource._Resource.persistenceVersion"></string>
<int value="2"></int>
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<string role="key" value="_parent"></string>
<reference key="15"></reference>
<string role="key" value="_thumbnailResource"></string>
<none></none>
<string role="key" value="exe.engine.galleryidevice.GalleryImage.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="makeThumbnail"></string>
<bool value="0"></bool>
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</instance>
<instance class="exe.engine.galleryidevice.GalleryImage">
<dictionary>
<string role="key" value="_caption"></string>
<instance class="exe.engine.field.TextField">
<dictionary>
<string role="key" value="_id"></string>
<int value="292"></int>
<string role="key" value="_idevice"></string>
<none></none>
<string role="key" value="_instruc"></string>
<string value=""></string>
<string role="key" value="_name"></string>
<string value=""></string>
<string role="key" value="content"></string>
<string value=""></string>
<string role="key" value="exe.engine.field.Field.persistenceVersion"></string>
<int value="4"></int>
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</instance>
<string role="key" value="_id"></string>
<unicode value="15_85.23"></unicode>
<string role="key" value="_imageResource"></string>
<instance class="exe.engine.resource.Resource" reference="17">
<dictionary>
<string role="key" value="_idevice"></string>
<reference key="14"></reference>
<string role="key" value="_package"></string>
<reference key="1"></reference>
<string role="key" value="_storageName"></string>
<string value="dos.png"></string>
<string role="key" value="_userName"></string>
<string value="c:\\users\\pelussa\\appdata\\local\\temp\\tmpclksdw\\dos.png"></string>
<string role="key" value="checksum"></string>
<string value="e2ecbba74067d9eec8e4f4617030cf16"></string>
<string role="key" value="exe.engine.resource.Resource.persistenceVersion"></string>
<int value="2"></int>
<string role="key" value="exe.engine.resource._Resource.persistenceVersion"></string>
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<string role="key" value="_parent"></string>
<reference key="15"></reference>
<string role="key" value="_thumbnailResource"></string>
<none></none>
<string role="key" value="exe.engine.galleryidevice.GalleryImage.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="makeThumbnail"></string>
<bool value="0"></bool>
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</instance>
<instance class="exe.engine.galleryidevice.GalleryImage">
<dictionary>
<string role="key" value="_caption"></string>
<instance class="exe.engine.field.TextField">
<dictionary>
<string role="key" value="_id"></string>
<int value="295"></int>
<string role="key" value="_idevice"></string>
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<string role="key" value="_id"></string>
<unicode value="15_85.24"></unicode>
<string role="key" value="_imageResource"></string>
<instance class="exe.engine.resource.Resource" reference="18">
<dictionary>
<string role="key" value="_idevice"></string>
<reference key="14"></reference>
<string role="key" value="_package"></string>
<reference key="1"></reference>
<string role="key" value="_storageName"></string>
<string value="tres.png"></string>
<string role="key" value="_userName"></string>
<string value="c:\\users\\pelussa\\appdata\\local\\temp\\tmpclksdw\\tres.png"></string>
<string role="key" value="checksum"></string>
<string value="364a4cc1f20432bdcd50185fbc5c0e1e"></string>
<string role="key" value="exe.engine.resource.Resource.persistenceVersion"></string>
<int value="2"></int>
<string role="key" value="exe.engine.resource._Resource.persistenceVersion"></string>
<int value="2"></int>
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</instance>
<string role="key" value="_parent"></string>
<reference key="15"></reference>
<string role="key" value="_thumbnailResource"></string>
<none></none>
<string role="key" value="exe.engine.galleryidevice.GalleryImage.persistenceVersion"></string>
<int value="3"></int>
<string role="key" value="makeThumbnail"></string>
<bool value="0"></bool>
</dictionary>
</instance>
<instance class="exe.engine.galleryidevice.GalleryImage">
<dictionary>
<string role="key" value="_caption"></string>
<instance class="exe.engine.field.TextField">
<dictionary>
<string role="key" value="_id"></string>
<int value="296"></int>
<string role="key" value="_idevice"></string>
<none></none>
<string role="key" value="_instruc"></string>
<string value=""></string>
<string role="key" value="_name"></string>
<string value=""></string>
<string role="key" value="content"></string>
<string value=""></string>
<string role="key" value="exe.engine.field.Field.persistenceVersion"></string>
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<string role="key" value="_id"></string>
<unicode value="15_85.25"></unicode>
<string role="key" value="_imageResource"></string>
<instance class="exe.engine.resource.Resource" reference="19">
<dictionary>
<string role="key" value="_idevice"></string>
<reference key="14"></reference>
<string role="key" value="_package"></string>
<reference key="1"></reference>
<string role="key" value="_storageName"></string>
<string value="uno.png"></string>
<string role="key" value="_userName"></string>
<string value="c:\\users\\pelussa\\appdata\\local\\temp\\tmpclksdw\\uno.png"></string>
<string role="key" value="checksum"></string>
<string value="278077312cdad2e5836a3ec29626c7b8"></string>
<string role="key" value="exe.engine.resource.Resource.persistenceVersion"></string>
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<string role="key" value="exe.engine.resource._Resource.persistenceVersion"></string>
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<string role="key" value="_parent"></string>
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<string role="key" value="_thumbnailResource"></string>
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<string role="key" value="makeThumbnail"></string>
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<string role="key" value="idevice"></string>
<reference key="15"></reference>
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<dictionary></dictionary>
<string role="key" value="nextImageId"></string>
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<string role="key" value="parentNode"></string>
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<string role="key" value="exe.engine.freetextidevice.FreeTextIdevice.persistenceVersion"></string>
<int value="7"></int>
<string role="key" value="icon"></string>
<string value=""></string>
<string role="key" value="id"></string>
<unicode value="15"></unicode>
<string role="key" value="lastIdevice"></string>
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<string role="key" value="originalicon"></string>
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<string role="key" value="parent"></string>
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<reference key="18"></reference>
<reference key="19"></reference>
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</list>
<string role="key" value="_id"></string>
<unicode value="1"></unicode>
<string role="key" value="_package"></string>
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<instance class="exe.engine.node.Node" reference="48">
<dictionary>
<string role="key" value="_title"></string>
<unicode value="Tratamientos: insuficiencia cardiaca estadio A"></unicode>
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<list>
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<dictionary>
<string role="key" value="_title"></string>
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<unicode value="The majority of a learning resource will be
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<string role="key" value="childs"></string>
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<instance class="exe.engine.field.TextAreaField" reference="21">
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<string role="key" value="_instruc"></string>
<unicode value="Use this field to enter text. This
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<string role="key" value="_name"></string>
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<string role="key" value="anchor_names"></string>
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<string role="key" value="anchors_linked_from_fields"></string>
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<string role="key" value="buttonCaption"></string>
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<string role="key" value="content_w_resourcePaths"></string>
<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Corresponde a pacientes con factores de riesgo (HTA, Diabetes Mellitus, dislipidemia, etc.), sin cardiopatía estructural y sin síntomas. En este grupo, el objetivo de la terapia es evitar el desarrollo de enfermedad coronaria o cambios estructurales en el ventrículo izquierdo mediante el adecuado control de los FRCV, por lo que los cambios de estilo de vida se hacen fundamentales.<br style="clear: both;" /><br style="clear: both;" /></span></p>
<ul>
<li style="text-align: justify;"><span style="font-size: medium;"><strong>Manejo de HTA:</strong> El tratamiento adecuado de la HTA reduce casi en un 50% el riesgo de desarrollar IC<span style="font-size: x-small;"><sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[1]</a></sup></span>, en particular en pacientes mayores de 80 años. La opción del tratamiento antihipertensivo debe ser apegada a las guías y debe considerar las comorbilidades asociadas (DM, cardiopatia coronaria, etc). <br style="clear: both;" /><br style="clear: both;" /></span></li>
<li style="text-align: justify;"><span style="font-size: medium;"><strong>Manejo de Dislipemia:</strong> Los pacientes con dislipidemia y enfermedad aterosclerótica presentan mayor riesgo de desarrollar IC. El manejo de la dislipidemia con estatinas reduce el riesgo de desarrollar IC<sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[2]</a></sup>.<br style="clear: both;" /><br style="clear: both;" /></span></li>
<li style="text-align: justify;"><span style="font-size: medium;"><strong>Manejo de Diabetes Mellitus</strong>: La resistencia a la insulina incrementa el riesgo de desarrollar IC<sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[3]</a></sup>. En pacientes diabéticos, la incidencia de IC es hasta tres veces mayor, en particular en mujeres<sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[4]</a></sup>. La magnitud de la hiperglicemia parece estar directamente ligada al riesgo; en pacientes con valores de hemoglobina glicosilada mayor a 10,5% el riesgo de desarrollar IC es hasta 4 veces mayor que en pacientes con hemoglobina glicosilada menor de 6,5% <sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[5]</a></sup>. Por esto se recomienda la optimización del control glicémico en todos los pacientes.</span></li>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Corresponde a pacientes que no han desarrollado síntomas de IC, pero que presentan alteraciones estructurales, tales como Hipertrofia Ventricular Izquierda (HVI), cicatriz de un infarto y/o función VI disminuida. En este grupo, el objetivo de la terapia es reducir el riesgo de progresión del daño ventricular y la disfunción del VI.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;">En general, todas las recomendaciones del estadio A siguen siendo válidas en los pacientes en estadio B, en particular el control de la HTA. El adecuado tratamiento a largo plazo de la HTA reduce el riesgo de desarrollar IC en alrededor de un 50%<sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[<span style="font-size: x-small;">6]</span></a><span style="font-size: x-small;"><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[7]</a></span></sup>. Los beneficios de tratar la HTA en pacientes que ya han tenido un IM o en pacientes diabeticos<span style="font-size: x-small;"><sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[8]</a></sup></span> son aún más marcados.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;">Las intervenciones farmacológicas con eficacia demostrada para este objetivo son los inhibidores de la enzima convertidora de angiotensina (IECA) y, en menor grado, los beta-bloqueadores (BB). En ausencia de contraindicaciones, ambos grupos de medicamentos se recomiendan en pacientes con IC estadio B y disfunción VI para disminuir la morbilidad y mortalidad. En efecto, el tratamiento crónico con un IECA ha demostrado retardar la aparición de síntomas y disminuir el riesgo de muerte y hospitalizaciones por IC, ya sea en sujetos con antecedente de un evento isquémico miocárdico o con cardiopatía no isquémica<span style="font-size: x-small;"><sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[9]</a></sup></span>.</span></p>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Todas las medidas no farmacológicas sugeridas para etapas previas son útiles y necesarias de implementar en los pacientes con IC refractaria, pero su importancia crece en este grupo.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;">Mención especial merece el compromiso nutricional en este estadio, hasta el 50% de los pacientes con IC refractaria presentan algún grado de malnutrición. La caquexia cardíaca se asocia a mal pronóstico, por lo cual es recomendable monitorizar y prevenir la malnutrición, recomendar una dieta saludable. Para los pacientes con alto riesgo de caquexia se han empleado estimulantes del apetito o anabólicos en combinación con suplementos nutricionales.<a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top"><sup><span style="font-size: x-small;">[30][31]</span></sup></a></span></p>"></unicode>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Sin embargo, ninguna de estas intervenciones ha probado beneficios, y su seguridad es desconocida, por lo cual no puede recomendarse su uso de forma rutinaria.</span></p>"></unicode>
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<unicode content="true" value="<p><span style="font-size: medium;">Los estudios sugieren que los pacientes con IC refractaria se benefician con el tratamiento farmacológico de la IC de manera similar a los pacientes en estadios previos, aun cuando presentan una menor tolerancia y desarrollan más efectos adversos. <span style="font-size: x-small;"><sup><a href="file:///C:/Users/PelussA/Desktop/Contenido%20%20Insuficiencia%20Cardiaca.docx#_ftn1" title="">[32]</a></sup></span></span></p>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">El estadio D o IC refractaria se caracteriza por la presencia de síntomas en reposo, a pesar de tratamiento con los fármacos de probada utilidad en IC en las dosis máximas toleradas. Aun cuando la definición de IC estadio D no está absolutamente consensuada, se consideran en este estadio aquellos pacientes que son candidatos para cuidados especializados como terapia dialítica para manejo de volumen, infusiones inotrópicas continuas o intermitentes, soporte mecánico, trasplante cardiaco, o aquellos que son candidatos para medidas paliativas. El pronóstico de la IC en esta etapa es de 50% de mortalidad al año y en general corresponde a pacientes con cardiopatía estructural avanzada que requieren hospitalizaciones frecuentes por descompensación<span style="font-size: x-small;">.<sup><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">[28</a><a href="exe-node:Tratamientos:Referencias%20bibliogr%C3%A1ficas%20#auto_top">][29]</a></sup></span></span></p>
<p style="text-align: justify;"><span style="font-size: medium;">El manejo de los pacientes en estadio D requiere personal especializado debido a la necesidad de evaluar la indicación de terapias de alta complejidad como Asistencia Circulatoria Mecánica y trasplante cardíaco.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;"><img src="resources/insuficiencia_cardiacaa.png" style="float: right; margin: 10px;" height="275" width="281" /></span></p>
<p style="text-align: justify;"><span style="font-size: medium;">Antes de asignar un paciente al estadio D, deben ser evaluados cuidadosamente, buscando algún factor reversible que pudiera mejorar la situación, tales como isquemia, presencia de factores de descompensación (mala adherencia a tratamiento, prescripción insuficiente de terapia, transgresión alimentaria, enfermedad intercurrente o fármacos que interfieran con los mecanismos de acción de los medicamentos usados en la IC). Pacientes severamente sintomáticos con un diagnóstico reciente de IC suelen mejorar una vez estabilizados.</span></p>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Corresponde a pacientes con evidencia de función sistólica disminuida y con síntomas actuales o pasados de IC. En este grupo de pacientes el objetivo del tratamiento es múltiple: educar al paciente en relación a su enfermedad, controlar los síntomas, prevenir hospitalizaciones y disminuir la mortalidad.</span></p>
<p style="text-align: justify;"></p>
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<td style="text-align: justify;"><span style="color: #ffffff; font-size: medium;">A continuación revisaremos las recomendaciones referidas a la Terapia Farmacológica y no Farmacológica, de la IC en este estadio.</span></td>
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Los IECA, ARA II, BB y los antagonistas de la aldosterona, son los fármacos recomendados en la primera línea de tratamiento ya que mejoran la sobrevida en los pacientes con ICFER. En el siguiente recurso revisaremos en detalle a cada uno de ellos.<br /></span></p>
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<string role="key" value="_id"></string>
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<table align="right" border="0" cellpadding="10" style="width: 261px; height: 309px;">
<tbody>
<tr>
<td><img src="resources/desfibrilador.jpg" height="216" width="221" /></td>
</tr>
<tr>
<td style="text-align: center;"><span style="font-size: medium;"><em>Ilustración <span>desfibrilador automático implantable</span></em></span></td>
</tr>
<tr>
<td style="text-align: center;"><span style="font-size: medium;"><em></em></span></td>
</tr>
</tbody>
</table>
<p style="text-align: justify;"><span style="font-size: medium;">Los pacientes con IC tienen igualmente, pese al manejo, una elevada mortalidad, explicada por el avance de la enfermedad (falla de bomba), asi como por la muerte súbita (MS). Es así como la prevención primaria es primordial en estos pacientes.</span></p>
<p style="text-align: justify;"></p>
<p style="text-align: justify;"><span style="font-size: medium;">Actualmente se dispone de un desfibrilador automático implantable (DAI), para prevenir la MS por arritmias ventriculares complejas, y de terapia de resincronización cardíaca (TRC), para disminuir morbilidad y mortalidad por el avance de la enfermedad. Estos dispositivos tienen indicaciones precisas y requisitos que cumplir para ser considerados como parte del tratamiento de la IC.</span></p>
<p style="text-align: justify;"><span style="font-size: medium;"></span></p>
<p style="text-align: justify;"><span style="font-size: medium;"></span></p>
<p style="text-align: justify;"><span style="font-size: medium;"> </span></p>
<p style="text-align: right;"><span style="font-size: small;"><em> </em></span></p>"></unicode>
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<unicode value="Objectives describe the expected outcomes of the learning and should
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<unicode content="true" value="<p style="text-align: justify;"><span style="font-size: medium;">Existen opciones quirúrgicas para el tratamiento de la insuficiencia cardíaca avanzada, tales como el trasplante cardíaco y el uso de la asistencia circulatoria mecánica.</span></p>
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<string role="key" value="string"></string>
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<string role="key" value="extensiontype_"></string>
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<string role="key" value="string"></string>
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<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
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<string role="key" value="extensiontype_"></string>
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<string role="key" value="string"></string>
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<string role="key" value="extensiontype_"></string>
<none></none>
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<instance class="exe.engine.lom.lomsubs.sourceValueSub">
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<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
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<string role="key" value="valueOf_"></string>
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<unicode value="Mi catálogo"></unicode>
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<none></none>
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<list></list>
<string role="key" value="language"></string>
<instance class="exe.engine.lom.lomsubs.LanguageIdSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="es"></string>
</dictionary>
</instance>
<string role="key" value="metadataSchema"></string>
<list>
<instance class="exe.engine.lom.lomsubs.metadataSchemaSub">
<dictionary>
<string role="key" value="valueOf_"></string>
<string value="LOMv1.0"></string>
</dictionary>
</instance>
</list>
<string role="key" value="uniqueElementName"></string>
<string value="metaMetadata"></string>
</dictionary>
</instance>
<string role="key" value="relation"></string>
<list></list>
<string role="key" value="rights"></string>
<instance class="exe.engine.lom.lomsubs.rightsSub">
<dictionary>
<string role="key" value="access"></string>
<none></none>
<string role="key" value="copyrightAndOtherRestrictions"></string>
<none></none>
<string role="key" value="cost"></string>
<none></none>
<string role="key" value="description"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<none></none>
</dictionary>
</instance>
<string role="key" value="technical"></string>
<none></none>
</dictionary>
</instance>
<string role="key" value="lomEs"></string>
<instance class="exe.engine.lom.lomsubs.lomSub">
<dictionary>
<string role="key" value="__index__"></string>
<dictionary></dictionary>
<string role="key" value="__oldchild__"></string>
<none></none>
<string role="key" value="annotation"></string>
<list></list>
<string role="key" value="classification"></string>
<list></list>
<string role="key" value="educational"></string>
<list>
<instance class="exe.engine.lom.lomsubs.educationalSub">
<dictionary>
<string role="key" value="cognitiveProcess"></string>
<list></list>
<string role="key" value="context"></string>
<list>
<instance class="exe.engine.lom.lomsubs.contextSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.contextValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="distance"></string>
</dictionary>
</instance>
</dictionary>
</instance>
<instance class="exe.engine.lom.lomsubs.contextSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.contextValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="real environment"></string>
</dictionary>
</instance>
</dictionary>
</instance>
</list>
<string role="key" value="description"></string>
<list></list>
<string role="key" value="difficulty"></string>
<none></none>
<string role="key" value="intendedEndUserRole"></string>
<list>
<instance class="exe.engine.lom.lomsubs.intendedEndUserRoleSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.intendedEndUserRoleValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="tutor"></string>
</dictionary>
</instance>
</dictionary>
</instance>
<instance class="exe.engine.lom.lomsubs.intendedEndUserRoleSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.intendedEndUserRoleValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="learner"></string>
</dictionary>
</instance>
</dictionary>
</instance>
</list>
<string role="key" value="interactivityLevel"></string>
<none></none>
<string role="key" value="interactivityType"></string>
<none></none>
<string role="key" value="language"></string>
<list>
<instance class="exe.engine.lom.lomsubs.LanguageIdSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="es"></string>
</dictionary>
</instance>
</list>
<string role="key" value="learningResourceType"></string>
<list>
<instance class="exe.engine.lom.lomsubs.learningResourceTypeSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.learningResourceTypeValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value=""></string>
</dictionary>
</instance>
</dictionary>
</instance>
</list>
<string role="key" value="semanticDensity"></string>
<none></none>
<string role="key" value="typicalAgeRange"></string>
<list></list>
<string role="key" value="typicalLearningTime"></string>
<none></none>
</dictionary>
</instance>
</list>
<string role="key" value="general"></string>
<instance class="exe.engine.lom.lomsubs.generalSub">
<dictionary>
<string role="key" value="aggregationLevel"></string>
<instance class="exe.engine.lom.lomsubs.aggregationLevelSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="uniqueElementName"></string>
<string value="aggregationLevel"></string>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.aggregationLevelValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="2"></string>
</dictionary>
</instance>
</dictionary>
</instance>
<string role="key" value="coverage"></string>
<list></list>
<string role="key" value="description"></string>
<list></list>
<string role="key" value="identifier"></string>
<list>
<instance class="exe.engine.lom.lomsubs.identifierSub">
<dictionary>
<string role="key" value="catalog"></string>
<instance class="exe.engine.lom.lomsubs.catalogSub">
<dictionary>
<string role="key" value="uniqueElementName"></string>
<string value="catalog"></string>
<string role="key" value="valueOf_"></string>
<unicode value="Mi catálogo"></unicode>
</dictionary>
</instance>
<string role="key" value="entry"></string>
<instance class="exe.engine.lom.lomsubs.entrySub">
<dictionary>
<string role="key" value="uniqueElementName"></string>
<string value="entry"></string>
<string role="key" value="valueOf_"></string>
<unicode value="88dd0b34-1074-4622-88c2-adcc1eaf9f8d"></unicode>
</dictionary>
</instance>
</dictionary>
</instance>
</list>
<string role="key" value="keyword"></string>
<list></list>
<string role="key" value="language"></string>
<list>
<instance class="exe.engine.lom.lomsubs.LanguageIdSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="es"></string>
</dictionary>
</instance>
</list>
<string role="key" value="structure"></string>
<none></none>
<string role="key" value="title"></string>
<instance class="exe.engine.lom.lomsubs.titleSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<none></none>
</dictionary>
</instance>
<string role="key" value="uniqueElementName"></string>
<string value="general"></string>
</dictionary>
</instance>
<string role="key" value="lifeCycle"></string>
<instance class="exe.engine.lom.lomsubs.lifeCycleSub">
<dictionary>
<string role="key" value="contribute"></string>
<list>
<instance class="exe.engine.lom.lomsubs.contributeSub">
<dictionary>
<string role="key" value="date"></string>
<instance class="exe.engine.lom.lomsubs.dateSub" reference="75">
<dictionary>
<string role="key" value="dateTime"></string>
<instance class="exe.engine.lom.lomsubs.DateTimeValueSub">
<dictionary>
<string role="key" value="uniqueElementName"></string>
<string value="dateTime"></string>
<string role="key" value="valueOf_"></string>
<string value="2016-03-24"></string>
</dictionary>
</instance>
<string role="key" value="description"></string>
<instance class="exe.engine.lom.lomsubs.LanguageStringSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list>
<instance class="exe.engine.lom.lomsubs.LangStringSub">
<dictionary>
<string role="key" value="language"></string>
<string value="es"></string>
<string role="key" value="valueOf_"></string>
<string value="Fecha de creaci\xc3\xb3n de los metadatos"></string>
</dictionary>
</instance>
</list>
</dictionary>
</instance>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<none></none>
</dictionary>
</instance>
<string role="key" value="entity"></string>
<list>
<instance class="exe.engine.lom.lomsubs.entitySub" reference="76">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="BEGIN:VCARD VERSION:3.0 FN:UVirtual S.A EMAIL;TYPE=INTERNET: ORG: END:VCARD"></string>
</dictionary>
</instance>
</list>
<string role="key" value="role"></string>
<instance class="exe.engine.lom.lomsubs.roleSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub" reference="77">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
<string role="key" value="uniqueElementName"></string>
<string value="role"></string>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.roleValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="author"></string>
</dictionary>
</instance>
</dictionary>
</instance>
</dictionary>
</instance>
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<string role="key" value="status"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<none></none>
<string role="key" value="version"></string>
<none></none>
</dictionary>
</instance>
<string role="key" value="metaMetadata"></string>
<instance class="exe.engine.lom.lomsubs.metaMetadataSub">
<dictionary>
<string role="key" value="contribute"></string>
<list>
<instance class="exe.engine.lom.lomsubs.contributeMetaSub">
<dictionary>
<string role="key" value="date"></string>
<reference key="75"></reference>
<string role="key" value="entity"></string>
<list>
<reference key="76"></reference>
</list>
<string role="key" value="role"></string>
<instance class="exe.engine.lom.lomsubs.roleSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<reference key="77"></reference>
<string role="key" value="uniqueElementName"></string>
<string value="role"></string>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.roleValueSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="creator"></string>
</dictionary>
</instance>
</dictionary>
</instance>
</dictionary>
</instance>
</list>
<string role="key" value="identifier"></string>
<list></list>
<string role="key" value="language"></string>
<instance class="exe.engine.lom.lomsubs.LanguageIdSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="es"></string>
</dictionary>
</instance>
<string role="key" value="metadataSchema"></string>
<list>
<instance class="exe.engine.lom.lomsubs.metadataSchemaSub">
<dictionary>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
</dictionary>
</instance>
</list>
<string role="key" value="uniqueElementName"></string>
<string value="metaMetadata"></string>
</dictionary>
</instance>
<string role="key" value="relation"></string>
<list></list>
<string role="key" value="rights"></string>
<instance class="exe.engine.lom.lomsubs.rightsSub">
<dictionary>
<string role="key" value="access"></string>
<instance class="exe.engine.lom.lomsubs.accessSub">
<dictionary>
<string role="key" value="accessType"></string>
<instance class="exe.engine.lom.lomsubs.accessTypeSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<instance class="exe.engine.lom.lomsubs.sourceValueSub">
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<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list></list>
<string role="key" value="uniqueElementName"></string>
<string value="source"></string>
<string role="key" value="valueOf_"></string>
<string value="LOM-ESv1.0"></string>
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</instance>
<string role="key" value="uniqueElementName"></string>
<string value="accessType"></string>
<string role="key" value="value"></string>
<instance class="exe.engine.lom.lomsubs.accessTypeValueSub">
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<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="source"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="value"></string>
<string role="key" value="value"></string>
<none></none>
<string role="key" value="valueOf_"></string>
<string value="universal"></string>
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</instance>
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</instance>
<string role="key" value="description"></string>
<instance class="exe.engine.lom.lomsubs.LanguageStringSub">
<dictionary>
<string role="key" value="extensiontype_"></string>
<none></none>
<string role="key" value="string"></string>
<list>
<instance class="exe.engine.lom.lomsubs.LangStringSub">
<dictionary>
<string role="key" value="language"></string>
<string value="es"></string>
<string role="key" value="valueOf_"></string>
<unicode value="Preestablecido"></unicode>
</dictionary>
</instance>
</list>
</dictionary>
</instance>
<string role="key" value="uniqueElementName"></string>
<string value="access"></string>
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</instance>
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<none></none>
<string role="key" value="description"></string>
<none></none>
<string role="key" value="uniqueElementName"></string>
<string value="rights"></string>
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</instance>
<string role="key" value="technical"></string>
<none></none>
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</instance>
<string role="key" value="mxmlforcemediaonly"></string>
<bool value="0"></bool>
<string role="key" value="mxmlheight"></string>
<string value=""></string>
<string role="key" value="mxmlprofilelist"></string>
<string value=""></string>
<string role="key" value="mxmlwidth"></string>
<string value=""></string>
<string role="key" value="resources"></string>
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<string role="key" value="1bc9a1f2627bee0674bfa08b1aa44912"></string>
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<reference key="47"></reference>
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<reference key="78"></reference>
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<reference key="4"></reference>
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<bool value="0"></bool>
<string role="key" value="scowwebsite"></string>
<bool value="0"></bool>
<string role="key" value="style"></string>
<unicode value="EducaMadrid"></unicode>
<string role="key" value="sugaractivityname"></string>
<string value=""></string>
<string role="key" value="sugarservicename"></string>
<string value=""></string>
<string role="key" value="tempFile"></string>
<bool value="0"></bool>
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