Análisis de inclusión social de población afro-descendiente en centros de práctica de medicina ancestral (Kilombos) en Bogotá / Analysis of social inclusion of Afro-descendant population in ancestral medicine practice centers (Kilombos) in Bogotá

En este estudio hace énfasis en el papel de la inclusión social y la medicina tradicional de la comunidad afrodescendiente en relación con el programa de medicina intercultural en la zona centro oriente de la ciudad de Bogotá, Se examinan los principales actores sociales en los niveles individual o micro (de los participantes), interno o meso (territorios saludables medicina intercultural, entidades relacionadas con el proyecto medicina intercultural) y macro (actores institucionales, percepción institucional) sobre el rol desempeñado por las entidades encargadas de dinamizar el componente de inclusión social para grupos étnicos proyecto medicina intercultural en el periodo 2012 ­ 2016, por medio de entrevistas semiestructuradas a funcionarios del Instituto Distrital de la Participación y Acción Comunal ­ IDPAC- , Secretaria de Salud, Funcionarios de los Kilombos y un grupo focal con la participación de lideresas en la comunidad Afrodescendiente; Los datos analizados sugieren que la inclusión social en general requiere el reconocimiento de las particularidades culturales de comunidades que como la Afro, así determinan sus prácticas como ciudadanos dignos; en particular en el sector salud, se requiere el acceso opcional a los Kilombos; El abordaje cultural a la salud debe establecerse en el diálogo entre los saberes de la medicina y desde el respeto por el conocimiento y las opciones individuales.

Estimation of Risk in Cancer Patients Undergoing Palliative Procedures by the American College of Surgeons Risk Calculator.

BACKGROUND: Surgical palliation is defined as the use of a procedure to relieve symptoms. The American College of Surgeons Risk Calculator (ACSRC) was created based on data from the National Surgical Quality Improvement Program to predict the risk of surgical complications on a patient-specific level. Whether the ACSRC can accurately predict the risk of postoperative complications following palliative procedures in cancer patients is unknown. The purpose of this study was to determine if the ACSRC accurately predicted postoperative complication rates in this setting. STUDY DESIGN: A prospectively maintained, surgical oncology database of patient outcomes from 2011 to 2013 was queried. Data extracted included the following: demographics, comorbidities, site and stage of cancer, type of procedure, and post-operative complication rate and type. Risk assessment was performed for each patient using the ACSRC. Predicted outcomes were compared to actual outcomes for length of stay (LOS), complications, and death. Main outcome measures were differences in actual versus predicted outcomes. RESULTS: Thirty-two patients were included. Occurrence of any complication was significantly lower than predicted (31% vs. 59%, p < 0.05). The predicted LOS, however, was 2.9 days; significantly lower than 5.4 days (p < 0.05). CONCLUSION: The ACSRC is a powerful tool for aid in surgical decision-making; however, in the case of palliative procedures for cancer patients, it overestimated the risk of postoperative complications and underestimated the LOS. Overestimation of post-operative complications could result in fewer patients being offered potentially beneficial palliative procedures.