Standardization of Trauma, General Surgical Morbidity and Mortality Conferences: Development and Dissemination of a "Toolkit" in Peru.

BACKGROUND: Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them. METHODS: The present study aims to gather general surgeons representing most of Peru's urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices. RESULTS: A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described "improve the system" as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p < 0.001). CONCLUSION: We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of "system improvement" as the goal of M&M conferences.

Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.

BACKGROUND: Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. METHODS: This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. RESULTS: Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. CONCLUSIONS: A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.

Optimizacion tecnica de un secador rotatorio para sal comun comestible

El alcance del presente trabajo comprende la optimizacion tecnica de un secador rotatorio de tipo indirecto, que funciona en las instalaciones de EMCOSAL Empresa Comercializadora de Sal, situadas en la ciudad de El Alto. A partir de un diagnostico y evaluacion de las fases de presecado y secado en la produccion de sal yodada clasificada, ademas de un analisis tecnico del secador en funcionamiento; se plantea la posibilidad de anular la fase de presecado y elevar la produccion del secador. En el proyecto, se analizan las caracteristicas estructurales del secador y los parametros de funcionamiento, se establecen constantes y variables. Cada variable se estudia para encontrar sus valores optimos, de acuerdo a los objetivos planteados. Luego, a partir de ello, se estipulan las recomendaciones sobre los cambios y modificaciones a realizarse en el secador. El trabajo continua con el planteamiento de reformulacion del secador y la elaboracion de los planos finales. Por ultimo, se plantea el analisis economico de costos unitarios antes y despues de la optimizacion tecnica; ademas de los beneficios de este tipo de creacion y/o adaptacion de tecnologia en el pais.

Partidos políticos y sociedad civil: Relación de ida y vuelta

1.Partidos y sociedad 2.Acerca de partidos políticos y sociedad 3.Sociedad civil y partidos políticos; viejas y nuevas relaciones 4.Partidos políticos y sociedad civil; repensando la representación política y la participación social en las nuevas democracias 5.Acerca de partidos políticos y sociedad civil de Berthin Siles 6.Las teorías institucionalistas y la percepción ciudadana con respecto a los partidos políticos