Proyecto PETICHAY

En el presente proyecto, se procede a desarrollar el procedimiento que toma el poder validar la idea de negocio nombrada PetiChay, la cual se centra en una aplicación que permite la cotización, localización y separación en tiempo real de citas y consultas veterinarias, a través de una plataforma interactiva, simple y amigable. De modo que, sirva para que el proceso de atención sea más ligero y sencillo en comparación a los que se tienen tradicionalmente. Asimismo, el presente modelo de negocio va dirigido a hombres y mujeres de sectores socioeconómicos de nivel A y B, que necesiten y estén en la condición de optar por un servicio que le brinde facilidades para una atención veterinaria segura y rápida. Es por esto, que, en el transcurso de la investigación realizada, se recurrieron a diversas fuentes, entrevistas y experimentos, que nos permitieron conocer sugerencias, críticas constructivas y demás aspectos que nos brindaban información sobre lo que requería el público objetivo. Además, se realizaron y validaron algunas herramientas y sus elementos, como en el caso de Value Proposition Canvas y el Business Model Canvas, los cuales sirvieron de apoyo para recopilar resultados valiosos, generar mejoras a través de retroalimentaciones y motivarnos al percibir la buena acogida de la idea al tener comentarios del público, en su mayoría, favorables. Finalmente, se procedió a realizar el plan financiero del proyecto con un alcance de 5 años, sirviéndose también de algunos indicadores financieros como apoyo para proyectar y verificar así la viabilidad de la idea de negocio, que es este caso resultó positiva.In this project, we proceed to develop the procedure that takes power to validate the business idea named PetiChay, which focuses on an application that allows real-time listing, location and separation of appointments and veterinary consultations, through an interactive, simple and friendly platform. So, it serves to make the care process lighter and easier compared to those traditionally held. Likewise, this business model is aimed at men and women from socioeconomic sectors of level A and B, who need and are in a position to opt for a service that provides facilities for safe and fast veterinary care. This is why, in the course of the research carried out, various sources, interviews and experiments were used, which allowed us to learn about suggestions, constructive criticism and other aspects that provided us with information about what the target audience required. In addition, some tools and their elements were made and validated, as in the case of the Value Proposition Canvas and the Business Model Canvas, which served as support to collect valuable results, generate improvements through feedback and motivate us by perceiving the good reception of the idea by having comments from the public, mostly favorable. Finally, the financial plan of the project was carried out with a scope of 5 years, also using some financial indicators as support to project and thus verify the viability of the business idea, which in this case was positive.Trabajo de investigació

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030