Influencia de la descentralización administrativa colombiana en el desarrollo social territorial.

Por su naturaleza y características adheridas especialmente a aspectos administrativos públicos, políticos, y fiscales; la descentralización administrativa, es tema obligado de discusión social y política en el ámbito de la gestión pública, de allí que es importante para los administradores públicos tener en cuenta como se enfoca el proceso desde las diferentes corrientes ideológicas y como se aplica especialmente en Colombia Es de suma importancia resaltar que, la descentralización administrativa nace en arreglo institucional al modelo centralista buscando combatir la ineficiencia del estado y la crisis fiscal, creando escenarios que permitieran al gobierno local promover la racionalización del gasto público y la reasignación de competencias entre los distintos niveles gubernamentales, así como la consolidación de reformas del Estado que facilitarán la efectiva asignación de los recursos sociales y el mejoramiento en la calidad de los servicios básicos, buscando para ello nuevos mecanismos de participación que involucren a la gente en la elección de sus gobernantes y en el control de lo público, desarrollando estrategias que permitan consolidar un modelo de desarrollo regional como en el caso colombiano. La importancia del estudio se ve reflejada de alguna manera cuando se advierte que la descentralización administrativa ha tenido aspectos positivos sustanciales que han implicado un importante proceso para el desarrollo social del nivel local. Pero también es cierto, que con la puesta en marcha de algunas de sus reformas de corte centralista y sectario lo mismo que el cumplimiento de las mismas se han generado aspectos negativos que han ido en contra de las premisas instauradas por los teóricos como uno de los instrumentos gubernativos de solución a los problemas de exclusión y abandono por parte del estado central. Razón por la cual, el presente documento se analiza el proceso de descentralización en Colombia y su incidencia en el desarrollo social territorial, desde la perspectiva crítica y teórica a fin de determinar el marco institucional en que se encuentra instituida, haciendo un recuento de lo acaecido en Colombia a través de la nueva Constitución y el legado adquirido con la Constitución de 1886, las ventajas y desventajas que han sido analizadas por los estudiosos del tema y las marcadas dentro de la realidad social del país, sin la pretensión de agotar el tema, sino como un punto de partida para su afianzamiento como materia de estudio dentro de los derroteros de la Administración pública colombiana.By its nature and characteristics attached especially fiscal policy public administrative, and; administrative decentralization, it must issue of social and political debate in the field of public administration, hence it is important for public administrators consider as the process is approached from different ideological currents as especially applies in Colombia. It is important to note that administrative decentralization in institutional born under the centralized model looking combat inefficiency and state fiscal crisis, creating scenarios that allow the local government to promote the rationalization of public expenditures and the reallocation of responsibilities between different levels government as well as the consolidation of state reforms that will facilitate the effective allocation of social resources and improving the quality of basic services, looking for that new participation mechanisms involving the people in the choice of their rulers and control of the public, developing strategies to consolidate a model of regional development as in the Colombian case. The importance of the study is reflected in some way when we see that administrative decentralization has had substantial positive aspects that have implicated an important process for social development at the local level. But it is also true that with the implementation of some of its reforms centralist and sectarian cut the same as the performance of them have generated negative aspects that have gone against the assumptions introduced by theorists as one of the gubernatorial instruments for solving the problems of exclusion and neglect by the central state. Reason, the present paper the decentralization process in Colombia and its impact on regional social development is analyzed from the critical and theoretical perspective to determine the institutional framework in which it is established, by recounting what happened in Colombia through the new constitution and the legacy acquired with the 1886 Constitution, the advantages and disadvantages have been discussed by the scholars and marked within the social reality of the country, without pretending to exhaust the subject, but as a starting point for its consolidation as a subject of study within the courses of the Colombian public administration

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended