Case study: public management of the cultural heritage of the municipalities of Cundinamarca - category 1, during the work carried out in the period from 2020 to 2022

El objetivo de este trabajo fue realizar un estudio de caso con metodología prospectiva al 2032, sobre las experiencias de la gestión pública del patrimonio cultural de los municipios de Cundinamarca - categoría 1, durante el periodo del 2020 al 2022. En la primera parte del documento, como primera instancia, se trabajó con metodología de análisis documental con textos oficiales como “Planes de Desarrollo”, “políticas públicas de cultura”, entre otros. Posteriormente, se realizaron entrevistas semiestructuradas a servidores públicos vinculados en relación con el patrimonio cultural. En la segunda parte del documento, implementé la metodología prospectiva para identificar variables claves en el problema de investigación, construyendo un posible escenario futuro de la gestión pública del patrimonio cultural. De esta manera, evidenciamos la gran importancia de factores cómo: las estrategias de las instancias encargadas de cultura a la hora de vincular a las comunidades en los planes, programas y proyectos de Patrimonio Cultural. Este hecho, aunado a algunas estrategias de fortalecimiento institucional podrían contribuir positivamente a la gestión pública del patrimonio cultural dinamizando en mayor medida los procesos concernientes.The objective of this research was to perform a case study with prospective methodology to 2032 about the experiences in public management of cultural heritage of Cundinamarca’s municipalities - category 1 from 2020 to 2022. In the first part of this paper, I applied the documental analysis methodology to official texts such as: “Development Plans” and “Public Policies of Culture” among others. Subsequently, I conducted semistructured interviews with public servants associated with cultural patrimony. In the second part of this paper, I implemented the prospective methodology to identify key variables in the research problem to build a possible future scenario of public management of cultural heritage. Consequently, I evidenced the great importance of factors such as: the strategies of the entities in charge of culture when they involve the community in the plans, programs, and projects of Cultural patrimony. This fact, added to a number of institutional strengthening strategies could contribute positively to the public management of cultural heritage. In addition to dynamizing to a greater extent the processes concerned

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)