Procesos de contratación pública y ejecución del presupuesto de gastos en la Municipalidad Distrital de Tinco - Carhuaz, 2021

La investigación tiene por título \"Procesos de contratación pública y ejecución del presupuesto de gastos en la municipalidad distrital de tinco - Carhuaz, 2021\", su objetivo fue analizar el efecto de los procesos de contratación pública en la ejecución del presupuesto de gastos de la Municipalidad Distrital de Tinco - Carhuaz, 2021; la investigación fue descriptivo, no experimental y transversal; para recolectar los datos se empleó la técnica de la encuesta y del análisis documental, con sus instrumentos el cuestionario y guía de análisis documental; la población-muestral fue de 14 servidores. Los resultados corroboran que la contratación pública incide positivamente en la ejecución del presupuesto de gastos de la entidad; sin embargo, requiere mejoras sustanciales toda vez que el 64% de trabajadores dijo que nunca la entidad cumple la prohibición de fraccionar las adquisiciones, el 57% indicó que nunca en los procedimientos de selección se respetan los principios que rigen las contrataciones; el 43% expresó que nunca la entidad cuenta oportunamente con la certificación del crédito presupuestario con la finalidad de garantizar el crédito presupuestario de libre afectación para comprometer los gastos; y el 64% indicó que nunca la entidad verifica el ingreso real de los bienes, la efectiva prestación de los servicios y la ejecución de obras.Tesi

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research