Proyecto de Implementación de ASEMANTTO Empresa de Servicios de Mantenimiento Total .

La presente investigación es un documento donde se recopila la información necesaria para llevar a cabo la implementación de una empresa de servicios de mantenimiento, se topan tópicos administrativos y técnicos que servirán para el desarrollo de diferentes aplicaciones. Se realizo el estudio de mercado para determinar la oferta demanda y precio, el estudio técnico y de ingeniería el cual nos da la mejor ubicación de la empresa, el estudio administrativo legal para constituirle a ASEMANTTO S.A. como una sociedad anónima, el estudio financiero y evaluación del proyecto para ver si es factible el mismo y por último el estudio ambiental para determinar los impactos, efectos y mitigaciones. Al observar el presente documento se obtendrán valiosa información del mercado en la ciudades de Ambato y Riobamba, de la real demanda de los servicios de mantenimiento en el sector, pudiendo ayudar en la toma de decisiones, además de investigar en el mundo de los emprendedores como y cuáles son los puntos que se deben investigar antes de la implementación de una empresa de servicios. En la realización del proyecto se alcanzó los objetivos planteados que son de gran utilidad para la implementación de ASEMANTTO S.A por lo que podemos decir que el presente proyecto es factible ya que tenemos una Tasa Interna de Retorno (TIR) de 30,21 % y una relación beneficio costo de 2,66 es decir que por cada dólar invertido tenemos 1,66 dólares.ASEMANTTO Enterprise has been implemented for Total Maintenance Services to contribute to the maintenance development in the industry of Riobamba and Ambato. Its demand, supply, price and competence were analyzed on the basis of the questionnaire in the principal industries of the above cities to determine the project feasibility. The market study was carried out to set the supply, demand and price; the technical study and engineering which determine the best enterprise location, the legal administrative study to constitute ASEMANTTO S.A. as an anonymous society, the finance study and the project evaluation to determine its feasibility, and, finally, the environmental study to determine the impacts, effects and mitigations. In the project elaboration the proposed objectives were obtained; these are of great utility for the implementation of ASEMANTTO S.A. this is why it can be said that the present project is feasible as there is a an Internal Return Rate (TIR) of 30.21% and a benefit-cost relationship of 2.66 i.e. for each invested dollar 1.66 USD is obtained. Upon observing the present document valuable information of the market will be obtained in the cities of Riobamba and Ambato, of the real demand of the maintenance services in the sector, helping decision making, investigating the entrepreneurs world, how and which the points are to be investigated before the implementation of a service enterpris

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

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit