Participación de la Facultad de Ciencias Naturales y Museo UNLP en la Cumbre de Rio+20, a través del Consejo Consultivo de la Sociedad Civil de Cancillería Argentina.

El mundo se encuentra en una  profunda crisis Ambiental Civilizatoria (manifiesto por la vida 2002) que impacta negativamente sobre los sistemas ecológicos. Como consecuencia de ésta, la mayor parte de la población mundial se encuentra en situación de pobreza y de inaccesibilidad de recursos para vivir dignamente. Esto se debe al colonialismo de los países dominantes sobre los países dominados, a los cuales históricamente los han saqueado y privado de sus recursos naturales a través de las guerras, dominación política y económica. Sin lugar a dudas el factor más influyente es el modelo capitalista que ha instalado un estándar de vida donde el bienestar humano y la felicidad solo se logran con la acumulación de riqueza y consumo desmedido. Para salir de esta crisis es necesario un cambio de mentalidad, construyendo un nuevo paradigma ambiental, donde la sustentabilidad ambiental debe consolidarse desde cuatro dimensiones; Económica, Ecológica, Social y Política. (García-Priotto 2009) En este sentido podemos decir que no hay justicia ambiental si no hay justicia social. Entre el 20 y 22 de junio de 2012 se volverá a realizar en Río de Janeiro la Conferencia de las Naciones Unidas sobre el Desarrollo Sustentable, conocida como la Cumbre de la Tierra, impulsado por el PNUMA, cuyos  principales ejes de debate son la “Economía Verde” y la “Gobernanza Mundial”. Ninguna presenta una alternativa de cambio entre progreso económico y sustentabilidad ambiental y por el contrario, profundizan el modelo consumista sin constituir una real alternativa enmarcada dentro de lo denominado sustentable, intentando capitalizar en el mercado los bienes y servicios de la naturaleza. (Colectivo Platense 2012). La Secretaría de Extensión de la FCNyM UNLP ha decidido participar del Consejo Consultivo de la Sociedad Civil de Cancillería Argentina  a través de la Red Social Argentina para el Desarrollo Sustentable, juntamente con organizaciones ambientalistas, ecologistas, sociales, Universitarias, sindicales, políticas y de pueblos originarios, para elaborar una propuesta alternativa al PNUMA en las negociaciones de la Cumbre que tenga en cuenta el derecho de los pueblos y los Estados al desarrollo, que implica el reconocimiento al derecho de las poblaciones para superar la pobreza, la eliminación de las condiciones que generan inequidad y exclusión, el ejercicio de derechos en armonía con la naturaleza, respetando a la Madre Tierra, y los derechos de los pueblos indígenas y comunidades locales, bajo los principios de la Agenda 21 y otros instrumentos relevantes

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

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)