Diseño de aplicación móvil utilizando Geomarketing como estrategia para el desarrollo turístico de la Ruta de las Flores.

La Corporación Salvadoreña de Turismo (CORSATUR) inició en 1997 el desarrollo de diferentes rutas turísticas con el propósito de orientar mejor al turista nacional como internacional, es así como nace la Ruta de Las Flores, denominada de esta manera debido a la riqueza ecológica y abundantes viveros con los que cuenta. Esta Ruta se ha convertido en un destino turístico con mucho auge, sin embargo, en la actualidad el crecimiento de la era tecnológica, especialmente de las redes sociales y plataformas que permiten a los usuarios compartir experiencias, son de gran importancia para promover sitios turísticos. A pesar que Ruta de las Flores cuenta con una extensa variedad turística a lo largo de toda la ruta y un número elevado de turistas que poseen características y gustos diferentes, se hace necesario y se convierte en una necesidad que se integren herramientas tecnológicas que permitan tener a disposición toda la información que los turistas requieran sobre toda la Ruta y así ofrecer a cada uno de ellos una actividad o un sitio turístico que cumpla con las expectativas de acuerdo a las necesidades que cada uno posea. En vista de lo anterior se plantea desarrollar una aplicación móvil para Ruta de Las Flores, con el fin de orientar a los turistas a conocer toda la oferta turística que esta ofrece la ruta, desde sitios para disfrutar de diferentes actividades de esparcimiento, conocer restaurantes con la variedad gastronómica, hasta sitios de alojamiento para aquellos que deseen recorrer la ruta por las noches. Esta es una estrategia que beneficiara en doble sentido tanto a los turistas como se mencionó anteriormente, pero también a los dueños de negocios al poder ofrecer sus productos y servicios en la aplicación, todo ello en el periodo de un año es decir 2019-2020. En el presente, se incorpora la conceptualización del marketing tradicional y marketing digital, seguido de la base teórica en la que se fundamenta la investigación que es el ii geomarketing como herramienta digital de geolocalización que nos permitirá el desarrollo de la aplicación móvil para Ruta de las Flores, al ser en internet una herramienta de comunicación entre la oferta y la demanda en un mundo conocido como SoLoMo (Social, Local y Móvil), diariamente se genera una gran cantidad de información compartida a través de redes sociales con un componente local y a través de los móviles desde cualquier sitio. Se analiza la industria turística en El Salvador, así como las instituciones que se encargan de velar por el desarrollo y la promoción del turismo en El Salvador (CORSATUR, ISTU, POLITUR, MARN, CASATUR Y SALVANATURA). Además, las leyes por las cuales se rige el mismo (Ley de Turismo, Reglamento de la Ley de Turismo, Ley de CORSATUR y Las Disposiciones sobre higiene y seguridad en el trabajo). Se hace mención específica de cómo afecta o como benefician dichas leyes a la Ruta de Las Flores. Posterior a ello, se presenta el procesamiento de los resultados de la investigación, a través de encuesta para facilitar la comprensión del lector y por el tipo de investigación que desarrollamos, la cual es el mejor modelo para llevarla a cabo. Se concluye la formulación del documento con el desarrollo de la aplicación móvil para Ruta de Las Flores la cual apunta a ser bastante competitiva al ser la primera aplicación móvil para un sitio turístico en específico, además de la funcionalidad, la interfaz de usuario y los múltiples beneficios que ofrecerá a los turistas en Ruta de Las Flores

Multiliteracidad crítica: Guía de recursos online para la formación inicial y permanente del profesorado

El proyecto de innovación docente nº 412, titulado Multiliteracidad crítica: Guía de recursos online para la formación inicial y permanente del profesorado, desarrollado en la Facultad de Educación de la UCM durante el curso 2020-21, es continuación de tres proyectos de innovación anteriores identificados como Géneros y sociedad I, II y III. Los tres proyectos tienen su origen en el proyecto multilateral Comenius Teacher Learning for European Literacy Education (TeL4ELE), que nació con el objetivo de mejorar los resultados de aprendizaje de lectura y escritura de estudiantes de educación obligatoria. En el curso 2020-21, el grupo de investigación implicado en estos proyectos (ForMuLE) orienta sus propuestas de innovación docente en los grados de Maestro hacia la alfabetización multimodal. Entre los objetivos generales del proyecto se planteó la creación de una guía de recursos guía de recursos multimedia que ofrezca herramientas para analizar de manera adecuada textos y recursos multimodales desde una perspectiva crítica, tanto a estudiantes del Grado y postgrado de formación del profesorado, como a profesores en activo de diferentes niveles educativos

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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)

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

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