Importancia de la seguridad física en Colombia como mecanismo de seguridad en el sector privado

El trabajo de grado tiene como objetivo general reconocer y describir la importancia de la seguridad física en Colombia como mecanismo de seguridad en el sector privado. Referenciado en varias fuentes documentales, permite presentar un marco histórico de la seguridad física en Colombia enfocada particularmente en el sector privado, se establece la legislación normativa de la seguridad física en Colombia, relacionando algunas de ellas, se plantea y describe la estructura protocolaria de la seguridad física en instalaciones en el ámbito privado, se establece y presenta someramente el avance de la seguridad física en Colombia, con la proyección de la seguridad del lado de las medidas tomadas por los Estados Unidos y afectan al sector privado, y por último se resalta la importancia a futuro de la seguridad física en Colombia. La línea de investigación está enfocada en la seguridad, específicamente en la temática de seguridad física y rigiéndose por los parámetros exigidos por la Universidad para optar el título de Especialista en Administración de la Seguridad

Effects of a program for the development of emotional skills in university students

The objective of this study was to evaluate the effects of the program I discover my potentialities in a group of first cycle university students; the study design was preexperimental, it worked with a sample of 382 students from the business, engineering and humanities areas, of both sexes and from national and private schools; BarOn's ICE emotional intelligence inventory was used for pre and post measurement. Significant differences were found between the pre and post after applying the PRODPE, which shows that the program achieved the development of emotional skills

Climate change models predict decreases in the range of a microendemic freshwater fish in Honduras

Despite their incredible diversity, relatively little work has been done to assess impacts of climate change on tropical freshwater organisms. Chortiheros wesseli is a species of Neotropical cichlid (Cichlidae: Cichlinae) restricted to only a few river drainages in the Caribbean-slope of Honduras. Little is known about this species and few specimens had been collected until recently; however, our work with this species in the wild has led to a better understanding of its ecology and habitat preferences making it an excellent model for how freshwater fishes can be affected by climate change. This study assesses the distribution and habitats of Chortiheros wesseli using a combination of field data and species distribution modeling. Results indicate this species is largely limited to its current range, with no realistic suitable habitat nearby. Empirical habitat data show that this species is limited to narrow and shallow flowing waters with rapids and boulders. This habitat type is highly influenced by precipitation, which contributed the greatest influence on the models of present and future habitat suitability. Although several localities are within boundaries of national protected areas, species distribution models all predict a reduction in the range of this freshwater fish based on climate change scenarios. The likelihood of a reduced range for this species will be intensified by adverse changes to its preferred habitats

Plan de Acción Territorial para víctimas del conflicto armado - PAT 2020-2023 de Barbosa (Santander)

El Proyecto “Plan de Acción Territorial para víctimas del conflicto armado - PAT 2020-2023 de Barbosa (Santander)”, nace de la necesidad que tienen las entidades territoriales de dar cumplimiento a lo establecido en la Ley de Víctimas 1448 de 2011 y demás normatividad relacionada. El presente trabajo de grado se encuentra orientado al plan de acción territorial de las víctimas del conflicto armado interno en el municipio de Barbosa en el departamento Santander para el cuatrienio 2020 – 2023, con la finalidad principal que la administración municipal a través de la gerencia de proyectos y los estándares del Project Management Institute (PMI®), establezca buenas prácticas cuanto a su diseño, implementación y desarrollo, bajo la premisa de mejora continua y basado en un análisis de la información recopilada, situación actual de las víctimas del conflicto armado del municipio y las necesidades del entorno para su implementación. Teniendo en cuenta que estos planes son el principal instrumento para la implementación de programas, acciones y estrategias definidas en todos los niveles de gobierno para la prevención, atención, asistencia y reparación integral de todas las víctimas del conflicto armado.The Project "Territorial Action Plan for victims of the armed conflict - PAT 2020- 2023 of Barbosa (Santander)", arises from the need for territorial entities to comply with the provisions of the Victims Law 1448 of 2011 and other regulations related. This degree work is oriented to the territorial action plan of the victims of the internal armed conflict in the municipality of Barbosa in the Santander department for the fouryear period 2020 - 2023, with the main purpose that the municipal administration through the management of projects and the standards of the Project Management Institute (PMI®), establish good practices regarding their design, implementation and development, under the premise of continuous improvement and based on an analysis of the information collected, current situation of the victims of the armed conflict of the municipality and the needs of the environment for its implementation. Bearing in mind that these plans are the main instrument for the implementation of programs, actions and strategies defined at all levels of government for the prevention, care, assistance and comprehensive reparation of all victims of the armed conflict

Study of risk factors for healthcare-associated infections in acute cardiac patients using categorical principal component analysis (CATPCA)

Epidemiology; Preventive medicineEpidemiologia, Medicina preventivaEpidemiología; Medicina preventivaUsing categorical principal component analysis, we aimed to determine the relationship between health care-associated infections (HAIs) and diagnostic categories (DCs) in patients with acute heart disease using data collected in the Spanish prospective ENVIN-HELICS intensive care registry over a 10-year period (2005–2015). A total of 69,876 admissions were included, of which 5597 developed HAIs. Two 2-component CATPCA models were developed. In the first model, all cases were included; the first component was determined by the duration of the invasive devices, the ICU stay, the APACHE II score and the HAIs; the second component was determined by the type of admission (medical or surgical) and by the DCs. No clear association between DCs and HAIs was found. Cronbach’s alpha was 0.899, and the variance accounted for (VAF) was 52.5%. The second model included only admissions that developed HAIs; the first component was determined by the duration of the invasive devices and the ICU stay; the second component was determined by the inflammatory response, the mortality in the ICU and the HAIs. Cronbach’s alpha value was 0.855, and VAF was 46.9%. These findings highlight the role of exposure to invasive devices in the development of HAIS in patients with acute heart disease

Infection related to health care in the Intensive Care Unit

Se realizó un estudio descriptivo y retrospectivo con el objetivo de describir las características clínicas y epidemiológicas de los pacientes con infección relacionada con los cuidados sanitarios en la unidad de cuidados intensivos del Hospital provincial general docente “Carlos Manuel de Céspedes”, de Bayamo, Granma, Cuba en el período comprendido desde el 1ero de enero de 2011 hasta el 31 de diciembre de 2011. De  556 pacientes ingresados, 47 (8.6%) cumplieron los criterios de infección asociada a cuidados sanitarios. Se seleccionaron variables como: edad, sexo, tipo de paciente, evolución final, localización de la infección, gérmenes aislados, cultivos indicados, factores de riesgos relacionados y tiempo de aparición de la enfermedad. Para el análisis estadístico se utilizaron como medidas de resumen el porcentaje, la razón, la proporción; la media aritmética y la desviación estándar. La infección se desarrolló con mayor frecuencia en enfermos entre los 66 y 75 años (23.4 %). Hubo ligero predominio del sexo femenino (51.1%). El paciente quirúrgico fue el más afectado (66,0%). La neumonía asociada a ventilación (46.8%) fue la localización más frecuente. Existió predominio de los gérmenes gramnegativos, entre ellos el Enterobácter sp. (28%). Se indicaron 67 cultivos, 54 de ellos fueron positivos. La sonda vesical (80.9%) constituyó el factor de riesgo fundamental. El mayor número de infecciones apareció entre el primer y el quinto día de ingreso (42.6%). Fallecieron seis pacientes (12,8%).It was performed a descriptive and retrospective study with the aim of describing the clinical and epidemiological features of patients with infections related to health care in the Intensive Care Unit at "Carlos Manuel de Céspedes" General Teaching Province Hospital in Bayamo, Granma, during the period  January 1rst, 2011 to  December 31rst, 2011. From the 556 patients admitted, 47 (8.6%) fullfiled the criteria of infection associated with health care. There were selected variables such as: age, sex, type of patient, final evolution, location of the infection, isolated germs, indicated cultures, time of the appearance of the disease and related risk factors. For the statistical analysis there were used as summary measures the percentage, reason, proportion; the arithmetic mean and deviation standard. The infection was most frequently developed in patients between 66 and 75 years (23.4%). There was a slight female predominance (51.1%). The surgical patient was the most affected (66,0%). The pneumonia associated to ventilation (46.8%) was the most common location. There was a predominance of the gram-negative bacteria, including Enterobacter sp. (28%). There were indicated 67 cultures, 54 of them were positive. The urinary catheter (80.9%) constituted the main risk factor. The largest number of infections appeared between the first and the fifth day of hospitalizations (42.6%). Six patients died (12.8%)

Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study

Introduction: Although standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study examines whether a high-protein diabetes-specific formula reduces insulin needs, improves glycemic control and reduces ICU-acquired infection in critically ill, hyperglycemic patients on mechanical ventilation (MV). Methods: This was a prospective, open-label, randomized (web-based, blinded) study conducted at nine Spanish ICUs. The patient groups established according to the high-protein formula received were: group A, newgeneration diabetes-specific formula; group B, standard control formula; group C, control diabetes-specific formula. Inclusion criteria were: expected enteral nutrition >= 5 days, MV, baseline glucose > 126 mg/dL on admission or > 200 mg/dL in the first 48 h. Exclusion criteria were: APACHE II = 40 kg/m(2). The targeted glucose level was 110-150 mg/dL. Glycemic variability was calculated as the standard deviation, glycemic lability index and coefficient of variation. Acquired infections were recorded using published consensus criteria for critically ill patients. Data analysis was on an intention-to-treat basis. Results: Over a 2-year period, 157 patients were consecutively enrolled (A 52, B 53 and C 52). Compared with the standard control formula, the new formula gave rise to lower insulin requirement (19.1 +/- 13.1 vs. 23.7 +/- 40.1 IU/day, p < 0.05), plasma glucose (138.6 +/- 39.1 vs. 146.1 +/- 49.9 mg/dL, p < 0.01) and capillary blood glucose (146.1 +/- 45.8 vs. 155.3 +/- 63.6 mg/dL, p < 0.001). Compared with the control diabetes-specific formula, only capillary glucose levels were significantly reduced (146.1 +/- 45.8 vs. 150.1 +/- 41.9, p < 0.01). Both specific formulas reduced capillary glucose on ICU day 1 (p < 0.01), glucose variability in the first week (p < 0.05), and incidences of ventilator-associated tracheobronchitis (p < 0.01) or pneumonia (p < 0.05) compared with the standard formula. No effects of the nutrition formula were produced on hospital stay or mortality. Conclusions: In these high-risk ICU patients, both diabetes-specific formulas lowered insulin requirements, improved glycemic control and reduced the risk of acquired infections relative to the standard formula. Compared with the control-specific formula, the new-generation formula also improved capillary glycemia

Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE

Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación “riesgo/beneficio”. En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la “alimentación de confort”, que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

AbstractThe use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications