Manejo Multidisciplinario del Adenocarcinoma de Páncreas: Guía de Práctica Clínica AUNA

Introduction: This article provides recommendations for the Multidisciplinary Management of Pancreatic Adenocarcinoma in the RED AUNA. Methods: A systematic search of clinical practice guidelines (CPG) similar to topics of interest was developed, it was assessed with the AGREE II instrument, a list of questions was elaborated under the PICO structure, a de novo search was carried out prioritizing reviews systematic with or without meta-analysis, followed by primary studies, the elaboration of the evidence tables and the evaluation of the global quality for the outcomes of the clinical questions was carried out following the GRADE methodology. Results: 5 PICO questions corresponding to initial management and systemic management were formulated with 18 recommendations regarding the most effective method for pathological diagnosis, biliary drainage and the most effective and safe systemic treatment in the neoadjuvant, adjuvant and metastatic setting. Conclusions: This article summarizes the methodology and evidence-based recommendations of the CPG for the multidisciplinary management of pancreatic adenocarcinoma of the AUNA Clinic Network.Introducción: Este artículo brinda recomendaciones para el Manejo Multidisciplinario del Adenocarcinoma de Páncreas en la RED AUNA. Métodos: Se desarrolló una búsqueda sistemática de guías de práctica clínica (GPC) similares al tópico de interés, se valoró con el instrumento AGREE II, se elaboró un listado de preguntas bajo la estructura PICO, se realizó una búsqueda de novo priorizando revisiones sistemáticas con o sin meta-análisis, seguida de estudios primarios, la elaboración de las tablas de evidencia y la evaluación de la calidad global para los desenlaces de las preguntas clínicas se realizó siguiendo la metodología GRADE. Resultados: Se formularon 5 preguntas PICO correspondientes al manejo inicial y manejo sistémico con 18 recomendaciones respecto al método más efectivo para el diagnóstico patológico, el drenaje biliar y el tratamiento sistémico más efectivo y seguro en el escenario neoadyuvante, adyuvante y metastásico. Conclusiones: El presente artículo resume la metodología y las recomendaciones basadas en evidencia de la GPC para el manejo multidisciplinario del Adenocarcinoma de páncreas de la Red de Clínicas AUNA

Caracterización del revisor fiscal en la empresa cooperativa

Trabajo de grado para la obtención del título de Contador PúblicoEl objetivo principal de este artículo es identificar la importancia del revisor fiscal y sus funciones en la empresa cooperativa. Con el paso del tiempo la figura del revisor fiscal se ha venido fortaleciendo en este sector, debido al control que legalmente los entes de vigilancia han implementado para minimizar todo riesgo que se pueda presentar con el desarrollo económico y social de estas organizaciones. Teniendo en cuenta el modelo asociativo de la economía solidaria y la importancia que tienen los asociados como dueños, gestores y usuarios.Resumen Ejecutivo.... 2 Introducción.... 4 Justificación.... 5 Capítulo 1.... 8 Objetivos.... 8 Objetivo General.... 8 Objetivos Específicos.... 8 Cronograma de Actividades.... 9 Capítulo 2.... 11 Marco Referencial.... 11 Antecedentes de la Revisoría Fiscal.... 13 Funciones del Revisor Fiscal.... 18 Responsabilidades del Revisor Fiscal.... 26 Marco Conceptual y Normativo.... 28 Metodología.... 89 Conclusiones.... 92 Recomendaciones.... 93 Referencias.... 9

Plan de negocios para la implementación de un servicio de hospitalización domicilaria en el ámbito de Lima Metropolitana

La creación de HaD (Hospitalización a Domicilio) es un modelo de negocio innovador y pionero en nuestro país, contribuyendo a solucionar un problema serio en el sector salud, como es una alta demanda de camas hospitalarias y un déficit de las mismas. El presente plan de negocios demuestra que nuestra empresa es viable, de acuerdo a las oportunidades del entorno y la propuesta del servicio, generando ventajas competitivas para satisfacer la demanda actual de los pacientes en Lima. El estudio de mercado realizado ha determinado que 60% de los encuestados tomaría el servicio, la principal preocupación de los encuestados es la seguridad y el punto crítico y de mayor preocupación para los prestadores es el servicio de emergencia. Se optó por la estrategia de operaciones de diferenciación del Servicio, considerando los siguientes atributos: Seguridad en la atención de salud de la hospitalización a domicilio, calidad en la atención, servicio oportuno de hospitalización a domicilio versus la hospitalización convencional los cuales buscan garantizar la posición corporativa de la empresa. En cuanto a los costos en relación a la hospitalización convencional supone un ahorro para el pagador del 30% sólo en hotelería y servicios médicos, lo cual le supone una ventaja frente a la hospitalización convencional. La estrategia de Marketing será B2B, y se desarrollarán estrategias conforme el servicio se posicione en el mercado. La propaganda se entregará fundamentalmente de forma directa a los clientes y se realizará reuniones de trabajo y venta del servicio con las IAFAS

AtLAST Science Overview Report

International audienceSubmillimeter and millimeter wavelengths provide a unique view of the Universe, from the gas and dust that fills and surrounds galaxies to the chromosphere of our own Sun. Current single-dish facilities have presented a tantalising view of the brightest (sub-)mm sources, and interferometers have provided the exquisite resolution necessary to analyse the details in small fields, but there are still many open questions that cannot be answered with current facilities. In this report we summarise the science that is guiding the design of the Atacama Large Aperture Submillimeter Telescope (AtLAST). We demonstrate how tranformational advances in topics including star formation in high redshift galaxies, the diffuse circumgalactic medium, Galactic ecology, cometary compositions and solar flares motivate the need for a 50m, single-dish telescope with a 1-2 degree field of view and a new generation of highly multiplexed continuum and spectral cameras. AtLAST will have the resolution to drastically lower the confusion limit compared to current single-dish facilities, whilst also being able to rapidly map large areas of the sky and detect extended, diffuse structures. Its high sensitivity and large field of view will open up the field of submillimeter transient science by increasing the probability of serendipitous detections. Finally, the science cases listed here motivate the need for a highly flexible operations model capable of short observations of individual targets, large surveys, monitoring programmes, target of opportunity observations and coordinated observations with other observatories. AtLAST aims to be a sustainable, upgradeable, multipurpose facility that will deliver orders of magnitude increases in sensitivity and mapping speeds over current and planned submillimeter observatories

AtLAST Science Overview Report

International audienceSubmillimeter and millimeter wavelengths provide a unique view of the Universe, from the gas and dust that fills and surrounds galaxies to the chromosphere of our own Sun. Current single-dish facilities have presented a tantalising view of the brightest (sub-)mm sources, and interferometers have provided the exquisite resolution necessary to analyse the details in small fields, but there are still many open questions that cannot be answered with current facilities. In this report we summarise the science that is guiding the design of the Atacama Large Aperture Submillimeter Telescope (AtLAST). We demonstrate how tranformational advances in topics including star formation in high redshift galaxies, the diffuse circumgalactic medium, Galactic ecology, cometary compositions and solar flares motivate the need for a 50m, single-dish telescope with a 1-2 degree field of view and a new generation of highly multiplexed continuum and spectral cameras. AtLAST will have the resolution to drastically lower the confusion limit compared to current single-dish facilities, whilst also being able to rapidly map large areas of the sky and detect extended, diffuse structures. Its high sensitivity and large field of view will open up the field of submillimeter transient science by increasing the probability of serendipitous detections. Finally, the science cases listed here motivate the need for a highly flexible operations model capable of short observations of individual targets, large surveys, monitoring programmes, target of opportunity observations and coordinated observations with other observatories. AtLAST aims to be a sustainable, upgradeable, multipurpose facility that will deliver orders of magnitude increases in sensitivity and mapping speeds over current and planned submillimeter observatories

AtLAST Science Overview Report

International audienceSubmillimeter and millimeter wavelengths provide a unique view of the Universe, from the gas and dust that fills and surrounds galaxies to the chromosphere of our own Sun. Current single-dish facilities have presented a tantalising view of the brightest (sub-)mm sources, and interferometers have provided the exquisite resolution necessary to analyse the details in small fields, but there are still many open questions that cannot be answered with current facilities. In this report we summarise the science that is guiding the design of the Atacama Large Aperture Submillimeter Telescope (AtLAST). We demonstrate how tranformational advances in topics including star formation in high redshift galaxies, the diffuse circumgalactic medium, Galactic ecology, cometary compositions and solar flares motivate the need for a 50m, single-dish telescope with a 1-2 degree field of view and a new generation of highly multiplexed continuum and spectral cameras. AtLAST will have the resolution to drastically lower the confusion limit compared to current single-dish facilities, whilst also being able to rapidly map large areas of the sky and detect extended, diffuse structures. Its high sensitivity and large field of view will open up the field of submillimeter transient science by increasing the probability of serendipitous detections. Finally, the science cases listed here motivate the need for a highly flexible operations model capable of short observations of individual targets, large surveys, monitoring programmes, target of opportunity observations and coordinated observations with other observatories. AtLAST aims to be a sustainable, upgradeable, multipurpose facility that will deliver orders of magnitude increases in sensitivity and mapping speeds over current and planned submillimeter observatories

AtLAST Science Overview Report

International audienceSubmillimeter and millimeter wavelengths provide a unique view of the Universe, from the gas and dust that fills and surrounds galaxies to the chromosphere of our own Sun. Current single-dish facilities have presented a tantalising view of the brightest (sub-)mm sources, and interferometers have provided the exquisite resolution necessary to analyse the details in small fields, but there are still many open questions that cannot be answered with current facilities. In this report we summarise the science that is guiding the design of the Atacama Large Aperture Submillimeter Telescope (AtLAST). We demonstrate how tranformational advances in topics including star formation in high redshift galaxies, the diffuse circumgalactic medium, Galactic ecology, cometary compositions and solar flares motivate the need for a 50m, single-dish telescope with a 1-2 degree field of view and a new generation of highly multiplexed continuum and spectral cameras. AtLAST will have the resolution to drastically lower the confusion limit compared to current single-dish facilities, whilst also being able to rapidly map large areas of the sky and detect extended, diffuse structures. Its high sensitivity and large field of view will open up the field of submillimeter transient science by increasing the probability of serendipitous detections. Finally, the science cases listed here motivate the need for a highly flexible operations model capable of short observations of individual targets, large surveys, monitoring programmes, target of opportunity observations and coordinated observations with other observatories. AtLAST aims to be a sustainable, upgradeable, multipurpose facility that will deliver orders of magnitude increases in sensitivity and mapping speeds over current and planned submillimeter observatories