The Buen Retiro Park in Madrid: heritage value and citizen and tourist use

Tras la exposición de los objetivos y metodología, se realiza un comentario sobre la preservación del patrimonio en España, en particular de El Retiro, así como de la reciente presentación de la candidatura “Paseo del Prado y el Retiro. Paisaje de las Artes y las Ciencias” a la lista del Patrimonio Mundial de la UNESCO. La evolución de El Retiro ha ido de la mano de su desarrollo como Real Sitio. La descripción de su patrimonio permite conocer detalles de su historia hasta la actualidad, que ha configurado un magnífico entorno de gran exotismo en el corazón de Madrid. El análisis de los recursos y de la actividad turística y cultural que soporta, junto con los resultados de una encuesta realizada a los visitantes, evidencian su gran aceptación por parte de residentes y turistas; también la existencia de problemas en la gestión e información dirigida al público, que respectivamente repercuten en el mantenimiento y aprovechamiento de este espacio singular.After outlining the objectives, methodology and making brief allusion to concepts and laws in relation to the preservation of heritage in Spain, and the recent presentation of the candidacy “Paseo del Prado y el Retiro. Landscape of the Arts and Sciences” to the UNESCO World Heritage list, the article goes on to give a brief historical description of the evolution of the Retiro Park, since its origins, as a highly exotic Royalty Site in the heart of Madrid. An analysis of the park’sresources and the tourist and cultural activity offered in El Retiro is given together with the results of a survey carried out among visitors, showing the great acceptance of the site by residents and tourists alike but also highlighting the existence of certain management and information problems iwhich respectively affect the maintenance and use of this unique space

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