Strengths-Weaknesses-Opportunities-Threats Analysis for a Pediatric Anesthesia Program

Background: Risk management in healthcare institutions begins by first identifying the potential risks within a certain organization or specific area and then goes on to develop further strategies to reduce harm. The most common tool for this type of analysis is Strengths–Weaknesses–Opportunities–Threats (SWOT). Methods: We conducted a SWOT analysis in our pediatric anesthesia program: key factors were identified in a matrix, prioritized in a score table, represented in a graph, and finally analyzed. Results: Items obtained partial scores from 20 to 120. The item “lack of clinical protocols” was given greater weight (60) and received a lower value (1), resulting in the highest partial score (60) among the negative key factors and indicating a need for greater efforts to improve this specific aspect. Conclusion: The SWOT tool proved effective in identifying safety and quality key factors, and it provided information for initiating an improvement program

Mecanismos de colaboración público - privada a través de entidades de la economía social

Los contratos públicos desempeñan una función esencial en las economías de los Estados miembros. El Parlamento Europeo cuantifica el volumen de contratación pública para la realización de obras y la prestación de servicios en 2.448 millones de euros, lo que convierte a este tipo de contratación en uno de los principales vectores de crecimiento económico, creación de empleo e innovación. En este contexto, las alianzas público-privadas se han desarrollado tradicionalmente con sociedades de capital cuyo principal objetivo es el ánimo de lucro repartible entre los socios. Alternativamente, en esta Guía se pretende reivindicar la incorporación de las cooperativas y de otras entidades de ES a este tipo de alianzas. En España se promueve la colaboración público-cooperativa tanto en la legislación estatal como en la Estrategia Española de la ES. Así, la Ley 27/1999 de Cooperativas reconoce como tarea de interés general la promoción, estímulo y desarrollo de las sociedades cooperativas y de sus estructuras de integración económica y representativa, en los términos establecidos por el art. 108. Por ello, la Disposición Adicional 11 de la citada Ley reconoce que el Ministerio competente en la materia elabora y lleva a cabo Programas anuales para el impulso, promoción y fomento del cooperativismo. En la misma línea, la Ley 5/2011 de 29 de marzo de ES (ES) reconoce la importancia de las empresas de este ámbito económico, así como la necesidad de su promoción en atención a sus fines y principios. Sin embargo, en la práctica se detectan ciertas rigideces en la materialización de este apoyo a través de colaboraciones público-cooperativas en forma de contratación pública. Esta ausencia es particularmente destacable en la medida en que los fines perseguidos por las entidades de ES y por las administraciones públicas se encuentran íntimamente vinculados y alineados, un ajuste que cobra mayor relevancia y pertinencia bajo la consideración del marco de objetivos delimitado por la Agenda 2030, conocidos como Objetivos de Desarrollo Sostenible (ODS). Las organizaciones de ES pretenden diseñar acciones dirigidas a atender las necesidades de las personas, el fin social, y de los miembros integrantes de la organización (sea ésta una administración pública, una cooperativa u otras entidades de la ES). Esto coincide con el espíritu que subyace a los ODS, que persigue superar el modelo económico imperante para priorizar la atención a las necesidades de las personas sobre otros objetivos de carácter financiero. Por tanto, con este proyecto se pretende explorar diferentes alternativas que permitan viabilizar y fomentar el desarrollo de alianzas público-cooperativas como mecanismo de fomento de las entidades de ES. Además, habida cuenta de que estas organizaciones han probado una mayor resiliencia en situaciones de grave crisis económica, este objetivo es particularmente importante en el contexto actual, en que se espera una crisis derivada de la situación de emergencia sanitaria de dimensiones tan desproporcionadas como desconocidas. Este trabajo se inscribe en un contexto general de demanda hacia el desarrollo de un nuevo paradigma económico que combine crecimiento económico y sostenibilidad, particularmente dirigido a la priorización de criterios sociales que permitan la atención de necesidades y la satisfacción de expectativas de personas y entornos. Esto es particularmente importante en el contexto actual de emergencia sanitaria y crisis económica, por cuanto las empresas de la ES han probado ser particularmente resilientes a las adversidades económicas. De igual forma, los retos que el Estado abordará a corto plazo, y a los que pretenderá responder con intervenciones públicas, determina la necesidad de general conocimiento multidisciplinar que permita mejora la calidad de las decisiones que se tomen, su idoneidad, eficacia y eficiencia. Lo cierto es que hasta fechas muy recientes nadie se había centrado en el análisis de las posibilidades de desarrollar alianzas estratégicas público-privadas con entidades de la economía social. En estos momentos el legislador español y especialmente el europeo, son conscientes de que las entidades de la economía social son el motor de cambio del modelo económico en la medida en que sus intereses se alinean con los intereses de las administraciones públicas, de mejor manera que las sociedades capitalistas con las que se han formalizado, tradicionalmente estas alianzas.Investigación financiada a través de la Línea nominativa: Laboratorio de Transformación Social ODS de Colaboración Público-Privada, Consellería d’Economia, Sostenible, Sectors Productius, Comerç i Treball ESNOMI/2022/22/46.La publicación es parte del Proyecto TED2021-129787B-I00, financiado por MCIN/AEI/10.13039/501100011033 y por la Unión Europea “NextGenerationEU”/PRTR, denominado COMUNIDADES DE AUTOCONSUMO CLAVE EN LA TRANSICION ENERGETICA y cuya IP es Mª José Vañó Vañó.Public procurement plays an essential role in the economies of the Member States. The European Parliament quantifies the volume of public procurement for works and services at 2,448 billion euros, making this type of procurement one of the main drivers of economic growth, job creation and innovation. In this context, public-private partnerships have traditionally been developed with capital companies whose main objective is the profit motive to be shared among the partners. Alternatively, this Guide intends to claim the incorporation of cooperatives and other HE entities to this type of alliances. In Spain, public-cooperative collaboration is promoted both in state legislation and in the Spanish Strategy for the SE. Thus, Law 27/1999 on Cooperatives recognizes as a task of general interest the promotion, encouragement and development of cooperative societies and their structures of economic and representative integration, in the terms established by Article 108. Along the same lines, Law 5/2011 of March 29 of ES (ES) recognizes the importance of companies in this economic sphere, as well as the need to promote them in accordance with their purposes and principles. However, in practice, certain rigidities are detected in the materialization of this support through public-cooperative collaborations in the form of public procurement. This absence is particularly noteworthy insofar as the aims pursued by HE entities and by public administrations are closely linked and aligned, an adjustment that becomes more relevant and pertinent under the consideration of the framework of objectives delimited by the 2030 Agenda, known as Sustainable Development Goals (SDGs). HE organizations aim to design actions aimed at addressing the needs of people, the social purpose, and the constituent members of the organization (be it a public administration, a cooperative or other HE entities). This coincides with the spirit underlying the SDGs, which seeks to overcome the prevailing economic model to prioritize attention to people's needs over other financial objectives. Therefore, this project aims to explore different alternatives to make viable and promote the development of public-cooperative alliances as a mechanism to promote HE entities. Moreover, given that these organizations have proven to be more resilient in situations of severe economic crisis, this objective is particularly important in the current context, in which a crisis is expected as a result of the health emergency of such disproportionate and unknown dimensions. This work is part of a general context of demand towards the development of a new economic paradigm that combines economic growth and sustainability, particularly aimed at the prioritization of social criteria that allow the attention of needs and the satisfaction of expectations of people and environments. This is particularly important in the current context of health emergency and economic crisis, as HE companies have proven to be particularly resilient to economic adversities. Similarly, the challenges that the State will address in the short term, and to which it will seek to respond with public interventions, determine the need for general multidisciplinary knowledge that will make it possible to improve the quality of the decisions taken, their appropriateness, effectiveness and efficiency. The truth is that until very recently no one had focused on analyzing the possibilities of developing strategic public-private alliances with social economy entities. At present, Spanish and especially European legislators are aware that social economy entities are the driving force for change in the economic model to the extent that their interests are better aligned with the interests of public administrations than those of the capitalist companies with which these associations have traditionally been formalized

The number of tree species on Earth

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global groundsourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are 73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness

The number of tree species on Earth.

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are ∼73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness

The number of tree species on Earth.

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are ∼73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness

Tapentadol retard en el dolor crónico intenso

Since the first orally administered morphine was introduced in Spain back in 1988 the bioavailability of potent opioid drugs to be administered via a route other than the intravenous one has increasingly evolved. Formulations allowing these drugs to be absorbed via the skin or oral mucosa have made a major difference in the administration of analgesic medication. Later still, novel immediate-release or controlled-release forms have finished off the positive efficacy and safety profile of these new opioid drugs. Tapentadol retard is a latest-generation, central-acting pain killer that was approved by the EMA (European Medicines Agency) in 2010 and recently by Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) for the treatment of severe chronic pain. The synergy between its two mechanisms of action - μ-opioid agonism and noradrenaline uptake inhibition -- allows approaching pain from two different physiological aspects. Tapentadol retard is rapidly absorbed following oral administration, and excreted almost exclusively by the kidneys. While the analgesic efficacy of other opioids, including codeine and tramadol, depend upon their metabolic actions, the analgesia resulting from tapentadol administration derives from its primary molecule's action, with no active metabolites involved. The papers analyzed in this review show the efficacy of tapentadol retard in the management of moderate to severe pain in patients with chronic low-back pain, chronic knee or hip osteoarthritis, and diabetic neuropathy. Regarding safety, this drug has a superior tolerability profile when compared to current opioid analgesics, which confers a significant potential for the treatment of pain resulting from chronic conditions. This literature review analyzes tapentadol retard's mechanism of action, pharmacokinetics, pharmacodynamics, efficacy, and safety, as well as its exchangeability for opioid pain killers.Desde la introducción en España de la primera morfina de administración oral, en el año 1988, se ha ido evolucionando en la biodisponibilidad de fármacos opioides potentes no administrados por vía endovenosa. Las formulaciones que permiten la absorción de estos fármacos por la piel o por la mucosa oral han supuesto un antes y un después en la administración de medicación analgésica. Posteriormente, las nuevas formas de liberación inmediata o liberación controlada han acabado de perfilar la seguridad y eficacia de estos nuevos fármacos opioides. Tapentadol retard es un fármaco analgésico de acción central de última generación, aprobado tanto por la EMA ("European Medicines Agency") en 2010 como recientemente por la Agencia Española de Medicamentos y Productos Sanitarios ("AEMPS") para el tratamiento del dolor crónico intenso. La sinergia de sus dos mecanismos de acción, el agonismo μ-opioide y la inhibición de la recaptación de noradrenalina permite abordar el dolor desde diferentes mecanismos fisiológicos. Tapentadol retard se absorbe rápidamente tras su administración oral y es excretado casi exclusivamente vía renal. Así como la eficacia analgésica de otros opioides, como codeína y tramadol dependen de su actividad metabólica, la analgesia producida por tapentadol se debe a la acción de la molécula principal, sin metabolitos farmacológicamente activos. Los trabajos analizados en esta revisión demuestran la eficacia de tapentadol retard en el tratamiento del dolor de moderado a intenso en pacientes con dolor lumbar crónico, dolor crónico por artrosis de rodilla o cadera y también en pacientes con dolor por neuropatía diabética. En aspectos de seguridad, este fármaco presenta un perfil de tolerabilidad superior al de los analgésicos opioides actuales, lo cual le confiere un potencial importante en el tratamiento de dolor por procesos crónicos. En esta revisión bibliográfica se hace análisis del mecanismo de acción de tapentadol retard, de su farmacocinética y farmacodinamia, eficacia y seguridad y de su intercambiabilidad respecto a analgésicos opioides