Diseño de un manual de estrategias metodológicas para la intervención del riesgo psicosocial basado en los aspectos intrapersonales de la Inteligencia emocional del personal adscrito al MNVCC de la Estación de Policía Cascajal del Distrito Especial de Policía Buenaventura

Diseño de un manual de estrategias metodológicas para la intervención del riesgo psicosocial

Diplomado en Servicios Públicos Domiciliarios

In the present work, addresses the contemporary view of the concept of domestic public services in Colombia, reviewing the public policies which make the rights of users effective, free competition, socio-environmental responsibility of companies providing public services, inclusion of the criterion of sustainability that is evidenced in aspects such as renewable energies and inclusion of management indicators of high environmental quality for companies providing the public service and finally the particularities of employment regimen in the context of privatization processes. Certainly, the management model for public utilities is in compliance with the regulatory guidelines redesigned in the 1990s and in turn is articulated with the model of sustainable development adopted in the Constitution, allowing the participation of both private capital and public capital for an optimal provision of the service, that responds to the basic principles of universality, low tariffs, continuity of service and efficiency. All of which gives rise to a series of specific legal relationships between the State and the companies that are governed by the concession contracts and by the state's regulatory authority, between the companies and their users, which is guided by uniform conditions contracts and between the companies and their workers with certain peculiarities in the employment regimen.En el presente trabajo aborda una visión contemporánea del concepto de los servicios públicos domiciliarios en Colombia, abordando las políticas públicas que hacen efectivos los derechos que de los usuarios, la libre competencia, la responsabilidad socio ambiental de las empresas prestadoras de servicios públicos, la inclusión del criterio de sostenibilidad que se evidencia en aspectos como energías renovables e inclusión de indicadores de gestión de alta calidad ambiental para las empresas prestadoras del servicio público y finalmente las particularidades de las relaciones laborales en el contexto de los procesos de privatización. Ciertamente, el modelo de gestión de los servicios públicos domiciliarios guarda observancia de las directrices regulatorias rediseñadas en los años noventa y a su vez se articula con el modelo de desarrollo sostenible adoptado en la Constitución Política, permitiendo la participación tanto de capital privado como por capital público para una óptima prestación del servicio que responda a los principios básicos de universalidad, continuidad en la prestación y eficiencia. Todo lo cual, da origen a una serie de relaciones jurídicas específicas entre el Estado con las empresas que se rige por los contratos de concesión y por la facultad regulatoria del Estado, ente las empresas y sus usuarios que se orienta por los contratos de condiciones uniformes y entre las empresas y sus trabajadores con ciertas particularidades en el régimen laboral

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)

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients