Browsing by Autor "Jorge García"

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Aplicación de la metodología de Legal Service Design de cara a contextos de derecho público vs. derecho privado
(2021) Angélica Flechas; Jorge García; Sofía Escobar
En Háptica hemos tenido la oportunidad de aplicar la metodología de Legal Service Design en espectros muy diversos del sector privado, los cuales involucran entre otros sectores el financiero, farmacéutico, tecnológico y retail. En el desarrollo de varios de estos proyectos, impactamos el sector público desde un rol que buscaba rediseñar la prestación de un servicio legal en un ámbito prevalecientemente privado, pero que tiene directa relación con lo público, como Diseñar documentos legales que requieren de la revisión de una entidad pública o de su uso constante, al ser una entidad de vigilancia de esta organización privada. Por otra parte, también hemos trabajado como consultores de entidades públicas, donde el objetivo ha sido rediseñar servicios y puntos de contacto legales para un contexto público de principio a fin. De estas experiencias, y al haber tenido la oportunidad de trabajar desde la visión de Legal Service Design en el Diseño de servicios públicos y privados, buscamos comparar ambos contextos con el fin de entender las similitudes y diferencias en la aplicación de la metodología y las herramientas de Diseño legal. Por lo tanto, la idea es que, a partir de la revisión de experiencias concretas, podamos verificar si intervenir un contexto público o privado debería requerir de cambios o adaptaciones considerables en el método. En el caso en que la respuesta a esta pregunta sea afirmativa, evaluaremos qué cambios estructurales hemos visto necesarios en el método y sus herramientas. En el caso en que sea negativa la respuesta, analizaremos en qué forma los retos de lo público se han adaptado a dichas herramientas y se ha cumplido con los objetivos no solo de Diseño sino también legales de un ecosistema público.
Effectiveness and safety of opioid-free anaesthesia and analgesia in pain control and postoperative recovery of patients undergoing gynaecologic oncologic surgery: a retrospective cohort study
(2024) Jorge García; Daniel Rivera Tocancipá; Elías Gracia; J Diaz; Francisco Javier Quinayas Pisso; Víctor Gil; Fredy Leonardo Carreño Hernández
<title>Abstract</title> <bold>Introduction:</bold> Opioids have been essential for the anesthesiologic management of patients undergoing surgical procedures such as gynecologic oncology. However, the use of opioids brings with it hemodynamic problems, which is why opioid-free anesthesia (OFA) and multimodal postoperative analgesia techniques that restrict the excessive use of opioids are necessary. <bold>Objective:</bold> To determine the effectiveness and safety of opioid-free anesthesia and analgesia in pain control and postoperative recovery of adult patients undergoing gynecologic oncology surgery. <bold>Methodology: </bold>A retrospective observational cohort study was conducted by reviewing the medical records of patients at the Neiva University Hospital. Female patients who underwent gynecologic oncology surgery at the Neiva University Hospital and who received OFA, or opioid-based anesthesia (OBA) were identified. Data on pain were collected using a visual analog pain scale (VAPS), along with hemodynamic variables and adverse events at 7 different times from admission to the operating room until discharge from the hospital. A bivariate analysis was performed for the type of anesthesia, comparing frequencies of VAPS and adverse events with chi2 and mean difference for hemodynamic variables with t student. A multivariate analysis was performed with multiple logistic regression to evaluate differences in frequency of pain by VAPS based on the anesthesia regimen and other clinical variables for statistical difference times. <bold>Results: </bold>Data were collected from 335 patients, of whom 196 (58.5%) received an OBA regimen and 139 (41.5%) an OFA regimen. A difference was identified for greater pain in OFA than in OBA (p<0.001) for the times before surgery, recovery discharge, and 24 hours after surgery. For heart rate, significant differences were only identified at admission to the operating room, 30 minutes of induction and admission to the recovery room. For respiratory rate, the differences were only significant at admission to the operating room, 30 minutes of induction. For mean arterial pressure, it was significant only in the recovery room and for oxygen saturation at admission to the operating room and discharge from recovery. As an adverse event, a higher frequency of requiring antiemetics was only identified in patients with AFO than with ABO on the fifth day of surgery. No significance was identified in multivariate analysis between OBA and OFA controlled for VAPS by other factors at 24 hours. <bold>Conclusions:</bold> Opioids for gynecologic oncologic surgery patients have a partial impact on pain control, with poor control upon discharge to recovery areas, at 24 and 48 hours, and no clinically relevant differences in hemodynamic variables or adverse events.