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Abstract Background There is lack of evidence regarding safety, effectiveness and applicability of prehabilitation on cardiac surgery population, particularly in patients candidates to cardiac valve replacement. The aim of the study is to assess and compare the effect of a multimodal prehabilitation program on functional capacity in patients with severe aortic stenosis (AoS) and severe mitral regurgitation (MR) proposed for valve replacement surgery. Methods Secondary analysis from a randomised controlled trial whose main objective was to analyze the efficacy of a 4–6 weeks multimodal prehabilitation program in cardiac surgery on reducing postoperative complications. For this secondary analysis, only candidates for valve replacement surgery were selected. The primary outcome was the change in endurance time (ET) from baseline to preoperative assessment measured by a cycling constant work-rate cardiopulmonary exercise test. Results 68 patients were included in this secondary analysis, 34 (20 AoS and 14 MR) were allocated to the prehabilitation group and 34 (20 AoS and 14 MR) to control group. At baseline, patients with AoS had better left systolic ventricular function and lower prevalence of atrial fibrillation compared to MR (p = 0.022 and p = 0.035 respectively). After prehabilitation program, patients with MR showed greater improvement in ET than AoS patients (101% vs. 66% increase from baseline). No adverse events related to the prehabilitation program were observed. Conclusions A 4–6 week exercise training program is safe and overall improves functional capacity in patients with severe AoS and MR. However, exercise response is different according to the cardiac valve type disfunction, and further studies are needed to know the factors that predispose some patients to have better training response. Trial registration The study has been registered on the Registry of National Institutes of Health ClinicalTrials.gov (NCT03466606) (05/03/2018).

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.

Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. Methods: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. Results: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4–6) vs. 7 days (IQR, 5–9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23–25) vs. 35 days (IQR, 28–45) in the control cohort, p = 0.03). Conclusions: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.

Introduction Prehabilitation programmes that combine exercise training, nutritional support and emotional reinforcement (multimodal prehabilitation) have demonstrated efficacy reducing postoperative complications in the context of abdominal surgery. However, such programmes have seldom been studied in cardiac surgery, one of the surgeries associated with higher postoperative morbidity and mortality. This trial will assess the feasibility and efficacy in terms of reduction of postoperative complications and cost-effectiveness of a multimodal prehabilitation programme comparing to the standard of care in cardiac surgical patients.Methods and analysis This is a single-centre, randomised, open-label, controlled trial with a 1:1 ratio. Consecutive 160 elective valve replacement and/or coronary revascularisation surgical patients will be randomised to either standard of care or 4–6 weeks of multimodal prehabilitation that will consist in (1) two times/week supervised endurance and strength exercise training sessions, (2) promotion of physical activity and healthy lifestyle, (3) respiratory physiotherapy, (4) nutrition counselling and supplementation if needed, and (5) weekly mindfulness sessions. Baseline, preoperative and 3-month postoperative data will be collected by an independent blinded evaluator. The primary outcome of this study will be the incidence of postoperative complications.Ethics and dissemination This study has been approved by the Ethics Committee of Clinical investigation of Hospital Clinic de Barcelona (HCB/2017/0708). The results will be disseminated in a peer-reviewed journal.Trial registration number NCT03466606.

La sujeción de los suministradores de bienes y servicios a la normativa impuesta por los departamentos de defensa en materia de auditoría de contratos motiva que las empresas hayan desarrollado procedimientos específicos para la elaboración de las ofertas y para el suministro de información sobre costes y precios referentes a la ejecución del contrato. En el marco de la teoría institucional, el objetivo de este trabajo es analizar la incidencia que los procesos de auditorías de costes y precios tienen en los sistemas de información para la gestión y las repercusiones económicas en las empresas del sector de la defensa auditadas. El trabajo realizado es de naturaleza cualitativa y se ha empleado el estudio de caso como estrategia de investigación. Los principales hallazgos muestran que la aplicación de la auditoría de costes y precios por los Departamentos de Defensa ha originado cambios y adaptaciones en los sistemas de información para la gestión de las empresas de la industria de la defensa y en particular, en sus sistemas de cálculo de costes.

The current crisis, unsustainable growth, financial scandals involves reflection on the role of universities in the professional training, particularly those who have to manage businesses. On this issue, there is a perception that the teaching of ethics and corporate social responsibility (CSR) is insufficient (Baetz and Sharp, 2004; Kashyap et al., 2006). In this regard, universities play a fundamental role due both to the impact of the incorporation of CSR into the design of their study and research programs, and its incorporation into universities’ mission, vision, and corporate strategy (Muijen, 2004). Then, the present study focuses jon analyzing both the definition of educational objectives and skills development to be acquired by students as the level of inclusion of CSR offered by Spanish universities. In particular, the present paper focuses on analyzing reports verified by National Agency for Quality Assessment of degrees related to the organizational management area implemented in the 2010-2011 academic course, which degrees has been developed based on European Higher Education Area. Based on previous papers, the results of the present paper show that the Bologna process and the Higher Education reform in Spanish universities have promoted an increase of the presence of CSR in the business education.

La crisis actual, el crecimiento insostenible, los escándalos financieros, exigen una reflexión sobre el papel de las universidades en la formación de profesionales, particularmente de aquéllos que tienen que administrar y gestionar empresas. En este sentido, existe una percepción de que la formación en valores éticos y en una conducta socialmente responsable de estos profesionales es insuficiente (Baetz y Sharp, 2004; Kashyap et al., 2006). Es por ello que el presente trabajo se encarga de analizar, tanto la definición de objetivos y competencias a adquirir por los estudiantes, como la oferta formativa de las universidades españolas en materia de responsabilidad social (RSC). Para ello se tomará como referencia las memorias verificadas positivamente por la Agencia Nacional de Evaluación y Acreditación de la Calidad (ANECA) de los títulos más cercanos al ámbito de la gestión de organizaciones ofertados por las universidades españolas en el curso 2010/2011, momento en el cual comienza a impartirse los nuevos grados adaptados al Proceso de Bolonia, con la finalidad de comparar los resultados obtenidos con la literatura. Sobre este particular, el presente estudio muestra que la adaptación de la oferta formativa universitaria al Espacio Europeo de Educación Superior ha supuesto una mayor presencia de la RSC en los estudios universitarios. ABSTRACTThe Bologna process and the Higher Education reform: Has there been greater incorporation of Corporate Social Responsibility in business education in Spain?The current crisis, unsustainable growth, financial scandals involves reflection on the role of universities in the professional training, particularly those who have to manage businesses. On this issue, there is a perception that the teaching of ethics and corporate social responsibility (CSR) is insufficient (Baetz and Sharp, 2004; Kashyap et al., 2006). In this regard, universities play a fundamental role due both to the impact of the incorporation of CSR into the design of their study and research programs, and its incorporation into universities’ mission, vision, and corporate strategy (Muijen, 2004). Then, the present study focuses jon analyzing both the definition of educational objectives and skills development to be acquired by students as the level of inclusion of CSR offered by Spanish universities. In particular, the present paper focuses on analyzing reports verified by National Agency for Quality Assessment of degrees related to the organizational management area implemented in the 2010-2011 academic course, which degrees has been developed based on European Higher Education Area. Based on previous papers, the results of the present paper show that the Bologna process and the Higher Education reform in Spanish universities have promoted an increase of the presence of CSR in the business education.

El Fondo Semilla de Agua busca aumentar la efectividad de la inversión en la conservación de seis subcuencas para disminuir el azolvamiento de las presa Chicoasén y La Angostura en Chiapas, México. Para ello se calcula la aportación de sedimentos y erosión de cada subcuenca a las presas a través de la plataforma Soil and Water Assessment Tool, (SWAT) y de álgebra de mapas para la Ecuación Universal de Pérdida de Suelo (EUPS), respectivamente, lo anterior como insumo del taller de generación de criterios para seleccionar los sitios más adecuados a conservar. La superficie total del área de estudio es de 850770 ha de las cuales solo es sujeta a conservación 120 759,18 ha, es decir el 14%. . Palabras claves: conservación, erosión, presas, sedimentos, subcuencas.