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Pérez-Torres D, Tamayo-Lomas LM, Domínguez-Gil González M, Almendros-Muñoz R, Sacristán-Salgado MA, González-González E, Berezo-García JA, Díaz-Rodríguez C, Canas-Pérez I, Lorenzo-Vidal B, Eiros-Bouza JM. [Antimicrobial stewardship program in an Intensive Care Unit: A retrospective observational analysis of the results 15 months after its implementation]. Rev Esp Quimioter 2023; 36:477-485. [PMID: 37253230 PMCID: PMC10586733 DOI: 10.37201/req/142.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We aim to evaluate the adherence rate to an Antimicrobial Stewardship Program (ASP) in an Intensive Care Unit (ICU), and to assess its effect on the use of antibiotics, quality indicators and clinical outcomes. METHODS Retrospective description of the interventions proposed by the ASP. We compared antimicrobial use, quality and safety indicators in an ASP versus a non-ASP period. The study was performed in a polyvalent ICU of a medium-size University Hospital (600 beds). We studied patients admitted to the ICU for any cause during the ASP period, provided that a microbiological sample aiming to diagnose a potential infection has been drawn, or antibiotics have been started. We elaborated and registered of non-mandatory recommendations to improve antimicrobial prescription (audit and feedback structure) and its registry during the ASP period (15 months, October 2018-December 2019). We compared indicators in a period with ASP (April-June 2019) and without ASP (April-June 2018). RESULTS We issued 241 recommendations on 117 patients, 67% of them classified as de-escalation type. The rate of adherence to the recommendations was high (96.3%). In the ASP period, the mean number of antibiotics per patient (3.3±4.1 vs 2.4±1.7, p=0.04) and the days of treatment (155 DOT/100 PD vs 94 DOT/100 PD, p <0.01) were reduced. The implementation of the ASP did not compromise patient safety or produce changes in clinical outcomes. CONCLUSIONS The implementation of an ASP is widely accepted in the ICU, reducing the consumption of antimicrobials, without compromising patient safety.
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Affiliation(s)
- D Pérez-Torres
- David Pérez-Torres, Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012 Valladolid, España Comisión Hospitalaria PROA, Gerencia de Atención Especializada de Valladolid Oeste, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012 Valladolid, Spain.
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Pisonero J, González-González E, García-Martín R, González-Aguilera D. Smartvessel: A New Extinguisher Prototype Based on New Materials and IoT Sensors. Sensors (Basel) 2023; 23:s23063134. [PMID: 36991844 PMCID: PMC10054406 DOI: 10.3390/s23063134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 05/31/2023]
Abstract
Smartvessel is an innovative fire extinguisher prototype supported by new materials and IoT technology that seeks to improve the functionality and efficiency of conventional fire extinguishers. Storage containers for gases and liquids are essential for industrial activity as they enable higher energy density. The main contributions of this new prototype are (i) innovation in the use of new materials that provide lighter and more resistant extinguishers, both mechanically and against corrosion in aggressive environments. For this purpose, these characteristics are directly compared in vessels made of steel, aramid fiber and carbon fiber with the filament winding technique. (ii) The integration of sensors that allow its monitoring and provide the possibility of predictive maintenance. The prototype is tested and validated on a ship, where accessibility is complicated and critical. For this purpose, different data transmission parameters are defined, verifying that no data are lost. Finally, a noise study of these measurements is carried out to verify the quality of each data. Acceptable coverage values are achieved with very low read noise, on average less than 1%, and a weight reduction of 30% is obtained.
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Affiliation(s)
- Javier Pisonero
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, 05003 Ávila, Spain
| | - Enrique González-González
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, 05003 Ávila, Spain
| | - Roberto García-Martín
- Department of Mechanical Engineering, Higher Polytechnic School of Zamora, Universidad de Salamanca, 49022 Zamora, Spain
| | - Diego González-Aguilera
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, 05003 Ávila, Spain
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González-González E, Galván-Román JM, García-Sanz Í, Casals F, Fernández-Bueno J, Real de Asúa D. Healthcare workers' perception of the usefulness of a healthcare ethics consultation service. Rev Clin Esp 2023; 223:10-16. [PMID: 36528057 DOI: 10.1016/j.rceng.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical ethics consultation services (CEC) have arisen from Healthcare Ethics Committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. MATERIALS AND METHODS This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. RESULTS A total of 213 professionals participated (mean age 44 ± 11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94% vs 61%; p < 0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94% v. 76%; p < 0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. CONCLUSIONS Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.
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Affiliation(s)
- E González-González
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
| | - J M Galván-Román
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Grupo de Trabajo en Bioética y Profesionalismo, Sociedad Española de Medicina Interna, Madrid, Spain
| | - Í García-Sanz
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Casals
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | - J Fernández-Bueno
- Servicio de Consultoría en Ética Clínica, Comité de Ética para la Asistencia Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain; Unidad de Cuidados Paliativos Hospitalarios, Hospital Universitario de La Princesa, Madrid, Spain
| | - D Real de Asúa
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain.
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González-González E, Alvarez MM, Márquez-Ipiña AR, Santiago GTD, Rodríguez-Martínez LM, Annabi N, Khademhosseini A. Anti-Ebola therapies based on monoclonal antibodies: current state and challenges ahead. Crit Rev Biotechnol 2017; 37:53-68. [PMID: 26611830 PMCID: PMC5568563 DOI: 10.3109/07388551.2015.1114465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The 2014 Ebola outbreak, the largest recorded, took us largely unprepared, with no available vaccine or specific treatment. In this context, the World Health Organization declared that the humanitarian use of experimental therapies against Ebola Virus (EBOV) is ethical. In particular, an experimental treatment consisting of a cocktail of three monoclonal antibodies (mAbs) produced in tobacco plants and specifically directed to the EBOV glycoprotein (GP) was tested in humans, apparently with good results. Several mAbs with high affinity to the GP have been described. This review discusses our current knowledge on this topic. Particular emphasis is devoted to those mAbs that have been assayed in animal models or humans as possible therapies against Ebola. Engineering aspects and challenges for the production of anti-Ebola mAbs are also briefly discussed; current platforms for the design and production of full-length mAbs are cumbersome and costly.
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Affiliation(s)
- E González-González
- Centro de Biotecnología-FEMSA, Tecnológico de Monterrey at Monterrey, Ave. Eugenio Garza Sada 2501 Sur Col. Tecnológico, CP 64849, Monterrey, Nuevo León, México
| | - MM Alvarez
- Centro de Biotecnología-FEMSA, Tecnológico de Monterrey at Monterrey, Ave. Eugenio Garza Sada 2501 Sur Col. Tecnológico, CP 64849, Monterrey, Nuevo León, México
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston 02139, MA, USA
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
| | - AR Márquez-Ipiña
- Centro de Biotecnología-FEMSA, Tecnológico de Monterrey at Monterrey, Ave. Eugenio Garza Sada 2501 Sur Col. Tecnológico, CP 64849, Monterrey, Nuevo León, México
| | - G Trujillo-de Santiago
- Centro de Biotecnología-FEMSA, Tecnológico de Monterrey at Monterrey, Ave. Eugenio Garza Sada 2501 Sur Col. Tecnológico, CP 64849, Monterrey, Nuevo León, México
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston 02139, MA, USA
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
| | - LM Rodríguez-Martínez
- Centro de Biotecnología-FEMSA, Tecnológico de Monterrey at Monterrey, Ave. Eugenio Garza Sada 2501 Sur Col. Tecnológico, CP 64849, Monterrey, Nuevo León, México
| | - N Annabi
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston 02139, MA, USA
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115
| | - A Khademhosseini
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston 02139, MA, USA
- Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston 02115, MA, USA
- Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, García JAA, Arranz MAG, García DL, González-González E, Puerta CV. Reflux patterns and risk factors of primary varicose veins’ clinical severity. Phlebology 2013; 28:153-61. [DOI: 10.1258/phleb.2011.011114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Primarily, to determine the association between the clinical severity of primary varicose veins and different reflux patterns in an anatomic and haemodynamic clinical study using duplex ultrasonography (DU). Secondly, to analyse the association of clinical severity with other aspects, such as risk factors for chronic venous insufficiency (CVI) and other concurrent diseases. Method A total of 2036 limbs were evaluated using DU. Clinical status was characterized by the CEAP (clinical, aetiological, anatomical and pathological elements) classification. The degree of clinical severity was grouped into two categories, mild to moderate CVI (C1–C3) and severe CVI, characterized by the presence of skin changes (C4–C6). We analysed the association of the different reflux patterns with CEAP status. Results Saphenofemoral junction (SFJ) reflux of the great saphenous vein (GSV) was associated with the most severe form of the disease (odds ratio [OR] = 2.96; confidence interval [CI] 95%: 2.2–3.8), whereas competent SFJ of the GSV with reflux from proximal veins (OR = 2; CI 95%: 1.4 –2.7) and the pure non-saphenous reflux (OR = 4.1; CI 95%: 1.8–9.0) were associated with mild to moderate CVI. Obesity increased the frequency of severe CVI 2.7 times (OR = 2.7; CI 95%: 1.6–4.6); being a woman also increased the frequency of more severe disease 1.3 times (OR = 1.3; CI 95%: 1.0–1.7). Conclusion Anatomical and haemodynamic studies by DU are postulated as a useful diagnostic tool that allow, by identifying the pattern of venous reflux of varicose pathology, characterization of the probable association to CVI clinical severity.
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Affiliation(s)
- M García-Gimeno
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | | | - S Tagarro-Villalba
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - E Ramalle-Gomara
- Department of Epidemiology, La Rioja Regional Authority, La Rioja
| | | | - M A González Arranz
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - D López García
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - E González-González
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - C Vaquero Puerta
- Department of Angiology and Vascular/Endovascular Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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González-González E, Ra H, Spitler R, Hickerson RP, Contag CH, Kaspar RL. Increased interstitial pressure improves nucleic acid delivery to skin enabling a comparative analysis of constitutive promoters. Gene Ther 2010; 17:1270-8. [PMID: 20463756 DOI: 10.1038/gt.2010.74] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nucleic acid-based therapies hold great promise for treatment of skin disorders if delivery challenges can be overcome. To investigate one mechanism of nucleic acid delivery to keratinocytes, a fixed mass of expression plasmid was intradermally injected into mouse footpads in different volumes, and reporter expression was monitored by intravital imaging or skin sectioning. Reporter gene expression increased with higher delivery volumes, suggesting that pressure drives nucleic acid uptake into cells after intradermal injections similar to previously published studies for muscle and liver. For spatiotemporal analysis of reporter gene expression, a dual-axis confocal (DAC) fluorescence microscope was used for intravital imaging following intradermal injections. Individual keratinocytes expressing hMGFP were readily visualized in vivo and initially appeared to preferentially express in the stratum granulosum and subsequently migrate to the stratum corneum over time. Fluorescence microscopy of frozen skin sections confirmed the patterns observed by intravital imaging. Intravital imaging with the DAC microscope is a noninvasive method for probing spatiotemporal control of gene expression and should facilitate development and testing of new nucleic acid delivery technologies.
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Affiliation(s)
- E González-González
- Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, Ajona J, González Arranz M, López García D, González-González E, Vaquero Puerta C. Reflux or not reflux? Reflexiones sobre la publicación anglosajona del término en las varices primarias de los miembros inferiores en relación con nuestro entorno. Angiología 2010. [DOI: 10.1016/s0003-3170(10)70017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Canche-Pool EB, Cortez-Gómez R, Flores-Mejía R, González-González E, González-Serrano ME, Lara-Rodríguez MC, Ledesma-Soto Y, Mendoza-Aguilar MD, Meza-Sánchez DE, Sánchez-García FJ, Silva-Sánchez A, Thompson-Bonilla MR, Trujillo-Vizuet MG, Wong-Baeza I. Probiotics and autoimmunity: an evolutionary perspective. Med Hypotheses 2007; 70:657-60. [PMID: 17720327 DOI: 10.1016/j.mehy.2007.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/05/2007] [Indexed: 11/28/2022]
Abstract
Probiotics are microorganisms that have demonstrated beneficial effects on human health. Probiotics are usually isolated from the commensal microflora that inhabits the skin and mucosas. We propose that probiotics represent the species of microorganisms that have established a symbiotic relationship with humans for the longest time. Cultural practices of ancient human societies used to favor that symbiosis and the transmission of probiotics from generation to generation. New practices, introduced as a result of industrialization, such as childbirth by surgical delivery, ingestion of pasteurized and synthetic compounds-supplemented food, cleaner homes, indiscriminate use of antibiotics and so on, have led in recent years to the replacement of probiotics by other microorganisms that are not as well adapted to the microenvironments of the human body. These newly settled microorganisms lack many of the beneficial effects of probiotics. Our hypothesis is that the sudden change (from an evolutive perspective) in human intestinal microflora may importantly contribute to the rise in the incidence of autoimmune diseases, observed in the last half a century.
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Affiliation(s)
- E B Canche-Pool
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala, Col. Sto. Tomás, México DF 11340, Mexico
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González-Sánchez M, González-González E, Molina F, Chiavarino AM, Rosato M, Puertas MJ. One gene determines maize B chromosome accumulation by preferential fertilisation; another gene(s) determines their meiotic loss. Heredity (Edinb) 2003; 90:122-9. [PMID: 12634817 DOI: 10.1038/sj.hdy.6800185] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Genotypes of high (H(m)) and low (L(m)) male B transmission rate (B-TR) were obtained. B-TR segregation in the F2 is reported, showing that the H(m) and L(m) lines differ in a single locus we call mBt (male B transmission), controlling B preferential fertilisation in maize. The egg cells control which one of the sperm nuclei is going to fertilise them, mBt(h) egg cells being preferentially fertilised by the sperm nucleus carrying the supernumerary B chromosomes (Bs). It is hypothesised that the mBt gene is involved in the normal fertilisation of maize but the parasitic Bs take advantage of the mBt(h) allele to increase their own transmission. Selection was also carried out when the Bs were transmitted on the female side (H(f) and L(f) lines). The F1 hybrids show that the gene(s) that we call fBt (female B transmission), controlling female B-TR, is located on the A chromosomes acting at diploid level, the fBt(l) allele(s) for low transmission being dominant. This allele causes the loss of Bs at meiosis, which is shown using a specific B molecular probe to determine B presence/absence in microspores of both lines and hybrids. Maize Bs are a nice example of intragenome conflict, because the mBt and fBt loci are a polymorphic system of attack and defence between A and B chromosomes.
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Affiliation(s)
- M González-Sánchez
- Departamento de Genética, Facultad de Biología, Universidad Complutense, 28040 Madrid, Spain
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