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Search Results: 1 - 10 of 32362 matches for " Antonio Artigas "
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Clinical review: Non-antibiotic strategies for preventing ventilator-associated pneumonia
Ricard Ferrer, Antonio Artigas
Critical Care , 2002, DOI: 10.1186/cc1452
Abstract: Ventilator-associated pneumonia (VAP) is the specific type of nosocomial pneumonia (NP) that occurs after the first 48 hours of initiating mechanical ventilation, and can be further differentiated into early VAP (<5 days after tracheal intubation) and late-onset VAP (>5 days after tracheal intubation) [1]. NP still remains the leading cause of death from hospital-acquired infections. Crude mortality rates range from 24% to 76% depending on the population and clinical setting studied [2,3,4,5].The average additional cost for NP was estimated to be as high as US$1255 per patient in 1982 [6]. A similar study in 1985 reported an average extra cost of US$2863 per patient and case of NP [7]. In trauma patients, this figure may eventually reach US$40,000 per patient [8]. It is almost impossible to directly evaluate extra costs associated with NP; however, the excess morbidity as a direct consequence of pneumonia may also be a good measurement.Initial reports found that NP extended the intensive care unit (ICU) stay threefold [9], whereas Jimenez et al. estimated the excess morbidity attributable to NP as between 10 and 32 days [10]. This figure was later corroborated by other workers. Leu et al. reported 9.2 days of additional hospital stay [11], and Fagon et al. calculated the median length of stay in the ICU for the patients that developed VAP to be 21 days, versus a median of 15 days for control patients [12]. Comparable figures were also reported for trauma patients with VAP [8].We may conclude from this data that prevention of NP is the most important step towards reducing hospitalisation costs. A variety of measures has been suggested for prevention of NP depending on the setting and the individual risk profile, non-antibiotic strategies being the main topic of this review (Table 1). These strategies are now outlined.Cross-contamination via the inoculation of bacteria into upper and lower airways is an exogenous mechanism in the aetiopathogenesis of NP, especially in
Introduction: severe sepsis and drotrecogin alfa (activated)
Antonio Artigas, Claude D Martin
Critical Care , 2007, DOI: 10.1186/cc6180
Abstract: Clinical trials conducted over more than half a century aimed at reducing the high acute morbidity and mortality rates associated with severe sepsis have shown that recombinant human activated protein C (rhAPC), or drotrecogin alfa (activated), is a treatment that reduces the overall mortality rate in patients with severe sepsis. However, this knowledge has been slow to spread, in part because of the complexity and heterogeneity of this condition, but also because rhAPC treatment is not without risks. Nevertheless, rhAPC is clearly a life-saving treatment, and the reduction in mortality far outweighs the risks involved.As outlined by the US Food and Drug Administration, rhAPC should be considered for patients with severe sepsis resulting in multiple organ failure who are at low risk for bleeding complications and high risk for death, as indicated by initial Acute Physiology and Chronic Health Evaluation or other measurement. Determining who to treat with rhAPC may be the biggest problem facing intensive care physicians.Since the publication of the positive results from the PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) trial, research into the protein C pathway has expanded significantly and additional clinical information about the uses of rhAPC and its specific activity have been reported. In this supplement to Critical Care, leading experts describe new insights into the role of the protein C pathway, along with clinical use of rhAPC and its results.The supplement begins with an article by Claessens and Dhainaut [6]. They review the main proposals of the Surviving Sepsis Campaign and focus on the difficulties in reaching the correct diagnosis and in providing appropriate treatment to septic patients at the right time.The next two articles focus on the protein C pathway and its clinical relevance. Levi and van der Poll [7] analyze the various mechanisms of action of rhAPC in sepsis. Given the central role played by inadequate
Overshadowing and potentiation of illness-based context conditioning
Joan Sansa,Antonio A. Artigas,Jose Prados
Psicológica , 2007,
Abstract: En cinco experimentos, se investigó el condicionamiento compuesto sabor-contexto empleando ratas como sujetos. Los animales fueron expuestos a un contexto novedoso en el que tenían acceso a una solución de ácido cítrico ó de sacarina antes de ser inyectados con LiCl. A continuación medimos la aversión condicionada al contexto empleando un procedimiento de bloqueo. Cuando el sabor que acompa aba al contexto durante el condicionamiento era relativamente aversivo (ácido cítrico) observamos un nivel relativamente bajo de condicionamiento contextual; de acuerdo con nuestra interpretación, el sabor ácido ensombreció al contexto. Por el contrario, cuando el sabor era agradable (solución de sacarina) se observó una potenciación del condicionamiento contextual. Nuestra discusión de los resultados toma en consideración las propiedades motivacionales del sabor que acompa a a contexto en el momento del condicionamiento.
Competencias requeridas para el ejercicio de las profesiones de la información: valoración de las listas relacionales de MERCOSUR y de la Unión Europea Competências requeridas para o exercício das Profiss es da Informa o: valora o das listas relacionais do Mercosul e da Uni o Européia
José Antonio Moreiro,Carlos Miguel Tejada Artigas
Informa??o & Informa??o , 2004, DOI: 10.5433/1981-8920.2004v9n0p
Abstract: A Sociedade da Informa o exige novas atitudes e desenvolvimento de competências necessárias para o bom desenvolvimento profissional, tendo como referência as profiss es que trabalham com informa o, assim como em rela o às necessidades empresariais referentes ao tratamento da informa o que necessitam e utilizam. As competências requeridas hoje, especificamente na área da Ciência da Informa o, s o necessidades a serem contempladas pela forma o universitária, principalmente nos cursos de gradua o. S o apresentadas no texto as competências profissionais em Biblioteconomia e Documenta o, de acordo com recomenda es do Conselho da Europa; as carências observadas na área; as competências definidas para o Mercosul e a Uni o Européia; assim como um projeto para o desenvolvimento dessas competências, co-nhecido pela sigla DECIDOC.
A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score
Rafael Fernandez, Francisco Baigorri, Gema Navarro, Antonio Artigas
Critical Care , 2006, DOI: 10.1186/cc5136
Abstract: A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome.We studied 1,521 patients with a mean age of 60.2 ± 17.8 years. The median (25–75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84–0.93) for the Sabadell score.The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.Mortality in the ward after intensive care unit (ICU) discharge is considered a quality parameter, and is commonly defined as a source of unexpected or avoidable mortality. Mortality has been reported to range from 6% to 27% [1] and can be related to factors occurring before or after the ICU stay. A worse outcome is associated with the physiological reserve before ICU admission [2], the type of illness, the intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge [3,4]. These data suggest that keeping at-risk patients in the ICU for a further 48 hours might reduce mortality after ICU discharge by 39% [5]. Accordingly, step-down units may reduce post-ICU mortality by avoiding inappropriate early discharges from the ICU [6]. It is also yet to be determined whether outreach teams have a favourable impact on the ward mortality rate in this specific popul
Characteristics and outcomes of cancer patients in European ICUs
Fabio Taccone, Antonio A Artigas, Charles L Sprung, Rui Moreno, Yasser Sakr, Jean-Louis Vincent
Critical Care , 2009, DOI: 10.1186/cc7713
Abstract: This was a substudy of the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a cohort, multicentre, observational study that included data from all adult patients admitted to one of 198 participating ICUs from 24 European countries during the study period. Patients were followed up until death, hospital discharge or for 60 days.Of the 3147 patients enrolled in the SOAP study, 473 (15%) had a malignancy, 404 (85%) had solid tumours and 69 (15%) had haematological cancer. Patients with solid cancers had the same severity of illness as the non-cancer population, but were older, more likely to be a surgical admission and had a higher frequency of sepsis. Patients with haematological cancer were more severely ill and more commonly had sepsis, acute lung injury/acute respiratory distress syndrome, and renal failure than patients with other malignancies; these patients also had the highest hospital mortality rate (58%). The outcome of all cancer patients was comparable with that in the non-cancer population, with a 27% hospital mortality rate. However, in the subset of patients with more than three failing organs, more than 75% of patients with cancer died compared with about 50% of patients without cancer (p = 0.01).In this large European study, patients with cancer were more often admitted to the ICU for sepsis and respiratory complications than other ICU patients. Overall, the outcome of patients with solid cancer was similar to that of ICU patients without cancer, whereas patients with haematological cancer had a worse outcome.Remarkable advances have been made in the early diagnosis and aggressive management of patients with malignancies, resulting in dramatic improvements in overall survival rates [1,2]. As a result, increasing numbers of patients are admitted to the intensive care unit (ICU), either for cancer-related complications or for treatment-associated side effects [3]. Several studies have reported very high mortality rates for cancer patients after a
The Barcelona Declaration from the World Alliance against Antibiotic Resistance: engagement of intensivists
Jean M Carlet, Antonio Artigas, Michael S Niederman, Antoni Torres, on behalf of World Alliance against Antibiotic Resistance
Critical Care , 2012, DOI: 10.1186/cc11427
Abstract: Microorganisms resistant to almost every antibiotic are already present in the ICUs of many countries, requiring the use of old and toxic antibiotics such as colistin [2]. We were usually saved from resistance in the past by the regular introduction of new compounds, but this time the pipeline is almost dry. No new antibacterial agent active against Gram-negative bacteria is expected in the next 5 years. We are therefore back in the situation of 50 years ago, and the risk of large epidemic outbreaks leading to a real pandemic with those multi-resistant bacteria is real. The European Centre for Diseases Control estimate is that 25,000 patients in Europe might die from infections due to resistant organisms every year. In most countries, people use too many antibiotics empirically - in particular, to treat viral infections such as pharyngitis, bronchitis, or urinary colonisation. To treat severe infections in the ICU, and for the sake of their patients, prescribers use broad-spectrum antibiotics empirically in order to prevent treatment failures - but they seldom re-evaluate this initial therapy even when it is not necessary or too broad, and they often treat for too long.It is time to react vigorously in order to protect and save antibiotics, and try to break this downward spiral of resistance. A strong cooperation between healthcare professionals - in both human and animal medicine - and consumers is therefore needed, providing simple but powerful and convincing information to the politicians and the public. Antibiotics must have a special status, with specific rules, regulations, and controls. Diagnostic tests must be developed to help clinicians know when not to treat, and to focus antibacterial therapy only on bacterial infections. Research must be facilitated, particularly to accelerate the development of new compounds. Infection control must be upgraded, in particular to emphasise the use of hand-rub alcoholic solutions, in the hospitals and in the community. Th
Coste-efectividad de drotrecogina alfa (activada) en el tratamiento de la sepsis grave en Espa?a
Sacristán,José A; Prieto,Luis; Huete,Teresa; Artigas,Antonio; Badia,Xavier; Chinn,Christopher; Hudson,Peter;
Gaceta Sanitaria , 2004, DOI: 10.1590/S0213-91112004000100009
Abstract: introduction: the prowess clinical trial has shown that treatment with drotrecogin alpha (activated) in patients with severe sepsis is associated with a reduction in the absolute risk of death compared with standard treatment. the aim of the present study was to assess the cost-effectiveness of drotrecogin alpha (activated) versus that of standard care in the treatment of severe sepsis in spain. patients and methods: a decision analysis model was drawn up to compare costs to hospital discharge and the long-term efficacy of drotrecogin alpha (activated) versus those of standard care in the treatment of severe sepsis in spain from the perspective of the health care payer. most of the information for creating the model was obtained from the prowess clinical trial. a two-fold baseline analysis was performed: a) for all patients included in the prowess clinical trial and b) for the patients with two or more organ failures. the major variables for clinical assessment were the reduction in mortality and years of life gained (ylg). cost-effectiveness was expressed as cost per ylg. a sensitivity analysis was applied using 3% and 5% discount rates for ylg and by modifying the patterns of health care, intensive care unit costs, and life expectancy by initial co-morbidity and therapeutic efficacy of drotrecogin alpha (activated). results: treatment with drotrecogin alfa (activated) was associated with a 6.0% drop in the absolute risk of death (p = 0.005) when all of the patients from the prowess trial were included and with a 7.3% reduction (p = 0.005) when the analysis was restricted to patients with two or more organ failures. the cost-effectiveness of drotrecogin alfa (activated) was euros 13,550 per ylg with respect to standard care after analysing all of the patients and euros 9,800 per ylg in the group of patients with two or more organ failures. in the sensitivity analysis, the results ranged from 7,322 to euros 16,493 per ylg. the factors with the greatest impact on the
Seroprevalencia de Toxoplasma gondii en donantes de sangre en la provincia de Guantánamo Seroprevalence of Toxoplasma gondii in blood donors from the province of Guantánamo
Rolando Sánchez Artigas,Walter Góngora Amores,Yordana Goya Batista,Antonio Miranda Cruz
Revista Cubana de Investigaciones Biom??dicas , 2012,
Abstract: Los riesgos de contaminación con Toxoplasma gondii a través de las transfusiones, están incrementados por la incidencia de este parásito en donantes y la tolerancia de este a los procesos de preparación y almacenamiento de la sangre, por lo que resulta peligroso para los grupos de riesgo. Esta enfermedad no es de declaración obligatoria en Cuba. El interés de conocer el comportamiento epidemiológico de esta parasitosis nos condujo a estudiar 562 muestras de donantes de sangre de la provincia de Guantánamo, donde resultaron positivos para IgG anti T. gondii el 47,0 %, con más del 62 % de positividad en los municipios de Baracoa y Maisí, con mayor prevalencia en áreas rurales. Los valores de seropositividad observados en los grupos etários estudiados y la relación entre sexo no fue significativa, aunque el contacto con el parásito en el grupo de edad entre 18 y 40 a os fue superior. Estos datos seroepidemiológicos alertan sobre la necesidad de proponer acciones de control en el uso de hemoderivados en los grupos de riesgo. The risk of contamination with Toxoplasma gondii via blood transfusion is increased by the incidence of this parasite in donors and its tolerance to blood processing and storage processes, which turns it into a hazard for risk groups. This disease is not notifiable in Cuba. The interest in learning about the epidemiological behavior of this parasitosis led us to study 562 blood donor samples from the province of Guantánamo, 47.0 % of which tested positive for anti-T. gondii IgG, with over 62 % positivity in the municipalities of Baracoa and Maisí, and higher prevalence in rural areas. Neither the seropositivity values found in the age groups studied nor their sex distribution were significant, though contact with the parasite was higher in the 18-40 age group. These seroepidemiological data point to the need to propose control actions for the use of blood products in risk groups.
Barrier-Protective Effects of Activated Protein C in Human Alveolar Epithelial Cells
Ferranda Puig, Gemma Fuster, Mélanie Adda, Lluís Blanch, Ramon Farre, Daniel Navajas, Antonio Artigas
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0056965
Abstract: Acute lung injury (ALI) is a clinical manifestation of respiratory failure, caused by lung inflammation and the disruption of the alveolar-capillary barrier. Preservation of the physical integrity of the alveolar epithelial monolayer is of critical importance to prevent alveolar edema. Barrier integrity depends largely on the balance between physical forces on cell-cell and cell-matrix contacts, and this balance might be affected by alterations in the coagulation cascade in patients with ALI. We aimed to study the effects of activated protein C (APC) on mechanical tension and barrier integrity in human alveolar epithelial cells (A549) exposed to thrombin. Cells were pretreated for 3 h with APC (50 μg/ml) or vehicle (control). Subsequently, thrombin (50 nM) or medium was added to the cell culture. APC significantly reduced thrombin-induced cell monolayer permeability, cell stiffening, and cell contraction, measured by electrical impedance, optical magnetic twisting cytometry, and traction microscopy, respectively, suggesting a barrier-protective response. The dynamics of the barrier integrity was also assessed by western blotting and immunofluorescence analysis of the tight junction ZO-1. Thrombin resulted in more elongated ZO-1 aggregates at cell-cell interface areas and induced an increase in ZO-1 membrane protein content. APC attenuated the length of these ZO-1 aggregates and reduced the ZO-1 membrane protein levels induced by thrombin. In conclusion, pretreatment with APC reduced the disruption of barrier integrity induced by thrombin, thus contributing to alveolar epithelial barrier protection.
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