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Garcia-Sureda L.,University of the Balearic Islands | Juan C.,University of the Balearic Islands | Juan C.,Hospital Universitario Son Dureta | Domenech-Sanchez A.,University of the Balearic Islands | Alberti S.,University of the Balearic Islands
Antimicrobial Agents and Chemotherapy | Year: 2011

To investigate the contribution of LamB in Klebsiella pneumoniae antimicrobial resistance, we determined the MICs of various antibiotics and the frequency of mutation to increased cefoxitin or meropenem resistance of the strains CSUB10S (expressing only OmpK36), CSUB10R (lacking OmpK35 and OmpK36), and their derived isogenic insertion-duplication mutants deficient in LamB. Expression of LamB was indispensable in order for CSUB10S to lose OmpK36 and become resistant to cefoxitin, while in CSUB10R, LamB deficiency promoted increased resistance to carbapenem. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Duran-Garcia E.,Hospital General Universitario Gregorio Maranon | Santos-Ramos B.,Hospital Universitario Virgen Del Rocio | Puigventos-Latorre F.,Hospital Universitario Son Dureta | Ortega A.,University of Navarra
International Journal of Clinical Pharmacy | Year: 2011

Aim of the review To review the literature on the structure and operation of hospital Pharmacy and Therapeutics Committees from an international point of view and examine the factors that influence decisionmaking of these committees. Method We performed a literature search in the Medline and Embase databases from 1997 to January 2009 with the search terms: formulary system decision making, pharmacy and therapeutics committee, formularies hospital, drug formulary, survey, drug selection and outcome assessment health care. Inclusion criteria were the following: studies analyzing Pharmacy and Therapeutics Committees published in English or Spanish from 1997 to January 2009. Exclusion criteria were: publications which were editorials or opinion pieces, studies relating to one hospital, and studies where full text could not be attained. The analysis was divided into structural/organizational data and data on factors affecting the decision-making process. Results Seventeen studies met the inclusion criteria. Pharmacy and Therapeutics Committees and formularies were present in more than 90% of the hospitals in four of the five countries examined. Therapeutic interchange programs existed only in two of these countries. The mean number of committee members ranged between six and eight. More than 89% of the committees included a pharmacist. Standard operating procedures were implemented by 89% of the committees. The most influential factors in the decision-making were clinical trial results or drug costs rather than pharmacoeconomic studies. Other local organization-dependent factors were also important. Conclusions The structure and operating procedures of Hospital Pharmacy and Therapeutics Committees are similar in select Western countries. Information from clinical trials is the most influential factor in the decision-making process. © Springer Science+Business Media B.V. 2011.


Hernandez-Martin A.,Hospital Infantil Del Nino Jesus | Hernandez-Martin A.,Research Unit | Aranegui B.,Research Unit | Martin-Santiago A.,Hospital Universitario Son Dureta | Garcia-Doval I.,Research Unit
Journal of the American Academy of Dermatology | Year: 2013

Background The ichthyoses comprise a group of inherited disorders of keratinization. Because of the need for lifelong treatment, it is important that therapies are beneficial, safe, and well tolerated. Objectives We sought to review the evidence on existing treatments for the congenital ichthyoses, excluding ichthyosis vulgaris. Method We undertook a systematic review using the methodology of the Cochrane Collaboration. Articles published in MEDLINE, EMBASE, and CENTRAL and registered clinical trials were screened. Randomized controlled trials involving patients with the inherited ichthyoses, either syndromic or nonsyndromic but excluding ichthyosis vulgaris, were considered. Results Six trials met the inclusion criteria. Topical treatments including 5% urea, 20% propylene glycol alone or in combination with 5% lactic acid, calcipotriol ointment, and liarozole 5% cream showed therapeutic benefit. Oral liarozole, a retinoic acid metabolism blocking agent, showed no advantage over oral acitretin. Limitations Most studies were performed on a small sample of patients and lacked methodological and reporting quality. The small number of trials and the nearly constant positive results make publication bias likely. The absence of standardization of outcome measures precluded the comparison of studies. Conclusions Topical treatments including emollients, calcipotriol ointment, and liarozole cream seem to have therapeutic benefit and a good safety profile, although the use of topical calcipotriol is limited by a maximum weekly dose of 100 g. The advantage of oral liarozole over acitretin is uncertain. Multicenter trials comparing oral and topical interventions and evaluation of long-term outcomes are needed. © 2013 by the American Academy of Dermatology, Inc.


Puigventos F.,Hospital Universitario Son Dureta | Santos-Ramos B.,Hospital Universitario Virgen Del Rocio | Ortega A.,University of Navarra | Duran-Garcia E.,Hospital General Universitario Gregorio Maranon
Pharmacy World and Science | Year: 2010

Objective: Define the structure and working procedures of the Pharmacy and Therapeutic Committees (P&T Committees) in Spanish hospitals. Setting: Hospitals over 75 beds located in all regions of the Spanish State. Method: A cross-sectional descriptive study based on the completion of a questionnaire that consisted of 138 questions. The participants were recruited by post, e-mail and telephone between November 2007 and January 2008. The Hospitals were classified according to their size and public or private and university or non-university status. Main outcome measures: They are related with the structure and composition of the P&T Committees, performance, drug evaluation process, working methods and the results of their activity. Results: A total of 200 hospitals answered the questionnaire (response rate of 39.0% of hospitals and 57.1% of the beds in Spain). All the hospitals have P&T Committees, 99.5% have a Drug Formulary, 71.0% have a Therapeutic Interchange Programme and 91.0% have a document determining the mission, objectives and functions of the P&T Committee. Almost all hospitals (95.5%) have established a formal application for the inclusion of a drug in the hospital, while 80.5% have established a model for evaluation reports. The mean (SD) number of participants in P&T Committees was 11.84 (3.82). The annual mean of drugs evaluated per hospital was 10.35 (7.45). The proportion of assessments that concludes the inclusion, rejection or deferral of the decision was 75.3, 21.4 and 3.2%, respectively. Conclusion: Spanish P&T Committees have a similar structure and function, a multi-disciplinary professional composition to carry out an important assessment activity. This activity is higher in large hospitals and in university hospitals. The proportion of the approved and rejected drugs is similar in different types of hospital. The Therapeutic Interchange Guidelines, the use of application models and the reports follow the indications of scientific collaborative groups, thus being used more in Spain than in other countries. © 2010 Springer Science+Business Media B.V.


Bethencourt A.,Hospital Universitario Son Dureta | Sievert H.,CardioVascular Center Sankt Katharinen | Santoro G.,Azienda Ospedaliera Universitaria Careggi | Meier B.,University of Bern | And 5 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Background: In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long-term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Methods: Investigator-initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans-septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. Results: In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. Conclusion: The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA. © 2011 Wiley-Liss, Inc.

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