Tecnologías de la información y la comunicación al servicio de la atención farmacéutica: “Tu farmacéutico de guardia”, una web por y para los pacientes / Information and communication technologies at the service of pharmaceutical care: «Your pharmacist on duty», a website by and for patients

Objetivo: Alineado con la recomendación de la OMS de incorporar a la atención sanitaria diferentes estrategias de salud digital, el objetivo es doble: describir las funcionalidades y recursos de una página web creada para formar e informar a los pacientes y analizar la actividad de la herramienta tras un periodo de funcionamiento de seis años.Material y métodos: Los pasos que se siguieron en la creación de la web fueron: 1) desarrollo del logotipo y sistema de marca; 2) creación de contenidos tanto escritos como audiovisuales y 3) campaña de lanzamiento. Para evaluar su uso se realizó un estudio descriptivo retrospectivo (septiembre 2015 – noviembre 2021) en el que se recogieron los indicadores clave de rendimiento.Resultados: La web se estructuró en 11 grupos de patologías disponiendo de información escrita (179 fichas) y audiovisual (61 videos) sobre medicamentos y un repositorio de temas actuales sobre la salud a modo de noticias (515 reseñas publicadas). Desde su lanzamiento se han registrado un total de 176.530 visitas por 150.004 usuarios diferentes. En noviembre de 2020 se rediseñó la web, optimizándola para móviles con un diseño de marca renovado; hecho que reportó un importante crecimiento de las visitas, siendo el móvil (74,9%) el dispositivo de visualización más utilizado en este último periodo. (AU)

Objectives: To write the functionalities and resources of a web page created to train and inform patients and to analyze the activity of the tool after a six-year operating period. These two objectives are aligned with the WHO recommendation to incorporate different digital health strategies into health care.Material and methods: To create the web page we followed the next steps: 1) development of the logo and brand system; 2) creation of written and audiovisual content and 3) launch campaign. To evaluate the use of the web page, a retrospective descriptive study was carried out (September 2015 – November 2021) and key performance indicators were collected.Results: The website was structured into 11 groups of pathologies, including written information (179 files) and audiovisual information (61 videos) about drugs and a repository of current health topics shown as news (515 published reviews). Since its launch, a total of 176,530 visits have been registered by 150,004 different users. In November 2020 the web was redesigned, optimizing it for mobile devices and with a renewed brand design. This update reported a significant growth in visits, with mobile phones being the most used display (74.9%) in this last period. (AU)

Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis / Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis

La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas (SEM) y el Servei Català de la Salut (CatSalut), han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia

Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis. / Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Microfluidics and catalyst particles.

In this review article, we discuss the latest advances and future perspectives of microfluidics for micro/nanoscale catalyst particle synthesis and analysis. In the first section, we present an overview of the different methods to synthesize catalysts making use of microfluidics and in the second section, we critically review catalyst particle characterization using microfluidics. The strengths and challenges of these approaches are highlighted with various showcases selected from the recent literature. In the third section, we give our opinion on the future perspectives of the combination of catalytic nanostructures and microfluidics. We anticipate that in the synthesis and analysis of individual catalyst particles, generation of higher throughput and better understanding of transport inside individual porous catalyst particles are some of the most important benefits of microfluidics for catalyst research.

Successful desensitization to cloxacillin in a patient with sepsis, with infective endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report.

WHAT IS KNOWN AND OBJECTIVE: Beta-lactam antibiotic (BLA) therapy is frequently needed to treat infective endocarditis (IE). Hypersensitive reactions to BLA restrict BLA therapy in allergic patients. In the current case, we aim to describe the utility of desensitization (DS) in this context. Although the evidence is limited, DS is recommended. CASE DESCRIPTION: This case report deals with a 79-year-old woman with a clinical suspicion of allergy to BLA and a methicillin-sensitive Staphylococcus aureus (MSSA) IE. A cloxacillin DS protocol was developed to enable treatment with cloxacillin. WHAT IS NEW AND CONCLUSION: Alternative antibiotic treatments may be less effective or not available in MSSA IE. In this case report, DS allowed optimal cloxacillin treatment.

Co-assembly of tetrapeptides into complex pH-responsive molecular hydrogel networks.

Here we prepare pH-responsive complex molecular hydrogels from oppositely charged tetrapeptidic components that can be pH-tuned resulting in interconversion between different networks. Two different systems are described based on tetrapeptides with an alternating sequence of non-polar (F) and polar (D or K) residues. Co-aggregated hydrogels are easily formed in situ at neutral pH whereas one-component networks are maintained after changing into acidic or basic pH. These systems have been applied for the pH selective release of two hydrophobic dyes - Methylene Blue and Bromothymol Blue - as drug models. Different release profiles have been observed depending on the characteristics of the network as well as the pH of the media. These materials offer great potential as multidrug carriers.

[Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology]. / Mejora del proceso farmacoterapéutico del paciente hospitalizado mediante la metodología Lean Seis Sigma.

BACKGROUND: Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. OBJECTIVE: To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. SCOPE: 1.000 beds tertiary hospital. DESIGN: prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. POPULATION AND SAMPLE: 131 patients with treatments prescribed within 24h after admission and with 4 drugs. VARIABLES: safety indicators (medication errors), and efficiency indicators (complaints and time delays). RESULTS: Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. CONCLUSIONS: An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects.

Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients.

Needleless valve connectors were introduced to avoid needlestick injuries in healthcare workers but some concerns exist about their microbiological safety. A randomised controlled trial was performed to assess hub colonisation affecting positive-pressure valve connectors (PPVCs) compared to conventional caps used for radial arterial catheters inserted into critically ill patients. Patients were randomly assigned either to the PPVC (Smartsite Plus positive bolus valve) or to the conventional cap group. Only catheters inserted for >24h were analysed. Of 100 consecutive arterial lines, 80 were inserted for >24h (mean insertion duration 5.8 days), 41 in the PPVC group and 39 in the conventional cap group. Catheter hubs were colonised in eight cases in the control group (20.5%) and in one case in the PPVC group (2.4%). Hub colonisation was caused by coagulase-negative staphylococci in all cases. No attributable bacteraemia was observed. In multivariate analysis, PPVC (odds ratio: 0.09; 95% confidence interval: 0.1-0.79; P=0.03) and use of the line for continuous haemodynamic monitoring (0.16; 0.03-0.89; P=0.037) were independently associated with a lower incidence of hub colonisation.

[Tetanus treated with continuous baclofen intrathecal perfusion]. / Tétanos tratado con perfusión continua de baclofeno intratecal.

After making a bibliographic search in our country and demonstrating the lack of original articles or communications on treatment with intrathecal baclofen for the generalized forms of tetanus, our objective is to present this treatment based on the successful experience of one clinical case. In relationship to the case, we review baclofen pharmacokinetic and pharmacodynamic effects and its possible utility in the treatment of tetanus.

Tétanos tratado con perfusión continua de baclofeno intratecal / Tetanus treated with continuous baclofen intrathecal perfusion

Tras realizar una búsqueda bibliográfica en nuestro país y constatar la ausencia de comunicaciones o artículos originales acerca del tratamiento con baclofeno intratecal para las formas generalizadas de tétanos, nuestro objetivo es dar a conocer dicho tratamiento, a través de la experiencia de un único caso clínico, con buen resultado. En relación con el caso, revisamos la farmacocinética y farmacodinamia del baclofeno y su posible utilidad en el tratamiento del tétanos

After making a bibliographic search in our country and demonstrating the lack of original articles or communications on treatment with intrathecal baclofen for the generalized forms of tetanus, our objective is to present this treatment based on the successful experience of one clinical case. In relationship to the case, we review baclofen pharmacokinetic and pharmacodynamic effects and its possible utility in the treatment of tetanus

Mycoplasma mycoides subsp. mycoides biotype large colony isolates from healthy and diseased goats: prevalence and typing.

Most severe goat mycoplasmosis outbreaks in France are caused by Mycoplasma mycoides subsp. mycoides biotype LC (MmmLC). However, MmmLC can also be recovered from ear canals of healthy goats or from bulk milk collected in herds showing no clinical signs of mycoplasmosis. To improve our understanding of how MmmLC strains are balanced between pathogenic ones and asymptomatically carried ones, descriptive epidemiological data were analysed, together with the genomic fingerprints of isolates generated using pulsed-field gel electrophoresis (PFGE). PGFE analyses were performed with isolates collected from the ear canals of goats or bulk milk in healthy herds, from individual clinical cases in different diseased herds at different times, and within a single herd during a severe outbreak, from various body sites including the ear canals at autopsy. Results showed that each isolate collected in healthy herds yielded a unique and characteristic PFGE profile. Isolates from diseased herds had profiles that were distinct for each outbreak and the group of 41 isolates from a single severe outbreak had 2 predominant PFGE profiles that persisted throughout the outbreak. These data suggest that while several distinct isolates are carried by healthy animals, only a few are responsible for the clinical signs observed within one herd during an outbreak. Whether this reflects differences in virulence between different field strains of MmmLC remains to be demonstrated.

Enzyme-linked immunosorbent assay with a Salmonella enteritidis antigen for differentiating infected from vaccinated poultry.

The specificity and sensitivity of indirect ELISA, based on the use of four different antigenic extracts obtained from a clinical isolate of Salmonella enteritidis, were compared with those obtained with the gm-flagellin based ELISA (IDEXX). A total of 116 serum samples from salmonellae free, naturally infected and vaccinated hens were studied. The results showed that the indirect ELISA, based on lipopolysaccharide (LPS), O-polysaccharide (PS) or membrane sediment (SD) antigens, enable the identification of a greater number of infected birds and discriminated field antibody responses from vaccinal ones better than the commercial IDEXX test. The indirect ELISA that used a O-polysaccharide rich fraction (PS) proved to be the most specific and sensitive test, suggesting that this indirect ELISA could be used to confirm IDEXX results, especially when the differentiation between vaccinated and infected poultry is required.

Vsp antigens and vsp-related DNA sequences in field isolates of Mycoplasma bovis.

The expression of the 1E5 epitope which is common to the three characterized variable lipoproteins VspA, VspB and VspC of Mycoplasma bovis type strain PG45 and the presence of vsp gene DNA sequences were assessed in field isolates randomly collected from cattle showing clinical manifestations due to M. bovis infection. Among 250 isolates tested, only four failed to react with mAb 1E5. Southern blot analysis of these four isolates and of 20 isolates expressing the 1E5 epitope were performed using synthetic oligonucleotide probes corresponding to a sequence located in the Vsp signal peptide coding region common to all known Vsp products or to selected regions of previously characterized vsp genes, vspA, vspE and vspF. The results demonstrate the presence of multiple vsp-related DNA sequences in all M. bovis field isolates tested and indicate that the vsp repertoire varies in size and composition among isolates.

Adaptive surface antigen variation in Mycoplasma bovis to the host immune response.

The variability of predominant Mycoplasma bovis surface antigens in the presence of specific immune pressure was analyzed in an in vitro assay to determine if M. bovis could escape immune destruction. We have shown that serum antibodies from immunized or experimentally infected calves and monoclonal antibodies which specifically react with previously characterized or as yet undefined major M. bovis membrane surface proteins cause repression of expression or shortening of the target protein, or induce switching to expression of an antigenically distinct variant protein. We have further demonstrated that removal of the inducing antibody results in reversion to the original phenotype. These results suggest that the level of expression and the length of M. bovis surface antigens in the host is modulated by cognate antibodies. According to the surface antigenic variation systems, random selection of preexisting variants resistant to antibody-mediated inhibition or direct regulation of gene expression may be means by which this organism evades host immune defences.

Variable expression and geographic distribution of Mycoplasma agalactiae surface epitopes demonstrated with monoclonal antibodies.

Species-specific monoclonal antibodies (MAbs) were developed against Mycoplasma agalactiae reference strain PG2 and French isolate P89 to study the in vitro expression of surface epitopes and to probe the antigenic profiles of 245 field isolates originating from 10 different countries. Colony immunostaining with MAbs on clonal lineage showed that 4 out of 9 species-specific epitopes exhibited a high rate of variation, demonstrating that M. agalactiae possesses a capacity for phenotypic diversification of its surface antigenicity. The emphasis was on dot immunobinding screening of the field isolates with MAbs recognizing permanently expressed epitopes. Eight different profiles could be defined. Great differences in epitope conservation were demonstrated with some area-specific strains completely lacking certain specific determinants. These results indicate that the antigenic variability of M. agalactiae relies not only upon surface switching mechanisms but also upon true epitope differences, partially related to the geographic origin of the isolates.

Genomic, protein homogeneity and antigenic variability of Mycoplasma agalactiae.

Eleven strains of Mycoplasma agalactiae differing in pathogenicity, animal species origin and geographic localisation, showed similar chromosome restriction profiles with four endonucleases. However the international reference strain PG2 showed a unique profile. The protein and antigenic variabilities of 31 strains of M. agalactiae were investigated using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting performed with naturally infected animal sera and purified antibodies against the 29 kDa protein. Protein profiles were similar but antigenic profiles could be separated into two main groups according to geographic origin: (i) strains isolated in south-west France and (ii) strains from north-east France. Some differences also occurred from strain to strain within each group. The antigenic profile variability found in immunoblotting, originated in two different phenomena: (i) some epitopes were expressed only in strains of one profile type and (ii) some other epitopes were common to all strains but located on several proteins which differed in number and molecular mass from one strain to another. The presence of epitopes which undergo phase variation in the same lineage of clones from a single cell is discussed.

Molecular epidemiology of Mycoplasma mycoides subsp. mycoides biotype Small Colony, the agent of contagious bovine pleuropneumonia.

Restriction endonuclease analysis (REA) and immunoblotting were used to compare field strains of Mycoplasma mycoides subsp. mycoides biotype Small Colony from different parts of Europe and Africa. Of the 27 strains tested by REA, the European ones (n = 15), except 3 from the Iberian peninsula, differed strikingly from the African ones (n = 10). Vaccinal strains T1-SR and KH3J had a unique REA pattern. Polyclonal immunoblot profiles of 46 strains appeared fairly similar. However most of the Italian strains (22 out of 24) shared a characteristic, in the 100 kDa area, unlike that of the other European strains. Immunoprofiles of the reference strain PG1 and vaccinal strain T1-SR were different from the others. These results allowed the determination of possible links between different geographic region of enzootic contagious bovine pleuropneumonia.

Genomic, protein and antigenic variability of mycoplasma bovis.

Restriction endonuclease analysis (REA) with three enzymes SmaI, PstI, BamHI- was used to identify 13 different genomic groups among 37 Mycoplasma bovis strains. One genomic group was comprised of 14 strains. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) patterns for one strain chosen from each genomic group and an international reference strain PG45 were all similar. Antigenic variability in M. bovis species was investigated by immunoblotting, using serum from a calf that had been naturally infected with M. bovis and three M. bovis-specific monoclonal antibodies--mAbs N2, I2 and 5D7. Twenty M. bovis field strains were tested, comprising one from each genomic group, six from the same genomic group and the reference strain. Antigenic profiles obtained with calf serum differed markedly one from the other, the heterogeneity being equally great among the strains belonging to the same genomic group as those coming from different groups. A stable antigen common to 164 out of 168 strains was detected by mAb N2, whilst with mAbs I2 and 5D7, two different membrane antigenic systems were demonstrated that were strikingly variable. These variations in expression occurred not only from one strain to another, but also within the same lineage of clones from a single cell.

[Use of nonradioactive probes to detect the gene for 3-aminoside-acetyltransferase type IV in strains of Escherichia coli and Salmonella spp]. / Utilisation de sondes non radioactives pour la détection du gène de la 3-aminoside-acétyltransférase type IV chez des souches de Escherichia coli et Salmonella spp.

Forty-three isolates of Escherichia coli, Salmonella dublin and S. thyphimurium of animal origin were studied by colony hybridization using an intragenic probe specific for the gene encoding 3-aminoglycoside acetyltransferase type IV, which confers resistance to apramycin and gentamicin. Non-radioactive biotinylated and sulphonated DNA probes were used. No false-positive results were found and the positive results obtained were in agreement with those previously revealed with radioactive probes.