Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético

Analizar los costos y la efectividad del uso de sistemas de presión negativa comparado con sistemas de oxigenoterapia tópica y nepidermina en el tratamiento de las úlceras de pie diabético en Colombia

Autores:
Maloof Roa, Cesar Augusto
Olivares Cerpa, Fánika de Jesús
Tipo de recurso:
Fecha de publicación:
2023
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
spa
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/10632
Acceso en línea:
https://hdl.handle.net/11323/10632
https://repositorio.cuc.edu.co
Palabra clave:
Costo-Efectividad
Análisis
Oxigenoterapia
Úlceras
Diabetes
RCEI
Rights
openAccess
License
Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
id RCUC2_d0a33aa42d6c96298fcac0a93a2ea3da
oai_identifier_str oai:repositorio.cuc.edu.co:11323/10632
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
title Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
spellingShingle Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
Costo-Efectividad
Análisis
Oxigenoterapia
Úlceras
Diabetes
RCEI
title_short Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
title_full Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
title_fullStr Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
title_full_unstemmed Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
title_sort Análisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabético
dc.creator.fl_str_mv Maloof Roa, Cesar Augusto
Olivares Cerpa, Fánika de Jesús
dc.contributor.advisor.none.fl_str_mv ALVIS ZAKZUK, NELSON RAFAEL
dc.contributor.author.none.fl_str_mv Maloof Roa, Cesar Augusto
Olivares Cerpa, Fánika de Jesús
dc.contributor.corporatename.spa.fl_str_mv Universidad de la Costa
dc.contributor.jury.none.fl_str_mv Beltrán Venegas, Tulia
Alvis Guzmán, Nelson
Orozco Africano, Julio
dc.subject.proposal.spa.fl_str_mv Costo-Efectividad
Análisis
Oxigenoterapia
Úlceras
Diabetes
RCEI
topic Costo-Efectividad
Análisis
Oxigenoterapia
Úlceras
Diabetes
RCEI
description Analizar los costos y la efectividad del uso de sistemas de presión negativa comparado con sistemas de oxigenoterapia tópica y nepidermina en el tratamiento de las úlceras de pie diabético en Colombia
publishDate 2023
dc.date.accessioned.none.fl_str_mv 2023-12-11T21:08:21Z
dc.date.available.none.fl_str_mv 2023-12-11T21:08:21Z
dc.date.issued.none.fl_str_mv 2023
dc.type.spa.fl_str_mv Trabajo de grado - Maestría
dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/11323/10632
dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv REDICUC - Repositorio CUC
dc.identifier.repourl.spa.fl_str_mv https://repositorio.cuc.edu.co
url https://hdl.handle.net/11323/10632
https://repositorio.cuc.edu.co
identifier_str_mv Corporación Universidad de la Costa
REDICUC - Repositorio CUC
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv Gordillo GM, Sen CK. Evidence-based recommendations for the use of topical oxygen therapy in the treatment of lower extremity wounds. International Journal of Lower Extremity Wounds. el 14 de junio de 2009;8(2):105–11. IWGDF. Practical guidelines on the prevention and management of diabetes related foot disease. IWGDF 2023 updates [Internet]. [citado el 7 de octubre de 2022]. Disponible en: https://iwgdfguidelines.org/guidelines-2023/ Lazarus GS, Cooper DM, Knighton DR, Margolis DJ, Percoraro RE, Rodeheaver G, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair and Regeneration. el 1 de julio de 1994;2(3):165–70. Eaglstein WH, Falanga V. Chronic wounds. Surgical Clinics. el 1 de junio de 1997;77(3):689–700.
Gupta S, Sagar S, Maheshwari G, Kisaka T, Tripathi S. Chronic wounds Magnitude, Socioeconomic Burden and Consequences. Wounds Asia 2021 [Internet]. 2021 [citado el 8 de agosto de 2022];4(1):8–14. Disponible en: www.woundsasia.com
Olsson M, Järbrink K, Divakar U, Bajpai R, Upton Z, Schmidtchen A, et al. The humanistic and economic burden of chronic wounds: A systematic review. Wound Repair and Regeneration. el 1 de enero de 2019;27(1):114–25
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Li S, Liu Y, Huang Z, Kou Y, Hu A. Efficacy and safety of nano-silver dressings combined with recombinant human epidermal growth factor for deep seconddegree burns: A meta-analysis. Burns. el 1 de mayo de 2021;47(3):643–53. Yip WL. Influence of oxygen on wound healing. Int Wound J. 2015;12(6):620–4. Kimmel HM, Grant A, Ditata J. The Presence of Oxygen in Wound Healing. Wounds. 2016;28(8):264–70.
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Frykberg RG. Topical wound oxygen therapy in the treatment of chronic diabetic foot ulcers. Medicina (Lithuania). el 1 de septiembre de 2021;57(9). Ji S, Liu X, Huang J, Bao J, Chen Z, Han C, et al. Consensus on the application of negative pressure wound therapy of diabetic foot wounds. Burns Trauma [Internet]. el 1 de enero de 2021 [citado el 7 de octubre de 2023];9:18. Disponible en: https://dx.doi.org/10.1093/burnst/tkab018
Janssen AHJ, Wegdam JA, De Vries Reilingh TS, Eskes AM, Vermeulen H. Negative pressure wound therapy for patients with hard-to-heal wounds: a systematic review. J Wound Care. el 11 de abril de 2020;29(4):206–12. Wynn M, Freeman S. The efficacy of negative pressure wound therapy for diabetic foot ulcers: A systematised review. J Tissue Viability. el 1 de agosto de 2019;28(3):152–60.
Maranna H, Lal P, Mishra A, Bains L, Sawant G, Bhatia R, et al. Negative pressure wound therapy in grade 1 and 2 diabetic foot ulcers: A randomized controlled study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. el 1 de enero de 2021;15(1):365–71.
Frykberg RG. Topical Wound Oxygen Therapy in the Treatment of Chronic Diabetic Foot Ulcers. Medicina (B Aires). el 1 de septiembre de 2021;57(9). Singh D, Siddique HR. Role of Growth Factors in the Treatment of Diabetic Foot Ulceration. Diabetic Foot Ulcer. 2021;233–49.
Kaufman H, Gurevich M, Tamir E, Keren E, Alexander L, Hayes P. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience. J Wound Care. el 17 de julio de 2018;27(7):426–33.
Carter MJ, Frykberg RG, Oropallo A, Sen CK, Armstrong DG, Nair HK, et al. Efficacy of Topical Wound Oxygen Therapy in Healing Chronic Diabetic Foot Ulcers: Systematic Review and Meta-Analysis. Wound. el 21 de junio de 2022; Serena TE, Bullock NM, Cole W, Lantis J, Li L, Moore S, et al. Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial. J Wound Care. el 12 de mayo de 2021;30:S7–14.
He S, Liang C, Yi C, Wu M. Therapeutic effect of continuous diffusion of oxygen therapy combined with traditional moist wound dressing therapy in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract. el 1 de abril de 2021;174. Tang TY, Mak MYQ, Yap CJQ, Boey JEC, Chan SL, Soon SXY, et al. An Observational Clinical Trial Examining the Effect of Topical Oxygen Therapy (NatroxTM) on the Rates of Healing of Chronic Diabetic Foot Ulcers (OTONAL Trial). Int J Low Extrem Wounds. el 6 de noviembre de 2021;15347346211053694.
Thanigaimani S, Singh T, Golledge J. Topical oxygen therapy for diabetes-related foot ulcers: A systematic review and meta-analysis. Diabetic Medicine. el 1 de agosto de 2021;38(8):e14585.
Cetinkaya OA, Celik SU, Boztug CY, Uncu H. Treatment of hard-to-heal leg ulcers with hyaluronic acid, sodium alginate and negative pressure wound therapy. J Wound Care. el 2 de julio de 2020;29(7):419–23.
Driver VR, Reyzelman A, Kawalec J, French M. A Prospective, Randomized, Blinded, Controlled Trial Comparing Transdermal Continuous Oxygen Delivery to Moist Wound Therapy for the Treatment of Diabetic Foot Ulcers. Ostomy Wound Manage. el 1 de abril de 2017;63(4):12–28
Frykberg RG, Franks PJ, Edmonds M, Brantley JN, Téot L, Wild T, et al. A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study. Diabetes Care. el 1 de marzo de 2020;43(3):616–24.
Niederauer MQ, Michalek JE, Liu Q, Papas KK, Lavery LA, Armstrong DG. Continuous diffusion of oxygen improves diabetic foot ulcer healing when compared with a placebo control: a randomised, double-blind, multicentre study. J Wound Care. el 12 de septiembre de 2018;27:S30–45.
Gomez-Villa R, Aguilar-Rebolledo F, Lozano-Platonoff A, Teran-Soto JM, Fabian-Victoriano MR, Kresch-Tronik NS, et al. Efficacy of intralesional recombinant human epidermal growth factor in diabetic foot ulcers in Mexican patients: A randomized double-blinded controlled trial. Wound Repair and Regeneration. el 1 de julio de 2014;22(4):497–503.
Fernández-Montequín JI, Valenzuela-Silva CM, Díaz OG, Savigne W, SanchoSoutelo N, Rivero-Fernández F, et al. Intra-lesional injections of recombinant human epidermal growth factor promote granulation and healing in advanced diabetic foot ulcers: multicenter, randomised, placebo-controlled, double-blind study. Int Wound J. el 1 de diciembre de 2009;6(6):432–43.
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Cacua Sánchez MT. Use of Human Recombinant Epidermal Growth Factor in Chronic Wounds: Experience in Colombia-Review Article. International Journal of Innovative Studies in Medical Sciences. 2020;
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Eriksson E, Liu PY, Schultz GS, Martins-Green MM, Tanaka R, Weir D, et al. Chronic wounds: Treatment consensus. Wound Repair and Regeneration. el 1 de marzo de 2022;30(2):156–71. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford university press; 2015. Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. 1a ed. Moreno Viscaya M, Mejia Mejia A, Castro Jaramillo HE, editores. Bogotá: Instituto de Evaluación Tecnológica en Salud - IETS;
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Espinosa O, Rodríguez-Lesmes P, Orozco L, Ávila Di, Enríquez H, Romano G, et al. Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy Plan. el 4 de marzo de 2022;37(3):359– 68.
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, et al. Implementing TIMERS: The race against hard-to-heal wounds. J Wound Care [Internet]. el 5 de marzo de 2019 [citado el 23 de junio de 2022];23(3):S1–52. Disponible en: https://www.magonlinelibrary.com/doi/10.12968/jowc.2019.28.Sup3a.S1 Gethin G, Probst S, Stryja J, Christiansen N. Evidence for person-centred care in chronic wound care: A systematic review and recommendations for practice. https://doi.org/1012968/jowc202029Sup9bS1 [Internet]. el 16 de septiembre de 2020 [citado el 23 de junio de 2022];29:S4–23. Disponible en: https://www.magonlinelibrary.com/doi/10.12968/jowc.2020.29.Sup9b.S1
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dc.publisher.program.spa.fl_str_mv Maestría en Gestión de Servicios de Salud
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spelling Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2ALVIS ZAKZUK, NELSON RAFAELMaloof Roa, Cesar AugustoOlivares Cerpa, Fánika de JesúsUniversidad de la CostaBeltrán Venegas, TuliaAlvis Guzmán, NelsonOrozco Africano, Julio2023-12-11T21:08:21Z2023-12-11T21:08:21Z2023https://hdl.handle.net/11323/10632Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.coAnalizar los costos y la efectividad del uso de sistemas de presión negativa comparado con sistemas de oxigenoterapia tópica y nepidermina en el tratamiento de las úlceras de pie diabético en ColombiaLista de Tablas y Figuras 9—Introducción 12-- Metodología 19-- Problema de Decisión 19--Población Objeto 19-- Intervención 19—Comparadores 20-- Desenlaces 20-- Pregunta de Evaluación Económica 20-- Horizonte Temporal 20—Perspectiva 21-- Tasa de Descuento 21-- Modelo de Decisión 21-- Diseño 21-- Supuestos del Modelo 24—Probabilidades 24--Desenlaces y Valoración 26-- Identificación, Medición y Valoración de los Costos 28-- Dispositivos y medicamento 29-- Interpretación de Resultados y Análisis de Sensibilidad 31--Resultados 34—Resultados del Caso Base 34-- Análisis de Sensibilidad 35--Discusión38--38 Conclusiones 42--Referencias 43-- Anexos 54-- Anexo 1. Descripción de las Tecnologías y Medicamento Evaluados 54-- Anexo 2. Búsqueda de Literatura Económica 55-- Anexo 3. Bitácora de Búsqueda de Estudios de Calidad de Vida 55--Magíster en Gestión de Servicios de SaludMaestría55 páginasapplication/pdfspaCorporación Universidad de la CostaCiencias de la saludBarranquillaMaestría en Gestión de Servicios de SaludAnálisis de costo-efectividad del uso de la terapia de presión negativa en el tratamiento del pie diabéticoTrabajo de grado - MaestríaTextinfo:eu-repo/semantics/masterThesishttp://purl.org/redcol/resource_type/TMinfo:eu-repo/semantics/acceptedVersionBarranquillaGordillo GM, Sen CK. Evidence-based recommendations for the use of topical oxygen therapy in the treatment of lower extremity wounds. International Journal of Lower Extremity Wounds. el 14 de junio de 2009;8(2):105–11. IWGDF. Practical guidelines on the prevention and management of diabetes related foot disease. IWGDF 2023 updates [Internet]. [citado el 7 de octubre de 2022]. Disponible en: https://iwgdfguidelines.org/guidelines-2023/ Lazarus GS, Cooper DM, Knighton DR, Margolis DJ, Percoraro RE, Rodeheaver G, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair and Regeneration. el 1 de julio de 1994;2(3):165–70. Eaglstein WH, Falanga V. Chronic wounds. Surgical Clinics. el 1 de junio de 1997;77(3):689–700.Gupta S, Sagar S, Maheshwari G, Kisaka T, Tripathi S. Chronic wounds Magnitude, Socioeconomic Burden and Consequences. Wounds Asia 2021 [Internet]. 2021 [citado el 8 de agosto de 2022];4(1):8–14. Disponible en: www.woundsasia.comOlsson M, Järbrink K, Divakar U, Bajpai R, Upton Z, Schmidtchen A, et al. The humanistic and economic burden of chronic wounds: A systematic review. Wound Repair and Regeneration. el 1 de enero de 2019;27(1):114–25Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. 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y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.

d.	Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:

i.	Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.

ii.	Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, los consagrados por la SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.

e.	Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, ACINPRO), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.

5. Representaciones, Garantías y Limitaciones de Responsabilidad.
A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.

6. Limitación de responsabilidad.
A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.

7. Término.

a.	Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.

b.	Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.

8. Varios.

a.	Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.

b.	Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.

c.	Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.

d.	Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.


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