http://hdl.handle.net/10256/2945 Thu, 27 Jun 2019 03:35:39 GMT 2019-06-27T03:35:39Z http://dugi-doc.udg.edu:443/bitstream/id/55943/ http://hdl.handle.net/10256/2945 http://hdl.handle.net/10256/16676 Angio-seal versus manual compression concerning puncture site related complications in peripheral arterial disease Garcia-Mendaza Martinez de Icaya, Lydia Background: Endovascular surgery, allows us to treat and diagnose peripheral vascular disease of low extremity just with a minimal incision in the common femoral artery. Manual compression has been the gold standard for haemostasis of the puncture site, but in the early 1990s, Vascular Closure devices were introduced with the aim of reducing time to haemostasis, time of ambulation, time of discharge and intervention- related complications. However, its advantage over MC has not been extensively studied following interventional procedures. Objectives: The aim of this study is to compare the vascular puncture-site related complications, using a VCD (Angio-Seal) instead of manual compression. This results will be evaluated in the 30 days’ post-operative. Secondary objectives also include a diminution on the hospital discharge time, time to haemostasis and need for reintervention. Methods: Randomized, controlled clinical trial. The study will be carried out for 3 years (2019-2022). Participants: Patients diagnosed with peripheral arterial disease of the femoro- popliteal sector and indication for percutaneous transluminal angioplasty Tue, 01 Jan 2019 00:00:00 GMT http://hdl.handle.net/10256/16676 2019-01-01T00:00:00Z http://hdl.handle.net/10256/16675 Clinical audit: assessing the quality of ECG monitoring in DR-TB patients García Fernández, Antía INTRODUCTION: multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are diseases of global concerns which require treatments with complex combinations of drugs. These drugs are associated with several adverse effects (AEs). QTc prolongation is one of those AEs, and it is considered as a risk factor for developing Torsades de Pointe (TdP), an arrhythmia that can lead to sudden cardiac death (SCD). In order to prevent cardiac events, ECG monitoring is recommended in patients treated with QTc-prolonging drugs. DATA/METHODS: four of the main guidelines for ECG monitoring in drug-resistant tuberculosis (DR-TB) patients were reviewed to define the range of recommendations. We reviewed the case records of 10 DR-TB patients managed in the North Central London TB service between 2016 and 2018. We analysed the data to assess the quality of health care provided, including ECG monitoring, and interviewed clinical staff to determine possible barriers to ECG monitoring in daily clinical practice. RESULTS: the recommendations for ECG monitoring in the case of Bedaquiline (BDQ) and Delamanid (DLM) were similar in all four guidelines analysed, while recommendations for Clofazimine (CFZ) and Fluoroquinolones (FQs) where only considered in one of the four guidelines. The care provided at the clinic largely adhered to the recommended guidelines. However, sometimes the results and actions taken were not clearly accessible. For example, we found that only 79.23% of the ECGs performed were compiled in the clinical records. There were not found remarkable barriers in the daily clinical practice, and there is a good team work between nurses and doctors at the clinic. CONCLUSIONS: there is a lack of guidance for the frequency for ECG monitoring in patients on CFZ, FQs or more than one QTc-prolonging drug. There is a quality health care imparted by the clinical staff at the TB service assessed. Due to the complexity of adverse event-monitoring in patients with DR-TB, we propose a standard proforma to record these data during clinic visits. This measure could simplify the work of the clinical staff by providing easy access to previous results. Finally, we also propose to standardize the way ECGs should be storage, either in the patient’s folder or scanned into NHS platform Tue, 01 Jan 2019 00:00:00 GMT http://hdl.handle.net/10256/16675 2019-01-01T00:00:00Z http://hdl.handle.net/10256/16674 Arxius i fonts primàries: Girona, una ciutat històrica i emblemàtica Albes Fernández, Melissa; Caro Seseras, Sílvia; Gil Jiménez, Xènia; Hansen García, Naiara Aquesta és una proposta didàctica, dins l'àrea de Coneixement del medi Social i Cultural, on els alumnes, a més de treballar amb fonts primàries coneguin una mica més es seu entorn, en aquest cas la ciutat de Girona. Aquest treball està enfocat al treball cooperatiu, ja que els alumnes hauran de crear grups de treball per tal que siguin ells mateixos els creadors de coneixement i el mestre els hi faci de guia, a partir de la observació i recerca d'informació i basant-se en les fonts primàries i elaborar una notícia. Fri, 01 Mar 2019 00:00:00 GMT http://hdl.handle.net/10256/16674 2019-03-01T00:00:00Z http://hdl.handle.net/10256/16673 Assessing the clinical impact of socialdiabetes medical device in patients with type 1 diabetes mellitus García Cosculluela, Andrea Diabetes mellitus is a chronic and prevalent disease that requires almost constant attention from the patient and regular evaluation by the clinician. However, in health care systems, physicians have some difficulties to provide optimal care for patients with diabetes due to the lack of patient involvement and poor communication. The rapid development of a variety of new technologies is making a huge impact on healthcare field because these new tools are helping to deal with those obstacles. The chance to automatically transfer data to clinicians and receive timely guidance in therapy adjustments through remote consults, can lead to an improvement of patients' diabetes self-management ability, which is directly related to an enhancement of blood glucose control, minor risk of long-term complications and better perception of quality of life and treatment satisfaction. Purpose The aim of this study is to determine the safety and the efficacy of SocialDiabetes mobile phone application in the management of the intensive insulin therapy of patients with type 1 diabetes mellitus in comparison to the management with current model of medical assistance. Design An open-label, controlled, randomized cluster sampling, non-inferiority clinical trial that will be executed at Hospital Universitari Doctor Josep Trueta of Girona with a follow-up period of 6 months. Participants The study will evaluate a total of 192 subjects. The sample will be composed by men and women (≥18-≤55 years old) who had been diagnosed of T1DM at least 1 year before the beginning of this study and at this moment are in treatment with intensive insulin therapy. Intervention SocialDiabetes intervention, involving the use of mobile devices and applications for remote patient monitoring and delivery of clinical feedback for self- management of diabetes, versus the current model of assistance through in-person hospital visits. Outcomes The main outcome will be changes in HbA1c and secondary outcomes will be perception of treatment satisfaction and quality of life Tue, 01 Jan 2019 00:00:00 GMT http://hdl.handle.net/10256/16673 2019-01-01T00:00:00Z