Children and adolescents with eating disorders during COVID-19 confinement: Difficulties and future challenges.

OBJECTIVE: To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. METHOD: Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. RESULTS: We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) face-to-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. CONCLUSIONS: The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.

La transdisciplinariedad en el hospital del día / No disponible

Propuesta de trabajo de equipo en el Hospital de Día de Adultos (HDA) bajo el paradigma de la trandisciplinariedad. Desde el reconocimiento de la interdependencia entre profesionales de las diferentes disciplinas, trabajar hacia generar espacios de construcción de los casos donde el protagonismo revierta en los pacientes. La propuesta sería concebir el caso como eje, motor y vector; el grupo como vida y el equipo como red de apoyo

This is a proposal of teamwork at Day Hospital using the paradigm of trandisciplinarity. From the recognition of the interdependence between professionals of different disciplines, the aim is to work towards creating spaces for the construction of cases where protagonism return to the patients. The proposal is to conceive the case as axis, motor and vector, the group as life and the team as support network

Utilization, effect, and benefit of the individualized Meeting Centers Support Program for people with dementia and caregivers.

PURPOSE: There are few interventions on an individual basis to support community-dwelling people with dementia to continue to fulfill their potential in society and to support their informal caregivers via e-Health. This study explored the effectiveness of the individualized Meeting Centers Support Program (iMCSP) consisting of DemenTalent (people with dementia work as volunteers in a society based on their talents), Dementelcoach (telephone coaching), and STAR e-Learning for caregivers, compared to regular MCSP and No day care support. METHOD: An explorative randomized controlled trial with pre/post measurements (M0-M6) and two groups (iMCSP and regular MCSP). In addition, a comparison was made between iMCSP and a reference No day care control group. Standardized questionnaires were administered on self-esteem, neuropsychiatric symptoms, experienced autonomy and quality of life of the person with dementia, and on caregiver's sense of competence, quality of life, and happiness. RESULTS: The iMCSP interventions resulted in a broader group of participants utilizing the Meeting Centers. Compared to regular MCSP, DemenTalent had a moderate positive effect on neuropsychiatric symptoms, which also proved less severe. Positive affect of participants improved within the DemenTalent and regular MCSP group after six months. Caregivers of DemenTalent participants experienced less emotional impact of neuropsychiatric symptoms. No differences were found in experienced burden, sense of competence, or quality of life in caregivers using iMCSP or regular MCSP. Compared to those receiving No day care support, caregivers of DemenTalent participants and caregivers using Dementelcoach or STAR e-Learning proved happier. Post-hoc analyses, accounting for potential between-group differences in outcome measures at baseline, generally showed results in the same direction. People with dementia and caregivers highly appreciated iMCSP and regular MCSP. CONCLUSION: iMCSP can be effectively applied as alternative or additional support via regular Meeting Centers for people with dementia and caregivers who prefer individualized activities/support. DemenTalent decreased the severity of neuropsychiatric symptoms of people with dementia and emotional burden of caregivers. All iMCSP interventions tended to result in caregivers being happier compared to those receiving no support. Larger-scale studies are needed to investigate the effect of iMCSP on other domains of quality of life of participants.

Experiencia del abordaje multidisciplinar aplicado en el hospital de día de neuropsiquiatría del hospital mare de déu de la mercè (años 2016, 2017 y 2018) / Multidisciplinary approach experience of the neuropsychiatry day hospital of the hospital mare de deu de la merce (period 2016 to 2018)

Introducción: El hospital de día de Neuropsiquiatría es un dispositivo sanitario especializado que atiende a personas adultas que presentan sintomatología cognitiva derivada de un daño cerebral sobrevenido, trastorno por uso de sustancias, enfermedad de Huntington y demencias degenerativas de inicio precoz. Se presenta la experiencia del abordaje multidisciplinar entre los años 2016 y 2018. Métodos: La información ha sido obtenida a partir de las valoraciones realizadas según los protocolos de evaluación multidisciplinar del hospital. Se ha realizado una estadística descriptiva y se ha utilizado la prueba t para medias de dos muestras emparejadas para evaluar diferencias significativas entre las valoraciones al ingreso y al alta. La muestra es de 179 pacientes, con una media de edad de 50.47 años, de las cuales 75 (41.90%) son mujeres. Como instrumentos de medida se han utilizado pruebas de despistaje cognitivo, de evaluación de la conducta, del equilibrio y funcionalidad, y un cuestionario de calidad de vida. Resultados: Se objetiva una mejoría significativa de las pruebas de despistaje cognitivo, de valoración de la conducta y de la sobrecarga del cuidador. En los pacientes con trastorno por uso de sustancias hay también una mejoría significativa del equilibrio. En los pacientes con enfermedad de Huntington hay una mejoría significativa de la apatía. Conclusiones: La intervención multidisciplinar del hospital de día de Neuropsiquiatría parece ser válida para mejorar las habilidades cognitivas, la conducta y disminuir la sobrecarga del cuidador. Hay que destacar la mejoría de la apatía en los pacientes con enfermedad de Huntington dado que es un síntoma refractario al tratamiento farmacológico. Se propone incluir grupos de rehabilitación física en otros recursos de la red de tóxicos

Introduction: The Neuropsychiatry day hospital is a specialized health care service that attends adults who present cognitive symptoms in the context of acquired brain damage, substance use disorder, Huntington's disease and early onset dementias. The manuscript exhibits the multidisciplinary approach experience from the period 2016 to 2018. Methods: The information has been obtained from the assessments made according to the multidisciplinary evaluation protocols of the hospital. A descriptive statistic has been performed and the t-test for means of two paired samples has been used to assess significant differences between admission and discharge assessments. A sample of 179 patients, with an average age of 50.47 years, of which 75 (41.90%) were women, is presented. As measuring instruments, tests of cognitive screening, behavioral assessment, balance and functionality, and a quality of life questionnaire have been used. Results: There is a significant improvement in the tests of cognitive screening, behavior assessment and caregiver burden. In patients with substance use disorder there is also a significant improvement in balance. In patients with Huntington's disease there is a significant improvement in apathy. Conclusions: The Neuropsychiatric day hospital intervention seems to be effective to improve cognitive abilities, behavior and caregiver burden. It is noteworthy the improvement of apathy in Huntington' disease patients, because it is a pharmacological refractory symptom. It is proposed to include physical rehabilitation groups in substance abuse programs

Conocimiento y valoración de las voluntades anticipadas del personal sanitario de unidades de hospitalización a domicilio, oncología médica, hospitales de día y servicios de urgencias / Knowledge and assessment of living wills by health professionals at home hospitalization units, medical oncology departments, daytime hospital services and emergency romos

OBJETIVO: Describir el conocimiento del personal sanitario de servicios implicados en el manejo de enfermos paliativos en situación avanzada, sobre el Documento de Voluntades Anticipadas (DVA) y su Registro Nacional. Conocer cómo valoran su uso y si lo consultan habitualmente. MATERIAL Y MÉTODO: Estudio multicéntrico, transversal descriptivo, mediante cuestionario anónimo cumplimentado por personal médico y de enfermería en tres centros hospitalarios. Se recogieron un total de 160 cuestionarios correspondientes a 58 médicos y 102 enfermeros, pertenecientes a Servicios de Urgencias (SU), Oncología, Unidades de Hospitalización a Domicilio (HaD) y Hospital de Día. El cuestionario constaba de 14 preguntas tipo test de respuesta única, además de las variables demográficas y laborales pertinentes para el estudio. RESULTADOS: Las medias de edad de la muestra fueron de 42 ± 9 años, y la experiencia profesional de 17 ± 9,3 años. El 83,1 % de los encuestados afirmaron conocer el DVA y el 53,7 % que sabrían cumplimentarlo, pero solo un 8,1 % de ellos contestaron correctamente a la pregunta de dónde localizar dicho documento. El 92,5 % de los encuestados no lo consultan nunca. Los dos encuestados que afirmaban consultarlo habitualmente, no supieron localizarlo. CONCLUSIONES: Existe un desconocimiento generalizado del DVA, siendo este independiente tanto de la categoría profesional como de los años de experiencia o del servicio en el que se trabaja. Incluso en los casos que dicen conocerlo, sus respuestas no corroboran tal afirmación

OBJECTIVE: To describe the knowledge healthcare providers at the units involved in the management of advanced palliatiave care patients have of the advance directives document (ADD). To find out how do they value its use, and whether they check it out regularly. MATERIAL AND METHODS: A multicenter, cross-sectional, descriptive study using an anonymous questionnaire to be completed by doctors and nurses in three hospitals. A total of 160 questionnaires were collected from 58 doctors and 102 nurses working at emergency rooms (ERs), oncology departments, home hospitalization units (HHUs), and day hospital services. Questionnaires included 14 multiple choice questions with only one valid option, and also collected the demographic and labor variables required by the study. RESULTS: Mean age in the sample was 42 ± 9 years, and professional experience was 17 ± 9.3 years. Among responders, 83.1 % claimed knowledge of the ADD, and 53.7 % said they could complete it, but only 8.1 % knew where to find it; 92.5 % of respondents never consult it. The two respondents who claimed they usually checked it out were eventually unable to locate it. CONCLUSIONS: Lack of knowledge about ADDs and their related National Registry is widespread, and occurs regardless of professional category or years of experience. Even in providers who claim awareness of this document the answers provided belie it

Linking DemenTalent to Meeting Centers for people with dementia and their caregivers: a process analysis into facilitators and barriers in 12 Dutch Meeting Centers.

OBJECTIVES: There have been relatively few interventions on an individual level to support community-dwelling people with dementia to continue to fulfill their potential in society. This study investigated the implementation of DemenTalent, an intervention in which people with dementia become active as volunteers in society based on their talents. The intervention was linked to existing Meeting Centers for people with dementia and their informal caregivers. METHOD: We conducted a qualitative multiple case study. Semi-structured interviews regarding experienced facilitators and barriers were conducted with 22 key figures/stakeholders in 12 Meeting Centers during the preparation, starting and continuation phases of the implementation of DemenTalent. RESULTS: Several influencing factors were found on a micro level (e.g. Public Relations, training, management involvement), meso level (e.g. finances, collaborating with others) and macro level (e.g. laws and regulations, national and regional policy) during the different phases of the implementation process. Factors mentioned by most stakeholders were human and financial resources. Another important factor appeared to be the culture of the region. CONCLUSION: The insight into facilitating and impeding factors in the implementation of DemenTalent provided by this study will inform and enable other Meeting Centers to adopt a fitting strategy to implement DemenTalent in their own center. This is expected to help disseminate the intervention further, giving more people with dementia the chance to fulfill their potential, find a meaningful and pleasant way of spending their time, and actively participate in society. This will contribute to a more inclusive society and less stigmatization of people with dementia.

Puesta en marcha de un hospital de día del área del corazón: análisis de actividad, calidad y coste-efectividad en el primer año de funcionamiento / Start-up of a cardiology day hospital: activity, quality care and cost-effectiveness analysis of the first year of operation

Introducción y objetivos: El hospital de día del área del corazón (HDC) es una alternativa asistencial a la hospitalización convencional relacionada con procedimientos cardiológicos programados. Los objetivos de este estudio son analizar la actividad asistencial, la calidad de la asistencia y el coste-efectividad del HDC. Métodos: Estudio observacional descriptivo de la actividad asistencial durante el primer año de funcionamiento del HDC. La calidad asistencial se analizó mediante el índice de sustitución (ambulatorización de los procedimientos programados), la tasa de cancelación, complicaciones y una encuesta de satisfacción. Para el coste-efectividad, se calculó el ahorro económico relacionado con las estancias hospitalarias evitadas. Resultados: Se atendió a un total de 1.646 pacientes (media de edad, 69 ± 15 años; el 60% varones). Se programaron 2.550 procedimientos con una tasa de cancelación del 4%; la cardioversión eléctrica fue el procedimiento con más suspensiones. La ambulatorización de los procedimientos invasivos programados fue del 66%. Únicamente fue necesario reingresar a 1 paciente por insuficiencia cardiaca. La mayoría de los pacientes encuestados consideraron buena o muy buena la atención recibida en el HDC (95%). La ambulatorización parcial de los procedimientos invasivos supuso un ahorro económico en estancias hospitalarias de 219.199,55 euros, superior a los costes del primer año de funcionamiento del HDC. Conclusiones: El HDC del centro ha permitido la ambulatorización de más de 2 tercios de los procedimientos invasivos manteniendo la calidad de la asistencia. En el primer año de funcionamiento se ha amortizado el gasto derivado de su puesta en marcha, gracias a una importante reducción de los ingresos hospitalarios

Introduction and objectives: The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH. Methods: An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays. Results: A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation. Conclusions: In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions

A Nurse-Led Care Program for Breast Cancer Patients in a Chemotherapy Day Center: A Randomized Controlled Trial.

BACKGROUND: Healthcare providers are facing the challenge of helping cancer patients cope with the impact of outpatient-based chemotherapy. A nurse-led care program was proposed to address this challenge. OBJECTIVE: The aim of this study was to examine the effects of a nurse-led care program for patients receiving outpatient-based chemotherapy. METHODS: This was a single-center, open-label, 2-arm parallel trial with equal randomization (NCT02228200). Breast cancer patients in Hong Kong were randomly allocated to the intervention arm or the control arm. The control arm received routine hospital care. The intervention arm received the nurse-led care plus the routine hospital care. The quality of life, self-efficacy, symptom distress levels, and satisfaction with care were evaluated with questionnaires before randomization (T0), in the middle of chemotherapy (T1), and 1 month after chemotherapy (T2). Individual interviews were conducted with some participants in the intervention arm at T2. RESULTS: The intervention arm participants reported significantly lower distress levels from oral problems, fatigue, peripheral neuropathy, distressful feelings, and higher satisfaction with care. According to the satisfaction evaluation and the interviews, the participants stated that the service was helpful in providing information and communication opportunities, filling the service gap after drug administration, providing psychological support, relieving discomfort, and building confidence. CONCLUSION: Breast cancer patients received support from the provision of comprehensive, continuous, and individualized care. IMPLICATIONS FOR PRACTICE: The nurse-led care program could be applied to breast cancer patients in other hospitals in Hong Kong. Exploring its applicability to cancer settings in other countries is recommended.

Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa.

Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.

Assessing mechanisms of benefit in adult day programs: the adult day services process and use measures.

Objectives: A limitation of adult day service (ADS) research is that there remains little understanding of how these community-based long-term care programs operate to benefit clients or family caregivers (i.e. the process of ADS use). The purpose of this study was to validate the 'ADS Process and Use Measures' (APUM) which were developed to assess such mechanisms. Method: Participant observation and semi-structured interviews in two ADS settings resulted in qualitative data to inform a conceptual model, subscales, and Likert-scale items. Three experts in ADS research reviewed the initial 129-item version of the APUM to establish content validity, and 27 family caregivers of current or prior ADS clients provided feedback on face validity of a subsequent 58-item version. Results: Principal components and confirmatory factor analyses on a sample of 269 family members of ADS clients recruited from 90 programs throughout the U.S. established a measure featuring 5 domains, 12 reliable subscales, and 49 items. Analysis of discriminant and convergent validity found that various subscales from four of the domains (Why ADS is Used, Events Prior to Use, Why ADS Does Not Work, and Pathways to Benefits) were significantly associated (p < 0.05) with family caregiver distress and ADS client quality of life variables. Conclusion: The ADS Process and Use Measures effectively assess mechanisms of program benefit and could help to enhance the overall quality of these critical community-based long-term care options for older persons and their families.

Throughput efficiency and service quality after process redesign at a cancer day care unit: Two sides of the coin?

This study was designed to focus on the patient perspective in a reorganisation of care processes at a cancer day care unit (CDU). The effects of dose banding and of taking blood samples one day (or more) before the day care treatment (on Day -1) are investigated in terms of throughput efficiency and perceived service quality. Data were collected by mapping patient processes in detail and surveying patients in two CDUs at a university hospital (n = 308). A univariate model was used to investigate the effect of these factors on patient throughput time, and perceived service quality was examined with multiple linear regression. Taking blood samples on Day -1 decreases patient throughput time and increases the perceived service quality by improving the patient's perception of technical expertise and the outcome. This has a globally positive effect on patients' perceived service quality. Dose banding affected neither patient throughput time nor perceived service quality. Taking the pretreatment blood sample on Day -1 can be considered an important process design characteristic, as it increases both efficiency and service quality.

Day Care for People with Dementia: A Qualitative Study Comparing Experiences from Norway and Scotland.

Potential benefits from day care attendance are reported in the literature for both people with dementia and caregivers, although the evidence-base is limited. The study aimed to explore and compare experiences of day care services for people with dementia as described by day care attendees and their caregivers in Norway and Scotland. Whereas day care receives prominence in Norway's national dementia plan, Scotland does not highlight day care in its national dementia strategy. A qualitative cross-national comparative study was undertaken. Semi-structured interviews were conducted with 17 people with dementia and 17 caregivers in Norway, and 19 people with dementia and 15 caregivers in Scotland. Data were analyzed thematically and comparatively to explore the experiences and outcomes of the participants. Findings indicate positive outcomes from day care for both people with dementia and caregivers. Satisfaction with services related to meaningful activities, getting out of the home, strengthening social connections and careful staff facilitation to create a positive and welcoming atmosphere. There were strong similarities in the content of services and experiences reported in the two countries. Some minor differences were noted, with caregiver support being an area of notable divergence in experiences. Specialist day care for people with dementia seems to provide important support and positive outcomes for people with dementia, and respite and reassurance for their caregivers. More research is needed to further explore the effect of day care designed for people with dementia both on the attendees and their caregivers.

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision.

BACKGROUND: An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors. METHODS: A prospective audit was undertaken over a 3-month period. Our practice was compared with evidence-based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti-inflammatory. RESULTS: The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10 months in a row after implementation. CONCLUSION: Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.

Validación de las actividades en centros de día para ancianos: contribuciones a la evaluación de la calidad / Validação das atividades desenvolvidas em centros dia para idosos: subsídios para avaliação da qualidade / Validation of activities developed in day-care centers for elderly: subsidies for assessing the quality

Objetivo: Validar el contenido de las actividades de atención al anciano desarrolladas en los centros de día. Métodos: Estudio metodológico con validez de contenido realizada por nueve especialistas, según los atributos relevancia, claridad, pertinencia y simplicidad. El índice de consenso establecido correspondió al 80%. La recopilación de datos se llevó a cabo entre septiembre y noviembre de 2014. Resultados: Ocho actividades fueron validadas y dos incluidas. En la dimensión salud fueron: capacidad funcional y fragilidad, alimentación y nutrición, higiene y confort, medicación continuada, manejo y estímulo cognitivo; en participación: actividades culturales, acogida y supervisión, apoyo espiritual/religioso; en seguridad, accesibilidad y control de factores de riesgo de caída y en educación, actividades educativas. De los 82 ítems evaluados, el 100% alcanzó el consenso respecto a la relevancia; el 91,4% respecto a la claridad; el 97,5% respecto a la pertinencia, el 92,6% respecto a la simplicidad. Conclusión: Creemos que la validez y la sistematización de las actividades contribuirán en el proceso de evaluación de la calidad en esta modalidad de atención

Objetivo:Validar o conteúdo das atividades de atenção ao idoso desenvolvidas em centros dia. Métodos: Estudo metodológico, com validação de conteúdo realizada por nove especialistas, segundo os atributos relevância, clareza, pertinência e simplicidade. O índice de consenso estabelecido correspondeu a 80%. A coleta de dados ocorreu entre setembro e novembro de 2014 Resultados: Oito atividades foram validadas e duas incluídas. Na dimensão saúde, foram: capacidade funcional e fragilidade, alimentação e nutrição, higiene e conforto, medicamentos de uso contínuo, manejo e estímulo cognitivo; na participação as atividades socioculturais, acolhimento e monitoramento, apoio espiritual/religioso; na segurança, acessibilidade e controle dos fatores de risco para queda e na educação, as atividades educativas. Dentre 82 itens avaliados, 100% atingiram o consenso quanto à relevância; 91,4% à clareza; 97,5% à pertinência; 92,6% à simplicidade. Conclusão: Acreditamos que a validação e a sistematização das atividades contribuirão para subsidiar a avaliação da qualidade nessa modalidade de atenção

Objective: Validate the content of care activities for elderly developed in day-care centers. Methods: Methodological study, with content validation carried out by nine specialists, based on the attributes relevance, clearness, pertinence and simplicity. The established consensus rate was at 80%. The data collection period was between September and November 2014. Results: Eight activities were validated and two included. In the health dimension, the activities were: functional capacity and frailty, food and nutrition, hygiene and comfort, drugs of continuous use, handling and cognitive stimulation; concerning participation: the socio-cultural activities, acceptance and monitoring, spiritual/religious support; concerning safety: accessibility and control of risk factors in falls; and concerning education: educational activities. Among 82 items assessed, 100% were considered relevant; 91,4% were considered clear; 97,5% were considered pertinent; and 92,6% were considered simple. Conclusion: We believe that validation and systematization of activities contribute to support the assessment of quality in this type of attention

The Hamburg Parkinson day-clinic: a new treatment concept at the border of in- and outpatient care.

To close a gap between inpatient and outpatient care, the Hamburg Parkinson day-clinic (HPDC) has been developed as a new and comprehensive, individual, interdisciplinary type of treatment for patients with complex Parkinsonian syndromes (PS). First, we describe the HPDC concept, in which a multi-professional medical team of PD specialists provide a time- and personnel-wise intensive care and focuses on the patients' individual deficits and resources. Second, we present short-term outcome results of the first 184 PS patients enrolled during 16 months including objective clinical motor and non-motor scores taken before and after participation in the HPDC, as well as the patients' subjective evaluation of the HPDC. Out of the 184 patients with PS (aged 39-88 years with Hoehn and Yahr scores between 1.0 and 4.5), 169 were diagnosed to have Parkinson disease (PD). HPDC treatment led to improvement of all applied motor (UPDRS III, AIMS) and non-motor (BDI-II, MoCA, PDNMS, PDSS-2, King's PD Pain Scale, QUIP, PDQ-39) scores (p < 0.05) indicating benefits for akinesia, tremor, dyskinesia, cognition, sleep, pain, impulse control disorders and quality of life. Patients evaluated HPDC care positively with values from 1.39 to 2.79 ("very good" to "satisfying") with an overall grade of 1.69 ("good") on a 6-point Likert scale (1-6: best to worst). Patients with advanced PS benefit from the HPDC concept which is considered to close a gap between inpatient and outpatient care.

Barreras y facilitadores en la implantación de estándares de calidad en las unidades de hospital de día reumatológicas. Análisis cualitativo del proyecto VALORA / Barriers to and facilitators of implementing quality standards in Hospital Day Care Units in Rheumatology: Qualitative approach to the VALORA study

Objetivo: Identificar las barreras y los facilitadores en la implantación de estándares de calidad en las unidades de hospital de día (UHdD) reumatológicas. Material y métodos: Se analizaron las valoraciones sobre UHdD clasificadas en torno a estándares de estructura, procesos y resultados. La aproximación cualitativa se llevó a cabo mediante 13 grupos de discusión (GD) formados por profesionales de Reumatología (7), de Enfermería (4) y pacientes (2) de UHdD. La captación de informantes se realizó mediante muestreo intencionado atendiendo a variables que configuran las percepciones de las UHdD. El análisis de los datos se realizó siguiendo una perspectiva descriptiva-interpretativa. Resultados: La especialización de las UHdD monovalentes y la formación específica en Reumatología para Enfermería se perciben como los principales facilitadores para la implantación de estándares. Por el contrario, la demora en la disponibilidad de los fármacos en las UHdD se identifica como una barrera que prolonga la estancia de pacientes y desaprovecha recursos. Las diferencias en regulaciones locales se perciben como una posible barrera para el acceso equitativo a fármacos. El elemento mejor valorado por los pacientes fue la atención recibida, por encima de las variables estructurales o de proceso. Conclusiones: Los hallazgos de este estudio sugieren que las mejoras para la implantación de estándares de calidad en las UHdD pueden incluir 3 niveles de actuación: la propia UHdD, el centro hospitalario, y un tercero relacionado con regulaciones locales de acceso a fármacos

Objective: To identify barriers and facilitators in the implementation of quality standards in hospital day care units (HDCU) in rheumatology. Material and methods: We analyzed appraisals of HDCU in terms of standards for structure, processes and results. The qualitative approach was conducted through 13 discussion groups created by rheumatology health professionals (7), nursing professionals (4) and HDCU patients (2). The recruitment of informants was done through purposive sampling, attending to variables that form the perceptions of the HDCU. Data analysis was performed using a descriptive-interpretive method. Results: The specialization of the HDCU and specific training in rheumatology for nursing are perceived as the main facilitator for the implementation of standards. Conversely, the delay in the availability of medicines at the HDCU is identified as a barrier that prolongs patient stay and wastes resources. Differences in local regulations are perceived as a potential barrier to equitable access to medicines. The patients gave higher ratings to the care received than to structural variables or those related to process. Conclusions: The findings of this study suggest that improvements in the implementation of quality standards in HDCU may include three levels of action: the HDCU, the hospital and a third related to local regulations to access to medicines

Unidad Nefrológica de Atención Continuada. Experiencia de un Hospital Universitario / Nephrological Unit for Continued Care. Experience of a University Hospital

Introducción: Los hospitales de día suponen una alternativa asistencial a la hospitalización convencional mejorando la eficacia de la asistencia sanitaria. Desde nuestro punto de vista, la nefrología se beneficiaria de esta modalidad de atención, ya que el paciente con enfermedad renal crónica tiene unas necesidades concretas de cuidado que conllevan al profesional de enfermería a generar una atención integral e individualizada. Por este motivo surge en nuestro servicio la creación de la Unidad Nefrológica de Atención Continuada. Objetivo: Presentar nuestra experiencia en la implantación y desarrollo de la Unidad Nefrológica de Atención Continuada en el Hospital Universitario del Henares. Material y Método: Estudio descriptivo retrospectivo de la actividad realizada en la Unidad Nefrológica de Atención Continuada entre enero-junio de 2017. Desarrollo y puesta en marcha de las distintas funciones y competencias profesionales. Resultados: En este periodo se asistieron a un total de 874 pacientes, con una media de 145,6 visitas/mes. De todas estas visitas, se atendieron 474 pacientes en programa de Diálisis Peritoneal (55% del volumen total), 149 pacientes con enfermedad renal crónica (16%), 245 pacientes con enfermedad renal crónica avanzada (18%) y 11 pacientes en tratamiento conservador (1%). Se realizaron diferentes técnicas, bien programadas en la agenda electrónica o a demanda. Conclusiones: La implantación de la Unidad Nefrológica de Atención Continuada, de forma estructurada y planificada, es una alternativa válida y necesaria en nuestro sistema sanitario. Permite aseguramos un abordaje integral de los pacientes renales y alcanzar una continuidad de cuidados con menor coste sanitario

Introduction: The daytime hospitals are an alternative to conventional hospitalization and improve the effectiveness of healthcare. From our point of view, nephrology is a specialty that should be able to benefit from this type of care, because chronic kidney disease (CKD) patients have specific care needs that lead to the nursing professional to generate comprehensive and individualized care. For this reason, the creation of the Nephrological Unit for Continued Care (NUCA) arises in our service. Aim: To present our experience in the implantation and development of a NUCA in the University Hospital of Henares. Material and Method: Retrospective descriptive study of the activity carried out at NUCA between January 1, 2017 and June 30, 2017. Development and implementation of different functions and professional competencies. Results: In this period, a total of 804 patients were attended, with an average of 145.6 visits per month. Of all these visits, 474 patients undergoing Peritoneal Dialysis (55% of total volume), 149 patients with CKD (16%), 245 patients with advanced CKD (18%) and 11 patients in conservative treatment (1%). Different techniques were carried out, either programmed by electronic agenda or by demand. Conclusions: The implantation of the NUCA, in a structured and planned way, is a valid and necessary alternative in our health system. It allows to ensure an integral approach to renal patients and achieve a continuity of care with lower healthcare costs

Cirugía mayor ambulatoria: dónde estamos y adónde vamos / Major ambulatory surgery: Where we are and where are we going

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