Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 805
Clin Interv Aging ; 14: 1527-1553, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692559


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.

Enfermedad de Alzheimer/rehabilitación , Cuidadores/psicología , Centros de Día/organización & administración , Procesos de Grupo , Apoyo Social , Anciano , Enfermedad de Alzheimer/psicología , Cuidadores/educación , Instrucción por Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Autonomía Personal , Calidad de Vida/psicología , Encuestas y Cuestionarios , Revisión de Utilización de Recursos
Rev. esp. cardiol. (Ed. impr.) ; 72(2): 130-137, feb. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-182544


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

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Instituciones Cardiológicas/organización & administración , Centros de Día/organización & administración , Análisis Costo-Beneficio , Instituciones de Atención Ambulatoria/organización & administración , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Evaluación de Procesos y Resultados (Atención de Salud)/estadística & datos numéricos
Eat Disord ; 27(4): 400-417, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30358497


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.

Anorexia Nerviosa/terapia , Centros de Día/organización & administración , Terapia Familiar , Aumento de Peso/fisiología , Adolescente , Índice de Masa Corporal , Niño , Femenino , Humanos , Masculino , Resultado del Tratamiento
Eur J Cancer Care (Engl) ; 28(1): e12918, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30284337


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.

Antineoplásicos/administración & dosificación , Centros de Día/organización & administración , Eficiencia Organizacional , Neoplasias/tratamiento farmacológico , Servicio de Oncología en Hospital/organización & administración , Calidad de la Atención de Salud , Atención Ambulatoria , Humanos , Modelos Lineales , Factores de Tiempo
Dementia (London) ; 18(4): 1393-1409, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-28587483


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.

Cuidadores/psicología , Comparación Transcultural , Centros de Día/psicología , Demencia/psicología , Centros de Día/organización & administración , Femenino , Humanos , Entrevistas como Asunto , Masculino , Noruega , Investigación Cualitativa , Calidad de Vida/psicología , Escocia
Cancer Nurs ; 42(1): 20-34, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-28926349


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.

Antineoplásicos/uso terapéutico , Neoplasias de la Mama/enfermería , Centros de Día/organización & administración , Pautas de la Práctica en Enfermería , Adulto , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Hong Kong , Humanos , Persona de Mediana Edad , Investigación en Evaluación de Enfermería
Paediatr Anaesth ; 28(10): 924-929, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30302885


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.

Circuncisión Masculina/estadística & datos numéricos , Centros de Día/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Paquetes de Atención al Paciente/métodos , Anestesia Local/métodos , Anestesia Local/estadística & datos numéricos , Anestésicos Locales/administración & dosificación , Preescolar , Circuncisión Masculina/efectos adversos , Circuncisión Masculina/métodos , Auditoría Clínica , Centros de Día/organización & administración , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Irlanda/epidemiología , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Paquetes de Atención al Paciente/estadística & datos numéricos , Mejoramiento de la Calidad/estadística & datos numéricos , Reino Unido/epidemiología
Enferm. glob ; 17(52): 202-218, oct. 2018. tab
Artículo en Español | IBECS | ID: ibc-173985


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

Humanos , Anciano , Calidad de la Atención de Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/organización & administración , Centros de Día/organización & administración , Planificación de Atención al Paciente/organización & administración , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Atención Integral de Salud/organización & administración , Atención de Enfermería/organización & administración , Proceso de Enfermería/organización & administración
J Neural Transm (Vienna) ; 125(10): 1461-1472, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30167934


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.

Atención Ambulatoria/métodos , Centros de Día/organización & administración , Servicio Ambulatorio en Hospital/organización & administración , Enfermedad de Parkinson/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Alemania , Humanos , Comunicación Interdisciplinaria , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/enfermería , Enfermedad de Parkinson/rehabilitación , Grupo de Atención al Paciente , Medición de Resultados Informados por el Paciente , Medicina de Precisión , Recuperación de la Función , Índice de Severidad de la Enfermedad
Reumatol. clín. (Barc.) ; 14(4): 196-201, jul.-ago. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-175921


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

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Centros de Día/organización & administración , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud , Unidades Hospitalarias/organización & administración , Satisfacción del Paciente/estadística & datos numéricos , Estudios Transversales , Evaluación del Resultado de la Atención al Paciente
Enferm. nefrol ; 21(2): 113-122, abr.-jun. 2018. ilus, tab
Artículo en Español | IBECS | ID: ibc-174048


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

Humanos , Insuficiencia Renal Crónica/terapia , Enfermería en Nefrología/tendencias , Atención de Enfermería/métodos , Terapia de Reemplazo Renal/enfermería , Centros de Día/organización & administración , Estudios Retrospectivos , Costos de la Atención en Salud/estadística & datos numéricos , Catéteres de Permanencia , Diálisis Renal/enfermería , Diálisis Peritoneal/enfermería
Aging Ment Health ; 22(8): 990-998, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-28541798


OBJECTIVES: To identify feasible models of intergenerational care programmes, that is, care of children and older people in a shared setting, to determine consumer preferences and willingness to pay. METHOD: Feasible models were constructed in extensive consultations with a panel of experts using a Delphi technique (n = 23) and were considered based on their practical implementation within an Australian setting. This informed a survey tool that captured the preferences and willingness to pay for these models by potential consumers, when compared to the status quo. Information collected from the surveys (n = 816) was analysed using regression analysis to identify fundamental drivers of preferences and the prices consumers were willing to pay for intergenerational care programmes. RESULTS: The shared campus and visiting models were identified as feasible intergenerational care models. Key attributes of these models included respite day care; a common educational pedagogy across generations; screening; monitoring; and evaluation of participant outcomes. Although parents were more likely to take up intergenerational care compared to the status quo, adult carers reported a higher willingness to pay for these services. Educational attainment also influenced the likely uptake of intergenerational care. CONCLUSIONS: The results of this study show that there is demand for the shared campus and the visiting campus models among the Australian community. The findings support moves towards consumer-centric models of care, in line with national and international best practice. This consumer-centric approach is encapsulated in the intergenerational care model and enables greater choice of care to match different consumer demands.

Cuidado del Niño/organización & administración , Disfunción Cognitiva/rehabilitación , Comportamiento del Consumidor , Centros de Día/organización & administración , Modelos Organizacionales , Cuidados Intermitentes/organización & administración , Adulto , Anciano , Australia , Niño , Técnica Delfos , Encuestas de Atención de la Salud , Humanos , Apoyo Social
Cuad. psiquiatr. psicoter. niño adolesc ; (64): 41-46, jul.-dic. 2017. graf
Artículo en Español | IBECS | ID: ibc-173896


En este trabajo, se presenta el abordaje en una Unidad Terapéutico Educativa de un paciente de doce años con un Trastorno grave de conducta consecuencia de un Trastorno mental grave. Se pone de manifiesto la necesidad de recursos intermedios y del diagnóstico estructural de la personalidad para la comprensión y abordaje de las dificultades de estos pacientes

In this paper, the therapeutic approach in an Educational Therapeutic Unit (UTE) for a twelve year old patient with severe behavioral disorder, as consequence of an underlying severe mental disorder, is presented. It highlights the need for intermediate resources and the structural diagnosis of personality concerning understanding and therapeutic approach to the difficulties of the patients

Humanos , Masculino , Niño , Problema de Conducta/psicología , Trastornos de la Conducta Infantil/psicología , Procesos Psicoterapéuticos , Trastornos de la Conducta Infantil/terapia , Composición Familiar , Crianza del Niño/psicología , Relaciones Madre-Hijo , Divorcio/psicología , Centros de Día/organización & administración
Bull Cancer ; 104(10): 869-874, 2017 Oct.
Artículo en Francés | MEDLINE | ID: mdl-29032944


New routes of administration available for some targeted therapies, especially subcutaneous injections, have an impact not only on the patients' daycare experience, but also on the unit's organization. This observational study conducted on 48 voluntary patients at the Institut universitaire du cancer Toulouse-Oncopole shows that the mean duration of the outpatient unit stay is diminished by one hour when a subcutaneous injection is used instead of an intravenous route. This duration decrease is mainly caused by an 82% average reduction in treatment duration. However, the waiting times before and after the treatment itself are not significantly impacted. Organizational methods related to the treatment prescription and preparation remain indeed the same. Anticipated prescription is not noticeably impacted either. This reduction of the duration of stay will truly be obtained if the whole unit's organization is adapted.

Antineoplásicos/administración & dosificación , Centros de Día/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Terapia Molecular Dirigida/métodos , Instituciones Oncológicas/organización & administración , Instituciones Oncológicas/estadística & datos numéricos , Centros de Día/organización & administración , Composición de Medicamentos/estadística & datos numéricos , Humanos , Inyecciones Intravenosas/estadística & datos numéricos , Inyecciones Subcutáneas/estadística & datos numéricos , Terapia Molecular Dirigida/estadística & datos numéricos , Pacientes Ambulatorios , Factores de Tiempo
Personal Ment Health ; 11(4): 266-277, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28703383


The quality of implementation of evidence-based treatment programs for borderline personality disorder (BPD) in routine clinical care is a neglected issue. The first aim of this mixed-method naturalistic study was to explore the impact of organizational changes on treatment effectiveness of a day-hospital programme of mentalization-based treatment. Consecutively referred BPD patients were divided into a pre-reorganization cohort (PRE-REORG) and a cohort during reorganization (REORG). Psychiatric symptoms (Brief Symptom Inventory) and personality functioning (Severity Indices of Personality Problems-118) before treatment and at 18- and 36-month follow-up were compared using multilevel modelling. Effect sizes in the PRE-REORG cohort were approximately twice as large at 18 months (PRE-REORG: range 0.81-1.22; REORG: range 0.03-0.71) and three times as large at 36 months (PRE-REORG: range 0.81-1.80; REORG: range 0.27-0.81). The quantitative results of this study suggest that even when mentalization-based treatment is successfully implemented and the structure of the programme remains intact, major organizational changes may have a considerable impact on its effectiveness. Second, we aimed to explore the impact of the reorganization on adherence at organizational, team and therapist level. The qualitative results of this study indicate that the organizational changes were negatively related to adherence to the treatment model at organizational, team and therapist level, which in turn was associated with a decrease in treatment effectiveness. The implications of these findings for the implementation of effective treatments for BPD in routine clinical practice are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Trastorno de Personalidad Limítrofe/terapia , Centros de Día/organización & administración , Psicoterapia/métodos , Teoría de la Mente , Adulto , Terapia Cognitivo-Conductual/métodos , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Psicoterapia de Grupo/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto Joven
J Child Adolesc Psychiatr Nurs ; 30(1): 18-24, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28463455


BACKGROUND: Rules and regulations represent an aspect of psychiatric hospitalization about which little is known. STUDY PURPOSE: To explore the perceptions of rules from the perspective of youth receiving hospital-based psychiatric services. DESIGN: Qualitative descriptive. METHODS: Perceptions of rules were elicited through semi-structured interviews with a convenience sample of six youth. RESULTS: Rules were perceived as governing virtually all aspects of everyday living in the hospital environment. Rules were used to structure daily activities, routines, and social interactions, and were embedded within clinical protocols and treatment plans. For each participant, "making sense" or "not making sense" were central themes through which rules were interpreted as being either therapeutic or oppressive. Rules that made "no sense" negatively affected youth mood, behavior, treatment adherence, and engagement in a collaborative relationship. CONCLUSION: Working in partnership with youth in psychiatric care to establish, implement, and evaluate rules that "make sense" can promote positive health outcomes and prevent negative, unintended consequences.

Adolescente Hospitalizado , Centros de Día/organización & administración , Pacientes Internos , Servicios de Salud Mental/organización & administración , Aceptación de la Atención de Salud , Servicio de Psiquiatría en Hospital/organización & administración , Adolescente , Femenino , Humanos , Masculino
Gerokomos (Madr., Ed. impr.) ; 28(1): 15-18, mar. 2017.
Artículo en Español | IBECS | ID: ibc-162348


Introducción: Existe una alta prevalencia de adultos mayores diagnosticados de demencia que generan una importante demanda de cuidados y recursos sociosanitarios. Los centros de día atienden a las personas en situaciones de dependencia y facilitan la integración familiar. Nuestras preguntas iniciales son acerca de las asociaciones de enfermos y familiares. ¿Cómo surgen y se organizan? ¿Qué servicios ofrecen? ¿Qué competencias desarrollan los profesionales de enfermería? Objetivo: Analizar la percepción que tienen los miembros del equipo de una asociación de familiares de enfermos de Alzheimer y otras demencias sobre el funcionamiento y el servicio que ofrecen a la sociedad. Material y métodos: Estudio cualitativo descriptivo, realizado en una asociación de familiares de enfermos de Alzheimer. Se realizan tres entrevistas semiestructuradas respetando las consideraciones éticas establecidas para los trabajos de investigación con personas. Resultados: Surgen tres categorías en el análisis de los relatos, la historia de la asociación, la estructura y organización del equipo interdisciplinar, destacando las competencias del profesional de enfermería y la oferta de servicios que ha desarrollado. Conclusiones: La asociación surge ante las necesidades de atención sentidas por parte de las familias y que no obtienen respuesta en otras instituciones. Se ha consolidado como un recurso imprescindible cuyo objetivo es mantener a la persona dependiente en su medio habitual y proporcionar apoyo a sus cuidadores. Atiende desde un equipo interdisciplinar que contribuye al desarrollo de unos fines comunes, donde la enfermería desarrolla las competencias propias de la profesión

Introduction: There is a high prevalence of elderly diagnosed of dementia that generates an important demand of well-taken care of and socio-sanitary resources. The day care centers take care of the people in dependency situations and facilitate familiar integration. Our initial questions are about the Associations of patients and relatives. How arises and how they are organized? What services do they offer? What competences develop the nurse professionals? Aim: To analyze the perception which the members of the equipment have of an Alzheimer´s patients relatives Association and other dementias on the operation and the service that offer to the society. Material and methods: Descriptive qualitative study, made in an Alzheimer´s Relatives Association. Three semi structured interviews are made respecting the established ethical considerations for the investigation works with people. Results: Three categories in the analysis arise from the stories, the history of the Association, the structure and organization of the multidisciplinary equipment, emphasizing the competitions of the nurse professional and the supply of services that it has developed. Conclusions: The Association arises from the needs of heartfelt attention from families and that do not obtain answer in other institutions. It has established as an essential resource whose aim is to maintain to the disabled person in its usual means and to provide support to its caretakers. It takes care of from a multidisciplinary equipment that contributes to the development of common aims, where nursing develops the own competitions of the profession

Humanos , Enfermedad de Alzheimer/epidemiología , Cuidadores/psicología , Grupos de Autoayuda/organización & administración , Atención de Enfermería/métodos , Percepción Social , Competencia Profesional , Centros de Día/organización & administración , Servicios de Atención a Domicilio Provisto por Hospital/organización & administración , Investigación Cualitativa
Reumatol. clín. (Barc.) ; 13(1): 10-16, ene.-feb. 2017. tab, graf, mapas
Artículo en Español | IBECS | ID: ibc-159880


Objetivos. Describir la variabilidad de las unidades de hospitalización de día (UHdD) de Reumatología en España, en términos de recursos estructurales y procesos de funcionamiento. Material y métodos. Estudio descriptivo, multicéntrico, con evaluación de las UHdD mediante cuestionario autocumplimentado a partir de estándares de calidad de la Sociedad Española de Reumatología. Se analizaron recursos estructurales y procesos de las UHdD estratificados por complejidad del hospital (comarcal, general, mayor y complejo), y se determinó la variabilidad mediante el coeficiente de variación (CV) de la variable con relevancia clínica que presentara diferencias estadísticamente significativas al comparar por centros. Resultados. Un total de 89 centros (16 comunidades autónomas y Melilla) se incluyeron en el análisis. El 11,2% de los hospitales son comarcales; el 22,5%, generales; el 27%, mayores, y el 39,3%, complejos. El 92% de las UHdD son polivalentes. El número de tratamientos aplicados, la coordinación entre las UHdD y farmacia hospitalaria y la presencia de formación posgrado fueron las variables de proceso que presentaron diferencias estadísticamente significativas en función del nivel de complejidad del hospital. La tasa de tratamientos más alta se halló en hospitales complejos (2,97 por 1.000 habitantes), y la más baja, en hospitales generales (2,01 por 1.000 habitantes). El CV fue de 0,88 en hospitales mayores, de 0,86 en comarcales, de 0,76 en generales y de 0,72 en los complejos. Conclusiones. Existe una mayor variabilidad en el número de tratamientos de UHdD en los hospitales mayores, seguido de los comarcales. Sin embargo, la variabilidad en estructura y funcionamiento no parece deberse a diferencias de complejidad de los centros (AU)

Objective. To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. Material and methods. Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. Results. A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. Conclusions. there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity (AU)

Humanos , Masculino , Femenino , Centros de Día/métodos , Centros de Día/organización & administración , Centros de Día/normas , Enfermedades Reumáticas/epidemiología , Garantía de la Calidad de Atención de Salud/organización & administración , Calidad de la Atención de Salud/normas , Centros de Día , Centros de Día/estadística & datos numéricos , Centros de Día/tendencias , Encuestas y Cuestionarios , Planes y Programas de Salud/organización & administración , Planes y Programas de Salud/normas
Psychiatr Prax ; 44(4): 228-233, 2017 May.
Artículo en Alemán | MEDLINE | ID: mdl-28125849


In 2014 the growing number of psychiatric Day-Clinics was surveyed for standards in facilities, organisation and therapy details. By the huge number of Day-Clinics there should be given some evidence for best practice. With a self-made questionnaire all 676 Day-Clinics were extensively interviewed. The results were evaluated for frequency, mean value and correlations. Relevant data is now available for duration, organisation and intensity of treatment, room and personnel. Also some Day-Clinical specifics can be shown with effects on financial support. On the basis of the current good clinical practice recommendations for existing or new established Day-Clinics can be developed.

Centros de Día/organización & administración , Trastornos Mentales/terapia , Servicio de Psiquiatría en Hospital/organización & administración , Actividades Cotidianas/clasificación , Adulto , Anciano , Benchmarking , Prestación de Atención de Salud/organización & administración , Femenino , Alemania , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Psicoterapia , Psicotrópicos/uso terapéutico , Habilidades Sociales , Estadística como Asunto , Encuestas y Cuestionarios