Satisfacción con la atención hospitalaria al final de la vida / Satisfaction with hospital care at the end of life

OBJETIVO: Conocer la satisfacción de familiares de pacientes fallecidos con la atención recibida en una unidad de cuidados paliativos (UCP) y comparar con los casos donde no intervino el equipo con atención psicológica específica. MATERIAL Y MÉTODOS: Administración de encuesta anónima (n=202) a familiares (tasa de respuesta = 42,1%). Se evaluaron 9 cuestiones relacionadas con el proceso de morir y la valoración global de la atención. RESULTADOS: La satisfacción global fue alta (9,22). La valoración del equipo completo fue 9,40 y sin la psicóloga, 8,40 (p = 0,005). Los ítems mejor valorados fueron «disponibilidad del equipo», «información recibida» y «ayuda para enfrentar la enfermedad», seguidos de «control del dolor», «muerte en paz», «ayuda para la comunicación entre paciente-familia», «apoyo en el duelo» y «calidad de vida». CONCLUSIONES: Según la valoración de los familiares, los equipos de las UCP hospitalarias contribuyen a incrementar la calidad de la atención al final de la vida

OBJECTIVES: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. MATERIAL AND METHODS: An anonymous survey (n = 202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. RESULTS: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P = .005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life". CONCLUSIONS: Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life

Satisfaction with hospital care at the end of life. / Satisfacción con la atención hospitalaria al final de la vida.

OBJECTIVES: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. MATERIAL AND METHODS: An anonymous survey (n=202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. RESULTS: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P=.005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life". CONCLUSIONS: Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life.

Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies.

OBJECTIVE: To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. METHOD: We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. RESULTS: Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). CONCLUSION: Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Calidad de vida en pacientes sometidos a cirugía bariátrica: evolución y determinantes / Quality of life in patients undergoing bariatric surgery: evolution and determinants

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Uso y dependencia de fármacos opioides en población española con dolor crónico: prevalencia y diferencias de género / Use and dependence on opioid drugs in the Spanish population with chronic pain: prevalence and differences according to sex

Objetivos. Analizar la prevalencia del uso y la dependencia a fármacos opioides en población española con dolor crónico y evaluar diferencias de género. Pacientes y métodos. En 229 usuarios de fármacos opioides se evaluaron variables sociodemográficas, características del tratamiento con opioides y uso de otras sustancias. Se realizó un análisis descriptivo y bivariado. Resultados. El 46% cumplía criterios de dependencia de fármacos opioides (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-TR]). El consumo de alcohol y cannabis fue mayor en hombres. Las tasas de dependencia en el uso de fármacos opioides fueron significativamente superiores en los tratamientos prolongados. Conclusiones. La planificación de tratamientos con opioides y las estrategias de prevención de uso inadecuado deben ser independientes del género. Son necesarios más estudios que profundicen en las variables médicas y psicológicas relacionadas con el uso y la dependencia de opioides (AU)

Objectives. To analyse the prevalence in the use and dependence on opioid drugs in the Spanish population with chronic pain and evaluate the differences according to sex. Patients and methods. The demographic variables, opioid treatment characteristics and use of other substances were assessed in 229 users of opioid drugs. A descriptive bivariate analysis of the data was performed. Results. Forty-six percent of the patients met the criteria of dependence on opioid drugs (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-TR]). Alcohol and cannabis consumption was greater in the men. The rates of dependence on the use of opioid drugs were significantly higher in the extended treatments. Conclusions. Planning for treatments with opioids and strategies for preventing inappropriate use should not depend on the patient's sex. We need further studies on the medical and psychological variables related to the use of and dependence on opioids (AU)

[Changes in quality of life in patients undergoing bariatric surgery following 24-months: comparison between gastric bypass and tubular vertical gastrectomy]. / Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular.

BACKGROUND: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. METHODS: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. RESULTS: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. CONCLUSION: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term. Key words. Bariatric surgery. Quality of life. Morbid obesity.

Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular / Changes in quality of life after 24 months in patients undergoing bariatric surgery: comparison between gastric bypass and tubular vertical gastrectomy

Fundamento: La cirugía bariátrica se ha convertido en el procedimiento de elección para afrontar, con las mayores posibilidades de éxito, los casos de obesidad mórbida y super-mórbida. Los objetivos de este estudio son: a) analizar la evolución del porcentaje del exceso de índice de masa corporal perdido (PEIMCP) y la calidad de vida a medio y largo plazo tras la cirugía bariátrica; b) evaluar las diferencias en PEIMCP y calidad de vida en función de la técnica quirúrgica realizada; y c) examinar la relación entre PEIMCP y la calidad de vida. Material y métodos: Han intervenido en el estudio 191 sujetos intervenidos de cirugía baríátrica con seguimiento a los 12 y 24 meses tras la cirugía. Se administraron los cuestionarios SF-36 y OP-53 para evaluar la calidad de vida tras la cirugía de manera autoinformada. Resultados: Se observa una reducción del porcentaje del exceso de índice de masa corporal (IMC) perdido estadísticamente significativa a los 12 y 24 meses y una mejora significativa en la calidad de vida a los 12 meses, que se mantuvo estable a los 24 meses para la mayoría de las variables. Los pacientes intervenidos mediante bypass gástrico muestran una mayor pérdida de PEIMCP a los 12 y 24 meses, y mejora significativa al año de evaluación en la mayoría de las dimensiones que miden calidad de vida con respecto a la técnica de gastrectomía vertical tubular. Conclusión: La cirugía bariátrica es eficaz para disminuir el porcentaje del exceso de IMC perdido y mejorar significativamente la calidad de vida de los pacientes con obesidad mórbida a largo plazo (AU)

Background: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. Methods: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. Results: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. Conclusion: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term (AU)

Use and dependence on opioid drugs in the Spanish population with chronic pain: Prevalence and differences according to sex. / Uso y dependencia de fármacos opioides en población española con dolor crónico: prevalencia y diferencias de género.

OBJECTIVES: To analyse the prevalence in the use and dependence on opioid drugs in the Spanish population with chronic pain and evaluate the differences according to sex. PATIENTS AND METHODS: The demographic variables, opioid treatment characteristics and use of other substances were assessed in 229 users of opioid drugs. A descriptive bivariate analysis of the data was performed. RESULTS: Forty-six percent of the patients met the criteria of dependence on opioid drugs (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-TR]). Alcohol and cannabis consumption was greater in the men. The rates of dependence on the use of opioid drugs were significantly higher in the extended treatments. CONCLUSIONS: Planning for treatments with opioids and strategies for preventing inappropriate use should not depend on the patient's sex. We need further studies on the medical and psychological variables related to the use of and dependence on opioids.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis.

BACKGROUND: Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS: We searched 6 databases until June 2015. INCLUSION CRITERIA: 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS: From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS: There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS: Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis.

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies.

OBJECTIVE: To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults. METHOD: We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775). RESULTS: From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07). CONCLUSION: Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.

[Communication skills: a preventive factor in Burnout syndrome in health professionals]. / Las habilidades de comunicación como factor preventivo del síndrome de Burnout en los profesionales de la salud.

BACKGROUND: Health professionals are a group that suffers high levels of job stress and burnout. The aim of this study is to demonstrate empirically that the healthcare count on communication skills helps prevent Burnout Syndrome. METHOD: An observational, analytical, cross-sectional study was proposed, involving a sample of 927 health professionals (197 doctors, 450 nurses and 280 auxiliary nurses). Participants completed questionnaires measuring communication skills in health care (EHC-PS) and the Maslach Burnout Inventory Human Services Survey (MBI-HSS). RESULTS: A negative and statistically significant correlation between the different dimensions of communication skills and emotional exhaustion and depersonalization dimensions of burnout was obtained. On the other hand, a positive and statistically significant correlation between the dimensions of communication skills and the personal accomplishment dimension of burnout was observed. CONCLUSIONS: It was shown that the communication skills of health professionals provide protection from and cushion Burnout Syndrome.

Las habilidades de comunicación como factor preventivo del síndrome de Burnout en los profesionales de la salud / Communication skills: a preventive factor in Burnout syndrome in health professionals

Fundamento: Los profesionales de la salud son un colectivo que sufre altos niveles de estrés laboral. El objetivo de este estudio es analizar la relación entre habilidades de comunicación y síndrome de Burnout en profesionales sanitarios. La propuesta es demostrar empíricamente la hipótesis de que el hecho de que el profesional de la salud cuente con habilidades de comunicación contribuye a prevenir el síndrome de Burnout. Material y método: Se plantea un estudio observacional, analítico, transversal en una muestra de 927 profesionales sanitarios, 197 médicos (21,3%), 450 enfermeras (48,5%) y 280 auxiliares de enfermería (30,2%). Se han usado la Escala sobre Habilidades de Comunicación en Profesionales de la Salud (EHC-PS) y el Maslach Burnout Inventory Human Services Survey (MBI-HSS). Resultados: Se obtiene una correlación negativa y estadísticamente significativa entre las diferentes dimensiones de las habilidades de comunicación y las dimensiones agotamiento emocional y despersonalización del burnout. Por otro lado, se observa una correlación positiva y estadísticamente significativa entre las dimensiones de las habilidades de comunicación y la dimensión realización personal en el trabajo. Conclusiones: Se ha encontrado evidencia de que las habilidades de comunicación de los profesionales de la salud protegen y amortiguan el síndrome de Burnout (AU)

Background: Health professionals are a group that suffers high levels of job stress and burnout. The aim of this study is to demonstrate empirically that the healthcare count on communication skills helps prevent Burnout Syndrome. Method: An observational, analytical, cross-sectional study was proposed, involving a sample of 927 health professionals (197 doctors, 450 nurses and 280 auxiliary nurses). Participants completed questionnaires measuring communication skills in health care (EHC-PS) and the Maslach Burnout Inventory Human Services Survey (MBI-HSS). Results: A negative and statistically significant correlation between the different dimensions of communication skills and emotional exhaustion and depersonalization dimensions of burnout was obtained. On the other hand, a positive and statistically significant correlation between the dimensions of communication skills and the personal accomplishment dimension of burnout was observed. Conclusions: It was shown that the communication skills of health professionals provide protection from and cushion Burnout Syndrome (AU)

Perfil de desarrollo en una cohorte de muy bajo peso al nacimiento / Developmental profile of a cohort of very low birth weight

Introducción: Los estudios longitudinales realizados en niños que presentaron un peso al nacimiento inferior a 1.500 g (muy bajo peso al nacimiento [MBPN]) han demostrado la presencia de dificultades en la edad adulta que no son explicables por las variables clásicamente analizadas (inteligencia, sexo, etc.). Objetivos: Conocer las condiciones evolutivas de estos niños en diferentes momentos cronológicos y la capacidad predictiva de los controles iniciales en edades tempranas respecto a la edad escolar. Sujetos y método: Se realizó un estudio descriptivo en una cohorte de 317 niños con MBPN, nacidos entre 2001 y 2010 en la Unidad de Neonatología del Hospital General Universitario de Alicante, y se obtuvieron datos del perfil psicomotor e intelectual y de las alteraciones conductuales. Las evaluaciones se realizaron a los 20 y 28 meses de edad corregida, y a los 6,5 años. Resultados: Observamos una mayor presencia de niveles de desarrollo psicomotor en el límite inferior del promedio adecuado a la edad cronológica, cocientes intelectuales en el rango medio-bajo, mayor frecuencia de síntomas y signos de trastorno por déficit de atención e hiperactividad (TDAH), y la presencia de alteraciones cualitativas como posibles indicadores de trastornos del espectro autista (TEA). Los controles iniciales a la edad de 20 y 28 meses han resultado ser predictivos de la capacidad intelectual y los síntomas de probable TEA obtenidos a los 6 años. Conclusión: Cabe afirmar que la evolución posterior de estos niños está condicionada no tanto por los aspectos relacionados con la capacidad intelectual, como por la posibilidad de que presenten TDAH y/o TEA (AU)

Introduction: Longitudinal studies done in children who presented at birth a weight lower than 1,500 g (very low birth weight [VLBW]), have evidenced difficulties in their adulthood which cannot be explained by the classical analyzed variables (intelligence, gender, etc.). Objectives: To research the developmental conditions of these children in different chronological moments and find out the predictive capacity of the initial trials done at early ages regarding to the results at school age. Subjects and method: A descriptive study was carried out in a cohort of 317children with VLBW, born between 2001 and 2010, on the Neonatology Unit at the Hospital General Universitario de Alicante obtaining data of the psychomotor and intellectual profiles, and behavior disturbances. Evaluations had been done at the corrected age of 20 and 28 months, and 6.5 years. Results: We observed higher presence of: psychomotor quotients in the low border of the appropriate average for the chronological age, intelligent quotients in the medium-low range, higher frequency of symptoms and signs of attention deficit and hyperactive disorder (ADHD), and presence of qualitative disturbances which might indicate an autism spectrum disorder (ASD). Initial controls at the age of 20 and 28 months had shown they are predictors of the intellectual capacity and the possible symptoms of ADS obtained at the age of 6. Conclusion: It is likely to affirm that the later development of these children is compromised not as much by their intellectual capacity, as by for the possibility of being presenting ASD or ADHD (AU)

What do Spaniards read about the prudent use of anti-microbial agents and what do they really do?

OBJECTIVES: The prudent use of antibiotics (PUA) is promoted not only by public information campaigns, but also in the printed media and on websites. This study assesses the correspondence between PUA information in the Spanish printed media and on websites and the messages put out by national campaigns. Spaniards' use of antibiotics following the campaigns was also analysed. METHODS: A two-phase descriptive study was carried out. First, antibiotics-related news in the Spanish printed media (January 2007-May 2009) and institutional and news media websites (March-May 2009) were systematically reviewed using a data collection tool. In addition, a telephone survey on antibiotics-related knowledge and behaviours was carried out with a random sample of 1526 people living in Spain who had recently received medical care. RESULTS: In total, 29 news items containing nine different messages were identified. All the messages were similar to those promoted by the campaigns. The survey showed that even after the campaigns, relevant gaps in knowledge about the PUA persist, particularly among men (p = .005), those living in rural areas (p = .02) and the elderly (p < .001). Keeping left-over antibiotics was associated with ignorance about the association between antibiotic use and resistance (OR 3.1, 95% CI 2.3-4.2). Also, patients who ask their doctor about drug interactions are less likely to self-medicate (p = .04). CONCLUSIONS: The information reaching the Spanish public via the media seems to be similar to the messages transmitted by public information campaigns. Nevertheless, there appears to be considerable room for improvement. Promoting an active role in patients might reduce self-medication.

Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica / Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients

Objetivo. Evaluar la satisfacción de los pacientes candidatos a cirugía bariátrica con la realización de un programa de preparación grupal precirugía, detectar oportunidades de mejora en el programa y evaluar la satisfacción de los participantes tras su implantación. Material y métodos. Se ha utilizado una encuesta diseñada ad hoc dirigida a evaluar la opinión sobre diferentes aspectos del programa, la satisfacción con el mismo y la identificación de mejoras. Se administró a dos grupos de pacientes: al primero un año después del programa para identificar propuestas de mejora y al segundo un año después de la implementación de la mejora. Se evaluaron 112 pacientes, 66 en el primer pase de la encuesta y 46 en el segundo. Ambos grupos fueron homogéneos en las variables sociodemográficas. Resultados. La principal mejora detectada fue la participación de pacientes expertos en el programa de preparación. Tras su implantación se produjeron ligeros cambios en las valoraciones de las diferentes preguntas, que no fueron significativos. La satisfacción general pasó de un 9,5 a 9,74 sobre 10. Otras propuestas de mejora fueron mejorar la presentación audiovisual y adaptar el mobiliario de la sala a las características de los pacientes. Conclusiones. La elevada satisfacción encontrada es habitual en los trabajos sobre satisfacción hospitalaria, siendo los resultados obtenidos aquí aún mayores que los de los estudios consultados y estando en todos los casos en niveles de excelencia. Esto impide que se produzcan diferencias estadísticamente significativas. Tampoco se encontró una diferencia significativa en los resultados pre y postimplantación de la mejora. La evaluación continua permite constatar nuevas posibilidades de mejora(AU)

Objective. To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. Method. An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables Results. The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. Conclusions. The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement(AU)

[Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients]. / Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica.

OBJECTIVE: To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. METHOD: An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables RESULTS: The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. CONCLUSIONS: The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

Buenas prácticas y satisfacción del paciente / Good practices and patient satisfaction

Objetivo. La Ley de Autonomía del Paciente (LAP) debe contribuir a lograr una atención sanitaria «centrada en el paciente». En este estudio pretendemos determinar en qué medida los pacientes consideran que se está cumpliendo con derechos básicos reconocidos en la LAP (buenas prácticas) y estudiar la relación entre este cumplimiento y el nivel de satisfacción declarado por el paciente. Material y métodos. Se entrevistó a 13.773 pacientes (el 31,7% tenía más de 60 años y el 53,6% fueron mujeres) atendidos en 21 hospitales públicos. La ocurrencia de buenas prácticas acordes a la LAP se analiza mediante estadísticos descriptivos; la relación entre buenas prácticas y satisfacción se estimó mediante regresión logística. Resultados. La información al alta médica fue una de las prácticas más consolidadas en todas las modalidades. Su nivel de cumplimiento osciló entre el 97,4% de padres de niños mayores de 6 años atendidos en Pediatría y el 76,2% de pacientes atendidas en plantas de Obstetricia. El proceso de acogida (odds ratio: 3,53; IC del 95%: 1,95–6,41), el consentimiento informado (odds ratio: 2,77; IC del 95%: 1,40–5,47) y conocer qué tipo de profesional lo está atendiendo en cada momento (odds ratio: 3,36; IC del 95%: 1,96–5,78) son algunos aspectos de la atención que incrementan la probabilidad de que el paciente se declare satisfecho. Conclusiones. El cumplimiento de los derechos de los pacientes es elevado en todas las modalidades de atención valoradas. Cuando se respetan estos derechos se incrementa la satisfacción del paciente(AU)

Objective. The Patient Autonomy Act should contribute to a “patient-centred” health care. The study objectives were to determine to what extent patients believe that their basic rights under the LAP (best practices) are being met. Secondly, to study the relationship between this performance and reported patient satisfaction levels. Materials & methods. A total of 13,773 patients were interviewed (31.7% >60 years and 53.6% women) receiving health care at 21 Spanish public hospitals. The number of “good practices” (GP) was analysed using descriptive statistics; relationship between GP and satisfaction was measured using logistic regression. Results. The medical discharge information was one of the most established practices. The compliance level ranged from 97.4% of parents of children over 6 years in paediatric service and 76.2% of patients attending obstetric services. The welcome process (Odds Ratio 3.53, IC-95% CI; 1.95–6.41, P<0.001), informed consent (Odds Ratio 2.77, 95% CI; 1.40–5.47), to recognize which type of professional was providing care at all the times (Odds Ratio 3.36, 95% CI; 1.96–5.78), were the aspects that increased probability that the patient felt satisfied. Conclusions. Compliance to patient rights was increased in all services analysed. When these rights are respected patient satisfaction increases(AU)