Telephone support vs. self-guidance in an Internet-based self-administered psychological program for the treatment of depression: Protocol for a hybrid type 1 effectiveness-implementation randomized controlled trial.

Background: Depression is already the leading psychological disability around the world, impairing daily life, well-being, and social functioning and leading to personal and social costs. Despite the effectiveness of Evidence-Based Psychological Practices (EBPP), a significant percentage of depressive individuals remain untreated, especially in Primary Care (PC) settings in Spain. There are numerous barriers that limit access to EBPPs, including high costs, professional training, and adherence problems. Information and Communication Technologies (ICTs) offer a cost-effective way to disseminate and scale EBPPs to address these barriers. The iCBT program Smiling is Fun has been demonstrated to be a cost-effective treatment for depression in various Randomized Control Trials. However, adherence and implementation problems in real-world settings need to be addressed. Implementation research can help evaluate these challenges by identifying facilitators and barriers to the implementation process in PC. In this regard, including human support has been pointed out as a possible key factor in addressing the population's mental health needs and promoting treatment adherence. Objective: The current study aims to examine the effectiveness, adherence rates, and implementation process of Smiling is Fun to address depression in a PC setting considering the influence of telephone support vs no support. Methods: The proposed research is a Hybrid Effectiveness-Implementation Type I study, with a two-armed randomized controlled design, which will test a clinical intervention for major depressive disorder while gathering information on its implementation in a real-world setting. The study will include adult patients with mild to moderate symptoms of depression. Participants will be randomly assigned to one of two groups: self-applied psychotherapy or self-applied psychotherapy with psychotherapeutic telephone support. The trial will recruit 110 patient participants, with a loss-to-follow-up rate of 30 %. Discussion: A study protocol for a hybrid effectiveness-implementation study is presented with the aim to assess the implementation of Smiling is Fun for the treatment of depression in PC. The study evaluates the influence of telephone support during a self-administered intervention compared to unguided self-administration. The main goal is to address the barriers and facilitators of the implementation process and to promote treatment adherence. Ultimately, the results of the study could help in the uptake of sustainable resources so that the population could gain better access to psychological interventions in mental health services. Registration: ClinicalTrials.gov; NCT06230237.

Flujo de pacientes a través del box de reanimación de un servicio de urgencias hospitalarias / Flow of patients through the recovery room of a hospital emergency room

Objetivos: describir las características de los pacientes que son atendidos e ingresados en el box de reanimación de urgencias, determinar el tiempo medio de permanencia e identificar los factores que pueden afectar el flujo de los pacientes a través del mismo. Material y método: estudio descriptivo transversal prospectivo, de la población de pacientes ingresados y atendidos en el box de reanimación durante un mes (15/4/2011 al 15/5/2011). Se han analizado las siguientes variables: socio-demográficas, procedencia, día de la semana, hora de entrada, hora de salida, tiempo de permanencia, motivo diagnóstico, prioridad según triaje, tipo de intervención, destino y valoración subjetiva del profesional que interviene sobre la adecuación del triaje. Resultados: de 5.512 pacientes atendidos en urgencias, el 2,2% (121) fueron ingresados en reanimación. La edad media de los pacientes ha sido 65,7 (±20,65). El 49,6% tenían entre 70 y 89 años. La patología más frecuente (59%)fue de origen cardiocirculatorio. El 38% de los casos atendidos fue clasificado como "Nivel II. Código naranja", el 30,6% se clasificó como "Nivel I. Código rojo". La mayor demanda se produjo en el turno de la mañana, entre las 12:01 h y las 15:00 h. El viernes fue el día de mayor frecuencia de ingresos (18,2%). El tiempo medio de permanencia del paciente en el box de reanimación ha sido de 60 minutos (rango 10-240 minutos) y es mayor cuando el motivo diagnóstico es más grave (infarto: 117,50 minutos).Conclusiones: la edad, patología y gravedad del paciente atendido en el box de reanimación de urgencias son elementos que contribuyen a alargar los tiempos medios de permanencia y enlentecen el flujo de pacientes. Sin embargo, hay otros factores externos e internos que también afectan a estos flujos y repercuten en la saturación de urgencias, como el ingreso de pacientes de menor gravedad y la concentración de pacientes en una determinada franja horaria (AU)

Objectives: to describe the characteristics of patients treated and admitted to the emergency recovery box, determine the mean stay time and identify factors that may affect the flow of patients through the recovery box. Material and method: prospective descriptive study of the patient population admitted and treated at the recovery box over a period of one month(15/04/2011 to 15/05/2011). The following variables were analyzed: sociodemographic characteristics, origin, day of the week, time of admission, time of discharge, length of stay, reason for diagnosis, priority based on triage, intervention type, destination and subjective assessment of the professional intervening on the adequacy of triage. Results: of 5,512 patients seen in the emergency room, 2,2% (121) were admitted to the recovery box. Mean patient age was 65,7 (± 20,65). 49,6% were between 70 and 89 years old. The most frequent pathology (59%) was of cardiovascular origin. 38% of the cases treated were classified as "Level II. Orange Code", 30,6% were classified as "Level I. Red Code". The greatest demand (highest frequentation) for care occurred in the morning shift, between12:01 and 15:00 h. Friday was the day when the highest number of admissions occurred (18,2%). Mean time of stay of patients in the recovery box was60 minutes (range 10-240 minutes), being greater when the subject present with a more serious diagnosis (infarction: 117.50 minutes).Conclusions: age, pathology and severity of the condition of patients treated at the emergency recovery box are contributing factors to longer mean stay times and slow down the flow of patients. However, there are other external and internal factors that also affect these flows and affect emergency room saturation, such as the admission of less seriously ill patients and the concentration of patients at a given time range (AU)