Hospital de día psiquiátrico en tiempos de COVID: grupos y telemedicina / Psychiatric day hospital in times of covid: Groups and telemedicine

Tras decretarse el estado de alarma y el confinamiento por la amenaza del COVID-19, el acceso a los servicios de salud mental y recursos psicosociales se vio obstaculizado, incluso interrumpido.Un colectivo especialmente en riesgo es el de pacientes diag-nosticados de Trastorno Mental Grave. Estos presentan una serie de características que los hace más vulnerables a padecer un em-peoramiento en su salud mental.Desde el Hospital de Día para primeros brotes psicóticos de Pontones se intentó mantener la atención y el seguimiento estre-cho de los pacientes mediante la reestructuración del programa de tratamiento, optando por una intervención terapéutica alternativa mixto (con atención individual presencial y telefónica y terapias grupales por videoconferencia).El objetivo de este trabajo es dar a conocer la experiencia de la implementación de la telemedicina en nuestro HD como res-puesta a la emergencia sanitaria que ocasionó la pandemia, así como recoger el programa de actividades que se desarrollaron y el nivel de satisfacción con el tratamiento recibido de los pacientes que participaron.(AU)

Following the state of alarm and containment due to the CO-VID-19 threat, access to mental health services and psychosocial resources was hampered, even interrupted.A particularly at-risk group is that of patients diagnosed with Severe Mental Disorder. They present a series of characteristics that make them more vulnerable to a worsening of their mental health.From the Day Hospital for first psychotic outbreaks in Pontones we tried to maintain the attention and close monitoring of patients by restructuring the treatment programme, opting for a mixed al-ternative therapeutic intervention (with individual face-to-face and telephone attention and group therapies by videoconference).The aim of this paper is to report on the experience of implemen-ting telemedicine in our HD as a response to the health emergency caused by the pandemic, as well as to record the programme of activities that were developed and the level of satisfaction with the treatment received by the patients who participated.(AU)

Impacto de la intervención en un Hospital de Día de Salud Mental sobre el uso posterior de recursos sanitarios y ocupacionales / Impact of an intervention in a mental health day hospital on the subsequent use of health and occupational resources

El presente trabajo examina el impacto del tratamiento intensivo en un Hospital de Día de Salud Mental (HD-SM) sobre el uso posterior de recursos asistenciales (comunitarios y hospitalarios), así como ocupacionales y formativos. Se parte de un diseño descriptivo longitudinal y ambispectivo en el que se estudia de forma innovadora el uso diferencial de los recursos por parte de los usuarios de la red de Salud Mental, antes y después del tratamiento en HD. Finalmente, se discuten las implicaciones y recomendaciones clínicas de acuerdo con los resultados. (AU)

This work examines the impact of intensive treatment in a Mental Health Day Hospital (HD) on the subsequent use of healthcare resources (community and hospital), as well as occupational and training ones. It starts from a longitudinal and ambispective descriptive design in which the differential use of resources by users of the Mental Health network is studied in an innovative way, before and after treatment in HD. Finally, the clinical implications and recommendations are discussed according to the results. (AU)

Caracterización de los registros de atención en una institución prestadora de servicios de salud mental en Bogotá, 2001-2017 / Characteristics of care delivery records in a mental health service providerinstitution in Bogota, 2001-2017 / Caracterização dos registros de atendimento em uma instituição prestadora deserviços de saúde mental em Bogotá, 2001-2017

Introducción:el abordaje integral de la salud mental es uno de los retos del país en salud pública, dado que la población colombiana ha presentado un deterioro en ese aspectoen los últimos veinte años de acuerdo con el documentoCONPES 3992del2020.Objetivo:Caracterizar los registros individuales de prestación de servicios en atención desalud mental en unainstitución prestadora de servicios enBogotá,Colombia, entre el 2001 y el2017. Métodos:estudio descriptivo trasversal. Se usaron los registros individuales de prestación de servicios como fuente de informacióny se tuvo en cuentaclasificación internacional de enfermedades (CIE-10) Entotal de registros RIPS en salud mental, por equipo interdisciplinario: médico general, médico psiquiatra, enfermería, psicología, trabajo social y terapia ocupacional. Resultados:se analizaron 2.360.295 registros individuales de prestación de servicios en salud mental de la institución seleccionada. Según los registros,el promedio de edad de las personas atendidas era de 47 añosypredominó el sexo femenino con el 52,5%. Los servicios utilizados fueronhospitalización (49,82%), consulta externa (43,42%), urgencias (4,54%)y hospital de día (0,39%). Elmayor número de registros (64,47%) se presentó en el grupo entre los 18 y 59 años de edad; seguido del grupo de 60 años o más (28,50%)y de menores de 18 años (7,03%). Los grupos de diagnóstico principales fueron trastorno psicótico con el 33,38%,depresióncon el 15,39%y ansiedad con el 13,71%. Conclusiones:Son las mujeres quienes más utilizan el servicio (52.5%). Es la hospitalización el servicio más utilizado (49.82%). Son los adultos entre 18 y 59 años quienes más utilizan los servicios (64.47%). Se observa un progresivo incremento en el número de atenciones. Los trastornos mentales severos esquizofrenia y bipolar son los másatendidos (33.38%) seguidos de trastornos de depresión y ansiedad (29%). Las enfermedades medicas generales se presentaron en el (10.95%)de las atenciones.

Introduction: The comprehensive approach to mental health is one of the country's public health challenges, as the Colombian population has deteriorated in this area over the past twenty years, according to the CONPES Document 3992, 2020. Objective:To characterize the individual mental health service delivery records at a service provider institution in Bogota, Colombia, between 2001 and 2017. Methods:Descriptive cross-sectional study. Individual service delivery records were used as a source of information, and the International Classification of Diseases (ICD-10) was considered. Total mental health RIPS by interdisciplinary team: general practitioner, psychiatrist, nurse, psychologist, social worker, and occupational therapist. Results:A total of 2,360,295 individualmental health service delivery records from the selected institution were analyzed. According to the records, the average age of the patients was 47 years, and females predominated with 52.5% of the patients. Inpatient (49.82%), outpatient (43.42%), emergency room (4.54%), and day hospital (0.39%) services were used. The highest number of records (64.47 %) were found among the 18-59 years age group, followed by the 60+ year age group (28.50 %) and those under 18 years of age (7.03 %). The main diagnostic groups were psychotic disorder (33.38%), depression (15.39%), and anxiety (13.71%). Conclusions:Women are the main users of the service (52.5%). Hospitalization is the service most frequently used (49.82%). Adults between the ages of 18 and 59 use the services the most (64.47%). There has been a progressive increase in the number of attendances. Severe schizophrenia and bipolar mental disorders are the most treated (33.38%), followed by depression and anxiety (29%). General medical conditions were present in 10.95% of attendances

Introdução:a abordagem integral da saúde mental é um dos desafios do país em saúde pública, visto que a população colombiana tem apresentadouma deterioração neste aspecto nos últimos vinte anos de acordo com o documento Conpes 3992de 2020. Objetivo:Caracterizar os registros individuais de prestação de serviços em saúde mental em uma instituição prestadora de serviços em Bogotá, Colômbia, entre 2001 e 2017. Métodos:estudo descritivo transversal. Usaram-se os registros individuais de prestação de serviços como fonte de informação e considerou-sea classificação internacional de doenças (CID-10). No total de registros RIPS em saúde mental, por equipe interdisciplinar: clínico geral, psiquiatra, enfermagem, psicologia, serviço social e terapia ocupacional. Resultados:Foram analisados 2.360.295 prontuários individuais de prestação de serviço de saúde mental da instituição selecionada. De acordo com os registros, a média de idade das pessoas atendidas foi de 47 anos e o sexo feminino predominou com 52,5%. Os serviços utilizados foram internação (49,82%), ambulatorial (43,42%), emergência (4,54%) e hospital-dia (0,39%). O maior número de registros (64,47%) foi apresentado no grupo entre 18 e 59 anos; seguido pelo grupo de 60 anos ou mais (28,50%) e os menores de 18 anos(7,03%). Os principais grupos diagnósticos foram transtorno psicótico com 33,38%, depressão com 15,39% e ansiedade com 13,71%. Conclusões:As mulheres são as que mais utilizam o serviço (52,5%). A internação é o serviço mais utilizado (49,82%). Os adultosentre 18 e 59 anos são os que mais utilizam os serviços (64,47%). Observa-se um aumento progressivo no número de atenções. Os transtornos mentais graves esquizofrenia e bipolaridadesão os mais atendidos (33,38%) seguidos de depressão e transtornos de ansiedade (29%). Doenças médicas gerais estiveram presentes em (10,95%) dos atendimentos

Levosimendan in outpatients with advanced heart failure: Single-center experience of 200 intermittent perfusions.

INTRODUCTION: Patients with advanced heart failure (HF) have high morbidity and mortality, with only a small proportion being eligible for advanced therapies. Intermittent outpatient levosimendan infusion has been shown to provide symptomatic relief and reduce the rate of HF events. Our aim was to assess the safety and efficacy of outpatient levosimendan administration in an advanced HF population. METHODS: This is a report of a single-center experience of consecutive advanced HF patients referred for intermittent intravenous outpatient administration of levosimendan, between January 2018 and March 2021. Baseline and follow-up evaluation included clinical assessment, laboratory tests, transthoracic echocardiography and cardiopulmonary exercise testing. Baseline and clinical follow-up data were compared using the Wilcoxon signed-rank test. RESULTS: A total of 24 patients (60.8 years, 83% male, mean left ventricular ejection fraction [LVEF] 24%), with a median of 1.5 HF hospitalizations in the previous six months, were referred for outpatient levosimendan pulses, the majority as a bridge to transplantation or due to clinical deterioration. At six-month follow-up there was a significant reduction in HF hospitalizations to 0.4±0.7 (p<0.001). NYHA class IV (52.2% to 12.5%, p=0.025) and NT-proBNP (8812.5 to 3807.4 pg/ml, p=0.038) were also significantly reduced. Exercise capacity was significantly improved, including peak oxygen uptake (p=0.043) and VE/VCO2 slope (p=0.040). LVEF improved from 24.0% to 29.7% (p=0.008). No serious adverse events were reported. CONCLUSION: Repeated levosimendan administration in advanced HF patients is a safe procedure and was associated with a reduction in HF hospitalizations, functional and LVEF improvement, and reduction in NT-proBNP levels during follow-up.

Descentralización de la elaboración de los tratamientos antineoplásicos. Optimización de los recursos / Decentralisation of the preparation of antineoplastic treatments. Resources

Objetivos: La metodología “Six Sigma” se basa en el análisis de los flujos de trabajo e identificación de los puntos de mejoras con el fin de lograr una máxima eficiencia en los procesos, tanto industriales como sanitarios. El objetivo de este estudio es comparar la eficiencia entre un sistema “clásico” de elaboración de quimioterapia centralizado en el Servicio de Farmacia frente a un modelo descentralizado. Material y métodos: Estudio observacional en el que se analizó la eficiencia de los modelos de elaboración de preparaciones quimioterápicas: 1.- Modelo clásico (MC), a partir del cual se suministran las preparaciones al Hospital de Día de Hematología: las campanas de elaboración de tratamientos y el farmacéutico están presentes en el Servicio de Farmacia.2.- Modelo descentralizado (MD): el farmacéutico y las campanas de preparación de la medicación se encuentran en Hospital de Día de Oncología. La eficiencia de cada sistema se evaluó mediante el tiempo transcurrido desde la recepción de la orden médica hasta la administración de la quimioterapia (TAQ).Resultados: El TAQ siguiendo el MD fue inferior que para el MC: 13,7 [5-28] minutos versus 71,0 [42-96] minutos (p<0,001) con una diferencia media de 57,3 minutos/preparación. El tiempo potencialmente ahorrado con el modelo descentralizado fue de 40,3 horas/día. Conclusiones: Con el presente trabajo hemos querido cuantificar y comparar la eficiencia de los dos modelos de elaboración de mezclas citostáticas, siendo desfavorable para el sistema clásico de centralización para la preparación de la medicación en los Servicios de Farmacia. (AU)

Aims: The «Six Sigma» methodology is based on the analysis of workflows and the identification of areas for improvement in order to achieve maximum efficiency in industrial and healthcare processes. The aim of this study is to compare the efficiency of a «classic» chemotherapy preparation system centralised in the Pharmacy Service versus a decentralised model.Material and methods: Observational study in which the efficiency of the models for the preparation of chemotherapy treatments was analysed: 1.- Classical model (MC), which has the treatment preparation cabinets and a pharmacist located in the Pharmacy Service, and from which the preparations are supplied to the Haematology Day Hospital. 2.- Decentralised model (MD), where both the pharmacist and the medication preparation cabinets are located in the Oncology Day Hospital .For the evaluation of the efficiency of each system, the time elapsed from the receipt of the medical order to the administration of chemotherapy (TAQ) was compared. Results: The TAQ following MD was less than for MC: 13.7 [5-28] minutes versus 71.0 [42-96] minutes (p<0.001) with a mean difference of 57.3 minutes/prescription. The potential time saved with the decentralised model was 40.3 hours/day. Conclusions: The aim of this study was to quantify and compare the efficiency of the two models for the preparation of cytostatic mixtures, showing that the classical centralised system for the preparation of medication in pharmacy services is unfavourable. (AU)

Sarcopenia en pacientes de hospital de día geriátrico / Sarcopenia in a geriatric day hospital

Introducción: La sarcopenia es una enfermedad muscular progresiva y generalizada asociada con un aumento de los resultados adversos para la salud (caídas, fracturas, discapacidad y mortalidad). Multiplica por 4 el riesgo de muerte por cualquier causa y tiene un gran impacto en otros resultados de salud y pérdida de calidad de vida. Objetivo: El objetivo principal de esta investigación es establecer la prevalencia y las variables relacionadas con la sarcopenia en pacientes de un hospital de día geriátrico. Metodología: Muestra de 55 pacientes: 40 mujeres (73%) y 15 hombres (27%), con una edad media de 73,25 años (desviación estándar de 13,4). Resultados: El 87% de los pacientes sobreviven al año de seguimiento. El coeficiente de correlación (positivo) (p < 0,01) para SARC-F y SPPB, SARC-F e índice de Barthel, y dinamómetro e índice de Barthel. El coeficiente de correlación de Pearson (negativo) (p < 0,05) para edad y medicación, índice de fragilidad e índice de Barthel, índice de fragilidad y GDS, e índice de Barthel y SPPB. Conclusiones: se puede concluir que el principal factor de riesgo para sarcopenia es la edad. Cuanto mayor es la edad, mayor es el riesgo de sarcopenia. En los mayores de 80 años se obtiene una alta prevalencia en comparación con otros estudios. La sarcopenia y la fragilidad se consideran fuertes predictores de morbilidad, discapacidad y mortalidad en las personas mayores (AU)

Introduction: Sarcopenia is a progressive and generalized muscledisease associated with an increase in adverse health outcomes (falls, fractures, disability and mortality). It is a disease that multiplies by 4 the risk of death from any cause and has a great impact on other health outcomes and loss of quality of life. Objective: The main objective of this research is to establish the prevalence and variables related to sarcopenia in patients from the geriatric day hospital. Methodology: Sample of 55 patients: 40 women (73%) and 15 men (27%), with a mean age of 73.25 years (standard deviation of 13.4). Results: The 87% of patients survive at one-year follow-up. The Pearson correlation coefficient (positive) (p < 0.01) for SARC-F and SPPB, SARC-F and Barthel index, and dynamometer and Barthel index. The Pearson correlation coefficient (negative) (p < 0.05) for age and medication, frailty index and Barthel index, frailty index (IFVIG) and GDS, and Barthel index and SPPB. Conclusions: it can be concluded that the main factor for sarcopenia is age. The older the age is, the greater the risk for sarcopenia. In those over 80 years of age, we obtain a high prevalence compared to other studies. Sarcopenia and frailty are considered strong predictors of morbidity, disability, and mortality in older people (AU)

Avaliação do impacto da primeira vaga da pandemia COVID-19 nos utentes seguidos num hospital de dia de psiquiatria / Impact assessment of the first outbreak of the COVID-19 pandemic on patients admitted in a psychiatric day hospital / Con la pandemia COVID-19, fue necesario reestructurar las intervenciones de un Hospital de Día de Psiquiatría (HD) portugués

Resumo Introdução: Com a pandemia COVID-19, foi necessária uma restruturação das intervenções do Hospital de Dia de Psiquiatria (HD) de um centro hospitalar. Objetivos: Os nossos objetivos foram: 1) identificar o impacto subjetivo das condições inerentes à pandemia ao nível da saúde mental dos utentes; 2) identificar o impacto subjetivo da alteração da dinâmica de funcionamento do HD e na relação com esta estrutura; e 3) obter feedback quanto à metodologia de trabalho e de intervenção dos técnicos do HD. Métodos: Realizámos um estudo transversal analítico misto. Enviámos questionários aos utentes em dois períodos: (1) um mês após o confinamento (Avaliação geral do período de confinamento; Satisfação com a atividade Despertar (e-mail); Satisfação com a atividade Serenar (online); Escala de Ansiedade do SCL-90-R); e (2) um mês após o início do novo modelo de funcionamento presencial do HD (Avaliação geral; Escala de Ansiedade do SCL-90-R). Resultados: Obtivemos a participação de 12 utentes. A intervenção e as atividades implementadas durante o confinamento foram percecionadas como positivas e permitiram a manutenção do vínculo ao HD; foi destacado negativamente a perda do apoio presencial e as dificuldades tecnológicas. Conclusões: Verificou-se uma tendência para a agudização de sintomas de ansiedade com o início do confinamento, tendo esta sido mantida após o retorno ao funcionamento presencial.

Abstract Introduction: With the COVID-19 pandemic, it was necessary to restructure the interventions of a Portuguese Psychiatry Day Hospital (DH). Aims: Thus, we proposed: (1) to identify the impact of the pandemic on the patients' mental health; (2) to identify the impact of the restructuring of the DH on patients and (3) to obtain feedback regarding the interventions. Methods: We carried out a cross-sectional analytical mixed study. We sent questionnaires to patients in two periods: (1) one month after confinement (General assessment of the confinement period; Satisfaction with the Despertar (awakening) activity; Satisfaction with the Serenar (mindfulness) activity (online); SCL-90-R Anxiety Scale); and (2) one month after the start of the new face-to-face operation model of the HD (General Evaluation; SCL-90-R Anxiety Scale). Results: We obtained the participation of 12 patients. The intervention and activities implemented during the confinement were perceived as positive and allowed the maintenance of the link to HD; the loss of face-to-face support and technological difficulties were negatively highlighted. Conclusions: There was a tendency for symptoms of anxiety to worsen with the beginning of confinement, which was maintained after returning to face-to-face functioning.

Resumen Introducción: Con la pandemia COVID-19, fue necesario reestructurar las intervenciones de un Hospital de Día de Psiquiatría (HD) portugués. Objetivos: Así, nos propusimos: (1) identificar el impacto de la pandemia en la salud mental de los pacientes del HD; (2) identificar el impacto subjetivo de la reestructuración del HD y (3) obtener feedback sobre las intervenciones. Métodos: Realizamos un estudio analítico transversal mixto. Enviamos cuestionarios a los pacientes en dos periodos: (1) un mes después del confinamiento (Evaluación general del periodo de encierro; Satisfacción con la actividad Despertar (despertar); Satisfacción con la actividad Serenar (mindfulness) (online); SCL-90-R Escala de ansiedad); y (2) un mes después del inicio del nuevo modelo de operación presencial de HD (Evaluación General; Escala de Ansiedad SCL-90-R). Resultados: Obtuvimos la participación de 12 pacientes. La intervención y actividades implementadas durante el encierro fueron percibidas como positivas y permitieron el mantenimiento del vínculo con HD. Se destacaron negativamente la pérdida de apoyo presencial y las dificultades tecnológicas. Conclusiones: Hubo una tendencia a que los síntomas de ansiedad empeoraran con el inicio del confinamiento, que se mantuvo luego de volver al funcionamiento presencial.

Evaluación clínica y social de pacientes depresivos en un programa de Hospital de Día Psicogeriátrico / Clinical and social evaluation of depressed patients in a Psychogeriatric Day Hospital program

Fundamento. El objetivo de este estudio fue identificar los problemas de los pacientes con sintomatología depresiva grave (GDS >9) mediante la escala HoNOS65+, evaluar la efectividad de un programa de hospitalización parcial para reducir los síntomas depresivos graves a GDS ≤ 9, e identificar los predictores de respuesta. Material y métodos. Estudio pre-post de pacientes con sintomatología depresiva grave tratados en el Hospital de Día Psicogeriátrico (HDPG) de Pamplona (España) entre 2013 y 2020. Se compararon las puntuaciones obtenidas en las escalas HoNOS65+, MMSE, GDS, BARTHEL, ALSAR y COTE al ingreso y al alta, y se determinaron los factores pronósticos de no mejora. Resultados. El 75,3% de los 81 pacientes fueron mujeres, con edad media 69,9 años (rango: 57-88). Al alta, la sintomatología depresiva grave se mantuvo en el 25,9% de los pacientes, los cuales mejoraron significativamente en las escalas HoNOS65+ total y COTE, pero mantuvieron los problemas de deterioro físico e incrementaron los cognitivos. Los pacientes con GDS ≤ 9 al alta redujeron significativamente los problemas presentados al ingreso, excepto el nivel de dependencia (Barthel). Al ingreso, los pacientes que no mejorarán mostraron mayores puntuaciones en sintomatología depresiva (GDS) y en problemas conductuales y sociales (HoNOS65+); las tres variables fueron predictores independientes de no mejora de la sintomatología depresiva grave. Conclusiones. El programa del HDPG impactó positivamente en los pacientes mayores con sintomatología depresiva grave. La mejoría clínica y social alcanzada apoya el formato de HDPG como una alternativa adecuada para la atención de estos pacientes.(AU)

Background. The aim of this study was to identify the problems of patients with severe depressive symptoms (GDS>9) according to the HoNOS+65 scale, to evaluate the effectiveness of a partial hospitalization program to reduce severe depressive symptoms, and to identify independent predictors. Methods. Pre-post study of patients with depression treated at the psychogeriatric Day Hospital (HDPG) of Pamplona (Spain). The scores obtained on the HoNOS+65, MMSE, GDS, BARTHEL, ALSAR, and COTE scales were compared at admission and discharge, and the prognostic factors for no improvement of severe depressive symptoms were determined. Results. The 75.3% of the 81 patients were women, with a mean age of 69.9 years (range: 57-88). At discharge, severe depressive symptoms only remained for 25.9%, who significantly improved on the HoNOS+65 total and COTE scales while problems of physical deterioration were maintained and cognitive ones increased. Patients with GDS <9 at discharge showed significant reductions in all the problems presented at admisión, except for the level of dependency (Barthel). On admission, the patiens who did not improve showed more severe despressive symptoms and greater behavioral and social problems: the three variables were independent predictors for no improvement of severe depressive symptoms. Conclusions. The HDPG program had a positive impact on patients with severe depressive symptoms. The clinical and social improvement achieved supports the HDPG format as an adequate alternative for the care of elderly patients with severe depressive symptoms.(AU)

Efectividad de la estimulación cognitiva en pacientes del hospital de dia del parc sanitari pere virgili / Effectiveness of cognitive stimulation in patients of the parc sanitari day hospital pere virgili

La demencia en España se da hasta en el 15% de los mayores de 65 años, y el 17,2% de los mayores de 70 años. Su abordaje no farmacológico incluye la estimulación cognitiva que aporta claros beneficios según la literatura. Objetivo: Evaluar la eficacia de la estimulación cognitiva en pacientes ingresados en el hospital de día del Hospital de día (HD) del Parc Sanitari Pere Virgili (PSPV), evaluando su impacto sobre el paciente a nivel cognitivo, funcional, social y emocional. Metodología: Se realizó un estudio longitudinal prospectivo de intervención. Se realizó un corte transversal antes de iniciar la terapia y un corte transversal al finalizarla. Se compararon ambos cortes concluyendo si había diferencias significativas entre ellos. El estudio se realizó en el HD del PSPV. Los sujetos de estudio fueron los pacientes ingresados en el HD del PSPV, que cumplan los criterios de inclusión y exclusión del estudio. Se recogieron los datos de los pacientes que realizaron la Estimulación Cognitiva desde Enero/febrero hasta noviembre/diciembre del 2018. Los participantes en el estudio fueron 56. La intervención realizada fueron las terapias que se llevan a cabo en el HD, estimulación cognitiva oral, escrita o a través de ordenador y gimnasia colectiva: en el caso que lo precisaran, también realizaron fisioterapia o terapia ocupacional. Las diferentes variables se recogieron en el Cuaderno de recogida de datos, incluyeron: Edad, Género, MMSE, Barthel y Lawton. El análisis estadístico de los datos se realizó mediante el programa estadístico SPSS® (Statistical Product and Service Solutions) versión 20.0.Se realizó un análisis descriptivo de todas las variables recogidas. El estudio cuenta con algunas limitaciones y aspectos éticos que se han tenido en cuenta en el desarrollo de este. El presupuesto que se precisó para dicha actividad fue limitado, ya que la intervención ya se estaba realizando previamente. Se llevó a cabo durante el año 2018 (AU)

Dementia in Spain occurs up to 15% of those over 65 years of age, and the 17.2% of those over the age of 70. Its nonpharmacological approach includes the cognitive stimulation which provides clear benefits according to the literature. Objective:To evaluate the efficacy of cognitive stimulation in patients admitted to the Parc Sanitari Pere Virgili (PSPV) day hospital (HD), evaluating it’s cognitive, functional, social and emotional impact on the patient. Methodology: A prospective longitudinal study of intervention. A transversal cut was made before starting the therapy and a cut cross when finished. Both cuts were compared concluding if there was significant differences between them. The study was carried out in the HD of the PSPV. Its subjects were the patients admitted to the HD of the PSPV, who met the inclusion and exclusion criteria of the study. The data was collected from the patients who underwent Cognitive Stimulation from January/February to November/December or 2018. There was a total of 56 participants in the study. Intervention carried out were the therapies are being fulfilled at the HD, including, oral, written or computerized cognitive stimulation and collective gymnastics: if it was required, they also could performe physiotherapy or occupational therapy. The different variables were collected in the Data Collection Notebook, they included: Age, Gender, MMSE, Barthel and Lawton. The statistical analysis of the data was carried out using the statistical program SPSS® (Statistical Product and Service Solutions) version 20.0. A descriptive analysis of all variables was performed. The study has some limitations and ethical aspects that have been taken into account in its development. The budget required for said activity was limited, since the intervention was already being carried out previously. It was executed out during the year 2018 (AU)

Day hospital during COVID-19 pandemic: adolescents experiences of telematic group interventions / Hospital de día en contexto de pandemia por COVID-19: experiencias de adolescentes asistiendo a intervenciones grupales telemáticas

Objective: To explore the experience of adolescent users of the day hospital who were part of the telematic adaptation of the usual group interventions of the day hospital. Background: Day Hospitals are specialized outpatient facilities whose objective is to stabilize the user through intensive treatment while remaining in their family or community. In Chile, there are not enough day hospitals. One way of expanding the coverage is telematic care, which also is adapted to the COVID-19 pandemic restrictions.  However, there are no studies on telematic day hospital services in Chile. Material and Methods: ten users participated in the study (out of 13 users of the intervention). We conducted semi-structured interviews and self-administered surveys between August 2020 and January 2021. Content Analysis was used to analyze the interviews, and the surveys were analyzed with descriptive statistics. Results: Positive social interactions were particularly valued by the participants (with both peers and therapists). There is a general perception of having improved socioemotional skills and mood. Telematic implementation was considered satisfactory by most participants, and they proposed incorporating more activities to promote deeper interactions with their peers. Conclusion: The core elements of this intervention would be the perception of social support (a possible therapeutic mechanism) and the feeling of having improved social skills and mood (possible primary outcome).

Objetivo: explorar la experiencia de adolescentes usuarios del hospital de día que fueron parte de la adaptación telemática de las intervenciones grupales habituales de dicho hospital. Antecedente teóricos: los Hospitales de Día (HDD) son puntos de atención de hospitalización diurna y especializada cuyo objetivo es alcanzar la estabilización del usuario/a por medio de un tratamiento intensivo permaneciendo en su familia o comunidad. Los HDD en Chile son insuficientes. Una forma de ampliar la cobertura es la atención telemática, la que además se adapta a las limitaciones impuestas por la pandemia por COVID-19.  Sin embargo, no existen estudios sobre atención telemática de HDD en Chile. Material y Métodos: de los 13 usuarios de la intervención, 10 participaron en este estudio. Se realizaron entrevistas semi-estructuradas y encuestas autoaplicadas entre agosto 2020 y enero 2021.  Las entrevistas fueron analizadas utilizando Análisis de Contenido y las encuestas se analizaron con estadísticas descriptivas. Resultados: se aprecia una especial valoración de los/las participantes por las interacciones sociales positivas (con pares y terapeutas). Aparece una percepción general de haber mejorado en habilidades socioemocionales y estado de ánimo. La implementación telemática resultó satisfactoria para la mayoría de los participantes quienes proponen agregar actividades que promuevan interacciones más profundas con sus pares. Conclusión: los elementos centrales de esta intervención serían la percepción de apoyo social (posible mecanismo terapéutico) y la sensación de mejorar las habilidades sociales y el estado de ánimo (posible resultado principal).

Results of a day-hospital program for personality disorders. Application of the PID-5 and DSM-5 dimensional model / Los resultados de un programa de hospital de día en los trastornos de la personalidad. La aplicación del modelo PID-5 y del DSM-5

DSM-5 dimensional-hybrid model and PID-5 Personality Inventory might be particularly useful in a day hospital treatment program for personality disorders, while the need for treatment for mixed personality disorder and unspecified personality disorder is such as frequent as for borderline personality disorder. Effective treatment programs in the public health system are required. The study shows the results from the day hospital treatment program for personality disorders implemented at San Juan Hospital in Alicante. The treatment involves an intensive and interdisciplinary program that applies the DSM-5 dimensional model and the PID-5 personality inventory to identify therapeutic needs, with both individual and group therapies with a cognitive-behavioural therapeutic approach. Results support the relevance of therapeutic components regarding this program. Moreover, its effectiveness has been demonstrated in achieving significant changes in symptoms, traits, comorbidity, and psychosocial functioning. It also appears to be efficient not only in reducing the number of visits to the emergency and hospital admissions, but also in ensuring continuity and therapeutic compliance, thus reducing public health costs. (AU)

El modelo híbrido dimensional del DSM-5 y el Inventario de Personalidad PID-5 pueden ser particularmente útiles en un programa de tratamiento de hospital de día para trastornos de la personalidad, cuando la demanda de tratamiento para el trastorno mixto de la personalidad y el trastorno de personalidad no especificado es tan frecuente como para el trastorno límite de la personalidad. Estos trastornos requieren programas de tratamiento eficaces en el sistema de salud pública. Nuestro estudio muestra los resultados del programa de hospital de día para trastornos de la personalidad implementado en el Hospital San Juan de Alicante. Se trata de un programa intensivo e interdisciplinario, que parte del modelo dimensional DSM-5 y el Inventario de Personalidad PID-5 para identificar las necesidades terapéuticas, aplicando terapias individuales y grupales basadas en un enfoque terapéutico cognitivo-conductual. Los resultados apoyan la pertinencia de los componentes terapéuticos del programa. Ha demostrado efectividad para lograr cambios significativos en síntomas, rasgos, comorbilidad y en el funcionamiento psicosocial. También parece ser eficiente no sólo por reducir el número de visitas a servicios de urgencias y estancias hospitalarias, sino también por garantizar la continuidad y el cumplimiento terapéutico, reduciendo así los costes en salud pública. (AU)

Diferencias en la efectividad clínica y funcional, entre trastornos psiquiátricos, de un hospital de día psiquiátrico de agudos para pacientes con enfermedad mental aguda / Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients

Introducción: El tratamiento intensivo y agudo en unidades psiquiátricas de ingreso a tiempo parcial puede representar una alternativa eficaz a los ingresos hospitalarios a tiempo completo. Sin embargo, existe evidencia que indica que estos dispositivos podrían no ser igualmente eficaces para todos los trastornos psiquiátricos.El objetivo primario del estudio fue explorar las diferencias entre los principales grupos de diagnóstico psiquiátrico en la efectividad de un programa de hospitalización parcial aguda, así como identificar predictores de respuesta al tratamiento.Material y métodosEl estudio se realizó en un hospital psiquiátrico de día. La gravedad clínica se evaluó mediante las escalas BPRS, CGI y HoNOS. También se recogieron variables sociodemográficas. Los pacientes se agruparon en 4grupos diagnósticos amplios (psicosis no afectiva, bipolar, depresión, trastornos de la personalidad).ResultadosSe seleccionó a 331 participantes, 115 de los cuales (34,7%) fueron diagnosticados de psicosis no afectiva, 97 (28,3%) de trastorno bipolar, 92 (27,8%) de trastorno afectivo y 27 (8,2%) de trastorno de personalidad. Los pacientes con trastorno bipolar mostraron una mayor mejoría BPRS (F = 5,30; p = 0,001) y CGI (F = 8,78; p < 0,001) que aquellos que presentaban psicosis o trastorno depresivo. Estancias más prolongadas en el hospital de día y una mayor gravedad inicial (BPRS) fueron factores predictores de buena respuesta. La tasa de reingreso en unidad psiquiátrica a los 30 días del alta fue del 3% y del 11,8% en los siguientes 6 meses.ConclusionesEl cuidado intensivo en una unidad psiquiátrica de día es factible y eficaz para los pacientes con un trastorno mental agudo. Sin embargo, esta eficacia difiere entre los grupos de diagnóstico. (AU)

Introduction: Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response.Material and methodsThe study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses.ResultsA total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups.ConclusionsIntensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups. (AU)

Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients. / Diferencias en la efectividad clínica y funcional, entre trastornos psiquiátricos, de un hospital de día psiquiátrico de agudos para pacientes con enfermedad mental aguda.

INTRODUCTION: Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder. The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response. MATERIAL AND METHODS: The study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses. RESULTS: A total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups. CONCLUSIONS: Intensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups.

Para além da fantasia: Contribuições psicanalíticas para o tratamento possível das psicoses no hospital-dia / Beyond the phantasy: Psychoanalytical contributions to the possible treatment on psychoses in a Day Hospital / Más allá de la fantasía: Contribuciones del Psicoanálisis al tratamiento posible de psicosis en el Hospital-de-Día

Pode-se afirmar que, ao longo de uma considerável parte da história da Psicanálise, a operacionalidade da transferência na psicose esteve questionada. Em sua época, Freud considerou que com a Psicanálise se podia entender muito melhor as psicoses, mas que não haveria como tratá-las. Ainda que Lacan, a partir de seu ensino, tenha legado operadores que permitem que o psicanalista possa melhor se situar nas especificidades dessa clínica tão delicada, resta perceptível que a questão da transferência na psicose se afigura ainda hoje como problemática em termos teóricos, ensejando discordâncias e questionamentos. Nesse contexto, os autores consideraram indispensável uma investigação que pudesse delimitar as especificidades da transferência em sujeitos estruturados pela via da psicose, delineando certos aspectos da posição do analista em relação ao sujeito psicótico e às possibilidades de intervenção desde o lugar a ele destinado. Assim, partindo da experiência de um dos autores em um hospital-dia, cujos dispositivos estão pensados para a facilitação do estabelecimento das condições de escuta para os sujeitos psicóticos, busca-se consolidar a sustentação teórica de tal práxis com base na contribuição de psicanalistas como José Zuberman e Jean Oury sobre o tema, problematizando as tensões entre o singular e o coletivo inerentes a uma clínica diferencial tendente à inclusão da instituição e à inclusão de "pequenos outros" no delineamento dos respectivos tratamentos possíveis.

One can affirm that, over a substantial part of Psychoanalysis History, the functionality of the transference on psychoses has been questioned. In his days, Freud has considered that by means of Psychoanalysis one could better understand the psychoses, but there was no possible treating. Although Lacan, through his teaching, had bequeathed operators that allow the psychoanalyst to better locate on the particularities of a such challenging clinics, it's still evident that the matter concerning the transference on psychoses remains, even today, as a problematic issue in theorical terms, entailing disagreements and questionings. In this context, the authors have considered imperative an investigation capable of delimiting the specificities of the transference on subjects structured by psychoses, delineating certain aspects on the analists' position regarding to the psychotic subject and the possibilities of intervention from his fated place. Thereby, from the experience of one of the authors in a Day Hospital, whose devices are conceived to facilitate the setting up of listening conditions to psychotic subjects, it's intended to consolidate the theorical basis of such practice taking into consideration the contribution of psychoanalysts, such as José Zuberman and Jean Oury about the matter, looking over the tensions between the singular and the collective inherent in a differential clinics inclined to the inclusion of the institution and to the inclusion of "others" on the delineation of the respective possible treatments.

Se puede afirmar que a lo largo de una considerable parte de la historia del Psicoanálisis, la operacionalidad de la transferencia en la psicosis estuvo cuestionada. En su época, Freud ha considerado que con el Psicoanálisis uno podría entender mucho mejor las psicosis, pero no habría manera de tratarlas. Aunque Lacan, desde su enseñanza, haya legado operadores que permiten al psicoanalista mejor ubicarse respecto de las especificidades de esta clínica tan delicada, sigue notable que la cuestión de la transferencia en la psicosis aun hoy es considerada problemática en términos teóricos, dando lugar a desacuerdos y cuestionamientos. En este contexto, los autores consideran indispensable una investigación que pueda delimitar las especificidades de la transferencia en sujetos estructurados por la vía de la psicosis, contornando ciertos aspectos de la posición del analista respecto del sujeto psicótico y las posibilidades de intervención desde el lugar a él determinado. Entonces, desde la experiencia de uno de los autores en un hospital-de-día, cuyos dispositivos están hechos para facilitar el establecimiento de las condiciones de escucha hacia los sujetos psicóticos, se busca consolidar la sustentación teórica de esta práctica a partir de la contribución de psicoanalistas como José Zuberman y Jean Oury respecto de la materia, problematizando las tensiones entre singular y colectivo inherentes a una clínica diferencial que tiene una tendencia a la inclusión de la institución y a la inclusión de "pequeños otros" en el establecimiento de los respectivos tratamientos posibles.

Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation.

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.

Contribuições de um hospital-dia para as redes de apoio social a pessoas com transtornos mentais / Contribuciones de un hospital día para redes de apoyo social para personas con trastornos mentales / A day hospital's contributions for social support networks for people with mental disorders

Resumo: Objetivo: Identificar as práticas terapêuticas de um Hospital-Dia em Saúde Mental dirigidas ao suporte às redes de apoio social a pessoas com transtornos mentais. Metodologia: Estudo qualitativo, exploratório, descritivo associado às técnicas de observação participante, entrevistas e revisão documental realizadas no período de 31 de março a 17 de abril de 2014, no Hospital-Dia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - HD/HCFMRP/USP. Resultados: O Grupo Comunitário de Saúde mental do HD/HCFMRP/USP se constitui em uma das abordagens terapêuticas do plano terapêutico para os pacientes em tratamento sob o regime de semi-internação, ao mesmo tempo em que se consolidou como uma estrutura para além do Hospital-Dia. É uma atividade aberta à comunidade e objetiva ser um espaço para o exercício dialogado de apropriação e comunicação de vivências cotidianas. Discussão: A Terapia Comunitária Integrativa vem se consolidando como uma nova tecnologia de intervenção psicossocial caracterizado por acolher, escutar e cuidar dos sujeitos e de seus sofrimentos. É um espaço de promoção de encontros interpessoais e intercomunitários, de compartilhamento de experiências e acumulações de vida de forma a valorizar cada uma das histórias de vida dos participantes, resgatando a auto-estima, a confiança em si, na perspectiva de ampliação da percepção dos problemas e do consequente vislumbrar de possibilidades de suas resoluções a partir das competências locais.

Resumen: Objetivo: Identificar las prácticas terapéuticas del Hospital de Día dirigidas a las redes de apoyo social de personas con trastornos mentales. Metodología: Estudio cualitativo, exploratorio descriptivo asociado a técnicas de observación participante, entrevistas y revisión documental realizados del 31 de marzo al 17 de abril de 2014 en el Hospital de Día del Hospital de Clínicas de la Facultad de Medicina de Ribeirão Preto Universidad de San Pablo. Resultados: El Grupo Comunitario de Salud Mental del HD/HCFMRP/USP se constituye en uno de los enfoques terapéuticos del plan terapéutico para los pacientes en tratamiento bajo el régimen de semi-internación, al tiempo que se consolidó como una estructura más allá del Hospital de Día. Es una actividad abierta a la comunidad y tiene como objetivo ser un espacio para el ejercicio dialogado de apropiación y comunicación de vivencias cotidianas. Discusión: La Terapia Comunitaria Integrativa se viene consolidando como una nueva tecnología de intervención psicosocial caracterizada por acoger, escuchar y cuidar de los sujetos y de sus sufrimientos. Es un espacio de promoción de encuentros interpersonales e intercomunitarios, para compartir experiencias de vida, para valorar cada una de las historias de vida de los participantes, promoviendo la autoestima y la confianza en sí, a modo de ampliar la percepción de los problemas y encontrar posibilidades de resolución a partir de las competencias locales.

Abstract: Objective: To identify the therapeutic practices of a Day Hospital Mental Health directed support to social support networks for people with mental disorders. Methodology: Qualitative, exploratory, descriptive study associated with participant observation techniques, interviews and documentary review carried out from March 31 to April 17, 2014, in Day Hospital, Hospital Clinical, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo - HD/HCFMRP/USP. Results: The Community Health Group of the HD/HCFMRP/USP constitutes one of the therapeutic approaches of the therapeutic plan for the patients under treatment under the semi-hospitalization regime, at the same time that it has consolidated as a structure beyond the Day Hospital. It is an activity open to the community and aims to be a space for the dialogical exercise of appropriation and communication of everyday experiences. Discussion: Integrative Community Therapy has been consolidating as a new technology of psychosocial intervention characterized by welcoming, listening and caring for the subjects and their sufferings. It is a space for the promotion of interpersonal and intercommunal meetings, sharing of experiences and accumulations of life in order to value each one of the life stories of the participants, rescuing the self-esteem, the confidence in itself, in the perspective of amplifying the perception of the problems and the consequent glimpsing of possibilities of their resolutions based on local competences.

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

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.

Variability in Rheumatology day care hospitals in Spain: VALORA study. / Variabilidad en los hospitales de día de Reumatología en España: proyecto VALORA.

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.

[Patient satisfaction as a quality indicator in mental health]. / Satisfacción del paciente como indicador de calidad en salud mental.

OBJECTIVE: To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction. MATERIAL AND METHOD: A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool. RESULTS: Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good¼) and perception of being helped (94% perceived «very/fairly helped¼); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat¼. As regards the knowledge that they have about their disease, 30% believe it has advanced «a lot.¼ CONCLUSIONS: Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation.