Letter to the Editor
Introduction of a Day-Care Hospital Model: Proposals for Measures That Guarantee the Specific Needs of Rheumatology Services in the Community of Valencia (Spain)
Implantación de un modelo de hospital de día: propuesta de medidas que garanticen las necesidades específicas de los servicios de reumatología de la Comunidad Valenciana (España)
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Román Ivorra, José Rosas Gómez-Salazar, Javier Calvo Catalá" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José A." "apellidos" => "Román Ivorra" "email" => array:1 [ 0 => "roman_jan@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José" "apellidos" => "Rosas Gómez-Salazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Javier" "apellidos" => "Calvo Catalá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:2 [ "colaborador" => "Grupo para el estudio de los hospitales de día de reumatología de la Sociedad Valenciana de Reumatología" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de la Marina Baixa de Villajoyosa, Villajoyosa, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Reumatología y Metabolismo Óseo, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implantación de un modelo de hospital de día: propuesta de medidas que garanticen las necesidades específicas de los servicios de reumatología de la Comunidad Valenciana (España)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Day hospitalization (DH) is medical or nursing medical attention for patients who require, during the same day, the application of treatments or diagnostic techniques that, without the existence of these centers, would require hospitalization. Day hospitals offer the same services available in a hospital to patients who need chronic treatment or biological therapy for rheumatic diseases, but without the need for their internment. This alternative reduces both the inherent risks of hospitalization to the patient as well as the costs of health assistance associated to treatment and hospitalization.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The motive of this letter is to describe a series of recommendations used to unify Rheumatology Day Hospitals of the Comunidad Valenciana. Currently, the scenario in which the Rheumatology Day Hospitals of the Comunidad Valenciana (Spain) is one of absence of legislation and rules that regulate the activities performed there or that establish a model of reference to which every hospital must adapt. This fact has generated an elevated variability between different DH in this community, analyzed by Román et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A meeting of 12 rheumatologists and one nurse was organized in Valencia, representing 11 hospitals in the Comunidad Valenciana (in Alicante, Hospital Clínico de San Juan, Hospital General de Elda, Hospital General Universitario de Alicante, Hospital de la Marina Baixa de Villajoyosa, Hospital General Universitario de Elche; in Castellón, Hospital General de Castellón, and in Valencia, Hospital Infantil La Fe, Hospital Universitario La Fe, Hospital Universitario Dr. Peset, Hospital General Universitario de Valencia and the Hospital Clínico Universitario de Valencia) in order to collect proposals for a new DH model, moderated by structured <span class="elsevierStyleItalic">brainstorming</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> From these proposals and the analysis of the current models deficiencies,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> a work frame for proposing recommendations to improve and unify the current DH model of the Comunidad Valenciana, as other documents or specialties recommend on a national level.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are established recommendations centered on resources (defining needs and competences of the rheumatologist, pharmacist and nursing staff), procedures (such as protocols, questionnaires, schedules and DH circuits, integral attention and telephone consultations) as well as quality-related aspects that include the rheumatologist in the DH management process.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We recommend adapting both material and human resources, anticipating an increase in patients receiving treatment for rheumatic diseases. Acting protocols should be developed for all DH processes (allowing for a better control of those patients treated in DH and a better functioning of the center<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>), elaborate satisfaction and quality of life questionnaires, improve the centers circuits, increase patient attention hours, perform integral attention, etc. To improve quality-related aspects and the service offered to patients, we recommend integrating the rheumatologist in the processes of the Day Hospital. An implantation plan for the recommendations and the establishment of recommendations and the establishment of indicators allow the evaluation of the improvements introduced.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main deficiencies of the current model and proposals for improvement are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">We believe it is relevant to consider these recommendations, because other studies<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> suggest the importance of evaluating the function of the DH to plan strategies that permit the increasing use of these centers.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, this study only shows those measures for the DH of the Comunidad Valenciana but we believe that these measures are applicable in DH in all of Spain (with prior studies to determine the situation of the Spanish DH and then adapt the measures proposed in this study).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study was carried out with the support of an unrestricted grant provided by <span class="elsevierStyleGrantSponsor">Roche Farma, S.A.</span></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:2 [ "identificador" => "xack38099" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara">En el anexo se relacionan los integrantes del Grupo para el estudio de los hospitales de día de reumatología de la Sociedad Valenciana de Reumatología.</p>" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Román Ivorra JA, et al. Implantación de un modelo de hospital de día: propuesta de medidas que garanticen las necesidades específicas de los servicios de reumatología de la Comunidad Valenciana (España). Reumatol Clin. 2011;<span class="elsevierStyleBold">7(6)</span>:421–22.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0055" class="elsevierStylePara elsevierViewall">Miguel Belmonte Serrano, Francisco Javier Navarro Blasco, Inmaculada Calvo Penadés, Emma Beltrán Catalán, Esteban Salas Heredia, Paloma Vela Casasempere, Jenny De la Torre, Vega Jovani Casano, Juan José García Borrás and Juan Ramón Corts Giner.</p>" "etiqueta" => "Annex 1" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Main Deficits of the Current Model \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Proposals for Improvement \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unification of the Rheumatology DH with other specialties DH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Integration of Rheumatology in the DH management: creation of a multidisciplinary management commission or creation of monographic DH with associated specialties \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor accessibility to the patient in some aspects: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Part time schedules (only mornings) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Widen scheduled hours (full time) according to requirements \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Little time for rheumatology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Increase time dedicated to rheumatic disease treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Scarce resources and space \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Increase spaces dedicated to rheumatology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Scarce human resources \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Increase in DH personnel \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No complementary testing (except laboratory) at the center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Performance of complementary tests in the DH \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No integrated visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Performance of integrated visits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Delay in dispensing treatments by the pharmacist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Optimization of current processes and evaluation in the preparation of DH treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of rheumatology specialized nursing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specialized rheumatology nurses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of rheumatology specialized burses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nursing formation: offline and online courses, clinical sessions, seminars, workshops, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Little health education for the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Health education (books, pamphlets, triptychs, etc.) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of a contact telephone line \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide contact numbers for the patient and assign a specific nurse for its attention \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scarce process protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creation of multidisciplinary workshops for dissemination, review and updating of protocols \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Few clinical sessions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concrete dates (weekly or biweekly) for multidisciplinary and specific clinical sessions on biologic treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of DH results evaluation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluation questionnaires for DH internal processes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of patient satisfaction and quality of life questionnaires \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elaboration of patient satisfaction and quality of life questionnaires \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Little discharge information \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elaboration of discharge referral notes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of internal communication between the personnel attending the patients in the DH and the department of rheumatology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coordination of the functions of all of the personnel involved in the attention of rheumatology patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dependence on the part of the rheumatology nursing staff \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of a responsible attending rheumatologist and physician at the DH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creation of the figure of attending rheumatologist and Physician \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of medical supervision before and after treatments administration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Before and after supervision of treatments on the part of a rheumatologist \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212103.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Main Deficits in the Current Valencia Rheumatology HD Model and Proposals for Improvement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado actual de los hospitales de día de reumatología en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Román" 1 => "C. Chalmeta" 2 => "G. Salvador" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Reumatol" "fecha" => "2004" "volumen" => "31" "paginaInicial" => "87" "paginaFinal" => "94" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado actual de los hospitales de día donde se administran los tratamientos de reumatología en la Comunidad Valenciana" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo para el estudio de los hospitales de día de Reumatología de la Sociedad Valenciana de Reumatología" "etal" => false "autores" => array:3 [ 0 => "J.A. Román" 1 => "J.R. Gómez-Salazar" 2 => "J. Calvo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2010.01.006" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2010" "volumen" => "6" "paginaInicial" => "244" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21794724" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Unicef. Visualization in participatory programmes. A manual for facilitators and trainers involved in participatory group events. Bangladesh; 1993." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitales de día: Recomendaciones según consenso nacional SEOM Madrid Marzo 2006" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Sociedad Española de Oncología Médica (SEOM)" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Primer libro blanco de la Oncología Médica en España" "fecha" => "2006" "editorial" => "Dispublic, SL" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unidad de Hospital de Día. Estándares y recomendaciones" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Grupo de Trabajo para la elaboración de «Estándares y recomendaciones de HdD»" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2008" "editorial" => "Ministerio de Sanidad y Consumo" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rheumatologic day-hospital: analysis of a five-year activity. Divisione di rheumatologia. Azienza ospedaliera s. Anna, Ferrara" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Delli-Gatti" 1 => "F. Girelli" 2 => "M. Scaramelli" 3 => "G. Menegale" 4 => "F. Trotta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Reumatismo" "fecha" => "1996" "volumen" => "48" "paginaInicial" => "123" "paginaFinal" => "128" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatology day care and the impact of biological therapies-the belfast experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.P. Cairns" 1 => "S.A. Wright" 2 => "J.D. Patton" 3 => "E. Campalani" 4 => "A.J. Taggart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2002" "volumen" => "41" "paginaInicial" => "356" "paginaFinal" => "367" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack38099" "titulo" => "Acknowledgements" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We thank Andreu Covas Estruga and Verónica Albert Sánchez, of Gestió Organització Comunicació, S.A., for their support in the conduction of the methodology used for the elaboration of the study.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000700000006/v1_201305061631/S2173574311000220/v1_201305061631/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000700000006/v1_201305061631/S2173574311000220/v1_201305061631/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574311000220?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 14 | 26 |
| 2024 October | 27 | 24 | 51 |
| 2024 September | 40 | 16 | 56 |
| 2024 August | 58 | 29 | 87 |
| 2024 July | 55 | 18 | 73 |
| 2024 June | 52 | 34 | 86 |
| 2024 May | 61 | 40 | 101 |
| 2024 April | 54 | 23 | 77 |
| 2024 March | 67 | 23 | 90 |
| 2024 February | 81 | 23 | 104 |
| 2024 January | 51 | 18 | 69 |
| 2023 December | 47 | 18 | 65 |
| 2023 November | 39 | 29 | 68 |
| 2023 October | 36 | 26 | 62 |
| 2023 September | 66 | 34 | 100 |
| 2023 August | 38 | 18 | 56 |
| 2023 July | 25 | 28 | 53 |
| 2023 June | 28 | 23 | 51 |
| 2023 May | 26 | 15 | 41 |
| 2023 April | 18 | 16 | 34 |
| 2023 March | 31 | 27 | 58 |
| 2023 February | 33 | 21 | 54 |
| 2023 January | 40 | 16 | 56 |
| 2022 December | 43 | 49 | 92 |
| 2022 November | 39 | 21 | 60 |
| 2022 October | 40 | 36 | 76 |
| 2022 September | 36 | 33 | 69 |
| 2022 August | 30 | 39 | 69 |
| 2022 July | 32 | 40 | 72 |
| 2022 June | 31 | 28 | 59 |
| 2022 May | 40 | 40 | 80 |
| 2022 April | 40 | 40 | 80 |
| 2022 March | 40 | 42 | 82 |
| 2022 February | 43 | 35 | 78 |
| 2022 January | 22 | 42 | 64 |
| 2021 December | 24 | 62 | 86 |
| 2021 November | 39 | 53 | 92 |
| 2021 October | 58 | 53 | 111 |
| 2021 September | 62 | 50 | 112 |
| 2021 August | 52 | 57 | 109 |
| 2021 July | 31 | 41 | 72 |
| 2021 June | 34 | 41 | 75 |
| 2021 May | 46 | 39 | 85 |
| 2021 April | 83 | 81 | 164 |
| 2021 March | 54 | 25 | 79 |
| 2021 February | 42 | 17 | 59 |
| 2021 January | 54 | 17 | 71 |
| 2020 December | 49 | 19 | 68 |
| 2020 November | 28 | 22 | 50 |
| 2020 October | 16 | 19 | 35 |
| 2020 September | 37 | 24 | 61 |
| 2020 August | 21 | 19 | 40 |
| 2020 July | 31 | 18 | 49 |
| 2020 June | 36 | 20 | 56 |
| 2020 May | 33 | 21 | 54 |
| 2020 April | 28 | 19 | 47 |
| 2020 March | 18 | 6 | 24 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 8 | 2 | 10 |
| 2018 April | 42 | 9 | 51 |
| 2018 March | 74 | 6 | 80 |
| 2018 February | 42 | 3 | 45 |
| 2018 January | 71 | 4 | 75 |
| 2017 December | 24 | 4 | 28 |
| 2017 November | 28 | 5 | 33 |
| 2017 October | 38 | 5 | 43 |
| 2017 September | 35 | 4 | 39 |
| 2017 August | 49 | 7 | 56 |
| 2017 July | 39 | 7 | 46 |
| 2017 June | 43 | 7 | 50 |
| 2017 May | 35 | 6 | 41 |
| 2017 April | 32 | 4 | 36 |
| 2017 March | 58 | 10 | 68 |
| 2017 February | 30 | 1 | 31 |
| 2017 January | 41 | 3 | 44 |
| 2016 December | 103 | 18 | 121 |
| 2016 November | 75 | 9 | 84 |
| 2016 October | 107 | 11 | 118 |
| 2016 September | 69 | 7 | 76 |
| 2016 August | 65 | 2 | 67 |
| 2016 July | 34 | 5 | 39 |
| 2016 June | 0 | 16 | 16 |
| 2016 May | 0 | 8 | 8 |
| 2016 April | 0 | 2 | 2 |
| 2016 March | 0 | 15 | 15 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 0 | 13 | 13 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 13 | 4 | 17 |
| 2015 June | 28 | 6 | 34 |
| 2015 May | 47 | 10 | 57 |
| 2015 April | 34 | 10 | 44 |
| 2015 March | 32 | 2 | 34 |
| 2015 February | 42 | 7 | 49 |
| 2015 January | 41 | 10 | 51 |
| 2014 December | 41 | 10 | 51 |
| 2014 November | 48 | 10 | 58 |
| 2014 October | 32 | 8 | 40 |
| 2014 September | 33 | 9 | 42 |
| 2014 August | 26 | 8 | 34 |
| 2014 July | 28 | 9 | 37 |
| 2014 June | 42 | 11 | 53 |
| 2014 May | 50 | 5 | 55 |
| 2014 April | 46 | 5 | 51 |
| 2014 March | 60 | 14 | 74 |
| 2014 February | 34 | 6 | 40 |
| 2014 January | 34 | 5 | 39 |
| 2013 December | 33 | 5 | 38 |
| 2013 November | 31 | 7 | 38 |
| 2013 October | 47 | 3 | 50 |
| 2013 September | 37 | 7 | 44 |
| 2013 August | 71 | 17 | 88 |
| 2013 July | 23 | 5 | 28 |
| 2013 June | 36 | 7 | 43 |
| 2013 May | 23 | 4 | 27 |
| 2013 April | 36 | 5 | 41 |
| 2013 March | 33 | 7 | 40 |
| 2013 February | 30 | 7 | 37 |
| 2013 January | 29 | 4 | 33 |
| 2012 December | 21 | 11 | 32 |
| 2012 November | 27 | 5 | 32 |
| 2012 October | 36 | 2 | 38 |
| 2012 September | 11 | 2 | 13 |
| 2012 June | 5 | 0 | 5 |
| 2012 May | 1 | 0 | 1 |
| 2012 April | 4 | 0 | 4 |
| 2012 March | 6 | 0 | 6 |
| 2012 February | 5 | 0 | 5 |
| 2012 January | 6 | 0 | 6 |
| 2011 December | 4 | 0 | 4 |
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