“La asistencia al enfermo mental” of Luis Valenciano: a profissionalização do cuidado a ao doente mental ao longo da Segunda República Espanhola

La reforma de la asistencia psiquiátrica, impulsada a través de los cambios legislativos implantados durante la Segunda República Española, planteó mejoras en la profesionalización de los cuidadores de los establecimientos psiquiátricos. A través del Decreto de 16 de mayo de 1932 se organizó el personal subalterno en Practicantes en Medicina y Cirugía con el diploma de enfermeros psiquiátricos y Enfermeros y Enfermeras Psiquiátricos; y se reguló la obtención del Diploma de Enfermero Psiquiátrico. En el Decreto de 17 de mayo de 1932 se publicó el programa oficial de estudios para obtener dicha titulación y, el 5 de Julio de 1932, las bases de un concurso para una obra que se ajustara al temario. El Consejo Superior Psiquiátrico eligió y recomendó “La asistencia al enfermo mental”(1933) de Luis Valenciano Gayá. El objetivo de este trabajo es analizar el contenido del libro, que incluía los cuidados que precisaban los enfermos mentales, así como las condiciones físicas y actitudinales requeridas para ser “enfermero psiquiátrico”. Asimismo se pretende valorar la importancia del manual que, si bien no fue el primero publicado en español, si presentó una difusión nacional y se convirtió en la obra de referencia para los enfermeros psiquiátricos en los años treinta.The reform of psychiatric care, driven by legislative changes implemented throughout the Second Spanish Republic, proposed improvements in the professionalization of caregivers of psychiatric facilities. By Decree of May 16, 1932 junior staff was organized in Practitioners of Medicine and Surgery diploma nurses and psychiatric nurses; and the Diploma in Psychiatric Nurse was regulated. By the Decree of May 17, 1932 the official curriculum was published for this degree and the July 5, 1932, the basis of a competition for a work that would fit the agenda. Psychiatric Superior Council elected and recommended “La asistencia al enfermo mental”(1933) by Luis Valenciano Gaya. The aim of this paper is to analyze the content of the book, including the care the mentally ill needed, as well as physical and attitudinal requirements for being “psychiatric nurse”. It also seeks to value the importance of the manual, while it was not the first published in Spanish, truly presented a national circulation and became the reference work for psychiatric nurses in the 30s.A campanha de reforma da assistência psiquiátrica, impulsada a través de mudanças legislativas impostas ao longo da Segunda República Espanhola, planteou melhoras na profissionalização dos cuidadores nos estabelecimentos psiquiátricos. A través do Decreto de 16 de Maio de 1932 o pessoal subalterno foi organizado em Practicantes em Medicina e Cirurgia com diploma de enfermeiros psiquiátricos e Enfermeiros e Enfermeiras Psiquiátricos; e regulamentou-se a obtenção do Diploma de Enfermeiro Psiquiátrico. No Decreto de 17 de Maio de 1932 foi publicado o programa oficial de estudos para obter o nomeado título e, no dia 5 de Julho de 1932, as bases de um concurso para uma obra que ajustar-seá ao temário. O Conselho Superior Psiquiátrico escolheu e recomendou “La asistencia al enfermo mental” escrita por Luis Valenciano Gayá, publicada em 1933. O objetivo deste trabalho é analisar o conteúdo do livro, que incluía os cuidados que precisavam os doentes mentais, assim como as condições físicas e actitudinais requeridas para ser “doente psiquiátrico”. Assim mesmo trata-se de avaliar a importância deste primeiro manual que, ainda não sendo o primeiro publicado em espanhol, apresentou uma difusão nacional e tornou-se obra de referência para os enfermeiros psiquiátricos nos anos trinta

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio