SELECT a.*, pi.* FROM tbdsigspaatencion a
INNER JOIN tbdsigspaplanitem pi ON (pi.fldplanitem_codigo=a.fldplanitem_codigo)
WHERE a.fldatencion_id IN (
              SELECT DISTINCT at.fldatencion_id FROM tbdsigspaatencion at
              INNER JOIN tbdsigspaplanitem pit ON (pit.fldplanitem_codigo=at.fldplanitem_codigo)
              INNER JOIN tblplanitem_usuario pu ON (pu.fldusuario_id=388)
              WHERE pit.fldplanitem_visibilidad='V' AND at.fldatencion_estado NOT IN ('r', 't', 'n', 'v')
              AND at.fldatencion_et IS NULL)