Management of Hypnotics in Patients with Insomnia and Heart Failure during Hospitalization: A Systematic Review

Background: Heart failure is a chronic, progressive syndrome of signs and symptoms, which has been associated to a range of comorbidities including insomnia. Acute decompensation of heart failure frequently leads to hospital admission. During hospital admission, long-term pharmacological treatments such as hypnotics can be modified or stopped. Aim: To synthesize the scientific evidence available about the effect of withdrawing hypnotic drugs during hospital admission in patients with decompensated heart failure and insomnia. Method: A systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was carried out in the following scientific databases: PubMed, Scopus, Dialnet and Cochrane. Inclusion criteria: studies including a population of adults with heart failure and sleep disorders in treatment with hypnotics and admitted to hospital, studies written in English or Spanish and published until June 2020. Exclusion criteria: studies involving children, patients admitted to intensive care and patients diagnosed with sleep apnea. Results: We identified a total of 265 documents; only nine papers met the selection criteria. The most frequently used drugs for the treatment of insomnia in patients with heart failure were benzodiazepines and benzodiazepine agonists; their secondary effects can alter perceived quality of life and increase the risk of adverse effects. Withdrawal of these drugs during hospital admission could increase the risk of delirium. Future research in this area should evaluate the management of hypnotics during hospital admission in patients with decompensated heart failure. In addition, safe and efficient non-pharmacological alternatives for the treatment of insomnia in this population should be tested and implemented

Pilot Testing and Psychometric Validation of the Nijmegen Professionalism Scale for Spanish Nursing

Background and purpose: Professional commitment is frequently used as a humanistic care indicator. Thus, it is important to design and validate a tool which is able to measure professional commitment of nurses in Spain. In this study we aimed to analyze the psychometric properties of the Nijmegen Professionalism Scale for Spanish (NPS-S) nursing in order to verify its validity and reliability. Methods: We undertook the pilot testing and psychometric validation of the NPS-S. A total sample of 249 nursing professionals from a variety of areas of expertise took part in this study. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was used for reporting this research. Results: The NPS-S achieved a high degree of content validity, construct validity, internal consistency, temporal stability, and usability; this version is, thus, equivalent to the Nijmegen Professionalism Scale in its original version. Implications for practice: Based on the results obtained from the validation of this tool, it is possible to affirm that the NPS-S is an effective instrument for measuring professional commitment in this population. The NPS-S will evaluate and thus contribute to the promotion of professional commitment in Spanish nursing. Additionally, it will serve to establish correlations between professional commitment and other variables including quality of care and patient satisfaction. Future studies should analyze the evaluation capacity of this tool

The Teaching and Learning Cultural Competence in a Multicultural Environment (CCMEn) Model

Background: Within the European higher education context, students and lecturers are encouraged to engage in teaching and learning activities abroad. This frequently involves using a second language and being exposed to students and lecturers from culturally different backgrounds. Objective: To design a model for teaching and learning cultural competence in a multicultural environment (CCMEn). Design: Theory development from empirical experience, research, and scholarly works. Method: This model was developed based on our experience of teaching and learning cultural competence in a multicultural environment in a nursing education context; it rests on three pillars, namely, Coyle's Content and Language Integrated Learning educational approach, the concept of social and emotional learning, as defined by the Collaborative for Academic, Social and Emotional Learning, and the existing literature surrounding teaching and learning cultural competence in higher education. Results: The CCMEn model is intended to guide the process of teaching and learning cultural competence in a multicultural environment through the use of a second language and has been adapted from existing educational approaches and theory. Conclusion: Teaching and learning in multilingual and multicultural contexts in Europe is becoming more common. Students who learn alongside students and teachers from different cultural backgrounds need to be supported from an academic, linguistic and socioemotional perspective. We believe that the CCMEn model can serve as a guide to enhancing student learning in this context

Association between adherence to the Mediterranean diet and prevalence of cardiovascular risk factors

Objective: to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up. Method: a cross-sectional descriptive study was carried out on a cohort of 23, 729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet. Results: 51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86). Conclusions: our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified. Objetivo: determinar la prevalencia de factores de riesgo cardiovascular en una cohorte de trabajadores y cuantificar su asociación con el seguimiento de la dieta mediterránea. Método: se llevó a cabo un estudio descriptivo transversal sobre una cohorte de 23.729 trabajadores. Se utilizaron los datos clínicos procedentes de los exámenes médicos anuales y el Mediterranean Diet Adherence Screener para evaluar la adherencia a la dieta mediterránea. Resultados: el 51, 3% de los participantes presentó una buena adherencia a la dieta mediterránea. El análisis multivariante evidenció una asociación inversa y significativa entre el seguimiento de la dieta mediterránea y la prevalencia de obesidad abdominal (Odds Ratio = 0, 64, IC 95% 0, 56; 0, 73), dislipidemia (Odds Ratio = 0, 55, IC 95% 0, 42; 0, 73) y de síndrome metabólico (Odds Ratio = 0, 76, IC 95% 0, 67; 0, 86). Conclusión: nuestros resultados sugieren que la dieta mediterránea es potencialmente eficaz en la promoción de la salud cardiovascular. Parece justificada la implementación de intervenciones que promuevan la dieta mediterránea en la población trabajadora

Prevalence of depression and associated factors in non-institutionalized older adults with a previous history of falling

The purpose of this paper was to estimate the prevalence of depression and associated factors in people aged 65 or older with a history of falling in the last 12 months. A cross-sectional descriptive study was performed involving a random sample of 213 participants from two social centers for older adults in the city of Zaragoza (Spain). The mean age of the participants was 77.3 years (SD ± 7.0). Our findings reveal a prevalence of depression of 28.2% in the study sample, with older adults who were at a high risk of falling being more susceptible to developing depression. In conclusion, one in three elderly people who were at risk of suffering a fall in the 12 months prior to data collection had symptoms of depression. This is in agreement with the results from previous studies, which confirm that there is a high prevalence of depression in elderly patients with a previous history of falls

Sleep quality in patients with heart failure in the spanish population: A cross-sectional study

Background: Heart failure is a major problem in western societies. Sleep Disorders maintain a bidirectional relationship with heart failure, as shown by studies conducted in other countries. This study aims to describe the quality of sleep in Spanish patients with heart failure. Materials and methods: We carried out a cross-sectional study to analyze the quality of sleep in a sample of 203 patients with a diagnosis of heart failure admitted to an Internal Medicine Service. The Pittsburg Sleep Quality Index (PSQI) was used to evaluate sleep quality in our sample over a one-month period. Results: 75% of the sample presented sleep disorders. The most common problems included the interruption of sleep (73.5% nocturia and 30% breathing difficulties); 35% had poor sleep efficiency; 33% showed a decrease in daytime performance; 84% had used hypnotics at some point to induce sleep and 35% used them regularly. Conclusions: This is the first study to report on the perceived sleep quality of patients with heart failure in Spain. Self-perception of sleep quality differed from that estimated by the PSQI. The prevalence of the use of sleep-inducing medication was very high. The diurnal dysfunction generated by sleep disorders in a heart failure environment can contribute to the development of self-care and cognitive deterioration problems

Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study

Background: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients’ level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. Patients and methods: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83 ± 8 were recruited to participate in this study. Results: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) “exercise for 30 minutes”, 1 ± 1; b) “forget to take one of your medicines”, 2 ± 2; c) “ask for low-salt items when eating out or visiting others”, 2 ± 1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2 ± 1; b) reduce fluid intake, 1 ± 1; c) take an extra diuretic, 1 ± 1. Over 50% of our sample felt confident or very confident at following professional advice (3 ± 1), keeping themselves free of symptoms (3 ± 1), recognizing changes in their condition (3 ± 1) and evaluating the significance of such changes (3 ± 1). Conclusions: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients

Care dependency in patients with heart failure: A cross-sectional study in Spain

Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients’ physical deterioration