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

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

Coagulation Parameters: An Efficient Measure for Predicting the Prognosis and Clinical Management of Patients with COVID-19

Background. COVID-19 is an ongoing global pandemic. Since the detection of the first cases of coronavirus disease 2019 (COVID-19) in Wuhan, China, the current pandemic has affected more than 25.3 million people worldwide. The aim of this study was to evaluate the relationship between coagulation abnormalities and prognosis in a cohort of patients with COVID-19. Methods. We performed a retrospective cohort study of 3581 patients admitted to Hospital La Paz (Madrid, Spain) due to respiratory infection by severe acute respiratory syndrome coronavirus from the beginning of the current pandemic to 15 July 2020. Results. Of the 3581 study patients, 48.94% were men, and 19.80% were healthcare workers. The median age was 62 years. Compared with the survivors, the non-survivors had lower prothrombin activity (82.5 (Interquartile range-IQR, 67-95) vs. 95.25 (IQR, 87-104) for non-survivors and survivors, respectively; p < 0.001), higher fibrinogen levels (748.5-IQR, 557-960) vs. 572.75 (IQR, 417-758; p < 0.001), and notably higher D-dimer levels (2329-IQR, 1086.12-5670.40) vs. 635.5 (IQR, 325.5-1194.8); p < 0.001). Conclusions. The evaluation of coagulation parameters could be an efficient measure for predicting the prognosis and improving the clinical management of patients with COVID-19

The prevalence of depression, anxiety and stress and their associated factors in college students

Aim: To estimate the prevalence of symptoms of depression, anxiety, stress and associated factors in a population of college students. Method: Cross-sectional study of psychological distress measured through the Depression, Anxiety and Stress Scale (DASS-21) in a sample of 1074 college students. Results: We found a moderate prevalence of depression (18, 4%), anxiety (23, 6%) and stress (34, 5%) symptoms in our study population. Being <21, having problematic Internet use behavior, smoking, presenting insomnia and having a low self-esteem were independently associated with symptoms of depression, anxiety and stress. Being a woman, living with their family, having a stable partner, consuming alcohol frequently and having poor nutritional habits were significantly associated with symptoms of stress; lacking a stable partner was significantly associated with depressive symptoms; and frequent consumption of alcohol was significantly associated with symptoms of anxiety. Conclusion: We found a moderate prevalence of depression, anxiety and stress symptoms in our population. Interventions aimed at promoting mental health among college students should be implemented

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

Relationship between Determinants of Health, Equity, and Dimensions of Health Literacy in Patients with Cardiovascular Disease

Background: Health literacy (HL) has been linked to empowerment, use of health services, and equity. Evaluating HL in people with cardiovascular health problems would facilitate the development of suitable health strategies care and reduce inequity. Aim: To investigate the relationship between different dimensions that make up HL and social determinants in patients with cardiovascular disease. Methods: Observational, descriptive, cross-sectional study in patients with cardiovascular disease, aged 50-85 years, accessing primary care services in Valencia (Spain) in 2018-2019. The Health Literacy Questionnaire was used. Results: 252 patients. Age was significantly related with the ability to participate with healthcare providers (p = 0.043), ability to find information (p = 0.022), and understanding information correctly to know what to do (p = 0.046). Level of education was significant for all HL dimensions. Patients without studies scored lower in all dimensions. The low- versus middle-class social relationship showed significant results in all dimensions. Conclusions: In patients with cardiovascular disease, level of education and social class were social determinants associated with HL scores. Whilst interventions at individual level might address some HL deficits, inequities in access to cardiovascular care and health outcomes would remain unjustly balanced unless structural determinants of HL are taken into account

Patient profile and management of delirium in older adults hospitalized due to COVID-19

SARS-CoV-2 can cause neurologic symptoms, as well as respiratory ones. Older adults are at risk of developing acute delirium in older persons (ADOP). The combination of experiencing respiratory isolation due to COVID-19, as well as other associated risk factors for older adults, may have had an impact on ADOP and ADOP management in the acute hospital setting. This study aimed to analyze the characteristics of ADOP in patients admitted to a COVID-19 unit. An observational prospective study on a sample of 108 patients was carried out between November 2020 and May 2021. The following data were collected: sociodemographic characteristics, risk factors for ADOP, management of ADOP, and impact on ADOP on both functional and cognitive deteriora-tion. A 29.6% proportion of older adults admitted to an acute COVID-19 unit presented hyperactive ADOP, mainly during the night. Management of ADOP in our sample involved mainly pharmaco-logical treatment and had a serious impact on hospital stay and both functional and cognitive dete-rioration. Preventive strategies and being accompanied by a relative or a carer may be useful to manage ADOP during hospital admission due to COVID-19

Association between life skills and academic performance in adolescents in the autonomous community of aragon (Spain)

Background: Learning and socio-emotional development is promoted through the creation and nurturing of an optimal school climate. This study aims to analyze the relationship between life skills and academic performance in a large sample of adolescents from the autonomous community of Aragón (Spain). Methods: A cross-sectional study was conducted on the life skills and academic performance of a sample of 7th and 8th grade middle school students during the academic year 2018–2019. A sample of 43 middle schools were randomly selected; the final sample comprised 1745 students. The following data were collected through an anonymized, previously validated questionnaire: sociodemographic variables, social skills, self-efficacy, affective balance, and academic performance. Results: We found a statistically significant association between life skills and academic performance (p < 0.001) in our sample. We also observed significant gender differences in life skills, with boys obtaining higher scores in cognitive skills and affective balance, and with girls achieving higher scores in social skills. Conclusion: We argue that life skills should be integrated into educational policies in order to improve the academic performance and health outcomes of students. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Elementos esenciales de los entornos profesionales enfermeros en Atencion Primaria y su influencia en la calidad del cuidado

Objectives Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. Method We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). Results One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Conclusions Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions

Professional practice environment in Nursing

Un entorno de práctica profesional en enfermería (EPPE) es el que promueve, facilita u obstaculiza al personal de enfermería para prestar cuidados de calidad, además de incrementar la seguridad y bienestar de los pacientes y de sus profesionales. Construir entornos positivos fomenta la excelencia de la organización, optimiza los resultados y mejora la percepción y satisfacción del usuario. En numerosos países se ha podido constatar que determinados ámbitos asistenciales de enfermería considerados excelentes influyen de forma objetiva en los resultados en salud, con disminución de la morbimortalidad, aumento de la calidad y mejora del cuidado (1), además de la contención de costes (2) y otros múltiples beneficios para la sociedad, el ciudadano, el usuario y el profesional