Nursing knowledge of the principles of self-care of heart failure in primary care: a multicentre study.

INTRODUCTION: Nurses play an important part in the education of patients with HF. To prepare patients with HF for self-care maintenance behaviours, nurses must have knowledge of basic self-care maintenance principles. AIM STUDY: The aim of this study was to determine the degree of knowledge of primary care (PC) nurses on the principles of self-management of HF and variables associated with this. METHODOLOGY: This is an observational, cross-sectional descriptive study, carried out in 2014, in the city of Barcelona (Catalonia). Nurses' Knowledge of Heart Failure Education Principles questionnaire (NKHFEP) was used to assess the principles of HF self-care education. Instrument items assess knowledge of nurses on 5 themes: diet, liquids/weight, worsening signs or symptoms, medication and exercise. Factors related to adequate knowledge were evaluated. RESULTS: Of 216 PC nurses, who completed the questionnaire, the average score was 15.6 (SD: 2.2). Only 36 (16.7%) obtained an adequate level of knowledge and defined as a score ≥ 18 points. In multivariate logistic regression, nurse factors associated with an adequate knowledge of principles of self-care of HF were having achieved a PhD degree (OR: 36.4, 95% CI: 2.8-468.2, p = 0.006) and previous specific training in HF (OR: 19.8, 95% CI: 1.4-279.3, p = 0.026). CONCLUSIONS: The degree of knowledge of PC nurses in the principles of self-care in HF was higher among nurses who had completed the doctorate and in nurses who had received specific training in HF.

Effect of effervescent paracetamol on blood pressure: a crossover randomized clinical trial.

OBJECTIVE: To evaluate the effect of effervescent paracetamol on office and ambulatory blood pressure (BP) compared with noneffervescent paracetamol in hypertensive patients. DESIGN: This was a multicenter open crossover randomized clinical trial. SETTING: Primary care centers in Catalonia and the Basque Country. PARTICIPANTS: Inclusion criteria were office BP 150/95 mmHg or less and daytime ambulatory BP 140/90 mmHg or less, stable pharmacologic or nonpharmacologic antihypertensive treatment, and concomitant chronic osteoarticular pain. INTERVENTIONS: Baseline randomized assignment to 3-week periods of effervescent paracetamol (1 g three times a day) first and noneffervescent paracetamol later, or inversely, during a 7-week study period. At the start and end of each treatment period, 24-h ambulatory BP monitoring was performed. MAIN OUTCOME MEASURES: Differences in 24-h SBP between baseline and end of both treatment periods. The main analyses were performed according to the intention-to-treat principle. RESULTS: In intention-to-treat analysis, 46 patients were analyzed, 21 were treated with paracetamol effervescent and noneffervescent later, and 25 followed the opposite sequence. The difference in 24-h SBP between the two treatments was 3.99 mmHg (95% confidence interval 1.35-6.63; P = 0.004), higher in the effervescent paracetamol treatment period. Similarly, the per-protocol analysis showed a difference in 24-h SBP between the two groups of 5.04 mmHg (95% confidence interval 1.80-8.28; P = 0.004), higher in the effervescent paracetamol treatment period. Self-reported pain levels did not differ between groups and did not vary by treatment period. No serious adverse events were reported in either study arm. CONCLUSION: Effervescent paracetamol tablets are responsible for a significant daytime and overall increase in ambulatory 24-h SBP. TRIAL REGISTRATION: NCT: 02514538 EudraCT: 2010-023485-53.

Evaluation of the relationship between effervescent paracetamol and blood pressure: clinical trial.

BACKGROUND: Paracetamol's solubility is achieved by adding to the excipient sodium salts, either as bicarbonate, carbonate or citrate. As the relationship between salt and hypertension is well known, due to the sodium content it has raised a hypothesis that may interfere with the control of that risk factor. Therefore, the objective of this study is to evaluate the effect on blood pressure of effervescent paracetamol compared to non-effervescent, in hypertensive patients. METHODS/DESIGN: This is the protocol of a phase IV multicenter clinical trial, randomized, controlled, crossover, open, which will compare the effect of two different formulations of paracetamol (effervescent or non-effervescent) in the blood pressure of hypertensive patients, with a seven weeks follow up. 49 controlled hypertensive patients will be included (clinical BP lower than 150 and 95 mmHg, and lower than 135 mmHg and 85 mmHg in patients with diabetes or a history of cardiovascular event, and daytime ambulatory measurements lower than 140 and 90 mmHg) and mild to moderate pain (Visual Analog Scale between 1 and 4). The study was approved by the ethics committee of the Fundació Jordi Gol i Gurina and following standards of good clinical practice. The primary endpoint will be the variations in systolic BP in 24 h Ambulatory Blood Pressure Monitoring, considering significant differences 2 or more mmHg among those treated with non-effervescent and effervescent formulations. Intention-to-treat and per-protocol analysis will be held. DISCUSSION: Despite the broad recommendation not to use effervescent drugs in patients with hypertension, there are relatively little studies that show exactly this pressor effect due to sodium in salt that gives the effervescence of the product. This is the first clinical trial designed to study the effect of effervescence compared to the non-effervescent, in well-controlled hypertensive patients with mild to moderate pain, performed in routine clinical practice. TRIAL REGISTRATION: NCT 02514538.

[Adaptation of a patient satisfaction questionnaire on medical and nursing care]. / Adaptación de un cuestionario de satisfacción del paciente con la consulta médica y de enfermería.

OBJECTIVE: Catalan and Spanish adaptation of a questionnaire to measure patient satisfaction with their family doctor and nurse visit. DESIGN: Descriptive study of adapting questionnaires. SETTING: Primary Care Team Gòtic, Institut Català de la Salut, Barcelona, Spain. PARTICIPANTS: Of all the patients visiting doctors or nurses, 1186 patients were systematically selected. Of these, 341 were excluded using the following criteria: illiteracy, not understanding either language, cognitive impairment, sight, or writing disability. MEASUREMENTS: Two translations of the original questionnaire. Analysis of the pattern of response. Exploratory factor analysis. Correlation item-scale corrected coefficients and Cronbach alpha for each dimension. RESULTS: There were 74.8% responses. The percentage of items not answered follows a pattern of declining response. There were 3 dimensions in the factor analysis: care offered by the professional, time devoted to the visit, and depth of the relationship with the professional, where the items weighed the same as in the original questionnaire, except two of them. The item-dimension correlation coefficients were greater than 0.4 except for items number 8 and number 18. The coefficient of internal consistency proved to be greater than 0.7 in all dimensions except in "depth of the relationship," which rises above 0.7 if item number 8 is excluded. CONCLUSION: Adaptation of a valid and reliable questionnaire into Spanish and Catalan is useful for evaluating aspects of the professional care visit.

Adaptación de un cuestionario de satisfacción del paciente con la consulta médica y de enfermería / Adaptation of a patient satisfaction questionnaire on medical and nursing care

Objetivo. Adaptación al catalán y al castellanode un cuestionario para medir la satisfaccióndel paciente con la consulta de medicina defamilia y de enfermería.Diseño. Estudio descriptivo.Emplazamiento. Equipo de Atención PrimariaGòtic, Institut Català de la Salut, Barcelona.Participantes. Se seleccionan 1.186 pacientessistemáticamente de las consultas médicasy de enfermería. Se excluyen 341 por lossiguientes criterios: analfabetismo, noentender ninguno de los dos idiomas,deterioro cognitivo e incapacidad visualo de escritura.Mediciones principales. Traducción yretrotraducción del cuestionario original.Análisis del patrón de respuesta. Análisisfactorial exploratorio. Coeficientes decorrelación ítem-escala corregidos y alfade Cronbach de cada dimensión.Resultados. Se obtiene un 74,8% derespuestas. El porcentaje de ítems nocontestados sigue un patrón de respuestadecreciente. Del análisis factorial se extraentres dimensiones: cuidados ofrecidos por elprofesional, tiempo dedicado a la consulta yprofundidad de la relación con el profesional,en los que pesan los mismos ítems que en elcuestionario original, excepto en dos de ellos.Los coeficientes de correlación ítemdimensiónhan sido superiores a 0,4 exceptopara el ítem número 8 y para el ítem número18. El coeficiente de consistencia internaresulta ser mayor de 0,7 en todas lasdimensiones excepto en «profundidad dela relación», en la que aumenta por encimade 0,7 si se excluye el ítem número 8.Conclusión. Es una adaptación delcuestionario válida y fiable en castellano ycatalán, útil para la evaluación de los aspectosrelacionados con la consulta del profesionalde atención primaria

Objective. Catalan and Spanish adaptationof a questionnaire to measure patientsatisfaction with their family doctorand nurse visit.Design. Descriptive study of adaptingquestionnaires.Setting. Primary Care Team Gòtic, InstitutCatalà de la Salut, Barcelona, Spain.Participants. Of all the patients visitingdoctors or nurses, 1186 patients weresystematically selected. Of these, 341 wereexcluded using the following criteria:illiteracy, not understanding either language,cognitive impairment, sight, or writingdisability.Measurements. Two translations of theoriginal questionnaire. Analysis of thepattern of response. Exploratory factoranalysis. Correlation item-scale correctedcoefficients and Cronbach alpha for eachdimension.Results. There were 74.8% responses. Thepercentage of items not answered followsa pattern of declining response. There were3 dimensions in the factor analysis: careoffered by the professional, time devoted tothe visit, and depth of the relationship withthe professional, where the items weighedthe same as in the original questionnaire,except two of them. The item-dimensioncorrelation coefficients were greater than 0.4except for items number 8 and number 18.The coefficient of internal consistencyproved to be greater than 0.7 in alldimensions except in “depth of therelationship,” which rises above 0.7 if itemnumber 8 is excluded.Conclusion. Adaptation of a valid and reliablequestionnaire into Spanish and Catalan isuseful for evaluating aspects of theprofessional care visit