Nursing Student Satisfaction with the Teaching Methodology Followed during the COVID-19 Pandemic.

Background: Halfway through the 2019−2020 academic year, the entire university system was affected by an exceptional situation caused by the COVID-19 pandemic. Online learning was globally implemented for all degrees to finish the course and to meet academic objectives. This unforeseen change in teaching and subsequent evaluations meant teachers and students had to invest significant effort. Student satisfaction is used to measure the evaluation of teaching/learning processes in higher education. Our objective was to know and compare the satisfaction of nursing students taught at a Spanish public university after making changes to the teaching methodology. Methods: A descriptive observational study that measures student satisfaction. Study population: 240 students registered in academic years 2019−2020 and 2020−2021 answered the survey. The survey contained 30 items answered on a Likert-type scale. The main variables: the learning methodology (online or blended) was the independent variable; student satisfaction was the dependent variable. Descriptive and bivariate analyses were performed. Results: A response rate between 37.4% and 41.2%. Overall satisfaction was 2.75 points (SD 0.56) and 2.94 points (SD 0.49) with online learning and bimodal learning, respectively (maximum score 4 points) (p < 0.004). Conclusions: Student satisfaction was moderate−high for both learning methodologies. Students found that the b-learning methodology was the most valued.

Predictive Model of Quality of Life in Patients with Parkinson's Disease.

Parkinson's disease is a chronic, progressive, and disabling neurodegenerative disease which evolves until the end of life and triggers different mood and organic alterations that influence health-related quality of life. The objective of our study was to identify the factors that negatively impact the quality of life of patients with Parkinson's disease and construct a predictive model of health-related quality of life in these patients. METHODS: An analytical, prospective observational study was carried out, including Parkinson's patients at different stages in the Albacete Health Area. The sample consisted of 155 patients (T0) who were followed up at one (T1) and two years (T2). The instruments used were a purpose-designed data collection questionnaire and the "Parkinson's Disease Questionnaire" (PDQ-39), with a global index where a higher score indicates a worse quality of life. A multivariate analysis was performed by multiple linear regression at T0. Next, the model's predictive capacity was evaluated at T1 and T2 using the area under the ROC curve (AUROC). RESULTS: Predictive factors were: sex, living in a residence, using a cane, using a wheelchair, having a Parkinson's stage of HY > 2, having Alzheimer's disease or a major neurocognitive disorder, having more than five non-motor symptoms, polypharmacy, and disability greater than 66%. This model showed good predictive capacity at one year and two years of follow-up, with an AUROC of 0.89 (95% CI: 0.83-0.94) and 0.83 (95% CI: 0.76-0.89), respectively. CONCLUSIONS: A predictive model constructed with nine variables showed a good discriminative capacity to predict the quality of life of patients with Parkinson's disease at one and two years of follow-up.

Evolution of Quality of Life in Persons with Parkinson's Disease: A Prospective Cohort Study.

Parkinson's disease (PD) is a chronic neurodegenerative disorder that results in important functional symptoms, altered mood, and deterioration in quality of life (QoL). This study aimed to determine the evolution of the QoL in persons with PD in the Albacete health district over a two-year period and identify associated sociodemographic, clinical, and socio-health characteristics. A cohort study was conducted of patients at different stages of PD in the Albacete health district. Calculated sample size: 155 patients. Instruments: A purpose-designed questionnaire for data collection and the "Parkinson Disease Questionnaire" (PDQ-39), which measures 8 dimensions and a global index where a higher score indicates worse quality of life. Three measurements were made: baseline, one year, two years. A descriptive and bivariate analysis was conducted. Ethical aspects: informed consent, anonymized data. Results: Mean age 69.51 (standard deviation, SD 8.73) years, 60% male, 75.5% married, and 85.5% lived with family. The most frequent motor symptoms were slow movement (86.23%), postural instability (55.5%), tremor (45.5%), and dyskinesia (24.6%). Among the non-motor symptoms were fatigue (66.2%), pain, daytime somnolence, constipation, and apathy, with approximately 50% each. The mean QoL score at baseline was 27.47 (SD 16.14); 95% CI (confidence interval) 24.91-30.03. At two years, global QoL had slightly worsened (28.3; SD 17.26; 95% CI 25.41-31.18), with a statistically significant worsening in mobility, activities of daily living, and communication, whereas social support improved.

Preventing Functional Urinary Incontinence in Hip-Fractured Older Adults Through Patient Education: A Randomized Controlled Trial.

The purpose of this study was to evaluate whether an educational intervention would reduce the incidence of functional urinary incontinence (UI) in older adults with a fall-related hip fracture. The project was conducted as a multicenter randomized controlled trial (RCT). A total of 109 patients that had been admitted to six hospitals in Castilla-La Mancha (Spain) for acute treatment of hip fracture, previously continent and without cognitive impairment, were enrolled and randomly assigned to the experimental group (EG) or the control group (CG). Intervention (on EG): urinary habit training (Nursing Interventions Classifications taxonomy) was performed during hospital stay (second to fourth postoperative day), with a telephonic reinforcement 10 days after discharge. The CG received routine care. Primary outcome measure: incidence of UI. Follow-up: telephone assessment 3 and 6 months after discharge (blinded evaluation). The incidence of UI at 6 months was 49% (CG) versus 25.5% (EG) (relative risk = 0.52, 95% confidence interval [0.3, 0.9]; number necessary to treat = 4). The mean of UI episodes was 0.54 (EG) versus 1.8 (CG), p = .007. The educational intervention prevents the development of UI and decreases the number of episodes in case of appearance, in a statistically significant way.

Relationship between Motor and Nonmotor Symptoms and Quality of Life in Patients with Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is a chronic neurodegenerative disease that implies a progressive and invalidating functional organic disorder, which continues to evolve till the end of life and causes different mental and physical alterations that influence the quality of life of those affected. OBJECTIVE: To determine the relationship between motor and nonmotor symptoms and the quality of life of persons with PD. METHODS: An analytic, descriptive, cross-sectional study was conducted with patients with different degrees of PD in the Albacete Health district. The estimated sample size required was 155 patients. The instruments used for data collection included a purpose-designed questionnaire and "Parkinson's Disease Questionnaire" (PDQ-39), which measures eight dimensions and has a global index where a higher score indicates a worse quality of life. A descriptive and bivariate analysis was conducted (SPSS® IBM 24.0). Ethical aspects: informed consent and anonymized data. RESULTS: A strong correlation was found between the number of motor and nonmotor symptoms and global health-related quality of life and the domains mobility, activities of daily living, emotional well-being, cognitive status, and pain (p < 0.05). Receiving pharmacological treatment and taking more than four medicines per day was significantly associated with a worse quality of life (p < 0.05). Patients who had undergone surgical treatment did not show better global quality of life (p = 0.076). CONCLUSIONS: All nonmotor symptoms and polypharmacy were significantly associated with a worse global quality of life.

Recovery of activities of daily living among older people one year after hip fracture.

This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 (SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery.

Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes / Characteristics of hip fracture and functional recovery in elderly people with a history of recurrent falling

Introducción. Las caídas recurrentes ocurren entre el 14,8 y 19% de la población anciana y se relacionan con mayor riesgo de tener fractura. Es poco conocida la influencia que los antecedentes de caídas recurrentes puedan tener sobre la recuperación tras una fractura de cadera. Material y método. Cohorte de pacientes mayores de 65 años ingresados en el Complejo Hospitalario Universitario de Albacete por fractura de cadera secundaria a caída, durante 1 año. Se consideró caída recurrente la presencia de 2 o más caídas en los 6 meses previos a la fractura. Se recogieron al ingreso variables sociodemográficas, circunstancias de la caída, número de caídas en los 6 meses previos, tipo de fractura y reparación, comorbilidad, situación cognitiva al ingreso (test Pfeiffer), tratamiento farmacológico e independencia para actividades de la vida diaria (Índice de Barthel–IB). Una submuestra de pacientes con IB previo a fractura ≥60 y Pfeiffer al ingreso ≤4 fueron seguidos a los 3, 6 y 12 meses. Resultados. De los 335 pacientes ingresados, se recogieron datos en 279, de los cuales un 19,4% habían sufrido previamente 2 o más caídas. Comparados con los que no tenían antecedentes de caídas recurrentes, presentan peor estado mental al ingreso, mayor media de patologías asociadas, menor porcentaje de independencia para vestirse y para transferencias cama-sillón, de manera estadísticamente significativa. En los 201 pacientes con seguimiento, el deterioro del IB al año respecto al previo a la fractura fue mayor en pacientes con caídas recurrentes (-20,8±31,54 vs -10,73±20,21; p=0,04) focalizándose más en la independencia para comer (76% vs 91,9%; p<0,05), asearse (72% vs 91,9%; p<0,01), continencia fecal (60% vs 78,7%; p<0,05) y deambular en domicilio (80% vs 93,3%; p<0,05). Conclusiones. En pacientes sin deterioro funcional moderado o severo previo a la fractura y cognitivamente estables, la recuperación de la independencia tras fractura de cadera es significativamente menor en el grupo de caídas recurrentes(AU)

Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture. Methods. Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months. Results. A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8±31.54 vs -10.73±20.21, P=.04), focusing more on independence in eating (76% vs 91.9%, P<.05), grooming (72% vs 91,9%, P<.01), faecal continence (60% vs 78.7%, p<.05) and walking indoors (80% vs 93.3%, P<.05). Conclusions. The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable(AU)

[Characteristics of hip fracture and functional recovery in elderly people with a history of recurrent falling]. / Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes.

UNLABELLED: Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture. METHODS: Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. VARIABLES: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI ≥ 60 and Pfeiffer at admission ≤ 4 was followed up at 3, 6 and 12 months. RESULTS: A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P=.04), focusing more on independence in eating (76% vs 91.9%, P<.05), grooming (72% vs 91,9%, P<.01), faecal continence (60% vs 78.7%, p<.05) and walking indoors (80% vs 93.3%, P<.05). CONCLUSIONS: The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable.

Analysis of hip-fracture falls in the elderly

Objetivos. Identificar circunstancias en que se producen caídas que comportan fractura de cadera en mayores de 65 años y factores de riesgo presentes en el momento de la caída. Método. Estudio observacional analítico. Pacientes mayores de 65 años, ingresados en el Complejo Hospitalario Universitario de Albacete por fractura de cadera secundaria a caída. Duracion recogida de datos 1 año. Variables: sociodemográficas, circunstancias de caída, características de fractura, caídas en 6 meses anteriores, enfermedades presentes, tratamiento farmacológico habitual y estado mental, recogidas de historia clínica y entrevista. Análisis estadístico descriptivo, comparación de medias (t de Student) y comparación de proporciones (χ2), según sus condiciones de aplicación; odds ratio con intervalos de confianza del 95%; regresión logística binaria múltiple. Resultados. Total, 312 pacientes. Media de edad, 81,68 años (65-99), 232 mujeres (74,3%). Estaban institucionalizados 35 (11,2%), 212 sin antecedentes de caídas (68%) ni alteración del estado mental (196; 62,8%). Las caídas se produjeron en el domicilio (189; 63,2%), y sólo en un 14% (41), por la noche. El modo de producirse está relacionado mayoritariamente con factores extrínsecos (tropezar, 31,5%; resbalar, 24,1%; n=257). En un 96% (n=300) existían enfermedades previas (media, 2,32), las más frecuentes, hipertensión arterial (177 casos; 59%) y diabetes (72; 24%). Los fármacos más utilizados fueron los inhibidores de agregación plaquetaria (31,9%; 82 casos), distintos antihipertensivos, diuréticos (30,4%; 78), hipoglucemiantes orales (16%; 41), ansiolíticos (14,4%; 37) y antidepresivos (13,6%; 35). La autonomía previa para deambulación en la calle aparece como factor protector para caídas en interiores. Conclusiones. En nuestro estudio las fracturas de cadera secundarias a caídas se han producido mayoritariamente en personas de edad avanzada, sin antecedentes de caídas en los 6 meses previos, en el domicilio familiar, en horario de mayor actividad y por factores extrínsecos (AU)

Aims. To identify the circumstances associated with falls resulting in hip fracture in the elderly, and risk factors for this kind of fall. Method. A 12 month observational study of patients over 65 years, admitted for hip fracture resulting from a fall to the General University Hospital of Albacete. Variables: demographic data, circumstances of fall, type of fracture, previous falls, associated diseases, regular drug treatment and mental status, collected from medical records and interviews. Descriptive statistical analyses were performed, which included, comparison of means (t test), comparison of proportions (χ2), odds ratio and corresponding 95% confidence intervals, and logistic regression models. Results. A total of 312 patients were included with a mean age 81.68 years (range, 65-99), of which 74.3% (232) were women. Only 35 patients (11,2%) lived in an institution, 212 (68%) had not had a fall during previous six months, and 116 patients (37.2%) had cognitive impairment. Falls occurred indoors (189 patients, 63.2%), with only 14% (41) during the night. Most of falls were related to extrinsic factors (31.5% tripping, slipping 24.1%; n=257). Patients had previous diseases in a 96% (300) of cases, with the most common being hypertension (177 patients, 59%) and diabetes (72, 24%). Drugs most frequently taken were anti-platelets (82, 31.9%), antihypertensives, diuretics (78, 30.4%), oral hypoglycaemic agents (41, 16%), anxiolytics (37, 14.4%) and antidepressants (35, 13.6%). The prior independence for walking on the street appears as a protective factor to fall indoors. Conclusions. In this sample, falls resulting in hip fracture occurred commonly in elderly people without previous falls, while at home, at a time of increased activity, and by extrinsic factors (AU)

[Analysis of hip-fracture falls in the elderly]. / Análisis de las caídas que producen fractura de cadera en ancianos.

AIMS: To identify the circumstances associated with falls resulting in hip fracture in the elderly, and risk factors for this kind of fall. METHOD: A 12 month observational study of patients over 65 years, admitted for hip fracture resulting from a fall to the General University Hospital of Albacete. VARIABLES: demographic data, circumstances of fall, type of fracture, previous falls, associated diseases, regular drug treatment and mental status, collected from medical records and interviews. Descriptive statistical analyses were performed, which included, comparison of means (t test), comparison of proportions (χ(2)), odds ratio and corresponding 95% confidence intervals, and logistic regression models. RESULTS: A total of 312 patients were included with a mean age 81.68 years (range, 65-99), of which 74.3% (232) were women. Only 35 patients (11,2%) lived in an institution, 212 (68%) had not had a fall during previous six months, and 116 patients (37.2%) had cognitive impairment. Falls occurred indoors (189 patients, 63.2%), with only 14% (41) during the night. Most of falls were related to extrinsic factors (31.5% tripping, slipping 24.1%; n=257). Patients had previous diseases in a 96% (300) of cases, with the most common being hypertension (177 patients, 59%) and diabetes (72, 24%). Drugs most frequently taken were anti-platelets (82, 31.9%), antihypertensives, diuretics (78, 30.4%), oral hypoglycaemic agents (41, 16%), anxiolytics (37, 14.4%) and antidepressants (35, 13.6%). The prior independence for walking on the street appears as a protective factor to fall indoors. CONCLUSIONS: In this sample, falls resulting in hip fracture occurred commonly in elderly people without previous falls, while at home, at a time of increased activity, and by extrinsic factors.

Autoestima, apoyo familiar y social en cuidadores familiares de personas dependientes / Self-esteem, family and social support in family members who take on the role of caregivers of their dependants

Objetivos: describir el perfil sociodemográfico de las cuidadoras familiares,las características del cuidado, su nivel de autoestima e identificar el apoyo familiar y social percibido. Método: estudio observacional descriptivo. Población: personas cuidadoras principales (PCP) de sus allegados dependientes atendidos en domicilio. Muestra: 76 cuidadores familiares del ámbito de la AP. Fuentes de información: escala de autoestima de Rosenberg (RSE), Apgar familiary cuestionario de elaboración propia. Resultados: perfil de la persona cuidadora: mujer, ama de casa, entre 45 y 65 años, que cuida al padre o madre, casada, con estudios primarios y convive con la persona cuidada. Suelen ser cuidadoras permanentes y únicas, aunque un 27,6% rotan en el cuidado y 1/3 reciben ayuda de otros familiares. Dedican 132 h/semanales de promedio al cuidado, la duración es alta (media 9 años). Valor medio de autoestima (RSE) fuede 34,36 (autoestima elevada considerada valor normal). El 78,4% tiene puntuaciones de autoestima elevada. La mayoría se considera satisfecha con la ayuda recibida por la familia, el valor medio es 8,4; la proporción de sujetos con carencias en la función familiar es el 16%. Los apoyos sociales son escasos: un 10% se siente apoyado por vecinos, asociaciones o amigos. El 24% percibe falta de apoyo social. Conclusiones: el cuidado del familiar dependiente continúa siendo asumido fundamentalmente por las mujeres con papel de amas de casa que,a pesar de la intensidad y dedicación al cuidado y de no percibir el suficiente apoyo social, tienen buena autoestima. No se aprecia un reemplazo generacional, ni reparto equitativo de la carga de cuidado según el género, es necesario investigar la causa (AU)

Objectives: to describe the sociodemographic profile of family members who take on the role of caregiver, the characteristics of this care, and theirself-esteem level, and to identify perceived family and social support. Method: descriptive observational study. Population: primary caregivers of dependant family members who receive care at home. Sample: 76 family caregivers of the PC setting. Information sources: Rosenberg selfesteem scale (RSE), family APGAR and self-elaborated questionnaire. Results: caregiver profile: woman, housewife, between the ages of 45and 65 years, who looks after her mother or father, is married, has aprimary education level, and lives with the person who receives her care.They are usually the permanent and only caregivers in the household, eventhough 27,6% do care rotation, and 1/3 receive help from other family members. They dedicate an average of 132h/week to care, and the duration of this care is high (mean 9 years). The mean self-esteem value(RSE) was 34,36 (elevated self-esteem considered a normal value). 78,4%has elevated self-esteem scores. Most feel satisfied with the help receivedfrom the family, with a mean value of 8,4; the proportion of subjects with lacks in family function is 16%. Social support is scarce: 10% feels supported by neighbours, associations or friends. 24% perceives a lack of social support.Conclusions: care of the dependant family member continues to be take non primarily by women who are housewives and who, in spite of the intensity of the care, the dedication it requires and limited perceived social support, have good self-esteem. A generational replacement or equal distribution of the care load by gender is not observed, leading to the need to investigate the cause of this reality (AU)

[Independence in activities of daily living 6 months after surgery in previously independent elderly patients with hip fracture caused by a fall]. / Independencia para actividades de la vida diaria en ancianos previamente autónomos intervenidos por fractura de cadera secundaria a una caída tras 6 meses de evolución.

OBJECTIVE: To measure recovery of independence in activities of daily living (ADL) 6 months after surgery in elderly patients (previously independent and without cognitive impairment) with hip fracture caused by a fall. METHOD: We performed a longitudinal, prospective cohort study of patients who were previously independent for ADL, or had mild dependence, and who showed no cognitive impairment. Consecutive sampling was performed. The variables studied were age, sex, habitual residence, type of hip fracture, mental status (SPMSQ Pfeiffer), and independence in ADL (according to Barthel Index [BI]) prior to the fall and 6 months after the fall. RESULTS: The study included 207 patients. There was a predominance of female sex (74.4%) and pertrochanteric fractures (45.9%). The mean age was 80.17 years old (SD = 6.95), and 7.7% were institutionalized. Six months after surgery, the mean BI score was 73.37 (SD = 26.76) (versus 90.05 before the fall), 16.8% showed urinary incontinence (versus 5.9%), 59.2% walked without assistance (versus 82.4%) and 24.6% climbed stairs unaided (versus 50.7%). The ability to walk down the street was regained in 64.6% (versus 82.1% before the fall). Recovery of autonomy for ADL was statistically significantly lower in patients unable to walk outdoors, who were institutionalized or who had mild cognitive impairment before the fall. CONCLUSIONS: Only 33.6% of patients regained prior levels of autonomy 6 months after surgery.