Aim Patients with advanced heart failure (AHF) who are not candidates to advanced therapies have poor prognosis. Some trials have shown that intermittent levosimendan can reduce HF hospitalizations in AHF in the short term. In this real‐life registry, we describe the patterns of use, safety and factors related to the response to intermittent levosimendan infusions in AHF patients not candidates to advanced therapies. Methods and results Multicentre retrospective study of patients diagnosed with advanced heart failure, not HT or LVAD candidates. Patients needed to be on the optimal medical therapy according to their treating physician. Patients with de novo heart failure or who underwent any procedure that could improve prognosis were not included in the registry. Four hundred three patients were included; 77.9% needed at least one admission the year before levosimendan was first administered because of heart failure. Death rate at 1 year was 26.8% and median survival was 24.7 [95% CI: 20.4–26.9] months, and 43.7% of patients fulfilled the criteria for being considered a responder lo levosimendan (no death, heart failure admission or unplanned HF visit at 1 year after first levosimendan administration). Compared with the year before there was a significant reduction in HF admissions (38.7% vs. 77.9%; P < 0.0001), unplanned HF visits (22.7% vs. 43.7%; P < 0.0001) or the combined event including deaths (56.3% vs. 81.4%; P < 0.0001) during the year after. We created a score that helps predicting the responder status at 1 year after levosimendan, resulting in a score summatory of five variables: TEER (+2), treatment with beta‐blockers (+1.5), Haemoglobin >12 g/dL (+1.5), amiodarone use (−1.5) HF visit 1 year before levosimendan (−1.5) and heart rate >70 b.p.m. (−2). Patients with a score less than −1 had a very low probability of response (21.5% free of death or HF event at 1 year) meanwhile those with a score over 1.5 had the better chance of response (68.4% free of death or HF event at 1 year). LEVO‐D score performed well in the ROC analysis. Conclusion In this large real‐life series of AHF patients treated with levosimendan as destination therapy, we show a significant decrease of heart failure events during the year after the first administration. The simple LEVO‐D Score could be of help when deciding about futile therapy in this population.
Few studies have analyzed the existence of homogeneous groups (profiles) in burnout and engagement among professionals, and none in social workers. This study with 448 social workers from Spain mainly examined their profiles in burnout and engagement and the characteristics of each profile in relevant job-related variables. Cluster analyses yielded four distinct profiles: the first, Burned Out, showed high burnout and low engagement; the second, Engaged, exhibited the inverse pattern with low burnout and high engagement; the third, Both, displayed simultaneously high burnout and high engagement; the fourth, Neither, showed low burnout and low engagement. The profiles also differed greatly in work-related variables: job demands (i.e., workload and work-–family conflict), job resources (i.e., support from supervisor and coworkers), personal resources (i.e., psychological detachment and relaxation), and outcomes (i.e., intrinsic job satisfaction and intent to leave). The findings support interventions, individual and organizational, tailored to the characteristics of different groups to boost engagement and decrease burnout and turnover.
Due to the indirect exposure to traumatic realities, social workers may experience emotional responses of vicarious traumatisation or vicarious resilience. Previous research indicated that risk factors (workload and trauma caseload) provoke vicarious traumatisation and that protection factors (recovery experiences and organisational support) can buffer this relationship. However, the empirical testing of these associations was scarce amongst social workers. This cross-sectional study aims to answer two main research questions: (i) can workload and trauma caseload predict vicarious resilience and vicarious trauma? (ii) Can recovery experiences and organisational support mediate the influence of risk factors on emotional responses? A sample of 373 Spanish social workers (87 per cent females) completed a questionnaire online. The structural equation modelling analyses showed that workload and trauma caseload make recovery experiences and organisational support less likely, facilitating the emergence of vicarious trauma. Recovery experiences and organisational support protect people from vicarious trauma and promote vicarious resilience, both directly and by limiting the influence of workload and trauma caseload. These results highlight the need for interventions enhancing recovery experiences and organisational support as a means to promote vicarious resilience and to decrease vicarious trauma. The need to reduce other risk factors, enhancing protective factors, is also noted.
As a result of secondary exposure to traumatic material, social workers may experience vicarious trauma. However, the analysis of this variable among social workers is scarce. The Vicarious Trauma Scale (VTS) is a brief instrument designed to measure the stress consequence of shared trauma. This study aims to examine the psychometrics of the VTS in a sample of 448 social workers from Spain. The results from the exploratory and confirmatory factor analyses (EFA and CFA) indicated that the VTS has satisfactory psychometric properties. Different indices of internal consistency supported the reliability of the VTS. Both EFA and CFA revealed the existence of two factors, corresponding to the cognitive and affective consequences of secondary exposure to trauma. Finally, the correlations of the VTS with other relevant and well-known job variables (workload, work–family conflict, detachment, supervisor support, burnout, and engagement) followed the expected pattern, and the VTS differentiated the social workers by their trauma caseload. Therefore, the VTS can be considered an adequate screening method of social workers’ vicarious trauma, and its application recommended to examine the possible risk and protective factors and consequences.
As a reaction to specific job stressors, social workers can experience job burnout. The job demands-resources theory posits that personal characteristics would mediate the influence of job stressors on either burnout or engagement. Within this framework, this cross-sectional research aimed to analyze the relationships between work–family interferences (as predictors), self-care practices (as mediators), and burnout and engagement (as outcomes). The sample included 437 graduate social workers from Spain. Structural equation modeling showed that family–work and work–family conflicts negatively predicted self-care practices and positively predicted burnout. Professional and personal self-care practices positively predicted engagement, negatively predicted burnout, and attenuated the impact of work–family interferences on burnout and engagement. To the authors’ knowledge, the present article is the first to test the job demands-resources theory with these variables on social workers. The findings support interventions for social work students and professionals enhancing self-care practices to promote engagement and to reduce burnout, and highlight the need to decrease job stressors and enhance job resources for social workers.
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