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AIMS AND OBJECTIVES: To describe migrant family caregivers' experiences and perceptions of caring for a family member with dementia. BACKGROUND: There are demographic trends of aging populations and increased migration between countries. Age-associated diseases, such as dementia, are expected to increase, with migrants being at significantly increased risk. Knowledge of how dementia care is provided within migrant families is scarce. DESIGN: Systematic review and thematic synthesis of qualitative research were performed to inform the development of interventions that can acknowledge and respond to the needs, concerns and preferences of migrant family caregivers. METHODS: Searches were performed in PubMed, PsycINFO and CINAHL and reference lists in published articles were reviewed for the period 2000-October 2020. The CASP checklist for qualitative research was used to assess evidence quality, and the ENTREQ framework was used as a guide for study reporting. RESULTS: Twenty-six articles from 10 Western countries, including 360 informal migrant caregivers from more than 30 countries of origin, were eligible. Within four areas of construct-perceptions of dementia and initial help-seeking; barriers to accessing and using formal dementia care; caregiver burden and coping and resilience-12 descriptive themes were identified. Several concepts cut across the themes, such as language difficulties; the role of the family in relation to care and support; cultural perceptions of dementia and care; stigma, pride and shame; the importance of religion and the importance of trust. CONCLUSIONS: The review revealed commonalities among migrant family caregivers that resulted in reduced understanding of dementia and the importance of diagnosis and treatment. RELEVANCE TO CLINICAL PRACTICE: To prevent a negative trajectory in caregiving, with perceived demands causing high levels of stress and strain, several barriers to migrants accessing and using formal care need to be assessed and addressed.

Aim: To explore nursing students’ experiences of applying problem-based learning to train the core competence teamwork and collaboration. Design: The study used a qualitative descriptive design. Method: The data were collected using individual interviews with a purposive sample of 11 students and analysed using inductive qualitative content analysis. Results: The students’ experiences of applying problem-based learning to train the core competence teamwork and collaboration were described in two generic categories: prerequisites to train teamwork and collaboration and abilities practised in the base group. The generic category “prerequisites to train teamwork and collaboration” includes three subcategories: previous experience and education, composition of the base group, and common goals and values in the base group. The generic category “abilities practised in the base group” includes four subcategories: taking personal responsibility, practising role distribution and leadership, developing communication skills and creating togetherness in the base group. open access

Background Insomnia, sleep apnoea and sleep loss are risk factors for the development of cardiovascular diseases. Most research on sleep disturbances includes patients with heart failure, while the role of sleep in sudden cardiac arrest survivors (SCA) has been only partially investigated and understood. Sleep-related breathing disorders and obstructive sleep apnoea increase illness and mortality in the aftermath of SCA. Also, post-traumatic stress is evident in SCA survivors, where sleep disruptions are some of the main symptoms of the condition. Consequently, it is important to identify sleep problems in SCA survivors at an early stage to avoid unnecessary suffering. Purpose The aim of this study was to investigate registered nurses perceptions of SCA survivors sleep, both in hospital and after discharge. Methods This was an explorative interview study with a phenomenographic approach. Nineteen registered nurses (RNs) varying in age, sex and years in the profession participated. Findings The nurses perceptions of SCA survivors sleep were categorized as: "The observer - noticing behaviours, emotions and habits of the patient that affect sleep", "The oblivious witness - attitudes that hinder the ability to recognise sleep behaviours", and "The practitioner - advising and medicating for sleep". The outcome space showed that the nurses detected both obvious and subtle signs relating to patients sleep. However, attitudes hindering the recognition of sleep behaviours were independent of acting as an observer or practitioner. If nothing unforeseen was observed, or if the patient did not spontaneously raise the subject, sleep was considered less important than other health problems in SCA survivors. Conclusions Although the nurses knew that SCA survivors suffered from poor sleep, they failed to reflect on the consequences for the patient. Nurses feelings of insufficient knowledge about sleep, as well as their omittance of sleep in the follow-up documentation could leave sleep issues unaddressed and cause unnecessary patient suffering. Relevance to clinical practice Nurses need increased knowledge and training to enable them to detect subtle signs of sleep problems in SCA survivors. Funding Agencies|Region Ostergotland, Linkoping University [LIO-820771]; Medical Research Council of Southeast Sweden [FORSS-556481]

Reliability and cost are two important driving factors in the development of wind energy. Automation and digitalization of operation and maintenance (O&M) procedures help to increase turbine reliability and reduce the levelized cost of energy (LCOE). Here, we demonstrate a novel method, coined as AQUADA, which may change the current labor-intensive and operation-interfering blade inspection by using thermography and computer vision. We experimentally show that structural damages below the surfaces can be detected and quantified remotely when wind turbine blades are subject to fatigue loads. The data acquisition and analysis are automatically done in one single step, which may shift the current inspection paradigm through more automated O&M procedures. The cost analysis shows that the AQUADA method has a potential to at least half the total inspection cost and reduce the LCOE by 1%–2% when applied to a baseline land-based wind farm consisting of twenty 2.45-MW turbines. All data and source codes are published for researchers to reproduce our results and facilitate further development of AQUADA towards more mature industrial applications.

Objective Patients are increasingly seeking nonsurgical treatment for the aging face. The purpose of this study was to evaluate the clinical efficacy and outcomes of a thermistor-controlled subdermal skin tightening device (ThermiTight) as a treatment modality for the aging face. Methods A retrospective analysis of 12 patients was completed on patients having undergone ThermiTight for midface and neck skin tightening. Only five patients had a greater than 1 year follow-up and were included in the study. Two blinded reviewers assessed photographs taken pre-procedure and 1 year post-procedure using a standardized skin laxity scale. Patient charts were reviewed to assess for complications up to 12 months post-treatment. Results The mean age of included patients was 57 years, and all five patients were female. One (20%) patient treated with ThermiTight was also treated with injectables (Botox, Juvederm) simultaneously. One (20%) patient developed a wound complication. One (20%) patient complained of incisional site pain at her first postoperative visit that subsequently self-resolved. On a five-point scale to assess facial skin laxity, there was an average improved score of 0.85 per patient (P < .001) at one year post-procedure. Two blinded reviewers correctly categorized photographs as either being "baseline" or "post-procedure" 100% of the time. There was no significant difference between the skin laxity scores by the blinded reviewers (P = .05). Conclusion ThermiTight is a new technology used for nonsurgical treatment of the aging face. Long-term outcomes demonstrate the safety and efficacy of the procedure. Complications are rare, but possible, in the use of ThermiTight. Level of Evidence: 3.

Evidence for the extrapulmonary benefits of (CFTR) modulators is rapidly expanding. The use of CFTR modulators in CF patients who have undergone lung transplantation is not clear without guidance published in the medical literature to assist clinicians in the care of these patients. We discuss the potential benefits of CFTR modulators and provide insight into their use based on our experience in a small cohort of CF LTx recipients. We present pros and cons of CFTR modulator therapy for LTx recipients with CF. CFTR modulators should be considered in CF patients after lung transplantation for the time being until further research defines how to best use these therapies in transplant recipients.

BACKGROUND: Sore throat is a common condition caused by viruses or bacteria, and is a leading cause of antibiotic prescription in primary care. The most common bacterial species is group A streptococcus (’strep throat’). Between 50% to 70% of pharyngitis cases are treated with antibiotics, despite the majority of cases being viral in origin. One strategy to reduce antibiotics is to use rapid tests for group A streptococcus to guide antibiotic prescriptions. Rapid tests can be used alone or in combination with a clinical scoring system. OBJECTIVES: To assess the efficacy and safety of strategies based on rapid tests to guide antibiotic prescriptions for sore throat in primary care settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and LILACS, as well as the trial registries ClinicalTrials.gov and the WHO ICTRP on 5 June 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing rapid tests with management based on clinical grounds to guide the prescription of antibiotics for people with a sore throat in ambulatory care settings. We included trials that randomised individuals, as well as cluster‐RCTs in which individual practitioners (or practices) or emergency departments were randomised. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data on the primary outcomes (number of participants provided with an antibiotic prescription; number of participants with an antibiotic dispensed) and secondary outcomes (duration of sore throat symptoms; duration of other symptoms; quality of life measures; number of participants with a complication attributed to the index infection; number of participants in need of re‐consultation by the end of follow‐up; number of participants in need of hospital admission by the end of follow‐up; number of satisfied participants; number of participants with an adverse event attributed to the rapid test). We assessed the risk of bias of all included trials and used GRADE to assess the certainty of the evidence. We performed meta‐analyses and sensitivity analyses when feasible. MAIN RESULTS: We included five trials (2891 children and adult participants in total; 2545 participants after adjusting for clustering). Management in the intervention group was as follows: in three trials rapid tests were used in combination with a clinical scoring system; in one trial, some physicians were asked to use rapid tests alone, while others were asked to use rapid tests in combination with a clinical scoring system; in one trial, rapid tests were used alone. Based on data from five trials (2545 participants), a large reduction in prescribed antibiotics was found in the rapid test group (481/1197) versus management based on clinical grounds (865/1348), for a summary risk difference (RD) of −25%, 95% confidence interval (CI) −31% to −18%; I(2) = 62%; moderate‐certainty evidence. Estimates of effect on antibiotic prescription rates were stable in various sensitivity analyses. Based on data from two trials (900 people) originating from the same overarching study, the evidence suggests that rapid tests may not reduce dispensed antibiotic treatments: rapid test group (156/445) versus management based on clinical grounds (197/455); summary RD −7%, 95% CI −17% to 2%; I(2) = 53%; low‐certainty evidence. Four trials (2075 participants) reported data on the number of participants with a complication attributed to the index infection; the summary odds ratio (OR) was 0.85, 95% CI 0.03 to 26.65; P = 0.93; I(2) = 62%; very low‐certainty evidence, which means that people in the rapid testing group were less likely to develop complications of the index infection, but the evidence is very uncertain. Two trials (1161 participants) reported on the number of participants in need of re‐consultation by the end of follow‐up; the summary OR was 1.12, 95% CI 0.57 to 2.21; P = 0.74; I(2) = 59%; low‐certainty evidence, which means that participants in the rapid testing group were more likely to be in need of re‐consultation by the end of the study follow‐up, but the evidence is uncertain. Lack of data impeded assessment of other secondary outcomes (including safety outcomes) and of sources of heterogeneity. AUTHORS' CONCLUSIONS: Rapid testing to guide antibiotic treatment for sore throat in primary care probably reduces antibiotic prescription rates by 25% (absolute risk difference), but may have little or no impact on antibiotic dispensing. More studies are needed to assess the efficacy and safety of rapid test‐guided antibiotic prescribing, notably to evaluate patient‐centred outcomes and variability across subgroups (e.g. adults versus children).

Understanding how nursing students in European countries perceive their future professional role is an important step in creating awareness of the diversity and similarities between countries. Investigating nursing students' perceptions of their future profession could help in the design of education and the retention of nurses.To compare nursing students' perceptions of the professional nurse's role between Belarus, Lithuania, Poland and Sweden.A cross-sectional design was implemented. The study used two scales of the Professional Nursing Image Survey, which has questions about 10 skills and abilities and 14 functions and duties of a nurse.A total of 392 final-year nursing students in four countries participated in the study. Statistically significant differences were found between countries in terms of all 10 skills and abilities and in the distribution of responses concerning functions and duties of a nurse.Nursing students in Belarus, Lithuania, Poland and Sweden perceive differently the role of a nurse in terms of some functions and responsibilities. This may influence the adaptation of nurses who enjoy freedom of movement among the countries.The knowledge gained in this study could be beneficial in improving nursing education, as it could illuminate the discrepancy between educational goals and students' perceptions of their future professional role.

BACKGROUND AND AIMS Early detection of renal dysfunction in cirrhosis is important, and several renal biomarkers have been put forward. Neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C are markers of renal dysfunction, but relations to splanchnic and systemic hemodynamics and kinetics are sparsely studied in cirrhosis. In patients with cirrhosis and portal hypertension, we studied plasma levels and renal, hepatic, and peripheral extraction of NGAL and cystatin C and relations to patients characteristics, liver dysfunction, and hemodynamics. METHODS Forty-five cirrhotic patients (Child class A/B/C:15/15/15) and 15 controls were evaluated with a full clinical, biochemical, and hemodynamic assessment. Urine and regional plasma concentrations of NGAL and cystatin C were measured. RESULTS There was no significant difference in circulating or hepatic NGAL or cystatin C between all patients and controls but a trend towards increased levels with increasing Child class. In addition, there was a significant renal but no hepatic or systemic extraction of both NGAL and cystatin C (P

The relative importance of exploitation rate and environmental variability in generating fluctuations of harvested populations is a key issue in academic ecology as well as population management. We studied how the eastern Baltic cod (Gadus morhua) is affected by fishing and environmental variation by using a newly developed single species state-space model. Survey data and auxiliary environmental data were used to estimate the model parameters. The model was then used to predict future development of the eastern Baltic cod under different fishing mortalities and abiotic conditions. Abiotic condition was represented by an index: reproductive volume which is the volume of water suitable (in terms of salinity and oxygen content) for the successful development of the early life stages of Baltic cod. The model included direct density dependence, fishing, and a lagged effect of reproductive volume. Our analysis showed that fishing rate is approximately three times more important than reproductive volume in explaining the population dynamics. Furthermore, our model suggests either under- or over-compensatory dynamics depending on the reproductive volume and long term catch levels. It follows that fishing can either reduce or increase temporal oscillations of the cod stock depending on whether the dynamics is over- or undercompensatory, respectively. The sustainable level of fishing rate is however dependent on reproductive volume. Our model predicts a dual role of fishing rate, stabilizing when reproductive volume is high and destabilizing when it is low. Exploitation rate may therefore increase or decrease the risk of the population of cod dropping below a given biomass reference point depending on the environmental conditions, which has practical implications for fisheries management.