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Notwithstanding its exit from the European Union itself, the United Kingdom still remains an influential European power with significant interests and equities in the Indo-Pacific region. This article probes the substance of London's engagement with the region through a distillation of relevant policy documents/statements appertaining to the Indo-Pacific. It reconciles this material within a three-tiered analytical framework that encompasses British 'aims'; the 'assets' it holds; and then 'assesses' its performance and prospects. Like the other European actors considered in this Symposium, it reveals the strong confluence of economic, security and normative elements that define its regional strategic outlook. While there are many synergies with the approaches of the other European powers, what makes the United Kingdom case distinctive is a more prolific set of regional partnerships alongside multilateral engagement ('networks and grids'), and a greater accent on hard power capabilities. The latter however are placed in service of the former – Britain has no aspirations to shift the regional balance of power independently. [ABSTRACT FROM AUTHOR]

Abstract Background Change is a very complex and multifaceted phenomenon that is intertwined with the understanding of nursing practice, so, resistance to change in nursing can be considered as an important challenge. Knowing the reasons for this resistance can help in solving it in nursing. Therefore, the present study was conducted with the aim of investigating the reasons for resistance to change in nursing as an integrated review. Methods This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, CINAHL, and Scopus were searched using the keywords; “Resistance”, “Change”, “Nursing”, “Resistance to Change” and their Persian equivalents in the time range of 2000 to January 2023. After applying inclusion criteria and assessing the articles using Bowling’s Quality Assessment Tool, finally, 15 papers were included from 2964. Results After reviewing and critically appraisal of the qualified articles, the findings were placed in three main categories including; (1) individual factors, (2) interpersonal factors, and (3) organizational factors and six subcategories. Conclusion Undoubtedly, change is an integral component in nursing care, and resistance to it is the result of a set of individual, interpersonal and organizational factors that change managers should pay special attention to in order to make changes due to the reasons of this resistance, and the development process of developing changes in the clinical field is easily possible.

This paper explores the dilemma faced by voice practitioner-researchers when working with literature. Within voice practice, researchers stand at the intersection of science and art and face philosophical conflicts due to the multi-disciplinary nature of their position. The paper explores the different literature review types and gives guidance on their paradigm roots and stylistic devices employed. It aims to provide an accessible framework by providing clarity and facilitating choice. [ABSTRACT FROM AUTHOR]

Background: Change is a very complex and multifaceted phenomenon that is intertwined with the understanding of nursing practice, so, resistance to change in nursing can be considered as an important challenge. Knowing the reasons for this resistance can help in solving it in nursing. Therefore, the present study was conducted with the aim of investigating the reasons for resistance to change in nursing as an integrated review. Methods: This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, CINAHL, and Scopus were searched using the keywords; "Resistance", "Change", "Nursing", "Resistance to Change" and their Persian equivalents in the time range of 2000 to January 2023. After applying inclusion criteria and assessing the articles using Bowling's Quality Assessment Tool, finally, 15 papers were included from 2964. Results: After reviewing and critically appraisal of the qualified articles, the findings were placed in three main categories including; (1) individual factors, (2) interpersonal factors, and (3) organizational factors and six subcategories. Conclusion: Undoubtedly, change is an integral component in nursing care, and resistance to it is the result of a set of individual, interpersonal and organizational factors that change managers should pay special attention to in order to make changes due to the reasons of this resistance, and the development process of developing changes in the clinical field is easily possible. [ABSTRACT FROM AUTHOR]

Copyright of Pedagogy Studies / Pedagogika is the property of Vytautas Magnus University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Fetal cardiology programs are evolving quickly and include multiple interdisciplinary health care professionals whose roles could benefit from clear definition. Nurses provide an essential function in this field; however, descriptions or definitions of nursing practice, education and knowledge requirements, and responsibilities are limited and vary across institutions and disciplines. Purpose: To conduct an integrative review summarizing the literature to determine the role of nurses in fetal cardiology programs. Methods: We conducted an integrative review as per Whittemore and Knafl's (2005) methodology of current literature to reveal strengths and opportunities in describing nursing practice as fetal cardiology nurses. The search strategy included five electronic databases: CINAHL, Medline, PsycINFO, Web of Science, and Google Scholar. Peer-reviewed English-language articles discussing nursing practices in fetal cardiology published between 2015 and 2022 were selected. Data extraction and analysis were completed on a final sample of 26 articles. Results: Four themes were identified on fetal cardiac nursing practice from nursing and medical perspectives: multidisciplinary key team member, psychosocial family support and counselor, coordinator or navigator, and role description. Clinical Implications: More discussion in the literature is needed to better understand and define fetal cardiac nursing practice. Although most experts agree nurses are an important member of the interdisciplinary fetal cardiology team, their roles and educational requirements are poorly described and defined. Quality metrics and benchmarks are needed to ensure safe and effective fetal cardiology care. The role of nurses in fetal cardiology programs is not fully described in the literature. Nursing practice and requirements for knowledge, skills, and education vary among programs and countries. In this integrative review of 26 articles from 9 countries, the role of nurses in fetal cardiology programs is explored and recommendations for role definition, quality measures, and educational requirements are discussed. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine how front‐line health professionals identify and manage nonfatal strangulation events. Design: Integrative review with narrative synthesis was conducted. Data Sources: A comprehensive database search was conducted in six electronic databases (CINAHL, Wed of Science, DISCOVER, SCOPUS, PubMed and Scholar) resulting in 49 potentially eligible full texts, reduced to 10 articles for inclusion after exclusion criteria were applied. Review Methods: An integrative review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement guidelines. Data were extracted, and a narrative synthesis using Whittemore and Knafl (2005) framework was undertaken to determine how front‐line health professionals identify and manage nonfatal strangulation events. Results: The findings identified three main themes: an overall failure by health professionals to recognize nonfatal strangulation, a failure to report the event and a failure to follow up on victims after the event. Stigma and predetermined beliefs around nonfatal strangulation, along with a lack of knowledge about signs and symptoms, were the salient features in the literature. Conclusion: Lack of training and fear of not knowing what to do next are barriers to providing care to victims of strangulation. Failure to detect, manage and support victims will continue the cycle of harm through the long‐term health effects of strangulation. Early detection and management of strangulation are essential to prevent health complications, particularly when the victims are exposed to such behaviours repeatedly. Impact This review appears to be the first to explore how health professionals identify and manage nonfatal strangulation. It identified the significant need for education and robust and consistent screening and discharge policies to assist health providers of services where victims of nonfatal strangulation attend. No Patient or Public Contribution: This review contains no patient or public contribution since it was examining health professionals' knowledge of identifying nonfatal strangulation and the screening and assessment tools used in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Self-care is essential for stroke survivors to recover from neurological disorders caused by stroke and to prevent recurrences. Self-care behaviors are activities that individuals undertake to prevent recurrence and complications, and have a positive effect on the quality of life of patients. Telehealth is an emerging technology through which self-care intervention can be provided from a distance. Review-based research is needed to determine the value and development of telehealth-based self-care interventions for stroke survivors. Objective: Based on the middle range theory of self-care of chronic illness, to provide an effective guide when developing telehealth self-care interventions for stroke survivors by comprehensively understanding telehealth interventions to support self-care of stroke survivors. Methods: An integrative review, this study was performed in accordance with Whittemore and Knafl's stages of an integrative review (problem identification, literature search, data evaluation, data analysis, and presentation of the results). The key search terms included combinations of concepts related to stroke survivors and self-care, and telehealth. The research year of searched publications was not limited, and five electronic databases (PubMed, Ovid-MEDLINE, Ovid-EMBASE, CINAHL and Cochrane Library) were searched. Results: Four attributes were identified that represented telehealth's functions that appeared to be associated with a self-care intervention for stroke survivors. These included introducing the concept of interaction, monitoring, education, and store and forward. These self-care interventions were found to influence the behaviors of stroke survivors' self-care maintenance (physical activity and treatment adherence), self-care monitoring (blood pressure, healthy behaviors, health diet, psychological well-being, glucose control, and depression), and self-care management (sense of control, healthcare resource utilization, social integration, and support). Conclusions: The results of this study can provide a guide for developing effective telehealth self-care intervention by identifying the attributes of telehealth self-care intervention for stroke survivors.

Copyright of Hoitotiede is the property of Hoitotieteiden Tutkimusseura HTTS r.y. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Integrated Review of Security, Defence, Development and Foreign Policy: Global Britain in a Competitive Age has been published in March 2021. It sets out the United Kingdom's foreign and security policy approach for the next decade. In the Integrated Review, the international system is described as more competitive, more fragmented, and multipolar. It introduces a new policy approach based on new trends namely geopolitical and geoeconomic shifts; systemic competition; rapid technological change; and transnational challenges in the world post-Covid-19 and post-Brexit. The Global Britain vision labels China as a challenging "systemic competitor" in this new world order. The United Kingdom-China relations have a long history, with a complex nature and include both cooperation and confrontation. This article focuses on the United Kingdom's China strategy which, according to the Integrated Review, requires a shift in policy making. This article claims that the United Kingdom lacks a clear China strategy although it describes it as the main systemic competitor. It elaborates on the historical developments of bilateral relations and questions the challenges that China pose to security, prosperity, and values from the British perspective. [ABSTRACT FROM AUTHOR]

Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searches for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.

Copyright of Logos: A Journal, of Religion, Philosophy Comparative Cultural Studies & Art (08687692) is the property of Logos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place. The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results: 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion: The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.

Abstract Background High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions. Methods An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included. Results Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients. Conclusions This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.

The United Kingdom's integrated defense and security review put "grey zone" or "hybrid" challenges at the center of national security and defense strategy. The United Kingdom is not alone: The security and defense policies of NATO, the European Union, and several other countries (including the United States, France, Germany, and Australia) have taken a hybrid-turn in recent years. This article attempts to move the hybrid debate toward more fertile ground for international policymakers and scholars by advocating a simple distinction between threats and warfare. The United Kingdom's attempts to grapple with its own hybrid policy offer a national case study in closing the gap between rhetoric and practice, or stagecraft and statecraft, before an avenue of moving forward is proposed—informally, through a series of questions, puzzles, and lessons from the British experience—to help international policy and research communities align their efforts to address their own stagecraft-statecraft dichotomies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to identify essential psychological-informed executive coaching approaches that enhance the organisational learning and development process and outcomes through integrating existing research evidence. Since coaching has been widely used in leadership development related areas and previous studies confirmed that this generates positive effects on individual-level learning in the organisational setting. The identified frameworks and influential factors outlined in this paper can serve as explicit guidelines for the organisation and management team when setting selection and evaluation benchmarks for employing executive coaches. Design/methodology/approach – An integrated review approach was applied to narratively synthesise 234 (k=234) identified peer-review articles between 1995 and 2018. This review followed a rigorous protocol that the authors consulted ten (n=10) experts in the field. Both qualitative and quantitative psychological-focused research evidence was included in this study. Findings – First, certain psychological approaches, such as cognitive behavioural, solution-focused, GROW and strength-based approaches, were highlighted in current research evidence. Second, the essential factors and skills, for instance, building trust, transparency and rapport, and facilitating learning were identified. Third, the main organisational learning and development outcome evaluation methods were outlined in this review, such as the self-efficacy scale, organisational commitment, workplace psychological well-being, 360-degree feedback and the Multifactor Leadership Questionnaire. Research limitations/implications – It is always challenging to integrate research evidence on coaching because of the diversity of theoretical disciplines upon which coaching interventions draw. Therefore, it is difficult to generate a meta-analytic review which can generate statistical results. This review also reveals room for improvement in the quality of existing coaching evidence in accordance with the criteria for evidence-based management or practice (Briner et al., 2009), such as research methodology and evaluation design. Moreover, there is a lack of evidence on this reflective process which helps professional coaches to ensure the quality of their practice and organisational support. Practical implications – This review offers a new perspective on the role psychology plays in the organisational learning and development practices. The identified coaching approaches, influential interpersonal skills and outcome evaluation methods can serve as practical guidelines when applying external coaching to facilitate a better organisational learning and development process and outcome. Originality/value – This is the first literature review to focus on contemporary psychological-informed coaching evidence (between 1995 and 2018) in the workplace setting. Despite the rapid growth in demand for professional coaching practitioners (International Coach Federation, 2016), there is a lack of research-informed evidence to overcome the challenges faced by organisations when employing external coaches, such as what selection criteria or evaluation benchmarks to use. This review takes a practical perspective to identify essential body of knowledge and behavioural indicators required for an executive coach to facilitate an effective learning and development outcome.

The social inclusion of people with dementia (PwD) is recognised as a global goal of legislation, societal initiatives and service provision. Ensuring the social inclusion of PwD in these areas implies that its dimensions and domains are clear and unambiguous. However, the concept of social inclusion as it is currently used by researchers and practitioners is often vague or acts as a container concept for a variety of different approaches. This paper reports on an integrative review that analysed qualitative and quantitative studies on social inclusion and exclusion of PwD. It focused not only on the empirical results of the included studies but also on the theoretical embedding and methodological approaches to the concept of social inclusion and exclusion. We find that empirical studies on the social inclusion of PwD are scarce and largely characterised by a lack of or inconsistent conceptualisation. Against this background, the operationalisation of the concept and the assessment of the individual aspects of social inclusion with standardised instruments seem to be premature. Substantial theoretical and methodological work is needed to guide research on the social inclusion of PwD. The empirical results show that relationships with other people and being integrated into social networks are essential aspects of social inclusion. Likewise, the strategies and attitudes of caring persons can help to create or reinforce exclusion. [ABSTRACT FROM AUTHOR]

Aim: To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. Background: Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. Design: A systematic integrated review. Data sources: Six databases were searched systematically between 18 June 2018 – 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. Review methods: Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. Results: The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well‐coordinated services or preventing them from accessing services. Second, health professionals' partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organizational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualized support for them to develop resilience is highly regarded. Conclusion: Stroke survivors and caregivers encounter enormous challenges in self‐management of hospital to home transition care. Further research is required to address their expectations of support during transition care. Impact: There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals' commitment to individualized care and the self‐management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences. [ABSTRACT FROM AUTHOR]

Many empirical studies have demonstrated the psychological effects of various aspects of money, including the aspiration for money, mere thoughts about money, possession of money, and placement of people in economic contexts. Although multiple aspects of money and varied methodologies have been focused on and implemented, the underlying mechanisms of the empirical findings from these seemingly isolated areas significantly overlap. In this article, we operationalize money as a broad concept and take a novel approach by providing an integrated review of the literature and identifying five major streams of mechanisms: (a) self-focused behavior; (b) inhibited other-oriented behavior; (c) favoring of a self–other distinction; (d) money's relationship with self-esteem and self-efficacy; and (e) goal pursuit, objectification, outcome maximization, and unethicality. Moreover, we propose a unified psychological perspective for the future—money as an embodiment of social distinction—which could potentially account for past findings and generate future work. [ABSTRACT FROM AUTHOR]

Purpose: To synthesise literature in order to elucidate the experiences of men who have survived testicular cancer and determine their quality of life following treatment.Methods: An integrated review sought appropriate literature by utilising a keyword search across seven databases. Retrieved studies were appraised for quality, with 2 qualitative, 12 quantitative and 2 mixed method studies deemed appropriate for this review. The data were extracted and aggregated into categories by way of a thematic analysis. The themes were personal challenges and impact on health, psychological and emotive challenges, perception of reproduction and sexual changes and outlook and support.Results: Men experienced physical, emotional and sexual difficulties. Some men believed they were infertile, despite evidence that fertility is not compromised in the long term. Psychological conditions can be exacerbated by cultural pressures to conceive and cultural expressions about male identity. Men who had undergone orchidectomy reported minimal impact on their mental health than the men who had chemotherapy or radiotherapy as part of their treatment modality. Sexual dysfunction caused by chemotherapy-associated side effects was detrimental to men's quality of life. In addition, men who had a partner, who were employed, and who had children were able to adjust better after treatment than those who did not. Provision of clear and honest information post-treatment helped testicular cancer survivors return to their normal lives.Conclusions: The evidence from the review suggests that the burden of disease for testicular cancer survivors is overall low. Men who had surgical intervention and were treated for testicular cancer experienced minimal impact on their mental health status than the men who had chemotherapy or radiotherapy as part of their treatment modality.Implications For Cancer Survivors: There is a need to provide appropriate referrals to the relevant services, including psychosocial support, and the development of more adequate communication resources for men following treatment for testicular cancer. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the burden of caring for the care-givers of the elderly in Korea by using an integrated literature review method. A total of 23 studies were analyzed using a search database. When care-givers had higher sense of filial and guilt or more than two diseases, they showed high level of feeling of burden. Also, they had high level of feeling of physical burden by their oldness, service period (especially at the period of 1-3 years). In the feeling of economic burden, they had high level of feeling of burden by their oldness, or elderly's disease periods. The feeling of burden by psychological condition was found in elderly in aged and the beginning of admission of nursing home. The feeling of burden by environment situation was found when the functional status of the elderly was bad. Therefore, we need to concern care-givers's feeling of burden with elderly people in the nursing home. In the future, I believe that the findings of this study will be helpful for development of the intervention program for alleviate burden for the care-giver. [ABSTRACT FROM AUTHOR]

Background: Although the implantable cardioverter defibrillator is successful in terminating life threatening arrhythmias, it might give unwanted shocks in the last phase of life if not deactivated in a timely manner. Aims: This integrated review aimed to provide an overview of studies reporting on implantable cardioverter defibrillator shock incidence and impact in the last phase of life. Methods and results: We systematically searched five electronic databases. Studies reporting on the incidence and/or impact of implantable cardioverter defibrillator shocks in the last month of life were included. Fifteen studies were included. Two American studies published in 1996 and 1998 reported on the incidence of shocks in patients who died non-suddenly: incidences were 24% and 33%, respectively, in the last 24 hours, and 7% and 14%, respectively, in the last hour of life. Six American studies and one Danish study published between 1991–1999 reported on patients dying suddenly: incidences were 41% and 68% in the last 24 hours and 22–66% in the last hour. Four American studies and two Swedish studies published between 2004–2015 did not distinguish the cause of death: incidences were 17–32% in the last month, 3–32% in the last 24 hours, and 8% and 31% in the last hour of life. Three American studies published between 2004–2011 reported that shocks in dying patients are painful and distressing for patients, and distressing for relatives and professional caregivers. Conclusion: If the implantable cardioverter defibrillator is not deactivated in a timely manner, a potentially significant proportion of implantable cardioverter defibrillator patients experience painful and distressing shocks in their last phase of life. [ABSTRACT FROM AUTHOR]

Purpose of the Study: There is a global imperative to increase awareness of the emerging evidence on physical activity (PA) among older adults. “Healthy aging” has traditionally focused on preventing chronic disease, but greater efforts are required to reduce frailty and dependency and to maintain independent physical and cognitive function and mental health and well-being. Design and Methods: This integrated review updates the epidemiological data on PA, summarizes the existing evidencebased PA guidelines, describes the global magnitude of inactivity, and finally describes the rationale for action. The first section updates the epidemiological evidence for reduced cardiometabolic risk, reduced risks of falls, the burgeoning new evidence on improved cognitive function and functional capacity, and reduced risk of depression, anxiety, and dementia. This is followed by a summary of population prevalence studies among older adults. Finally, we present a “review of reviews” of PA interventions delivered from community or population settings, followed by a consideration of interventions among the “oldest-old,” where efforts are needed to increase resistance (strength) training and balance. Results: This review identifies the global importance of considering “active aging” beyond the established benefits attributed to noncommunicable disease prevention alone. Implications: Innovative population-level efforts are required to address physical inactivity, prevent loss of muscle strength, and maintain balance in older adults. Specific investment in healthy aging requires global policy support from the World Health Organization and is implemented at the national and regional levels, in order to reduce the burden of disease and disability among older adults. [ABSTRACT FROM AUTHOR]

Marked by a progressive increase in the amplitude of climate oscillations, an evolving waveform, and a shift towards a quasi-100 ky frequency, the Early–Middle Pleistocene transition (EMPT), previously known as the Mid-Pleistocene Transition (or Mid-Pleistocene Revolution) (1.4–0.4 Ma), represents a fundamental transformation in the Earth's climate state. The EMPT began with a substantial change in climate dynamics and ended with the Mid-Brunhes Event, signaling the establishment of a new steady state. The reasons for the EMPT while uncertain appear to involve a non-linear response of the Earth climate system. The physical and biotic responses to this transition, amplified by the growth of Northern Hemisphere ice sheets, have been profound. Two important chronostratigraphic markers characterize the EMPT, the Jaramillo Subchron (1.070–0.988 Ma) and the Matuyama–Brunhes Chron boundary (∼773 ka). The latter has been chosen as the primary guide for the Lower–Middle Pleistocene Subseries boundary, as it lies at the approximate midpoint of the EMPT and aids in global recognition both in marine and terrestrial deposits. The Jaramillo Subchron has received less attention, but the late Early Pleistocene is important in Europe because it saw the progressive transition from the Villafranchian to Galerian mammal faunas, and expansion of hominins into western and northern Europe. The Jaramillo Subchron is represented by Marine Isotope Stages (MIS) 31 to 28, with MIS 30 already showing the asymmetrical (sawtooth) pattern characteristic of the Middle Pleistocene. Indeed, while variation in the 40-ky band (obliquity) remains strong throughout the EMPT, low frequency variability begins at around 1250–1200 ky, which coincides with a progressive increase in global ice volume. Against a backdrop of increasingly severe glacial cycles, notably during MIS 36, 34, 24–22 (the so-called “0.9 Ma event”), 16 and 12, pronounced phases of warming are also documented globally, including the “super-interglacial” MIS 31. The early phase of the EMPT is characterized by important glaciations beginning with MIS 36 and continuing to MIS 24–22, a major intensification of the East Asian monsoon system, intensification of loess deposition in northern Europe, development of open landscapes in western Siberia, increased fluvial incision, higher amplitude sea-level change, and spread of large mammals across northern Eurasia, and a strong reduction in the North Atlantic thermohaline circulation. In Europe, the loss of thermophilous plant taxa during the EMPT and indeed throughout the Quaternary is a reminder of the progressive cooling that took place here and elsewhere. [ABSTRACT FROM AUTHOR]

Background: Many children with life-threatening conditions who would have died at birth are now surviving months to years longer than previously expected. Understanding how parents make decisions is necessary to prevent parental regret about decision-making, which can lead to psychological distress, decreased physical health, and decreased quality of life for the parents. Objective: The aim of this integrated literature review was to describe possible factors that affect parental decision-making for medically complex children. The critical decisions included continuation or termination of a high-risk pregnancy, initiation of life-sustaining treatments such as resuscitation, complex cardiothoracic surgery, use of experimental treatments, end-of-life care, and limitation of care or withdrawal of support. Design: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO were searched using the combined key terms ‘parents and decision-making’ to obtain English language publications from 2000 to June 2013. Results: The findings from each of the 31 articles retained were recorded. The strengths of the empirical research reviewed are that decisions about initiating life support and withdrawing life support have received significant attention. Researchers have explored how many different factors impact decision-making and have used multiple different research designs and data collection methods to explore the decision-making process. These initial studies lay the foundation for future research and have provided insight into parental decision-making during times of crisis. Conclusions: Studies must begin to include both parents and providers so that researchers can evaluate how decisions are made for individual children with complex chronic conditions to understand the dynamics between parents and parent–provider relationships. The majority of studies focused on one homogenous diagnostic group of premature infants and children with complex congenital heart disease. Thus comparisons across other child illness categories cannot be made. Most studies also used cross-sectional and/ or retrospective research designs, which led to researchers and clinicians having limited understanding of how factors change over time for parents. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the UK. Methods: We conducted an integrated review of published and unpublished literature (1996–September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google. Results: Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor–patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services. Conclusion: The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the UK are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs. Practical implication: We have made several recommendations that could be used to improve existing services in Canada. [Copyright &y& Elsevier]

Aim. The literature on nursing care in nurse clinics that focus on chronic management of chronic obstructive pulmonary disease (COPD) is analysed and synthesised with the purpose of advancing research of practice in nurse clinics. Background. Along with the rising prevalence of COPD and a growing recognition of long-lasting, comprehensive and complex healthcare needs of people with COPD and their families, nurses are challenged to restructure their practice. Methods. An integrated review was conducted. The databases searched were NCBI’s PubMed database, Scopus, CINAHL and Web of Science from 1996 to 2006. Terms searched were ‘COPD’ and ‘nurse managed clinic’ with all subheadings. A nurse had to be primary in managing and providing the services and the methodological approach was inclusive. Results. Of 385 potentially relevant papers, 20 papers reporting 16 studies met the inclusion criteria. The methodological approach was diverse with randomised controlled trials being most common. Significant benefits from experimental treatments were seldom demonstrated. Nursing care in the chronic phase of COPD has mainly been conceptualised as: home-based respiratory care; self-management educational programmes and telephone service with influences of specialisation in respiratory nursing care on patients’ outcomes as an emphasis as well. Family focus was not found in any of the studies. Conclusion. Research on nurse clinics that focus on the chronic phase of COPD is in its infancy. Innovative research that addresses the structure and content of the nursing care is essential. Relevance to clinical practice. Nursing care in nurse clinics that focus on the chronic phase of COPD needs to be based on nursing knowledge, evidence based, comprehensive, family-centred, focused on health and the health experience and be situated within the service system. Diversity, creativity and nursing values should prevail when developing nurse clinics for the purpose of creating possibilities to attend to the whole of patients’ and their families’ needs and experiences. [ABSTRACT FROM AUTHOR]

Objective: To examine interventions and outcomes of medication compliance studies in older adults. Methods: An integrated review of randomized controlled trials was completed. Results: Thirty-one of 57 studies reported significantly greater medication compliance in treatment subjects versus control subjects. Interventions included counseling, education, self-medication programs, cues and organizers, and decreasing dosing frequency. Decreasing dosing frequency and self-medication programs were successful, although not frequently evaluated. Conclusions: Future studies should address methodologic flaws (eg, small sample sizes, measurement validity issues), test theory-based interventions delivered by diverse providers, evaluate intervention dose, and examine persistence of compliance behavior changes. [ABSTRACT FROM AUTHOR]