Statins did not reduce the frequency of exacerbations in individuals with COPD and cardiovascular comorbidities in the COSYCONET cohort

BACKGROUND

The evidence regarding effects of statins on exacerbation risk in COPD remains controversial. Previous studies often excluded patients with cardiovascular comorbidities despite their high prevalence in COPD and role for exacerbations. Based on the cardioprotective properties of statins, we hypothesised that statins may reduce the risk of exacerbations especially in patients with cardiovascular comorbidities.

METHODS

One thousand eight hundred eighty seven patients of the German COPD cohort COSYCONET (COPD and Systemic Consequences Comorbidities Network) of GOLD grades 1-4 (37.8% female, mean age 64.78 ± 8.3) were examined at baseline and over a period of 4.5 years for the occurrence of at least one exacerbation or severe exacerbation per year in cross-sectional and longitudinal analyses adjusted for age, gender, BMI, GOLD grade and pack-years. Due to their collinearity, various cardiovascular diseases were tested in separate analyses, whereby the potential effect of statins in the presence of a specific comorbidity was tested as interaction between statins and comorbidity. We also identified patients who never took statins, always took statins, or initiated statin intake during the follow-up.

RESULTS

One thousand three hundred six patients never took statins, 31.6% were statin user, and 12.9% initiated statins during the follow-up. Most cardiovascular diseases were significantly (p < 0.05)may associated with an increased risk of COPD exacerbations, but in none of them the intake of statins was a significant attenuating factor, neither overall nor in modulating the increased risk linked to the specific comorbidities. The results of the cross-sectional and longitudinal analyses were consistent with each other, also those regarding at least 1 exacerbation or at least 1 severe exacerbation per year.

CONCLUSION

These findings complement the existing literature and may suggest that even in patients with COPD, cardiovascular comorbidities and a statin therapy that targets these comorbidities, the effects of statins on exacerbation risk are either negligible or more subtle than a reduction in exacerbation frequency.

TRIAL REGISTRATION

Trial registration ClinicalTrials.gov, Identifier: NCT01245933. Other Study ID (BMBF grant): 01GI0881, registered 18 November 2010, study start 2010-11, primary completion 2013-12, study completion 2023-09. https://clinicaltrials.gov/study/NCT01245933?cond=COPD&term=COSYCONET&rank=3.

The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic

BACKGROUND

Stress impacts healthy behaviours and may influence life and health-related quality of life (HRQOL). A stressful event occurred when the COVID-19 pandemic hit in March 2020. The present study aims to explore possible gender differences in stress, psychosocial factors (self-efficacy, self-esteem, loneliness), pain, HL, and HRQOL in parents of adolescents one year into the COVID-19 pandemic, and to explore possible associations between gender, demographic and psychosocial factors, pain, HL, and HRQOL.

METHODS

Parents of adolescents aged 16-17 took part in the study from January to February 2021, when the COVID-19 pandemic was ongoing. Data on socio-demographics, stress, self-efficacy, self-esteem, pain, HL, loneliness, and HRQOL were collected. HRQOL was assessed using RAND-36.

RESULTS

Among the 320 parents from the general population, the mean age was 47.6 (standard deviation (SD) = 4.6) years, 81% were mothers, 79% were married or cohabiting, 81% had a university degree, and the majority worked full time (78%) or part time (13%). The average pain score was low, 0.48 (95% CI [0.43-0.54]). However, 50% of the parents reported persistent pain and more mothers reported persistent pain compared to fathers (53% vs. 37%). The parents' mean (SD) score for RAND-36 was 52.1 (95% CI [51.2-53.0]) for the physical component summary (PCS) score and 51.0 (95% CI [50.0-52.1]) for the mental component summary (MCS) score. Mothers reported significantly lower scores for all the eight RAND-36 domains and the PCS and MCS scores. Adjusting for gender, age, living condition, education, pain, HL, self-efficacy and loneliness, we revealed no associations between stress and RAND-36-PCS. University education of four years or more was positively associated (B = 3.29, 95% CI: [0.78-5.80]) with RAND-36-PCS, while persistent pain was negatively associated (B = -7.13, CI: [-9.20- -5.06]). We identified a strong negative association between RAND-36-MCS and stress (B = -43.11, CI: [-48.83- -37.38]) and a positive association with older age (B = 0.21, CI: [ 0.04, 0.39)].

CONCLUSION

One year into the COVID-19 pandemic, we identified a strong negative association between stress and mental HRQOL, while pain was strongly negatively associated with physical HRQOL.

Acceptability and usefulness of the EORTC 'Write In three Symptoms/Problems' (WISP): a brief open-ended instrument for symptom assessment in cancer patients

BACKGROUND

The use of open-ended questions supplementing static questionnaires with closed questions may facilitate the recognition of symptoms and toxicities. The open-ended 'Write In three Symptoms/Problems (WISP)' instrument permits patients to report additional symptoms/problems not covered by selected EORTC questionnaires. We evaluated the acceptability and usefulness of WISP with cancer patients receiving active and palliative care/treatment in Austria, Chile, France, Jordan, the Netherlands, Norway, Spain and the United Kingdom.

METHODS

We conducted a literature search on validated instruments for cancer patients including open-ended questions and analyzing their responses. WISP was translated into eight languages and pilot tested. WISP translations were pre-tested together with EORTC QLQ-C30, QLQ-C15-PAL and relevant modules, followed by patient interviews to evaluate their understanding about WISP. Proportions were used to summarize patient responses obtained from interviews and WISP.

RESULTS

From the seven instruments identified in the literature, only the free text collected from the PRO-CTAE has been analyzed previously. In our study, 161 cancer patients participated in the pre-testing and interviews (50% in active treatment). Qualitative interviews showed high acceptability of WISP. Among the 295 symptoms/problems reported using WISP, skin problems, sore mouth and bleeding were more prevalent in patients in active treatment, whereas numbness/tingling, dry mouth and existential problems were more prevalent in patients in palliative care/treatment.

CONCLUSIONS

The EORTC WISP instrument was found to be acceptable and useful for symptom assessment in cancer patients. WISP improves the identification of symptoms/problems not assessed by cancer-generic questionnaires and therefore, we recommend its use alongside the EORTC questionnaires.

What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies

BACKGROUND

Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important.

AIM

To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies.

DESIGN

A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022).

DATA SOURCES

Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients' and informal caregivers' experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion.

RESULTS

We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use.

CONCLUSION

Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders' priorities.

Sleep duration in schooldays is associated with health-related quality of life in norwegian adolescents: a cross-sectional study

BACKGROUND

Insufficient sleep is commonly reported in adolescence and is negatively associated with a wide range of health outcomes. A way to grasp the complicated challenge of how sleep impact different aspects of the adolescents´ everyday life is by examining the relationship between sleep duration in schooldays and weekends on different health-related quality of life (HRQOL) subscales. Furthermore, to expand the understanding of possible underlying mechanisms between sleep and HRQOL, testing for self-efficacy as a possible mediator is of importance.

METHODS

A cross-sectional study was performed among 696 adolescents aged 13-15 years from a school-based setting. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the School Sleep Habits Survey, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using SPSS Statistics software including PROCESS macro by Andrew Hayes.

RESULTS

Our findings revealed overall similar sleep patterns in boys and girls including longer sleep duration in the study sample during weekends (10:09 h) than in schooldays (08:36 h). Regression analyses revealed that sleep duration in schooldays was positively and statistically associated with HRQOL subscales psychological well-being (95% CI [0.44 to 1.33]), autonomy and parents (95% CI [0.12 to 1.06]), school environment (95% CI [0.47 to 1.40]), and self-efficacy (95% CI [0.01 to 0.47]). Sleep duration in weekends revealed no associations with the HRQOL subscales, except for the HRQOL subscale psychological well-being (95% CI [0.09 to 0.85]). Mediation analyses revealed that sleep duration in schooldays explained most of the associations (64 - 75%) in 4 out 5 HRQOL subscales, except in the association with the HRQOL subscale physical well-being revealing an indirect effect of 71.9%.

CONCLUSIONS

This cross-sectional study described sleep among Norwegian adolescents and demonstrated that sleep durations in weekends and schooldays impact HRQOL and self-efficacy, revealing overall better outcome in HRQOL and self-efficacy with sufficient sleep during schooldays. These findings support the regularity of sleep and highlight the importance of sufficient sleep during schooldays, especially in a school-based sample of adolescents.

Updating our understanding of health-related quality of life issues in children with cancer: a systematic review of patient-reported outcome measures and qualitative studies

BACKGROUND

Health-related quality of life (HRQOL) is a key concept in pediatric oncology. This systematic review aims to update the conceptual HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), covering physical, emotional, social and general HRQOL aspects, and to present a comprehensive overview of age- and disease-specific HRQOL issues in children with cancer.

METHODS

Medline, PsychINFO, the Cochrane Database for Systematic Reviews (CDSR), and the COSMIN database were searched (up to 31.12.2020) for publications using patient-reported outcome measures (PROMs) and qualitative studies in children with cancer (8-14-year) or their parents. Items and quotations were extracted and mapped onto the conceptual model for HRQOL in children with cancer mentioned above.

RESULTS

Of 2038 identified studies, 221 were included for data extraction. We identified 96 PROMS with 2641 items and extracted 798 quotations from 45 qualitative studies. Most items and quotations (94.8%) could be mapped onto the conceptual model. However, some adaptations were made and the model was complemented by (sub)domains for 'treatment burden', 'treatment involvement', and 'financial issues'. Physical and psychological aspects were more frequently covered than social issues.

DISCUSSION

This review provides a comprehensive overview of HRQOL issues for children with cancer. Our findings mostly support the HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), but some adaptations are suggested. This review may be considered a starting point for a refinement of our understanding of HRQOL in children with cancer. Further qualitative research will help to evaluate the comprehensiveness of the HRQOL model and the relevance of the issues it encompasses.

Being a nursing student during the coronavirus pandemic: a mixed methods study

BACKGROUND

The COVID-19 pandemic led to major changes in people's lives via protective strategies aimed at limiting the transmission of COVID-19, including social distancing, lockdowns, cancelled or limited leisure activities and tutorials and supervision for students taking place digital. All of these changes may have influenced students' health and quality of life.

AIM

To describe and explore fear of COVID-19 and psychological distress, as well as general health and quality of life, among baccalaureate nursing students at 1 year into the COVID-19 pandemic.

METHOD

We used a mixed method study design, including quantitative data from University of Agder, data that was a part of a national survey of baccalaureate nursing students nearly one year into the pandemic. All the nursing students at the university were invited to take part between 27 January and 28 February 2021. The quantitative survey included 396 (out of total 858) baccalaureate nursing students (response rate: 46%). The quantitative data were collected using well-validated measures of fear of COVID-19, psychological distress, general health and quality of life, and the data were analysed using the ANOVA-tests for continuous data and chi-square tests for categorical data. Qualitative data were gathered from focus group interviews from the same university two-three months later. Five focus group interviews were conducted with a total of 23 students (7 men, 16 women). The qualitative data were analysed using systematic text condensation.

RESULTS

The mean score (standard deviation [SD]) for fear of COVID-19 was 2.32 (0.71), for psychological distress was 1.53 (1.00), for general health was 3.51 (0.96) and for overall quality of life was 6.01 (2.06). In the qualitative data, we identified the overarching theme effect of COVID-19 on students' quality of life and the three main themes; importance of personal relations, physical health challenges and mental health challenges.

CONCLUSION

The COVID-19 pandemic influenced negatively nursing students' quality of life and physical and mental health, and they often felt lonely. However, most of the participants also adapted strategies and resilience factors to cope with the situation. Via the pandemic situation, the students learned additional skills and mental mindsets that may be useful in their future professional lives.

Working as a nurse in community health services during Covid-19: a qualitative study

BACKGROUND

During the Covid-19 pandemic, new roles, increased workload, lack of staffing and infection control equipment, unclear infection control guidelines and conflicting information have led to uncertainty and unpredictability for health workers. Although community home-care nurses have been exposed to a range of personal and professional stressors during the pandemic, few studies have focused on their experiences. The aim of this study was to explore how Norwegian home-care nurses experienced the first wave of the Covid-19 pandemic. This knowledge may contribute to preparations for meetings with patients in future pandemics, how management can support its employees and how to structure a successful organization.

METHODS

This study was a qualitative descriptive design comprising 12 semi-structured individual interviews with home-care nurses. A thematic analysis was carried out.

RESULTS

Four main themes and 11 subthemes were constructed. The results revealed challenges related both to the organization and to management, experiences of unclear information, lack of available equipment, redeployment of staff and increased workload. Furthermore, it was challenging to provide high qualitative care. The nurses missed collegial togetherness and had feelings of uncertainty with a great fear of infecting others. Positive consequences were feelings of being valued and a greater awareness of infection control.

CONCLUSION

This study highlighted the importance of unambiguous information and clear delegation of responsibility, and that enough infection control equipment will likely minimize the fear of infecting each other. Being visible and admired for their work was important for the nurses' psychological well-being. Nurses, nursing managers and policymakers in community health care can use these results to develop strategies for future pandemic planning.

The relationship between stress and health-related quality of life and the mediating role of self-efficacy in Norwegian adolescents: a cross-sectional study

BACKGROUND

During the transitional phase from childhood to adulthood, adolescents encounter many changes and challenges. Stress is associated with reduced health-related quality of life (HRQOL) in adolescents and, thus, impacts all aspects of their life. Adolescents' thoughts and beliefs in their capacity may be essential with regard to their subjective perception of stress and coping with it. Insights into the complexity of stress and exploration of the possible underlying mechanisms in adolescence are needed. We sought to describe stress, HRQOL, and self-efficacy and explore the association between stress and HRQOL by testing for self-efficacy as a possible mediator in adolescents.

METHODS

In total, 696 school-based adolescents aged 14-15 years participated in this study. Participants were recruited from 22 schools in the Eastern and Southern parts of Norway. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the Perceived Stress Questionnaire, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using the PROCESS macro for SPSS Statistics software by Andrew Hayes model 4.

RESULTS

Descriptive analyses revealed overall low levels of stress with a score of 0.29 (SD, 0.15). Nevertheless, stress was negatively associated with all HRQOL subscales: physical well-being (B =  - 25.60), psychological well-being (B =  - 38.43), autonomy and parents (B =  - 28.84), social support and peers (B =  - 21.05), and school environment (B =  - 30.28). Furthermore, these respective associations were all mediated by self-efficacy, which explained approximately one-fifth of the reduction in HRQOL. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL subscale physical well-being (31.7%).

CONCLUSIONS

Our findings extend prior research on the mechanisms underlying the relationship between perceived stress and HRQOL in adolescents. They demonstrated that perceived stress explained most of the reduction in the HRQOL after adjusting for the effect of self-efficacy. Hence, stress itself appears to be an important target for future interventions to enhance HRQOL, rather than purely focusing on increasing self-efficacy to enhance the HRQOL in adolescents. Our findings highlight the importance of a better understanding of the underlying mechanisms to develop strategic and accurate interventions for adolescents.

Health-related quality of life in parents of adolescents one year into the COVID-19 pandemic: a two-year longitudinal study

AIM

For many adults, their role as a parent is a vital part of their life that may influence their health-related quality of life (HRQOL) and vary with the age of their child. The aim of the present study was to describe and compare sociodemographic and psychological factors, pain and HRQOL in parents of adolescents assessed at baseline and 2 years later,-during the COVID-19 pandemic.

METHODS

A longitudinal study of 309 parents from the general Norwegian population was conducted. The parents were chosen based on their adolescent's school belonging and responded to a web-based questionnaire. We used data collected at baseline (T1), when the adolescents were aged 14-15 years (2018/2019), and two years later (T2), in 2021, when the COVID-19 pandemic was ongoing. The response rate was 55%. HRQOL was assessed using RAND-36. Data were analysed using McNemar tests, paired samples t-tests and multiple linear regression analyses.

RESULTS

Of the participants, 82% were mothers and 18% fathers. From T1 to T2, the average pain score increased, 1.6 (95% CI [-1,4; 1.8]) vs 1.8 (95% CI [1,6; 2.0]), the pain interference emotion score increased, 1.6 (95% CI [1.3; 1.9]) vs 1.8 (95% CI [1.5; 2.1]), and a larger proportion reported pain duration > 3 months (44% vs 50%, p = 0.014). The parents were more lonely, 12.8 (95% CI [12.3; 13.3]) vs 13.7 (95% CI [13.2; 14.2]), and reported lower RAND-36 mental component summary (MCS) scores, 52.2 (95% CI [51.3; 53.2]) vs 50.9 (95% CI [49.8; 52.0]). There were no significant associations between gender, sociodemographic factors, psychological factors, pain at T1 and changes in RAND-36 physical component summary (PCS). A positive change in MCS from T1 to T2 was predicted by working part time, B = 5.22 (95% CI [1.05; 9.38]) (ref no paid work) and older age, B = 0.24, (95%CI [-001; 0.42]), and there was a negative change with stress, B = -17.39, (95%CI [-27.42; -7.51]).

CONCLUSION

The parents experienced more pain and were lonelier, and more reported reduced mental HRQOL. However, the changes appear to be of limited clinical significance.

Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway

BACKGROUND

Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses' experiences in caring for patients with an ethnic minority background.

METHODS

Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews.

RESULTS

The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding.

CONCLUSIONS

Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.

Coping in the role as next of kin of a person with a brain tumour: a qualitative metasynthesis

OBJECTIVE

Being the next of kin of a person with a brain tumour is a stressful experience. For many, being a next of kin involves fear, insecurity and overwhelming responsibility. The purpose of this study was to identify and synthesise qualitative original studies that explore coping in the role as next of kin of a person with a brain tumour.

METHODS

A qualitative metasynthesis guided by Sandelowski and Barroso's guidelines was used. The databases Medline, CHINAL and PsycINFO were searched for studies from January 2000 to 18 January 2022. Inclusion criteria were qualitative original studies that aimed to explore coping experience by the next of kin of a person with brain tumour. The next of kin had to be 18 years of age or older.

RESULTS

Of a total of 1476 screened records data from 20 studies, including 342 participants (207 females, 81 males and 54 unclassified) were analysed into metasummaries and a metasynthesis. The metasynthesis revealed that the next of kin coping experiences were characterised by two main themes: (1) coping factors within the next of kin and as a support system, such as their personal characteristics, perceiving the role as meaningful, having a support system, and hope and religion; (2) coping strategies-control and proactivity, including regaining control, being proactive and acceptance.

CONCLUSION

Next of kin of patients with brain tumours used coping factors and coping strategies gathered within themselves and in their surroundings to handle the situation and their role. It is important that healthcare professionals suggest and facilitate these coping factors and strategies because this may reduce stress and make the role of next of kin more manageable.

Changes in health-related quality of life in adolescents and the impact of gender and selected variables: a two-year longitudinal study

Background

Increased knowledge about factors that can impact changes in adolescents’ health-related quality of life (HRQOL) is needed. The present study aimed to investigate possible HRQOL changes in adolescents at 14 and 16 years, and assess the impact of sociodemographic factors, gender, pain, self-esteem, self-efficacy, loneliness, and stress on HRQOL changes over time. Further, to assess HRQOL stratified by gender.

Methods

A longitudinal study involving 211 adolescents was conducted. Sociodemographic variables, pain, self-esteem, self-efficacy, loneliness, and stress were all assessed with well-validated instruments. KIDSCREEN-27 was used to measure HRQOL. Data were analyzed using independent t-tests, paired samples t-tests, and linear mixed models for repeated measures.

Results

When all variables were added to the linear mixed models, stress, loneliness, and pain were significantly, independently associated with a reduction in HRQOL change scores for four of the five KIDSCREEN subscales. Time was significantly associated with a reduction in physical and psychological well-being. Self-efficacy and self-esteem were significantly associated with an increase in HRQOL change scores for four and two subscales, respectively. Male gender was significantly negatively associated with changes in social support and peers compared to female gender.

Conclusion

Our results demonstrated a significant decline in adolescents’ HRQOL regarding physical and psychological well-being for the age range 14–16 years. Furthermore, we found that stress, loneliness, and pain have a significant negative impact on HRQOL changes, whereas self-esteem and self-efficacy have a significant positive impact. Our results highlight the importance of increased understanding regarding factors associated with changes in adolescents’ HRQOL to enable accurate and strategic interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-02035-4.

The impact of educational concerns and satisfaction on baccalaureate nursing students' distress and quality of life during the Covid-19 pandemic; a cross-sectional study

Background

High levels of psychological distress and poor overall quality of life (QOL) have been identified among nursing students during the COVID-19 pandemic. The pandemic necessitated improvised reconstructions of educational curriculums and restrictions in clinical placement and training at campuses, possibly reducing educational quality.

Objectives

We explored whether baccalaureate nursing students’ concerns and satisfaction with the educational curriculum, focusing on the conduct of clinical training, were associated with perceived psychological distress and overall QOL.

Methods

Baccalaureate nursing students (N=6088) from five Norwegian universities were invited to an internet-based, cross-sectional survey during the second wave of the pandemic. The survey included COVID-19 specific questions on health, education and clinical training, the Fear of COVID-19 scale (FCV-19S), The Hopkins Symptom Checklist (SCL-5) and overall QOL. Data from national surveys on satisfaction with the educational curriculum, before and during the pandemic were used for comparison.

Results

In total, 2605 (43%) students responded, of whom 1591 (61%) had been engaged in clinical training during the pandemic. Overall, 53% were either satisfied or fully satisfied with their educational curriculum, with the level of satisfaction being significantly lower than pre-pandemic reference values. Also, 79% were concerned or highly concerned about the educational quality. In multiple regression analyses for all students, lower levels of satisfaction and higher levels of quality concerns were associated with worse SCL-5 scores. Furthermore, satisfaction with the educational curriculum was positively associated with overall QOL. For students engaged in clinical training, only concerns about infecting others were additionally associated with psychological distress. None of the items related to clinical training were associated with overall QOL.

Conclusion

Nursing students’ educational satisfaction and quality concerns may significantly impact perceived psychological distress and overall QOL during a pandemic. However, with necessary adaptations implemented, concerns regarding the conduct of clinical training account for little of these associations.

Health-related quality of life, health literacy and COVID-19-related worries of 16- to 17-year-old adolescents and parents one year into the pandemic: a cross-sectional study

Background

The uncertain and challenging situation caused by the COVID-19 pandemic affects adolescents and their parents in an exceptional way. More knowledge of health-related quality of life (HRQoL), health literacy (HL) and COVID-19-related worries in adolescents and parents 1 year into the pandemic is needed. The present study aimed to describe HRQoL, HL and COVID-19-related worries of 16- to 17-year-old adolescents and parents of adolescents. Further, to assess the strength of associations between gender, HL, COVID-19-related worries and HRQoL.

Methods

A cross-sectional study involving 215 adolescents and 320 parents was conducted, exploring HRQoL, HL, COVID-19-related worries and sociodemographic variables. KIDSCREEN-10 and RAND-36 were used to measure HRQoL. Data were analyzed using bivariate methods, multiple linear regression and robust regression.

Results

Adolescents’ HRQoL was notably lower compared to previous Norwegian studies and European norms. Parents’ HRQoL was comparable to Norwegian norms. Adolescents and parents reported moderate-to-high HL and high degrees of COVID-19-related worries. Females reported significantly lower HRQoL and more worries compared to males. In adolescents, higher HL was significantly associated with higher HRQoL. COVID-19-related worries were not significantly associated with HRQoL. In parents, higher HL in the “understand health information” domain was significantly associated with higher HRQoL for mental well-being (mental component sum scores [MCS]) and with lower HRQoL for physical well-being (physical component sum scores [PCS]). Being worried a lot about infecting others and about family/friends becoming sick was significantly associated with higher MCS and lower MCS, respectively. COVID-19-related worries were not significantly associated with PCS.

Conclusions

Our results indicate that the pandemic has a major negative impact on adolescents’ HRQoL. Parents’ HRQoL remained unchanged and comparable to previous studies. Our study demonstrates that HL, gender and COVID-19-related worries are significantly associated with adolescents’ and parents’ HRQoL, indicating that efforts aimed at increasing their HL might indirectly affect their HRQoL as well and that gender-specific interventions or strategies could be beneficial.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13737-1.

Baccalaureate nursing students' experiences of how the COVID-19 pandemic influenced learning - a mixed method study

BACKGROUND

The COVID-19 pandemic mandated the reconstruction of educational programs globally. For nursing students in need of practical learning and training as a part of their curriculum, the pandemic also caused restrictions and alterations in practical placements and limited access to simulation training at campuses. The aim of this study is therefore, to describe and explore how the COVID- 19 pandemic influenced baccalaureate nursing students' experiences of learning and their social life as a student.

METHOD

We used a mixed method study design including quantitative data from one of the universities (University of Agder) from a national Norwegian survey of baccalaureate nursing students and qualitative data from focus-group interviews from the same university. The quantitative survey included 396 baccalaureate nursing students (response rate, 46%). We arranged five focus groups with a total of 23 students (15 females and 8 males). The students took part in one of the focus-group interviews. The quantitative data were analyzed using chi-square test for categorical data and ANOVA tests for continuous data, while the qualitative data were analyzed using Systematic Text Condensation and an editing analysis style.

RESULTS

Most students (70%) were concerned about the quality of the education program. In clinical placement, 83% of students had cared for patients with confirmed COVID-19 or unclear COVID-19 status. The qualitative data revealed three main themes: missing the social dimension of learning; worries and challenges in clinical placement; and experiencing normal instructive days in clinical placement. The general picture emerging from our analysis is the importance of social interactions for learning.

CONCLUSION

As the COVID-19 pandemic continues, our findings of students' worries about the quality of the education program and not reaching learning outcomes must be taken into consideration. Social interaction is considered crucial and fundamental for student learning. A follow-up study following baccalaureate completion is necessary to explore the consequences over time of disrupted education.

Navigating the care between two distinct cultures: a qualitative study of the experiences of Arabic-speaking immigrants in Norwegian hospitals

Background

During the past decades, there has been an increase in the number of immigrants to European and Scandinavian countries. This has challenged the health-care systems, which cater to the needs of patients despite their cultural and linguistic barriers, in these countries. Most studies on this topic have focused on the perspectives of health-care providers in delivering their service. The purpose of this qualitative study was to explore how hospitalized Arabic-speaking patients experienced their interaction with the Norwegian health-care system.

Methods

In-depth interviews with 20 participants and researcher’s participant observation were conducted to explore the idiosyncratic details and ascribed meanings that foreign-born patients attach to their everyday experience of the Norwegian health-care system. Thematic analysis was performed on the transcribed and translated versions of the in-depth interviews.

Results

The findings of this study indicated three interrelated core themes. Firstly, there exist challenges in understanding and being understood because of linguistic and cultural differences of newly migrated patients. Secondly, some patients missed the holistic and direct care available in their home countries. Finally, patients were satisfied with the Norwegian health-care system because of its compassion, care, and respect toward them as well as advanced health-care equipment.

Conclusion

Arabic-speaking patients in Norwegian hospitals experienced long waiting times and linguistic problems. Hence, a better and specialized interpreter service may resolve problems emanating from communication within the system and the subsequent delays in treatment. Compassionate care and the feeling of respect and love is the core strength of the Norwegian system as perceived by the patients.

Stress, pain, and work affiliation are strongly associated with health-related quality of life in parents of 14-15-year-old adolescents

BACKGROUND

For many adults, their role as a parent is a vital part of their lives. This role is likely to be associated with a parent's health-related quality of life (HRQOL). The aim of this study was to explore the associations between gender, demographic and psychosocial variables, pain, and HRQOL in parents of 14-15-year-old adolescents.

METHODS

This was a cross-sectional study that included 561 parents. Data on demographic, psychosocial variables and pain were collected using validated instruments. HRQOL was assessed using the RAND-36. Data were analysed using univariate and hierarchical multiple linear regression analyses.

RESULTS

Four hundred and thirty-six (78%) mothers and 125 (22%) fathers with a mean age of 45 (SD = 5) years were included. Eighty-one per cent were married/cohabiting, 74% worked full time, and 50% had university education of more than 4 years. Almost one-third reported daily or weekly pain, and more than half (58%) reported using pain analgesics during the previous 4 weeks. Mothers reported significantly lower scores on self-efficacy, self-esteem and for all RAND-36 domains, including the physical component summary (PCS) and mental component summary (MCS) and experienced greater stress than fathers. Hierarchical regression analyses showed that working part-time (beta = 0.40) or full time (beta = 0.52) (reference: not working) had the strongest positive effect on PCS. Absence from work for > 10 days (beta = -0.24) (reference: no absence), short-term pain (beta = -0.14), chronic pain (beta = -0.37) (reference: no pain), and stress (beta = -0.10) had the strongest negative effects on PCS. High self-esteem (beta = 0.11) had the strongest positive effect, whereas stress (beta = -0.58) and absence from work for > 10 days (beta = -0.11) (reference: no absence) had the strongest negative effects on MCS.

CONCLUSION

Mothers reported significantly lower scores on self-efficacy, self-esteem, and HRQOL, and experienced greater stress than the fathers. A high proportion of parents reported pain. Pain, stress, and low work affiliation were strongly associated with decreased HRQOL in parents. We recommend that parents of adolescents should be provided guidance about coping with pain and stress, and facilitation of a strong work affiliation because these seem to be important to parents' HRQOL.

If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research

BACKGROUND

The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings.

METHODS

A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles).

RESULTS

Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods.

CONCLUSIONS

It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.

Patterns of cardiac involvement in patients with long COVID syndrome using cardiovascular magnetic resonance

Background

Long COVID (LC) is an increasingly recognized late complication of COVID-19 infection. Cardiovascular involvement has also been implicated, however, the type and extent of the underlying cardiovascular injury remains unknown.

Purpose

To evaluate the association between ongoing symptoms and findings with cardiovascular magnetic resonance (CMR) in consecutive patients recently recovered from COVID-19 illness.

Methods

Prospective observational cohort study of patients recently recovered from COVID-19 illness and no previously known cardiovascular disease were included between April 2020 and April 2021. Demographic characteristics, cardiac blood markers, and CMR imaging a minimum of 4 weeks from the diagnosis were obtained.

Results

Of the 389 included patients, 192 (49%) were male, the mean (±standard deviation) age was 44 (±13) years and 61 (16%) required hospitalization during the acute illness. The median (IQR) time interval between COVID-19 diagnosis and CMR was 94 (71–165) days. 298 (77%) of patients continued to experience ongoing cardiovascular symptoms (long COVID, LC), including dyspnea, palpitations, atypical chest pain and fatigue at the time of CMR at least 4 weeks after the infection. In most patients, the symptoms were only effort related 137 (46%), whereas in 98 (33%) the symptoms affected the activities of daily life; 10 (3%) had severe and debilitating symptoms at rest. Compared to those with no LC (NLC, n=91), LC patients were more commonly hospitalized, had significantly higher native T1, native T2, and showed pericardial enhancement and effusion (Figure 1). There were no differences in cardiac biomarkers, left ventricular (LV) and right ventricular ejection fraction and mass. Proportionally, men and women were similarly affected (n=144 (73%) vs. n=157 (80%), p=0.18). Previous hospitalization was associated with hypertension and ongoing detectable troponin. LC status was associated with previous hospitalization and CMR findings of raised native T1 and native T2, and in females also pericardial enhancement. Severity of symptoms were associated with increased native T1 and T2 and decreased end-diastolic volume, whereas cardiac function showed no significant difference.

Conclusions

In this cohort of patients recently recovered from COVID-19 infection, ongoing cardiovascular symptoms were common. The LC status was related to previous hospitalization and CMR imaging findings of myopericardial inflammation. The extent and type of cardiovascular findings was associated with the severity of symptoms. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The German Heart Foundation (Deutsche Herzstiftung) and Bayer AG, Leverkusen, Germany

Increased proportion of comorbidities but no deterioration of sexual quality of life during a 5-year follow-up in patients with axial spondyloarthritis in the biologic treatment era

OBJECTIVE

To explore patient perception of sexual quality of life (SQOL), an important category of QOL, in male and female patients with axial SpA (axSpA) after a 5 year follow-up.

METHODS

A broad spectrum of demographic, disease-related, treatment and SQOL data was collected at baseline and at the 5 year follow-up. SQOL was assessed by the SQOL-Female (SQOL-F) questionnaire. For statistical analysis, McNemar's tests, paired t-tests and multiple regression analyses were applied.

RESULTS

A total of 245 axSpA patients (168 men and 77 women) from outpatient clinics were examined (mean age 46 years, mean disease duration 11.9 years at baseline). Compared with baseline, the patients had lower CRP, lower Maastricht Ankylosing Spondylitis Enthesitis Scores, lower BASFI scores, less use of smoking and significantly more patients were treated with biologic DMARDs at the 5 year follow-up. Patient perception of SQOL was basically unchanged at the 5 year follow-up despite a significantly increased proportion of comorbidities, including cardiovascular, endocrine and gastrointestinal disease. A decrease in SQOL after 5 years was observed only in patients exercising <1 h/week at baseline (P = 0.048) and in patients >65 years old.

CONCLUSION

In our axSpA patients, no statistically significant changes in SQOL were observed over 5 years, despite a significant increase in comorbidities. Overall disease symptoms decreased, indicating better disease control. Increased use of biologic drugs at the 5 year follow-up may have contributed to this favourable outcome.

Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents

Background

To promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy.

Methods

A cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses.

Results

Adolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%).

Conclusions

Our findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00629-z.

Quality of life and fear of COVID-19 in 2600 baccalaureate nursing students at five universities: a cross-sectional study

Background

The COVID-19 pandemic has caused significant disruptions in the implementation of programs across educational institutions. Nursing students, being both young adults and by practical training, part of the health care system, may be particularly vulnerable during the COVID-19 pandemic. The purpose of this study was to explore the associations between self-reported fear of COVID-19, general health, psychological distress and overall quality of life (QoL) in a sample of Norwegian baccalaureate nursing students compared to reference data.

Methods

The survey targeted baccalaureate nursing students from five universities in February 2021. An electronic questionnaire consisted of the Fear of COVID-19 Scale (FCV-19S), the Hopkins Symptom Checklist 5 (SCL-5), one general health and one overall QoL question. The respondents’ mean scores were compared to reference data. Hierarchical regression analyses were conducted, and effect sizes (Cohen’s d) were evaluated.

Results

In total, 2605 out of 6088 (43%) students responded. Their FCV-19S scores (mean 2.45, CI 2.42, 2.48) were significantly higher than those of the reference population (mean 1.8, P < 0.001). Nursing students scores showed significantly lower general health (mean 3.50 ± 0.93 SD, population mean = 3.57, Cohen’s d = 0.07), higher levels of psychological distress (mean 2.68 ± 1.03 SD, population mean = 2.12, Cohen’s d = 0.55) and lower overall QoL (mean 5.50 ± 2.16 SD, population mean = 8.00, Cohen’s d = 1.16) compared to pre-pandemic reference data. FCV-19S scores were significantly associated with levels of general health (Cohen’s d = 0.26), psychological distress (Cohen’s d = 0.76) and overall QoL (Cohen’s d = 0.18).

Conclusions

Baccalaureate nursing students reported worse outcomes during the Covid-19 pandemic on general health, psychological distress and overall QoL compared to the reference population. Level of fear of Covid-19, however, accounted for few of these differences. Other factors related to the pandemic may have reduced nursing students’ overall QoL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01837-2.

Comparing the use of patient-reported outcomes in clinical studies in Europe in 2008 and 2018: a literature review

PURPOSE

Several guidelines for the use of patient-reported outcomes (PROs) in clinical studies have been published in the past decade. This review primarily aimed to compare the number and compliance with selected PRO-specific criteria for reporting of clinical studies in Europe using PROs published in 2008 and 2018. Secondarily, to describe the study designs, PRO instruments used, patient groups studied, and countries where the clinical studies were conducted.

METHODS

A literature search was conducted in MEDLINE to identify eligible publications. To assess the number of publications, all abstracts were screened for eligibility by pairs of reviewers. Compliance with PRO-specific criteria and other key characteristics was assessed in a random sample of 150 eligible full-text publications from each year. Randomized controlled trials (RCTs) were assessed according to the full CONSORT-PRO checklist.

RESULTS

The search identified 1692 publications in 2008 and 4290 in 2018. After screening of abstracts, 1240 from 2008 and 2869 from 2018 were clinical studies using PROs. By full-text review, the proportion of studies discussing PRO-specific limitations and implications was higher in 2018 than in 2008, but there were no differences in the other selected PRO-specific criteria. In 2018, a higher proportion of studies were longitudinal/cohort studies, included ≥ 300 patients, and used electronic administration of PRO than in 2008. The most common patient groups studied were those with cancer or diseases of the musculoskeletal system or connective tissue.

CONCLUSION

The number of clinical studies from Europe using PROs was higher in 2018 than in 2008, but there was little difference in compliance with the PRO-specific criteria. The studies varied in terms of study design and PRO instruments used in both publication years.

[Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

Experiences of a non-clinical set of adolescents and young adults living with persistent pain: a qualitative metasynthesis

PURPOSE

Around 15%-30% of adolescents and young adults (AYAs) experience persistent or chronic pain. The purpose of this study was to synthesise evidence from qualitative primary studies on how AYAs in a non-clinical population experience living with persistent pain.

METHOD

A qualitative metasynthesis guided by Sandelowski and Barroso's guidelines was used. The databases Medline, Embase, Cinahl, PsycINFO, Mednar and ProQuest were searched for studies from 1 January 2005 to 15 February 2021. Inclusion criteria were AYAs aged 13-24 years with first-hand experience of living with persistent, recurrent or episodic non-clinical pain in any body site. Pain associated with a medical diagnosis, malignant diseases, medical procedures or sport activities was excluded.

RESULTS

Of 2618 screened records, data from nine studies conducted in a Western cultural context including 184 participants (127 female and 57 male aged 11-28 years) were analysed into metasummaries and a metasynthesis. Headaches was the most focused pain condition (n=5), while three of the studies did not specify type of pain. The participants' experiences were characterised by (1) juggling pain with everyday life; (2) exploring sources of information to manage pain; (3) AYAs' use of medication to find relief and (4) non-pharmacological strategies for pain relief.

CONCLUSION

These AYAs experience of how pain influences everyday life, and their striving to find relief from pain by support from family, friends, professionals and the Internet should be strongly respected. Public health nurses and other healthcare professionals encountering AYAs need to respect their pain experiences, and to support them in healthy coping strategies. Further studies on this issue are needed, especially research focusing on AYAs pain in exposed populations and AYAs from non-Western cultures.

[Dyspnoea and Comorbidity in Lung Cancer-Patients: The Therapy Starts with Taking the Patients History]

AIM

 Dyspnoea is a frequent and compromising symptom in patients with advanced and metastatic lung cancer. Exogenous as well as endogenous factors contribute to development of shortness of breath. Knowledge of these influences is essential for effective treatment of this important symptom. In our study, we evaluated the influence of cofactors and comorbidity on development of dyspnoea in lung cancer patients for the purpose of effective therapy of shortness of breath in this target group.

METHODS

 In this prospective monocentric study, we registered severity of dyspnoea in advanced lung cancer patients using the modified Medical Research Council-Scale (mMRC-scale). Patients' history of COPD and cardiopulmonary comorbidity was recorded using a standardized questionnaire. Moreover, cofactors such as pain or cancer-induced mental stress were documented by visual rating scale.

RESULTS

 25 (48,1 %) of 52 recruited lung cancer-patients reported moderate or severe dyspnoea. In logistic regression analysis history of COPD or cardiopulmonary comorbidity, severe pain, airway obstruction or pleural effusion were associated with severe dyspnoea (mMRC-scale ≥ 3). Furthermore, in our study cohort lower cancer level III UICC and absence of metastasis correlated with severe dyspnoea.

CONCLUSIONS

 Our findings confirm the relevance of dyspnoea in patients with advanced lung cancer. Probability of occurrence is influenced by comorbidity and cofactors. The knowledge of these factors contributes to better understanding of occurrence and treatment of dyspnoea.

Bypassing the Structural Bottleneck in the Ultrafast Melting of Electronic Order

Impulsive optical excitation generally results in a complex nonequilibrium electron and lattice dynamics that involves multiple processes on distinct timescales, and a common conception is that for times shorter than about 100 fs the gap in the electronic spectrum is not seriously affected by lattice vibrations. Here, however, by directly monitoring the photoinduced collapse of the spectral gap in a canonical charge-density-wave material, the blue bronze Rb_{0.3}MoO_{3}, we find that ultrafast (∼60  fs) vibrational disordering due to efficient hot-electron energy dissipation quenches the gap significantly faster than the typical structural bottleneck time corresponding to one half-cycle oscillation (∼315  fs) of the coherent charge-density-wave amplitude mode. This result not only demonstrates the importance of incoherent lattice motion in the photoinduced quenching of electronic order, but also resolves the perennial debate about the nature of the spectral gap in a coupled electron-lattice system.

[Technological Innovations in Pulmonology - Examples from Diagnostics and Therapy]

A significant proportion of the current technological developments in pneumology originate from the various areas of information technology. The spectrum ranges from smartphone apps to be used in daily life or in patient care to the use of artificial intelligence in screening and early detection of diseases. The diagnostic accuracy of apps for symptom analysis is currently very limited. Research projects are performed on the integration of symptoms and functional parameters into early detection, but also on mobility measurements as a prognostic marker in COPD. Lung cancer screening using computed tomography represents a major challenge. Here, artificial intelligence can help radiologists to cope with huge amounts of data. However, the quality of the software depends on the sufficient training of the system. Technological developments shape all fields of pneumology. For diagnostic and interventional endoscopy, they offer improved biopsy techniques and microstructural imaging. Advances in lung function measurements allow the differentiated analysis of respiratory mechanical disorders, and they could be transferred to ventilation technology. The translation of basic findings about the lung microbiome into patient care may perspectively help to better understand and treat COPD exacerbations.

80% Valley Polarization of Free Carriers in Singly Oriented Single-Layer WS_{2} on Au(111)

We employ time- and angle-resolved photoemission spectroscopy to study the spin- and valley-selective photoexcitation and dynamics of free carriers at the K[over ¯] and K[over ¯]^{'} points in singly oriented single-layer WS_{2}/Au(111). Our results reveal that in the valence band maximum an ultimate valley polarization of free holes of 84% can be achieved upon excitation with circularly polarized light at room temperature. Notably, we observe a significantly smaller valley polarization for the photoexcited free electrons in the conduction band minimum. Clear differences in the carrier dynamics between electrons and holes imply intervalley scattering processes into dark states being responsible for the efficient depolarization of the excited electron population.

No deterioration in health-related quality of life in patients with axial spondyloarthritis followed for 5 years in ordinary outpatient clinics in the biological treatment era

BACKGROUND

Axial spondyloarthritis (ax-SpA) causes pain, fatigue, stiffness, loss of physical function and impaired health-related quality of life (HRQOL).

AIMS

The study aimed to explore the changes in HRQOL over 5 years in patients with ax-SpA and to identify baseline predictors associated with changes in HRQOL assessed using three HRQOL measures.

METHODS

Demographic, disease, medication and HRQOL data were collected at baseline and at 5-year follow-up. HRQOL was assessed using SF-6D, 15D and SF-36. Analyses involved McNemar, independent paired t tests and multiple regression.

RESULTS

In the 240 (women 31%, men 69%) ax-SpA patients assessed (mean age 46 years), measures reflecting disease activity decreased and co-morbidities increased, and more patients were treated with biologic drugs during follow-up. No deterioration in HRQOL was observed between baseline and 5-year follow-up; indeed, there was a significant increase in SF-6D and SF-36 PCS scores. Improvement in HRQOL measured by SF-6D was associated with younger age, higher education, low Bath Ankylosing Spondylitis (BAS) Activity Index (BASDAI), high BAS Patient Global Score and high C-reactive protein; improvement in SF-36 PCS was associated with younger age, higher education, low BASDAI and no use of biological treatment at baseline.

CONCLUSION

Our ax-SpA outpatient clinic patients, with more patients treated with biologic drugs during the 5-year follow-up, did not deteriorate in HRQOL. In fact, the physical dimension in HRQOL improved over the years, as did measures reflecting disease activity. Our study adds evidence to the importance of suppressing inflammation to maintain and improve HRQOL in ax-SpA patients.

Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study

OBJECTIVES

Patients with colorectal cancer undergoing palliative treatment receive extensive treatment-related information throughout their disease trajectory. We aimed to explore the experiences of patients with incurable colorectal cancer while in palliative care and their reflections on the information provided by physicians and nurses. Our main focus was the patients' thoughts about how information about disease status and life expectancy was communicated, from the first time that they were informed about the incurable nature of their disease through to postsurgery palliative treatment.

SETTINGS

Patients with colorectal cancer receiving palliative chemotherapy.

RESEARCH DESIGN

We used a qualitative approach, and the data were analysed by qualitative content analysis.

PARTICIPANTS

20 patients (34-75 years of age) were included in the study; 12 received first-line chemotherapy and 8 received second-line chemotherapy. Eleven patients were treated by oncologists, and nine were treated by junior physicians.

RESULTS

Data-driven empirical analysis identified three themes: (1) inadequate information during the initial phase of the disease trajectory; (2) hope and information further into the disease trajectory and (3) personal, professional and organisational factors that influenced information and communication throughout the disease trajectory.

CONCLUSION

The participants' experience of being told for the first time that they had an incurable disease was perceived as inadequate, while postsurgery palliative chemotherapy, physicians and nurses offered hope. The participants preferred customised information about their treatment and likely future prospects and physicians and nurses who took a holistic and compassionate approach focusing on their lifeworld. To be a sensitive, holistic and compassionate physician or nurse requires knowledge and confidence. To achieve this requires training and guidance at universities and in hospitals.

Ultrafast Formation of a Fermi-Dirac Distributed Electron Gas

Time- and angle-resolved photoelectron spectroscopy with 13 fs temporal resolution is used to follow the different stages in the formation of a Fermi-Dirac distributed electron gas in graphite after absorption of an intense 7 fs laser pulse. Within the first 50 fs after excitation, a sequence of time frames is resolved that are characterized by different energy and momentum exchange processes among the involved photonic, electronic, and phononic degrees of freedom. The results reveal experimentally the complexity of the transition from a nascent nonthermal towards a thermal electron distribution due to the different timescales associated with the involved interaction processes.

Supportive and palliative care in people with cirrhosis: International systematic review of the perspective of patients, family members and health professionals

BACKGROUND & AIMS

People with cirrhosis have unmet needs, which could benefit from a palliative care approach. Developing effective services needs to be based on evidence from those with personal experience. This review aims to explore; patient and family perspectives of perceived needs including communication; health professionals' perspectives on delivery of care and improving palliative care between specialities.

METHODS

A literature search was conducted in Medline, Embase and CINAHL using key words reporting on the perspectives of patients with liver cirrhosis (18 years and over), family members or health professionals on the provision of care in liver cirrhosis. Study quality was assessed using the Mixed Methods Appraisal Tool. Qualitative and quantitative findings were grouped together according to the main relevant themes identified.

RESULTS

Nineteen research studies predominantly from high-income Western countries were identified, with a total sample consisting of 1,413 patients, 31 family carers and 733 health professionals. Patients and family members had limited understanding of cirrhosis or its impact. They wanted better information about their disease, its treatment and help with psychological and practical needs. Health professionals had difficulty communicating about these issues to patients and their families. General practitioners left care predominantly to the liver clinicians, who lacked confidence to have discussions about prognosis or future care preferences. The role of palliative care was recognised as important in caring for this group through earlier integration with liver and community services.

CONCLUSIONS

Health professionals need support to improve their communication with patients, to address patients' broader needs beyond medical treatment and to develop new models to improve palliative care coordination between different medical specialities. Future research should focus on developing communication aides, testing existing tools to identify suitable patients for supportive care and exploring robust ways of evaluating supportive care interventions, with more studies needed from middle- and low-income countries. Registration number: PROSPERO CRD42017064770.

LAY SUMMARY

Patients and their families had a poor understanding of advanced liver disease and its impact on them. They need more information about the treatments they receive and how to get practical and psychological support. Liver specialists and GPs found it difficult to talk to patients and their families about the seriousness of advanced liver disease and the lack of healthcare options available to them if their condition gets worse. All doctors and nurses involved in the care of patients with advanced liver disease recognise that palliative and supportive care have an important role in improving patient care.

[Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.

How school nurses experience and understand everyday pain among adolescents

Background

Pain problems are a rapidly growing health problem found among both children and adolescent, and about 15–30% have reported chronic pain problems. School nurses in Norway meet adolescents with various ailments, including pain. Yet research on how school nurses perceive the pain experienced by adolescents is limited. The aim of the present study was to explore how school nurses explain and experience the everyday pain of adolescents.

Method

A qualitative study with an explorative design comprising five focus group interviews. Each group consisted of three to five school nurses. Seventeen female school nurses in five junior high schools in Norway, age range 29–65 years participated. To cover the issues a semi structured interview guide was used. The transcribed text was analysed with qualitative content analysis.

Results

The experience of school nurses with adolescents’ pain in everyday life is mainly that pain is a social, physical, and psychological phenomenon. School nurses experienced that everyday pain is reflecting: 1) high expectations, 2) difficult relationships and traumatic experiences and 3) an unhealthy lifestyle. School nurses have ambivalent attitudes to medicalisation of pain.

Conclusion

Despite of a biopsychosocial understanding of pain, the school nurses maintained referral practice of medical examinations, with the results that many adolescents became shuttlecocks in the health system. Although the school nurses´ were sceptical of the tendency towards medicalization in society, it appears that they actually help maintain this tendency.

Spiritual Well-being in Patients With Metastatic Colorectal Cancer Receiving Noncurative Chemotherapy: A Qualitative Study

BACKGROUND

Spiritual well-being (SWB) is an important quality-of-life dimension for cancer patients in the palliative phase. Therefore, it is important for healthcare professionals to recognize the concept of SWB from the patient's point of view. A deeper understanding of how patients experience and reflect upon these issues might influence patient care.

OBJECTIVES

The aim of this study was to explore SWB in colorectal cancer patients receiving chemotherapy in the palliative phase.

METHODS

We used a qualitative method of in-depth interviews and a hermeneutic editing approach for the analyses and interpretations.

RESULTS

Twenty colorectal cancer patients in the palliative phase, aged 34 to 75 years, were included: 12 patients were receiving first-line chemotherapy, and 8 patients were receiving second-line chemotherapy. Through empirical analyses, we identified subthemes according to the SWB dimensions defined by the European Organisation for Research and Treatment of Cancer quality-of-life group. Under the SWB dimension, (i) relationships with self and others, we identified the subthemes: (a) strategies for inner harmony and (b) sharing feelings with significant others. Under the dimension, (ii) existential issues, we identified the subtheme (c) coping with end-of-life thoughts. Under the dimension, (iii) specifically religious and/or spiritual beliefs and practices, we identified the subtheme (d) seeking faith as inner support.

CONCLUSION

Knowledge about cancer patients' use of different strategies to increase their SWB may help healthcare professionals to guide patients through this vulnerable phase.

IMPLICATION FOR PRACTICE

Healthcare professionals need sufficient courage and willingness to share their patients' thoughts, beliefs, and grief to be able to guide patients toward improving their SWB.

The relationship between demographic- and disease-related variables and health-related quality of life in patients with axial spondyloarthritis

Background

Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease of the spine causing pain, stiffness, loss in physical function, and fatigue. Therefore, the physical and psychological burden of having this chronic disease can reduce the quality of life. We aimed to explore the relationship between demographic- and disease-related variables and health-related quality of life (HRQoL) in patients with ax-SpA.

Methods

Demographic- and disease-related, HRQoL-related and treatment data were collected. Disease measures included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the BAS Functional Index (BASFI), the BAS Global (BAS-G) score, the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), the Health Assessment Questionnaire (HAQ) and co-morbidity. HRQoL was assessed using the SF-36 and the utility measures SF-6D and 15D. Variables associated with HRQoL were identified in unadjusted and adjusted analyses.

Results

We examined 380 patients with ax-SpA (67% men) with a mean age of 46 years. Among them, 86% reported exercising >1 h per week. Mean values were as follows: BASDAI, 3.17; MASES, 3.19; BASFI, 2.71; BAS-G. 3.88; and HAQ, 0.56. The percentage of current users of NSAIDs was 44%, and of DMARDs 23%. In multivariate analyses, exercising 1–3 h per week (B = 2.73, p = 0.022) and exercising >3 h per week (B = 2.71, p = 0.020), lower HAQ scores (B = −4.61, p = 0.001), lower BASFI scores (B = −1.05, p = 0.010) and lower BAS-G scores (B = −0.91, p = 0.001) were independently associated with higher SF-36-PCS scores, whereas modest alcohol consumption (B = 4.63, p = 0.018) and a lower BAS-G score (B = −1.73, p < 0.001) were independently associated with higher SF-36-MCS scores. Exercising 1–3 h per week (B = 0.032, p = 0.004) and exercising >3 h per week (B = 0.036, p = 0.001), lower HAQ scores (B = −0.051, p < 0.001), lower BAS-G scores (B = −0.010, p < 0.001) and co-morbidity (B = −0.014, p = 0.004) were independently associated with higher 15D scores. Finally, exercising 1–3 h per week (B = 0.045, p = 0.001) and exercising > 3 h per week (B = 0.053, p < 0.001), lower HAQ scores (B = −0.054, p = 0.001) and lower BAS-G scores (B = −0.020, p < 0.001) were associated with higher SF-6D scores.

Conclusions

In patients with ax-SpA, a low level of physical activity, impaired physical function and impaired general well-being were independently and consistently associated with a decreased HRQoL across all applied measures.

Changes in health-related quality of life in elderly men after 12 weeks of strength training

Background

Muscular strength is associated with functional ability in elderly, and older adults are recommended to perform muscle-strengthening exercise. Understanding how improved muscle strength and -mass influence general and specific domains of quality of life is important when planning health promotion efforts targeting older adults. The aims of the present study were to describe changes in health-related quality of life (HRQOL) in older men participating in 12 weeks of systematic strength training, and to investigate whether improvements in muscle strength and muscle mass are associated with enhancements in HRQOL.

Methods

We recruited 49 men aged 60–81 years to participate in an intervention study with pre-post assessment. The participants completed a 12-week strength training program consisting of three sessions per week. Tests and measurements aimed at assessing change in HRQOL, and changes in physical performance (maximal strength) and physiological characteristics. HRQOL was measured using the 12-item short-form survey (SF-12). Muscle mass was assessed based on changes in lean mass (leg, trunk, arm, and total), and strength was measured as one-repetition maximum in leg extension, leg press, and biceps curl.

Results

Two of the eight HRQOL SF-12 scores, role physical and general health, and the physical component summary scores, increased significantly during the intervention period. Small significant positive correlations were identified between improvements in muscle strength, and better physical and social function. Moreover, a significant increase in total muscle mass was seen during the intervention period.

Conclusions

The positive, findings from this study would suggest that systematic strength training seems to be a beneficial intervention to improve HRQOL, muscle strength and muscle mass in older men.

[Strategies for the Treatment of Community-Acquired Pneumonia in HIV-Positive Patients]

Study purpose According to the Robert Koch Institute, 84,700 people in Germany suffer from HIV infection. One-third of the affected persons is over 50 years old. In Germany, community-acquired pneumonia (CAP) is a widespread disease with more than 250,000 cases per year. Incidence and mortality increase with the age of the affected individuals. For this reason, diagnostic and therapeutic strategies are needed to guide medical care of HIV-infected patients presenting with CAP. Methodology HIV therapists were interviewed about their diagnostic approach, risk stratification strategy and therapeutic approach to HIV-associated community-acquired pneumonia (HIV⁺/CAP) using a questionnaire. 56 completed questionnaires were analysed. Results Half of the respondents reported that CAP occurred in 1 to 5 % of HIV-infected individuals per year. This indicates an estimated number of up to 4200 HIV⁺/CAP cases per year in Germany - a much higher number than expected from the literature. 58.9 % of respondents considered that the pathogenic spectrum did not differ in HIV⁺/CAP from non-HIV/CAP. 80.3 % of respondents applied the same antibiotic regimens in HIV⁺/CAP as used in patients with non-HIV/CAP. Conclusion Even though over 40 % of HIV therapists agree that the pathogenic spectrum of HIV⁺/CAP differs from that of non-HIV/CAP, over 80 % of therapists managed these patients in accordance with the S3-guidelines for non-immunocompromised CAP-patients, because specific guidelines for the treatment of HIV⁺/CAP are lacking. Since specific data on the aetiology and the clinical course of HIV⁺/CAP depending, for instance, on CD4-count and antiretroviral therapy are missing, we feel that the clinical course of HIV⁺/CAP should be further analysed in the context of prospective cohort studies.

Fun, influence and competence-a mixed methods study of prerequisites for high school students' participation in physical education

Background

Many adolescents do not reach the recommended levels of physical activity (PA), and students attending vocational studies are less committed to take part in physical education (PE) than other students. The purpose of the present study was twofold: 1) to examine differences in physical activity, diet, smoking habits, sleep and screen time among Norwegian vocational high school students who selected either a PE model focusing on PA skills, technique and improvement of physical performance (“Sports enjoyment”) or more on health, play and having fun when participating in PE lessons (“Motion enjoyment”), and 2) to explore the students’ experiences with PE programs.

Methods

In this mixed methods study 181 out of 220 invited students (82%) comprising 141 (78%) girls and 40 (22%) boys attending vocational studies of Restaurant and Food Processing (24%), Design, Arts and Crafts (27%) or Healthcare, Childhood and Youth Development (49%) were recruited for participation in the new PE program. PA level, sedentary time and sleep were objectively recorded using the SenseWear Armband Mini. A self-report questionnaire was used to assess dietary habits, smoking and snuffing habits, use of alcohol, screen use and active transportation. Four focus group interviews with 23 students (12 boys) were conducted to explore how the students experienced the new PE program.

Results

Students attending “Motion enjoyment” accrued less steps/day compared to the “Sports enjoyment” group (6661 (5514, 7808) vs.9167 (7945, 10390) steps/day) and reported higher screen use (mean, 3.1; 95% CI, 2.8, 3.5) vs. 2.4 (2.0, 2.9) hours/day). Compared to those attending “Sports enjoyment”, a higher number of students attending “Motion enjoyment” reported an irregular meal pattern (adjusted odds ratio, 5.40; 95% confidence interval (CI), 2.28, 12.78), and being a current smoker (12.22 (1.62, 107.95)). The students participating in the focus group interviews emphasized the importance of having competent and engaging teachers, being able to influence the content of the PE program themselves, and that PE classes should include a variety of fun activities.

Conclusion

Students selecting “Motion enjoyment” accrued less steps/day and reported overall more unhealthy lifestyle habits, including higher screen time, a more irregular meal pattern and a higher number were current smokers, compared to those selecting “Sports enjoyment”. Program evaluation revealed that both groups of students valued competent PE teachers and having influence on the content of the PE program.