Objectives: Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care.

Methods: This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE)–were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients’ medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care.

Results: During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was −4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period.

Conclusions: This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.

INTRODUCTION: Cardiac arrest (CA) survivors often face significant health challenges, including insomnia, which can adversely affect their health-related quality of life. The Minimal Insomnia Symptom Scale (MISS) is a brief, self-reported instrument designed to screen for insomnia. This study aimed to identify the measurement properties of the MISS in CA survivors and to explore a relevant cut-off score.

METHODS: Data were collected from two studies: a health survey of CA survivors and a sub-study of a randomized controlled trial (RCT) on targeted temperature management (TTM2). A total of 269 CA survivors participated, with 212 from the survey and 57 from the RCT, the data was collected 6-7 months after CA. The MISS was evaluated using the polytomous Rasch model, focusing on model fit, local independence, response category functioning, targeting, reliability, and differential item functioning (DIF).

RESULTS: In total, 212 participants were males and 57 females, with a mean age of 66 years. Overall, 51% had survived in-hospital CA and 49% out-of-hospital CA. The MISS exhibited acceptable model fit and targeting, with no disordered thresholds or DIF for age, sex, or place of arrest. The reliability was acceptable. The suggested optimal cut-off score for identifying insomnia was ≥6 points.

CONCLUSIONS: The findings indicate that MISS is a valid and reliable screening instrument for insomnia in CA survivors. These results support the use of MISS for screening insomnia in CA survivors.

Restless Legs Syndrome (RLS) affects 3% of the world's population, causing tingling sensations primarily in the legs. Incorporating self-care activities could improve the management of RLS symptoms, yet knowledge about effective self-care actions is limited. This study employs the Capability, Opportunity, and Motivation-Behaviour (COM-B) model to explore self-care behaviours in individuals with RLS, as research in this area is sparse. Qualitative content analysis of interviews with 28 participants with RLS, 26 subcategories emerged, aligning with the COM-B model's components. The first part, Capability, highlighted the importance of being able to be in motion, while the second, Opportunity referred to situations where there was a lack of trust and guidance for self-care. The third part, Motivation, emphasised the importance of fixed routines of sleep, rest, and activity. These identified prerequisites can inform the development of screening instruments and patient-reported outcome measures to evaluate self-care needs and interventions for individuals with RLS.

Oral dryness is common in persons with untreated obstructive sleep apnoea (OSA) as well as in those using positive airway pressure (PAP). OSA with or without PAP treatment could therefore be a risk factor of dental caries.

Objectives: To describe and compare the prevalence of dental caries among persons with or without PAP-treated OSA.

Methods: Cross-sectional data derived from a clinical examination of 121 adults without OSA, and with or without long-time experience of PAP treated OSA (>10 years) were used. The participants responded to a questionnaire and were clinically and radiographically examined. Decayed, missing, and filled teeth, decayed surfaces, gingivitis and presence of dental plaque were registered. Descriptive analyses were performed to describe dental caries prevalence among groups. To compare groups, one-way ANOVA and Kruskal-Wallis tests was conducted.

Results: Participants (52% females, mean age 69.5±5.8 years) were categorised into groups based on OSA status; non-OSA (n=49), non-PAP-treated OSA (n=38), and PAP-treated OSA (n=34). Dental caries prevalence showed no statistically significant differences among groups, except for occlusal caries, where the PAP-treated OSA group had a higher mean compared to the non-OSA group (p=0.033). Most participants did not report xerostomia, but the highest prevalence was found in the non-PAP-treated OSA group (31.6%).

Conclusions: The prevalence of dental caries was slightly higher in persons with PAP treated OSA compared to non-PAP-treated OSA and persons without OSA, but the results were not statistically significant.

BACKGROUND: Restless legs syndrome (RLS) is a common, neurological disease. Primary healthcare (PHC) nurses are often the patient's first contact, but studies regarding their experience assessing RLS-associated symptoms and treatment needs in telephone nursing (TN) are lacking.

PURPOSE: To describe how PHC nurses experience symptoms and treatment needs of patients with RLS-associated symptoms during TN.

METHODS: A descriptive abductive design, including semi-structured interviews with 18 PHC nurses from six Swedish regions. Data was deductively analyzed using the Four Habits communication model. Facilitators and barriers were inductively identified.

RESULTS: Invest in the beginning included the use of professional competence, interpretation of influencing factors at the start of the conversation and initial understanding of the patient's RLS symptoms. Elicit the patient's perspective involved originate from the patient's perception of the symptoms and comprehending the symptoms' impact on the patient's life situation. Relate to the patient's situation and the importance of trust in the patient meeting described demonstrating empathy. Invest in the end involved triaging patients with RLS-associated symptoms, providing self-care advice to patients with RLS-associated symptoms and achieving consensus at the end of the conversation.

CONCLUSION: Using the Four Habits communication model could enrich communication regarding RLS-associated symptoms and treatment needs during TN.

Purpose of Review: The COVID-19 pandemic has promoted behavioral changes and elevated mental distress. Addictive behaviors often increased, generating mental health problems. The present study’s primary aim was to investigate associations between different types of behavioral addictions (including behavioral addictions, related conditions, and phenomena) and different types of mental health problems. The secondary aims were: (i) to identify possible sources of heterogeneity and (ii) to explore potential moderators in associations between different types of behavioral addictions (including behavioral addictions, related conditions, and phenomena) and different types of mental health problems.

Recent Findings: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), studies from the period between December 2019 and May 2023 were sought from PubMed, Scopus, ISI Web of Knowledge, and Google Scholar in its first ten pages. The articles’ relevance was screened and evaluated. The included papers’ quality was assessed according to the Newcastle Ottawa Scale. Fisher’s Z scores were computed to present magnitudes of associations and I2 indices were used to estimate levels of heterogeneity in the meta-analysis. Among the 85 included studies (N = 104,425 from 23 countries; mean age = 24.22 years; 60.77% female), most were internet-related behavioral addictions, related conditions, and phenomena (28 studies on social media, 25 on internet, 23 on smartphone, and 12 on gaming). The pooled estimation of the associations showed that higher levels of behavioral addictions, related conditions, and phenomena related to internet use (regardless of type) were associated with more mental health problems (regardless of which type). Moderator analyses showed that almost no variables affected heterogeneity for the founded associations.

Summary: Most studies of behavioral addictions, related conditions, and phenomena focused on internet-related behaviors, with studies suggesting relationships with specific types of mental health problems during the COVID-19 pandemic. Moreover, associations between behavioral addictions (including behavioral addictions, related conditions, and phenomena) and mental health problems found in the present systematic review and meta-analysis were comparable to the associations identified in studies conducted before the COVID-19 pandemic. How to help people reduce internet-related behavioral addictions, related conditions, and phenomena and address associated mental health concerns are important topics for healthcare providers.

OBJECTIVES: Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP).

MATERIALS AND METHODS: In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8) chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38), or adherent CPAP (n = 34) groups.

RESULTS: The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages.

CONCLUSIONS: Hypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

BACKGROUND: In today's complex healthcare organisations there is an increasing recognition of the need to enhance care quality and patient safety. Nurses' competence in demonstrating caring behaviour during patient encounters affects how patients experience and participate in their care. Nurse educators are faced with the challenge of balancing the demand for increasingly complex knowledge and skills with facilitating students' abilities essential to becoming compassionate and caring nurses.

AIM: The aim was to describe undergraduate nursing students' development of caring behaviour while participating in a caring behaviour course.

METHOD: This pilot study used a quantitative observational design. At a university in Sweden, video-recorded observational data from twenty-five students were collected in the first and last weeks of a full-time five-week Caring Behaviour Course (the CBC). In total, 56-min video-recorded simulation interactions between a student and a standardised patient were coded by a credentialed coder using a timed-event sequential continuous coding method based on the Caring Behaviour Coding Scheme (the CBCS). The CBCS maps the five conceptual domains described in Swanson's Theory of Caring with related sub-domains that align with Swanson's qualities of the Compassionate Healer and the Competent Practitioner. The CBCS contains seventeen verbal and eight non-verbal behavioural codes, categorised as caring or non-caring.

RESULTS: Between the two simulations, most verbal caring behaviours increased, and most non-verbal caring behaviours decreased. Statistically significant differences between the simulations occurred in the sub-domains Avoiding assumptions and Performing competently/skilfully in the quality of the Competent Practitioner. Most observed caring behaviours aligned with the Compassionate Healer.

CONCLUSION: Generally, the students' development of caring behaviours increased while participating in the CBC. Using a structured observational behavioural coding scheme can assist educators in assessing caring behaviour both in education and in practice, supporting caring as the universal foundation of nursing and a key to patient safety.

PURPOSE: Restless Legs Syndrome (RLS) is a widespread condition that affects sleep leading to daytime sleepiness, depression, and reduced quality of life. This study aims to determine and describe how patients with RLS experience their everyday life, with a focus on facilitators and barriers related to Maslow's hierarchical theory of human needs.

METHOD: Semi-structured interviews were analysed with qualitative content analysis resulting in facilitators and barriers affecting the fulfilment of the five human needs.

RESULTS: Addressing RLS symptoms through medications and a quiet sleep environment fulfils psychological needs. Control over RLS symptoms, engagement in activities, trust in treatments, and social support meet safety and security needs. Social inclusion, close relationships, and meaningful interactions fulfil a sense of belongingness and love needs despite RLS. Competence in managing RLS, effective self-care strategies, confident communication, and trust-building support esteem needs. Finally, comprehensive understanding through person-centred interventions and coping fulfils the self-actualization needs in managing RLS.

CONCLUSION: Holistic and person-centred interventions, including facilitators for the fulfilment of physiological, psychological, and social needs could help healthcare professionals to provide holistic care.

Restless Legs Syndrome (RLS) is a prevalent sensory-motor disorder. Symptoms such as an urge to move the arms and legs, often associated with a severe impact on sleep can lead to reduced quality of life. Treatment for RLS contains pharmacological therapy, and/or non-pharmacological treatment. Self-care can both in patients with mild and severe symptoms be a valuable addition, but more evidence is needed to provide accurate recommendations. Studies exploring prerequisites for self-care could fill a significant knowledge gap. Understanding these aspects, as described by patients with RLS, could increase health care personnels' awareness of potential and beneficial self-care activities. The aim was to explore and describe thefundamental factors for patients with RLS to engage in self-care actions based on the COM-B model.