Tilgangur Að lýsa reynslu hjúkrunarfræðinga af framkvæmd snemmbærrar hreyfingar sjúklinga á gjörgæsludeildum. Snemmbær hreyfing er lykilþáttur í endurhæfingu og langtímalífsgæðum gjörgæslusjúklinga en framkvæmd hennar í klínísku starfi getur verið flókin. Mikilvægt er því að greina þætti sem hvetja og hindra framkvæmd hennar. Aðferð Hraðsamantekt var framkvæmd í samræmi við leiðbeiningar Cochranestofnunarinnar. Gagnaúrvinnsla byggðist á samþættri heildarmynd (e. meta-aggregation) samkvæmt aðferðafræði Joanna Briggs-stofnunarinnar. Aðleiðsla var notuð við greiningu gagna. Leitað var í rafrænum gagnagrunnum (CINAHL, PubMed, Scopus, Web of Science og Leitir.is) án tímamarka og var leitin síðast uppfærð í janúar 2025. Tveir rýnar mátu gæði rannsóknanna og unnu sameiginlega að samþættingu gagna. Gögnum var raðað e$ir innihaldi og þeim lýst með orðum (e. narrative) og í töflu sem gerði klei$ að greina samspil hvetjandi og hindrandi þátta. Niðurstöður Tólf eigindlegar rannsóknir uppfylltu inntökuskilyrðin. Alls voru 217 hvetjandi og 242 hindrandi þættir. Þættirnir sameinuðust í eitt meginþema: „Áhrif einstaklingsbundinna, faglegra og skipulagslegra þátta á framkvæmd snemmbærrar hreyfingar“, með fjórum undirþemum: (a) Einstaklingsbundnir þættir – innri trú og viðhorf sem drifkra$ur; (b) Fræðsla og ytri hvatning – aðgangur að þekkingu og fyrirmyndum; (c) Skipulagsþættir og umhverfi – samhæfing, verklag og aðstæður sem mótandi afl og (d) Samskiptamynstur og samvinna – teymisvinna og þátttaka sjúklinga og aðstandenda. Ályktanir Framkvæmd snemmbærrar hreyfingar á gjörgæsludeildum ræðst af fjölmörgum einstaklingsbundnum, faglegum og skipulagslegum þáttum í klínísku starfi hjúkrunarfræðinga. Draga má úr hindrunum með markvissri fræðslu, þjálfun starfsfólks og skýrri stefnu í hjúkrun gjörgæslusjúklinga. Framsetning á hvetjandi og hindrandi þáttum getur verið gagnleg til að styðja árangursríka framkvæmd snemmbærar hreyfingar gjörgæslusjúklinga í klínísku starfi hjúkrunarfræðinga. Lykilorð snemmbær hreyfing, gjörgæsla, hjúkrun, hvetjandi, hindrandi, eigindlegar rannsóknir
Purpose: Postural instability is one of the earliest and most disabling features of Parkinson's disease (PD). While previous studies using the BioVRSea paradigm have demonstrated alterations in alpha-band dynamics, the frequency-specific reorganization of large-scale brain networks during postural control (PC) remains poorly understood. The present study aimed to characterize the dynamic functional connectivity in the delta, theta, and beta bands during a virtual reality (VR) postural task in early-stage PD. Methods: Twenty early-stage PD patients and twenty-two age-matched healthy controls (CTR) performed the BioVRSea paradigm, which integrates immersive visuomotor stimulation with platform-induced perturbations. EEG source connectivity was estimated using the phase-locking value (PLV), and the resulting connectivity was clustered into recurrent Brain Network States (BNSs) using k-means++. Temporal metrics, including coverage, duration, occurrence, and phase-wise presence, were computed and compared between groups using linear mixed-effects models with FDR correction. Results: PD patients exhibited a frequency-specific redistribution of BNS dynamics across experimental phases. In the beta band, PD showed reduced coverage (Adjusted p-value=0.004) and duration (Adjusted p-value=0.012) of a DMN-dominant state during baseline in BNS1, alongside increased occurrence (Adjusted p-value=0.032) in BNS2. In the delta band, PD demonstrated an increased occurrence of BNS4 during baseline (Adjusted p-value=0.016), along with a higher percentage of presence across phases, particularly during post-movement recovery, reflecting a persistent, globally synchronized configuration. In the theta band, PD exhibited prolonged BNS4 duration during the pre-movement phase (Adjusted p-value=0.048), accompanied by reduced recruitment of integrative attentional–sensorimotor states during the pre-movement and movement phases. Conclusion: Early-stage PD is characterized by altered frequency-specific brain network dynamics during PC, reflecting reduced flexibility and abnormal stabilization of large-scale connectivity states. These findings extend previous alpha-band evidence and highlight delta-, theta-, and beta-band BNS metrics as potential neurophysiological biomarkers of early postural dysfunction in PD.
Multiple myeloma (MM) and related malignancies develop from an asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS), detectable via blood testing. The benefits and harms of population-based MGUS screening remain uncertain. We conducted a nationwide screening study for monoclonal gammopathies and a randomized trial of follow-up strategies in Iceland (Iceland Screens, Treats, or Prevents Multiple Myeloma; ClinicalTrials.gov identifier: NCT03327597). In total, 75,422 (53% of those invited) were screened and those with MGUS (n = 3,541) were randomly assigned to no notification (arm 1), guideline-based follow-up (arm 2), or intensified follow-up (arm 3). Progression, symptom burden, and psychological well-being were compared between the control arm (arm 1) and intervention arms (arms 2 and 3). After a median follow-up of 4.5 years, screening led to a 27-fold increase in the detection of smoldering MM (8.6% v 0.3%; hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001), but active malignancy rates did not differ. Active MM and related malignancy were diagnosed 1 year earlier in the intervention arms with fewer symptomatic presentations and hospitalizations at diagnosis. MGUS notification was not associated with adverse psychological outcomes. These findings demonstrate that population-based screening facilitates earlier detection of MM and expands access to early intervention without detectable psychological harm. Longer follow-up is required to determine the effects on survival and cost-effectiveness.
BackgroundObstructive sleep apnea (OSA) is typically evaluated with single-night sleep studies. In adults, night-to-night variability (NtNV) is well documented, but less so in children. The current study evaluated NtNV in apnea events for misclassification in disease severity in young children to investigate if multi-night sleep-recordings may be clinically relevant to improve diagnostic accuracy and affect treatment decisions.MethodsParents/guardians of healthy 4–9-year-old children participating in a study to evaluate prevalence of OSA were asked to record the child's sleep for up to 5-nights. This analysis is from children who completed three consecutive night sleep recordings.ResultsAverage age of participants was 6.1 years (n = 200, 58.0%-girls/42.0%-boys), prevalence of overweight/obesity was 25% and moderate-severe-OSA (AHI3% ≥ 5) based on single-night testing protocol was 29.0%. Using the highest AHI3% value from the three recordings, the first-night correctly identified 57.0% of participants and adding a second night identified 86.0% of participants, with 14% of participants not identified until the third night of sleep testing.Bland-Altman plots (BAplots) demonstrated non-statistically significant mean-differences and 95% upper and lower-limits (LOA95%) close in absolute terms night-one/night-two; −0.024 events/hour-of-sleep LOA95% [−5.062, 5.013], 8.0% of observations outside the LOA95% (p = 0.894) and night-two/night-three; −0.009 events/hour of sleep, LOA95% [−5.227, 5.209] and 6.0% of observations outside LOA95%, (p = 0.9620).The intra-class correlation coefficient (ICC) for AHI3% for all 3 nights was 0.45 [0.37, 0.54], p < 0.001, for night-one/night-two (0.44; p < 0.001), and night-two/night-three (0.44; p < 0.001). Cohens Kappa (0.304–0.462) and Brennan-Prediger Kappa (0.403–0.490), respectively indicated low-to-moderate interrater agreement, with quadratic-weighted Cohen's Kappa for the four ordinal severity categories of 0.37 and 0.48 for the two night-pairs, demonstrating NtNV, which is consistent with the variability demonstrated by the BAplots.ConclusionObserved NtNV in apnea events affected severity categorization, suggesting that multi-night sleep testing may have clinical value and improve accuracy of sleep apnea evaluation in young children.Clinical trial registrationURL: clinicaltrials.gov/study/NCT05479201, identifier NCT0547920 .
Introduction:Obstructive sleep apnea (OSA) is an underdiagnosed health condition and in young children, if untreated, may have negative effects on mental and physical health. Although in adults obesity is recognized as a major risk factor for OSA in adults, the association between weight and OSA has not been as well documented in children. This study was conducted to evaluate prevalence of OSA in young children and if there is an association with weight gain, overweight and/or obesity. Methods:Cross-sectional study, conducted over period of one-year in young children (4-9 years old) which included 29% (n = 371) of young children 4-9-years old this age group living within the general population in the recruitment area. Sleep was evaluated subjectively with the pediatric-sleep-questionnaire (PSQ) and objectively using a home sleep test. Two-nights of >4-h of sleep-duration was required for diagnosis of OSA. Overweight and obesity was evaluated using BMI z-score. Multivariable log-binomial regression analysis was used to assess the relationship between OSA and overweight/obesity. The analyses were adjusted for age, sex, history of asthma/allergies and prior adenotonsillar surgery. Results:Undiagnosed OSA is prevalent in young children or 22.7%; with prevalence of moderate-OSA 16.2% and severe-OSA 6.5%. Each 1 (one) unit increase in BMI z-score was associated with 1.35-times (CI95%:1.22, 1.50) higher risk of having moderate/severe OSA. Childhood overweight (RR = 2.71; CI95%1.76, 4.16) and obesity (RR = 2.80; CI95%1.75, 4.49) were associated with almost 3 (three) times higher risk of having moderate/severe OSA. When analyzing BMI z-score from 18 months of age to current age (ΔBMI z-score), each 1 BMI z-score increase was associated with 1.24-times (CI95%: 1.08, 1.41) higher risk of having moderate/severe OSA. Conclusions:The prevalence of OSA in young children is higher than previously reported. With weight gain, overweight, and obesity were strongly associated with OSA diagnoses.
