Aim To investigate how immigrants from the Balkan region experienced their current life situation after living in Sweden for 30 years or more. Materials The study was designed as a qualitative study using data from interviews with informants from five Balkan countries. The inclusion criteria were informants who were immigrants to Sweden and had lived in Sweden for more than 30 years. Five groups comprising sixteen informants were invited to participate in the study, and they all agreed. Results The analysis of the interviews resulted in three main categories: "from someone to no one", "labour market", and "discrimination". All the informants reported that having an education and life experience was worth-less, having a life but having to start over, re-educating, applying for many jobs but often not being answered, and finally getting a job for which every in-formant was educated but being humiliated every day and treated separately as well as being discriminated against. Conclusion Coming to Sweden with all their problems, having an education and work experience that was equal to zero in Sweden, studying Swedish and re-reading/repeating all their education, looking for a job and not receiving answers to applications, and finally getting a job but being treated differently and discriminated against on a daily basis was experienced by all the in-formants as terrible. Even though there are enough similar studies in Sweden, it is always good to write more to help prospective immigrants and prospective employers in Sweden.

Objectives. The purpose of this study was to determine whether fear and prejudice in relation to organ donation and the transplantation of organs may influence the decision to become an organ donor. Materials and Methods. Data were collected through four group interviews using open-ended questions and qualitative content analysis. Forty participants, 16 males and 24 females from seven countries, participated in the focus group interviews. Results. The analysis resulted in three main categories, and nine subcategories. Fears and prejudice caused by tradition and customs, approval of organ donation by family members, perception of the body as a gift from parents, the influence of religious leaders, knowledge about the religious understanding of organ donation, influence of social ambience on respondents, knowledge of the donation process in the healthcare system, including knowing about life after eventual organ donation, were some of predictors in the decision to agree to organ donation. Conclusion. More education on the factors that influence organ donation, more information in schools, health institutions and through the media, as well as more research with the aim of “dispelling” fears and prejudice about organ donation would significantly improve the current situation and result in a larger number of potential organ donors.

Background: Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS). Methods: Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups. Results: There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005). Conclusions: Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.

Abstract Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

Background: Despite the overall success of THA, betwen 5-20% report unsatisfactory results. Several factors may cause this variable outcome. One of them is ethnicity, which because of its potential social impact on living conditions may influence life quality. We investigated whether patients born and operated in their home country Bosnia and Herzegovina, report the same results as do patients living in Sweden, born in Europe outside the Nordic countries.Methods: Data were prospectively collected from 280 patients planned to be operated with a THA in Bosnia and Herzegovina, and 449 immigrants born in Europe but outside the Nordic countries. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, pain, VAS, and satisfaction VAS. Data collected before the operation and 1 year after were studied. Results: Before the operation patients born and living in Bosnia and Herzegovina reported more problems with self-care and usual activities before and after adjustment for confounding. Patients living in Sweden reported higher EQ-VAS and more pain on VAS than did those born in Bosnia and Herzegovina, but the difference in EQ-VAS became statistically insignificant after adjustment for confounding. A higher share of patients living in Bosnia and Herzegovina reported more benefit 1 year after the operation in all dimension except from self-care as reflected in the basic chi-square test and the unadjusted and adjusted regression analyses. After adjustment for confounding this group of patients was also more satisfied, but there was no statistically significant difference in pain VAS and EQ-VAS when compared to the immigrant group living in Sweden. Conclusion: Our findings that immigrant patients operated in Sweden despite a tendency to more symptoms before the operation have less benefit from a THA according to EQ5D 1 year after the operation cause concern. We do not know to what extent this situation can be improved by a more multidimensional caretaking of immigrant patients. Probably other factors not only involving the healthcare system play a role as do probably also methodological problems related to these types of studies.

Aim To explore the experiences of registered nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes. Methods The study was designed as a qualitative study using data from a self-reported questionnaire form. Data were collected through the self-administered questionnaire with 23 questions, mainly addressing demographic and social data, information about communication and pain assessment. Results All nurses reported that large part of verbal communication with dementia patients was lost, and non-verbal communication was very important to optimize the care of these patients in postoperative situations. An assessment of pain in patients with dementia and hip fractures was a complex process because cognitive ability of these patients was reduced. Conclusion Registered nurses need to know various and different forms of evaluation and tools to assess the experience of pain in patients with dementia who had undergone surgery for hip fractures. This is a complicated task, which requires a great deal of time, and means that nurses must work together with other medical staff, using a holistic approach.

Aim To explore the experiences of anaesthesia nurses in assessing postoperative pain in patients undergoing total hip and/or knee arthroplasty. Methods Data were collected through four focus group interviews (FGI) using the critical incident technique (CIT). The participants were six men and 12 women, all registered nurses with further education in anaesthesia with at least five-year experience of caring for patients on a postoperative ward. Results Maintaining communication with orthopaedic patients, different ways to assess pain, the assessment of unresponsive patients, using pain assessment scales and different work circumstances influencing their use, were stated as the main problems the nurses emphasize while assessing the pain of patients. Conclusion Skills related to observing the behaviour and experience of pain in different individuals are needed to ensure an understanding of patients' pain, as well as the patients' ability to estimate their pain, where the intensity of the pain varies in different patients. Further studies are needed to examine the way health professionals assess pain, depending on the patients' ability to transform their pain from a subjective feeling into an objective numeric grade. The way individuals assess their pain differently and the way the resulting knowledge and experience of postoperative care may help nurses and other health-care professionals.

Aim To explore the experience of anaesthetist nurses in brief meetings with immigrant patients in the perioperative setting. Methods The study was conducted through open individualised interviews using open-ended questions. Eighteen anaesthetist nurses (six men and twelve women) participated in the interviews. Their age varied between 35 and 65 and they had worked as anaesthetist nurses for a period between six and twenty eight years. The text was analysed using qualitative content analysis. Results Meetings with immigrant patients made nurses with less experience to prepare more, to study behaviour of these patients and to ask their older colleagues for advice. More experienced nurses acted on the basis of their previous experience and treated the patients in the same way as before. They also emphasised the great responsibility and wider scope of assistance needed by these patients than those born in Sweden. The majority of nurses begin the meetings with these patients by requesting an interpreter, while some nurses begin the meeting directly with the patient and, if they see it is not going well, they request an interpreter. Conclusion Nurses need better guidelines and education in how to deal with the legislation relating to immigrant patients in order to handle the situation more effectively. Training in cross-cultural care should be improved to help nurses deal with stress through co-operation with the Migration Board and others. In order to provide for good communication and patient safety professional interpreters should be used.

Aim To investigate existence of scientific support for linking differences in the experience of pain to ethnicity. Methods The study was designed as a systematic literature review of qualitative and quantitative studies. The inclusion criteria were scientific studies published in scientific journals and written in English. Studies that described children's experiences and animals were excluded. There were 10 studies, one qualitative and nine quantitative. Results The result was divided into two main sections. The first section presents the results of investigated material regarding different ethnic groups, the groups' different experiences with regard to pain and its treatment focusing entirely on the patients' perspective. Several studies have revealed major differences in the way individuals perceive their pain, using various pain evaluation tools. The second section explained different coping strategies depending on ethnicity and showed that different ethnic groups handle their pain in different ways. Conclusion Healthcare professionals have a duty to pay attention to and understand the patients' experience of their disease and suffering and, as far as possible, mitigate this using appropriate measures. For this purpose, ethnic, cultural and religious differences between different patients need to be understood. It is necessary to continue to study ethnic differences in reporting and predicting pain and its consequences, including the assessment of variables associated with pain, as well as examining the use of prayer as a form of dealing with pain, with an evaluation of various effects of such different influences.

Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.