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To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. A systematic review and meta-synthesis. Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place. • This paper provides an understanding of caregiver experiences and challenges while caring for children with cerebral palsy. • The review findings can be used for policy formation and guide clinical practice. • The finding helps clinicians to respond meaningfully when providing supportive interventions to meet caregivers' needs. [ABSTRACT FROM AUTHOR]

There have been some studies on the needs of women experiencing perinatal loss in various socio-cultural contexts, but there is no research that systematically and comprehensively synthesizes these needs. Perinatal loss has profound psychosocial effects. The misconceptions and prejudices existing in the public, the lack of satisfactory clinical care, and the available social support may all increase the negative impact. To synthesize evidence for the needs of women experiencing perinatal loss, attempt to explain the findings, and provide insights into the application of evidence. Published papers were searched in seven electronic databases until 26 March 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of the included studies. Through meta-aggregation, the data was extracted, rated, and synthesized, resulting in new categories and findings. The credibility and dependability of the synthesized evidence were evaluated by ConQual. Thirteen studies that fulfilled the inclusion criteria and quality assessment were included in the meta-synthesis. Five synthesized findings were identified, covering information needs, emotional needs, social needs, clinical care needs, as well as spiritual and religious needs. Women's perinatal bereavement needs were individualized and diverse. There is a necessity to understand, identify, and respond to their needs in a sensitive and personalized way. Families, communities, healthcare institutions, and society form a coordinated whole and provide accessible resources to improve recovery from perinatal loss and a satisfactory outcome in the subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Gout flares are an important concern for people with gout and an understanding of patients' experiences with gout flares is central in developing meaningful outcome measures for clinical trials. This study aimed to systematically review and thematically synthesize the qualitative literature reporting the patient experience of gout flares, to inform the development of flare-specific outcome measures. MEDLINE, EMBASE, CINAHL Plus and PsycINFO electronic databases were searched in October 2019 to identify original qualitative research articles reporting on the patient experience of gout flares. Methodological quality of all included papers was assessed using the Critical Appraisal Skills Program (CASP) tool. Following data extraction, coding and synthesis was undertaken using reflexive thematic analysis. Sixteen papers reporting the patient experience of gout flares were included. The majority of CASP criteria were met by most studies, indicating good methodological quality. Four predominant and overlapping themes were identified from the thematic analysis: gout flare characteristics (pain, swelling, location, duration and frequency); impact on function and activities of daily living (walking, housework and yard work, self-care, exercise and sports, driving, sleep); effects on social and family life (social participation, inability to plan, employment, dependency, relationships, intimacy); and psychological impact (boredom, irritability, fear, shame and embarrassment, isolation, financial worry, depression and anxiety). Gout flares impact many aspects of patients' lives, including physical and psychological and social and family life. The patient experience of gout flares goes beyond what is routinely measured in research settings. Measurement and reporting methods that capture these aspects of patients' experiences with gout flares would provide more meaningful outcome measures in clinical trials of flare prevention. [ABSTRACT FROM AUTHOR]

The humanisation of childbirth has been identified as a practice of care focusing on the physical, psychological, and emotional wellbeing of women. Healthcare professionals (HCPs) are expected to understand and embed humanised practice when supporting women in childbirth. The aim of this paper is to present a meta-synthesis of the experiences and perspectives of HCPs who undertake care for women at the time of birth regarding the humanisation of childbirth. A systematic search of the electronic databases CINAHL, Medline, PsycINFO, and SocINDEX were conducted in July 2020. Qualitative studies exploring HCPs' experiences and perspectives of humanisation in childbirth were eligible. Studies were synthesised using a meta-ethnographic approach. Fourteen studies involving 197 participants were included. Two themes were identified: 'Women at the centre' and 'Professional dissonance'. Two line of argument synthesis were identified: 'invisible boundaries' and 'unconscious undermining'. HCPs recognised that women required positive interactions which met both their emotional and physical needs. Human touch supported bonding between HCPs and women. HCPs understood humanisation as the reduction of unnecessary intervention and/or technology but had difficulties enacting this and often used disempowering language when discussing women's choices. The management of pain and the presence of a companion were considered important by HCPs. This synthesis revealed that HCPs do understand the humanisation of childbirth but have difficulties in enacting it in practice. Women classified as high risk were identified as having specific needs such as increased emotional support. Further research is required for women classified as high risk who may require technology and/or interventions to maintain a safe birth. [ABSTRACT FROM AUTHOR]

Abstract Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990′s but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient – professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions , which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change. Highlights • A synthesis of 15 qualitative studies on digitized patient-provider interaction. • Four concepts emerged: respatialization; reconnection; reaction; reconfiguration. • Our synthesis goes beyond the micro level and point at structural processes of change. • We propose a conceptual framework to explore the societal relevance of e-health. [ABSTRACT FROM AUTHOR]

Background the transition to parenthood (TTP) is associated with changes to a couple's relationship. Quantitative evidence shows the TTP is associated with reduced satisfaction and quality of a couples’ relationships. Qualitative research provides information on the lived experience of couples in the TTP so can provide a more in-depth understanding of the impact. This review therefore aimed to synthesise qualitative research of the perceived impact of the TTP on a couple's relationship in contemporary Western society. Design a systematic search was conducted of nine databases and grey literature. Key author, citation and reference searches were also undertaken. Papers were included if they presented qualitative data of romantic partner relationships during the TTP with parents aged 18 or over. Studies were restricted to those conducted from 1996 in Western societies. Analysis was conducted using meta-ethnography. Findings searches identified 5256 papers. After applying inclusion criteria 12 papers were included in the meta-synthesis. Six main themes were identified: (1) Adjustment Phase (a period of change in the relationship), (2) Focus on the Baby (with a sub-theme of feeling unprepared for the relationship impact), (3) Communication (shifts in communication patterns and importance), (4) Intimacy (changes to sexual relations, romance and closeness), (5) Strain on the Relationship (short-term or prolonged), and (6) Strengthened Relationships (deepening of connection and new affinity). Except for the themes of Strain on the Relationship and Strengthened Relationships, the findings showed the TTP had positive and negative impacts on couples’ relationships. Key conclusions and implications for practice the review highlights a range of TTP relationship issues that couples experience and may require help with. Health care professionals working with parents in the TTP may be able to provide support through antenatal education that includes preparation for relationship changes, and provision of postnatal support to identify and overcome problems. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a systematic review that synthesizes the qualitative findings for acculturation and education experiences among African-born migrants. Systematic searches were conducted across seven databases for English language studies using qualitative research methodologies. The search strategy identified 25 studies (n = 511), and a meta-synthesis of their findings revealed that typically adoption of host culture enhanced African-born migrants' academic achievement, academic adjustment, and peer relationships, participation in education, and parent and guardian-based support. The findings were interpreted as suggesting that migrants who can adopt the host culture have better educational experiences. However, adoption of host culture in some cases was not related to better educational experiences. The findings of this review have implications for policy to support African-born migrants. • Synthesizes qualitative studies on African migrants' acculturation and education. • Acculturation to host typically positively impacts educational experiences. • Findings are largely in relation to language proficiency. • Found limited use of acculturation models in qualitative studies. [ABSTRACT FROM AUTHOR]

In this paper, we provide a critique focused on the What Works Clearinghouse (WWC) Standards for Single-Case Research Design (Standards 4.1). Specifically, we (a) recommend the use of visual-analysis to verify a single-case intervention study's design standards and to examine the study's operational issues, (b) identify limitations of the design-comparable effect-size measure and discuss related statistical matters, (c) review the applicability and practicality of Standards 4.1 to single-case designs (SCDs), and (d) recommend inclusion of content pertaining to diversity, equity, and inclusion in future standards. Within the historical context of the WWC Pilot Standards for Single-Case Design (1.0) , we suggest that Standards 4.1 may best serve as standards for meta-analyses of SCDs but will need to make clear distinctions among the various types of SCD studies that are included in any research synthesis. In this regard, we argue for transparency in SCD studies that meet design standards and those that do not meet design standards in any meta-analysis emanating from the WWC. The intent of these recommendations is to advance the science of SCD research both in research synthesis and in promoting evidence-based practices. [ABSTRACT FROM AUTHOR]

In this review, we aimed to explore the benefits, effects and experiences of mentoring on those with an eating disorder or disordered eating. After a systematic search of the literature, four papers were included in the review. A qualitative analysis of the papers identified three key themes. The themes were (1) diverse benefits (mentees), (2) finding comfort in belonging (mentees), and (3) affirmation of the transformation they have made (mentors). The experience of mentoring was shown to have value for both mentors and mentees. Mentorship should be further utilized in the areas of eating disorders and disordered eating, as it shows promising reciprocal benefits for both mentor and mentee. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le suicide est un enjeu majeur de santé publique et les jeunes y sont particulièrement exposés. Cette méta-synthèse explore le vécu de l’expérience du suicide chez l’adolescent et le jeune adulte afin de mettre en perspective l’expérience du jeune suicidant et les modalités de prises en charge. Méthode La méthode est une analyse thématique (Thematic Synthesis) de 30 articles qualitatifs interrogeant des adolescents et les jeunes adultes, obtenus par une recherche systématique sur les principaux moteurs de recherche en psychiatrie. La qualité des études a été évaluée à l’aide du Critical Appraisal Skills Programme (CASP). Résultats L’analyse dégage six thèmes organisés autour de deux principaux axes d’expérience. La dimension interpersonnelle regroupe le sentiment de différence et de rejet, le vécu d’incompréhension et la relation à l’autre ; la dimension individuelle regroupe le vécu de dépressivité, le contrôle de soi et la perception de soi. Conclusion L’expérience du suicide est intimement liée au vécu de la relation à l’autre, et cette relation est au cœur du processus thérapeutique. Les prises en charges doivent d’avantage prendre en compte cette dimension du lien et de la nécessité de travailler avec l’entourage du jeune. Les recherches sur le sujet gagneraient à mieux prendre en compte les interactions entre les éléments socioculturels et l’expression de la souffrance conduisant au suicide. Aims Suicide is a major public health issue, one particularly affecting youth. This meta-synthesis of qualitative research studies the experience of adolescent and young adult suicide in order to suggest therapeutic propositions. Method Thematic analysis included 30 qualitative papers elicited by web searching on principal psychiatric databases. The papers questioned adolescents and young adults. Quality appraisal used the Critical Appraisal Skills Programme (CASP). Results The results are organized around two main axes. The relational experience included three themes: feelings of difference and rejection; the experience of incomprehension; and the relation to others. The interpersonal experience included three themes: the experience of distress, self-control and self-perception. Conclusion The experience of suicide is bounded to the relation with others, and this relation is at the center of the therapeutic process. Therapists have to keep in mind this relational dimension and the necessity of the work with families and peers. Researchers have to take account of sociocultural impact on the expression of distress. [ABSTRACT FROM AUTHOR]

As rates with which women are incarcerated have risen around the world, research examining how incarceration affects the health of people who are pregnant, their newborns, and their family members has burgeoned. Lived experience is seldom accounted for in this research, however, highlighting a gap with relevance to advocates, policy makers, researchers, and practitioners seeking to better understand health inequities and redress human suffering. In this paper we present a qualitative meta-synthesis of 31 papers reporting qualitative studies of how people who are incarcerated in prisons and jails around the world experience pregnancy, labour and childbirth, and the postpartum period. Theoretical perspectives from the reproductive justice and prison abolition movements guided our analysis, which identified connectedness (to baby) and disconnectedness (from support) as twinned themes characterizing the lived experiences of navigating pregnancy in a carceral institution. We argue that the conditions of reproductive justice – including self-determination in pregnancy, in parenting, and in managing one's reproductive capacity – are fundamentally irreconcilable with mass incarceration. We conclude by considering the strategic opportunities for health practitioners and researchers to support the movement for prison abolition by mobilizing health-focused arguments for decarceration. • Pregnant people who are incarcerated face barriers to accessing healthcare and social supports. • Common carceral and clinical practices during labour are retraumatizing. • Postpartum opportunities for connection with newborns are contingent and uncertain. • People with lived experience should direct carceral research and research agendas. [ABSTRACT FROM AUTHOR]

Approximately 20 years ago O’Donohue and Elliott (1992) reviewed the treatment outcome literature for sexually abused children and evaluated each study on several criteria (e.g., adequacy of the description of therapy, subjects, and research design; assessment of clinical significance and social validity; inclusion of follow-up assessment to establish the durability of treatment effects etc.). At that time they were only able to identify 11 treatment outcome studies. Currently, a similar search has yielded several hundred outcome studies related to the treatment of child sexual abuse, several reviews of the literature, and seven relevant meta-analyses, clearly indicating a proliferation of much needed outcome research. In this paper we critically reviewed the seven meta-analyses and noted that different criteria for inclusion were used and some cases quite different conclusions were drawn. In this paper we describe and evaluate the seven meta-analyses and provide evidence-based treatment recommendations for children and adolescents who have been sexually abused. [ABSTRACT FROM AUTHOR]

Children and adolescents with non-communicable disease face more difficulties in achieving developmental milestones than their healthy peers, which affect their life and overall wellbeing. A non-disease-specific approach is important in identifying common challenges faced by children and adolescents across multiple non-communicable diseases. Qualitative studies reporting first-hand accounts of children and adolescents aged 4 to19 years with non-communicable disease. A library search was conducted in five electronic databases (CINAHL, Embase, PsycINFO, PubMed, Scopus, and ProQuest Dissertations and Theses) for original qualitative English language papers. Fifty-five articles met the inclusion criteria and were subjected to a two-step meta-synthesis. Initial reports of negative emotional experiences and disease perceptions were mixed with gradual acceptances of their diseases and positive coping strategies. Children and adolescents with non-communicable disease all desired a normal life, but physical limitations often led to social exclusions and self-imposed restrictions. Although most were highly appreciative of the support received from family, friends, and healthcare providers, they still struggled with disease management, the need for autonomy, and the fear of illness disclosure. The impacts of non-communicable disease on children and adolescent's lives suggest a need for joint efforts between parents, clinicians, and educators to ensure children and adolescents' positive development of the self, acceptance and positive coping. This review is able to inform the development of future educational and psychosocial intervention programs in the school and healthcare setting, and also encourages a revision of education policies to be more flexible and accommodating. • Children with chronic illnesses are more at risk of lower self-esteem and psychiatric disorders. • Flexible school curriculums and advocacy for inclusion are essential in education settings. • Direct communication from healthcare providers is essential to facilitate adolescents' autonomy. [ABSTRACT FROM AUTHOR]

• A model was introduced using meta-synthesis and ISM to help analyze ICFs in industrial workers. • ISM is quite applicable to represent the cause and effect relationships between ICFs. • Lack of alertness due to mental overload and lack of person's resilience were the most influential ICFs. Most of the incidents including near misses are attributed to human unsafe acts. An available means for preventing incidents is to recognize "accident prone" workers in a system as the last layer of working system. This study was conducted to recognize individual cognitive factors affecting unsafe acts among Iranian industrial workers as well as finding hierarchical relationships among the factors. This study was mainly performed in two phases including a seven stage meta-synthesis as a basic qualitative approach to extract the effective factors on unsafe acts of workers in industries and Interpretive Structural Modeling (ISM) as an appropriate approach to modeling the factors hierarchically with a glance on their relationships. Twenty experts partook in this study from different universities and industrial companies in Iran to complete the matrices used in ISM model. Fifty-one papers were included out of which 10 dimensions were extracted as the main dimensions affecting unsafe acts individually. Kappa indicator was 0.69 indicating valid status of agreement for the extracted items. Lack of alertness due to mental overload and lack of individual's resilience were identified as the driving factors. The factor of difficulties in remembering work-related information had the characteristics of both independent and linkage clusters. The study provided a hierarchy of factors influencing unsafe acts; hence, the hierarchy could help all employers, industrial managers and even workers themselves to make a better decision when predicting workers' possible unsafe acts. [ABSTRACT FROM AUTHOR]

Background: The aim of this work was to identify the main contextual factors and processes that influence patients' self-care of heart failure (HF). Methods and Results: A systematic review was conducted with the use of qualitative meta-synthesis. Ten databases were searched up to March 19, 2012. Of the 1,421 papers identified by the systematic search, 45 studies were included in this meta-synthesis. To be included, studies had to contain a qualitative research component, data pertaining to self-care of HF from adults (≥18 y) and be published as full papers or theses since 1995. These studies involved: 1,398 patients (mean age 65.9 y), 180 caregivers, and 63 health professionals. Six main types of contextual factors were found to influence HF self-care in the studies: caregivers; social networks and social support; place; finances and financial capacity; work and occupation; and HF support groups and programs. Conclusion: HF self-care is influenced by contextual elements that fall outside of traditional elements of a HF self-care program. Inclusion of these elements may help to address the current concerns about poor adherence to self-management programs. [ABSTRACT FROM AUTHOR]

Background: women can experience an array of serious and enduring morbidities following a difficult or traumatic childbirth. These complications have a negative impact on maternal behaviours and infant and family well-being. Objective: to undertake a meta-synthesis of existing qualitative research to explore the psychosocial implications of a traumatic birth on maternal well-being. Method: a systematic review across 10 databases was undertaken: Nursing and Allied Health Source, Medline, the Allied and Complementary Medicine Database (AMED), Embase, PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), International Bibliography of Social Sciences (IBSS), Science Direct, Academic Search Complete and Health Management Information Consortium. Quality appraisal was conducted and Noblit & Hare0s meta-ethnographic method adopted to identify first, second and third order constructs within the selected papers. Findings: 13 papers were included in the final synthesis. Three third order constructs were identified and are described as 'consumed by demons' (through the intense negative emotions and responses they endured and the subsequent dysfunctional coping strategies employed); an 'embodied sense of loss' (through women0s loss of self and family ideals) and 'shattered relationships' (which reflected the fractious and difficult relationships that women described with their infants and partners). A line of argument synthesis was developed which revealed how women are 'tormented by ghosts' from their past. Conclusions and implications for practice: this synthesis reveals how a traumatic birth experience can lead to women being drawn into a turmoil of devastating emotions that have long-term, negative repercussions on self-identity and relationships. Professionals require training, awareness and skill development to prevent against trauma and to enable them to identify and sensitively respond to women0s psychosocial concerns. Further insights and research into the timing and type of interventions to resolve postnatal morbidity following a traumatic birth are needed. [ABSTRACT FROM AUTHOR]

Objectives: Communicating genetic risk is a distressing process for families affected by inherited genetic conditions. This systematic review identifies and explores the challenges faced by parents and their (non)affected or at risk children caused by the (non)disclosure of genetic risk information. Design: Qualitative meta-synthesis and thematic analysis. Data sources: Ovid databases; Ovid 'in progress', British Nursing Index, Embase, Medline and Psychinfo were combined with searches of EBSCOhost databases; CINAHL and ERIC and Web of science and ZETOC databases using truncations of communication, chronic illness and disease and words relating to family with specific genetic conditions; Cystic Fibrosis, Duchenne Muscular Dystrophy, Familial Adenomatous Polyposis, Hereditary Non-polyposis Colorectal Cancer, Huntington's Disease, Neurofibromatosis and Sickle Cell Anaemia. This was augmented with free Internet and hand searches and an exploration of the bibliographies of all included papers. Review method: All papers were quality assessed to ascertain their research quality and methodological rigour. Results: A total of 2033 citations were retrieved. Following the removal of duplicates, irrelevant articles and the application of an inclusion criterion, 12 articles remained. A further three papers were omitted due to poor quality leaving nine papers which focussed on the disclosure of genetic information between parent and child (<18 years). Eight papers were qualitative in design and one used a mixed method approach. Thematic synthesis produced four themes that inform the structure of the paper; disclosure, emotions involved in disclosure, desired disclosure and recommendations. Conclusion: Disclosure of genetic risk information within families is a highly complex and affective process often resulting in delayed disclosure. This can lead to increased family tensions generated by misunderstanding, blame and secrecy. Early, age appropriate disclosure can better prepare children for future considerations such as care planning and reproductive decision-making. It also contributes to effective coping strategies that promote enhanced adaptation and emotional well being. Early disclosure also reduces parental anxieties concerning disclosure from an unwitting source. Research shows that children and young people want their parents to engage in open and honest discussions about the genetic condition. Therefore to help facilitate effective family communication health professionals should provide family centred care and better emotional and informational support. [ABSTRACT FROM AUTHOR]

Summary: Aim: The aim of the study was to gain new insights into the experiences and accounts of adult pre-registration student nurse clinical allocations in hospital settings in the UK. Design: A systematic review and meta-synthesis of the qualitative literature was undertaken. Data sources: Pertinent papers published from 1990 to 2010 were identified through searches of Cumulative Index for Nursing and Allied Health Literature, Proquest, Medline (PubMed), and the British Nursing Index. Hand and citation searching was also undertaken. Review methods: Ten relevant papers were identified for review. Quality checks on the robustness of the studies were undertaken. Data extraction included identifying details of the study''s settings, sample details, focus of the study, research design, data collection methods, data analysis approaches and qualitative data themes. Results: Approximately 40 qualitative data themes were identified and were the subject of a meta-synthesis. Five cross-cutting synthesised data themes were identified including: pre-placement anticipation, the realities of the clinical environment, clinical learning and becoming a nurse. Stress and coping was a concurrent topic area and related to all the synthesised themes. Conclusions: The findings give new insights into the clinical experiences of student nurses of which the stress of learning in clinical environments and the development of emotional resilience is a focal issue. Whilst the majority of students in the UK experience nurturing, caring clinical environments and positive staff relationships, however, some do not. Reports of negative student nurse clinical experiences are shown in this review to have endured through time. Nurse educators should be alert to the possibility that some students may have very negative clinical experiences. The consequences such negative experiences will affect such things as increases to student attrition and the help perpetuate the cycle of negative clinical learning experiences occurring in the future. [Copyright &y& Elsevier]

Objective: To explore patient and health professional views and experiences of antidepressant treatment with particular focus on barriers and facilitators to discontinuing use.Design: Systematic review with thematic synthesis DATA SOURCES: MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, OpenGrey, and the Networked Digital Library of Theses and Dissertations from inception until February 2017. Updated searches were carried out in July 2018.Eligibility Criteria: Primary studies, published in English, that used qualitative data collection and analysis, and had data on attitudes, beliefs, feelings, perceptions on continuing or discontinuing antidepressant use, of patients (aged 18 or above, who received treatment with antidepressants for at least 6 months) or any health professionals.Data Extraction: One reviewer extracted data and assessed study quality, which was checked by a second reviewer.Findings: Twenty two papers were included in the review. A thematic synthesis was performed for patient perspectives only, due to insufficient data from a health professional perspective. The thematic synthesis yielded nine themes: (1) psychological and physical capabilities; (2) perception of antidepressants; (3) fears; (4) intrinsic motivators and goals; (5) the Doctor as a navigator to maintenance or discontinuation; (6) perceived cause of depression; (7) aspects of information that support decision-making; (8) significant others - a help or a hindrance; and (9) support from other health professionals.Limitations: Coding and development of subthemes and themes was performed by one researcher and further developed through discussion between two researchers.Conclusions: Barriers and facilitators to discontinuing antidepressant use are numerous and complex, and likely to require detailed conversations between patients and their general practitioners (GPs). These conversations are more likely to happen if GPs raise the issue of discontinuation. Further research from a health professional perspective including, but not limited to GPs, is needed. [ABSTRACT FROM AUTHOR]

Background: Adults with mental disorders are at a high risk of loneliness. Loneliness has been implicated in a wide variety of physical and mental health problems. Social connectedness interventions are one means to tackle loneliness but have shown mixed effectiveness. This study aims to: (1) identify existing measures of social connectedness and (2) develop a conceptual framework of social connectedness to inform future measurement and the development of new interventions.Methods: A systematic review of studies from six bibliographic databases was conducted. Studies were included if a quantitative measure of social connectedness was used amongst samples of adults with a mental disorder. Two analyses were conducted: a best evidence synthesis of measurement properties for identified measures and a narrative synthesis of items from these measures.Results: Twenty-eight papers were included, employing 21 different measures. Measurement properties were of poor or unknown quality. Data synthesis identified a five-dimension conceptual framework of social connectedness: Closeness, Identity and common bond, Valued relationships, Involvement and Cared for and accepted (giving the acronym CIVIC).Limitations: The majority of studies were conducted in high-income countries. It was not possible to validate the conceptual framework using the identified psychometric data.Conclusions: The new five-dimension framework of social connectedness in mental disorders provides the theoretical foundation for developing new measures and interventions for social connectedness. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries. Design A meta-ethnographic synthesis of qualitative research. Data sources Five databases were searched for papers published in English between January 2000 and January 2017. Review methods The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool. Results One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries. Conclusion Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women. [ABSTRACT FROM AUTHOR]

Abstract Multi-label classification problem is a key learning task where each instance may belong to multiple class labels simultaneously. However, there exists four main challenges: (a) designing an effective multi-label classifier, (b) learning the high-order asymmetric label correlations automatically, (c) reducing the dimensionality of feature space, (d) dealing with both the full labels and missing labels cases. In this paper, we directly address the above four problems in a unified learning framework, and propose a novel Multi-Label classification approach joint with label correlations, Missing labels and Feature selection, named MLMF. The proposed MLMF not only makes the joint learning of independent binary classifiers, but also allows the joint learning of multi-label classification and label correlations. Meanwhile, the shared sparse feature structure among labels are selected by l 2 , 1 -norm. Furthermore, MLMF can also handle missing labels. Experimental results on sixteen multi-label data sets in terms of six evaluation criteria demonstrate that MLMF outperforms the state-of-the-art multi-label classification algorithms. Highlights • Joint multi-label classification with label correlations and feature selection. • Obtaining the high-order asymmetric label correlations automatically by learning. • Selecting the shared sparse feature structure among labels by l 2 , 1 -norm. • Dealing with both full labels and missing labels cases. [ABSTRACT FROM AUTHOR]

Objectives: To identify what factors affect women's' decisions to delay childbearing, and to explore women's' experiences and their perceptions of associated risks. Design: Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography. Data sources: We included qualitative papers, not confined to geographical area (1980–2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous. Review methods: Twelve papers fulfilled the selection criteria and were included for synthesis. Results: Women appear to face an issue of ‘informed and uninformed decision making’; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing. Conclusions: Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing. [Copyright &y& Elsevier]

Abstract: The diffusion of antenatal screening programmes for Down syndrome has triggered much discussion about their powerful potential to enhance pregnant women''s autonomy and reproductive choices. Simultaneously, considerable debate has been engendered by concerns that such programmes may directly contribute to the emergence of new and complex ethical, legal and social dilemmas for women. Given such discussion and debate, an examination of women''s decision-making within the context of antenatal screening for Down syndrome is timely. This paper aims to undertake a meta-synthesis of qualitative studies examining the factors influencing pregnant women''s decisions to accept or decline antenatal screening for Down syndrome. The meta-synthesis aims to create more comprehensive understandings and to develop theory which might enable midwives and other healthcare professionals to better meet the needs of pregnant women as they make their screening decisions. Ten electronic health and social science databases were searched together with a hand-search of eleven journals for papers published in English between 1999 and 2008, using predefined search terms, inclusion and exclusion criteria, and a quality appraisal framework. Nine papers met the criteria for this meta-synthesis, providing an international perspective on pregnant women''s decision-making. Twelve themes were identified by consensus and combined into five core concepts. These core concepts were: destination unknown; to choose or not to choose; risk is rarely pure and never simple; treading on dreams, and betwixt and between. A conceptual framework is proposed which incorporates these themes and core concepts, and provides a new insight into pregnant women''s complex decision-making processes with regard to antenatal screening for Down syndrome. However, further research is necessary to determine whether or not the development of a model of decision-making may empower pregnant women in making choices about screening. [Copyright &y& Elsevier]

Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy. In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI. [ABSTRACT FROM AUTHOR]

Summary: In the process of undertaking a meta-synthesis of qualitative studies of free-standing midwife-led units, the authors of this paper encountered a number of methodologically and epistemologically unresolved issues. One of these related to the assessment of the quality of qualitative research. In an iterative approach to scoping this issue, we identified eight existing checklists and summary frameworks. Some of these publications were opinion based, and some involved a synthesis of pre-existing frameworks. None of them provide a clear map of the criteria used in all their reviewed papers, and of the commonalities and differences between them. We critically review these frameworks and conclude that, although they are epistemologically and theoretically dense, they are excessively detailed for most uses. In order to reach a workable solution to the problem of the quality assessment of qualitative research, the findings from these frameworks and checklists were mapped together. Using a technique we have termed a ‘redundancy approach’ to eliminate non-essential criteria, we developed our own summary framework. The final synthesis was achieved through reflexive debate and discussion. Aspects of this discussion are detailed here. The synthesis is clearly rooted in a subjectivist epistemology, which views knowledge as constructed and hermeneutic in intent, encompassing individual, cultural and structural representations of reality. [Copyright &y& Elsevier]

The government seeks to accelerate scientific and technological progress to benefit society. However, the government may promote or hinder breakthrough innovation. It is difficult to thoroughly understand the characteristics of governmental action in innovation process. To better define the role of government, we focused on inter-organizational relationships and discussed the governance structures of government in the process of promoting breakthrough innovation from the perspectives of situation and motivation. A meta-synthesis process is adopted in this paper to integrate 28 case studies on the theme of governmental action in innovation activities. A theoretical landscape of government-embedded typology in the innovation process was established using an analytical framework of "situation, motivation, action, and effect." First, the government views technological innovations as governance objects or tools. Then, four government-embedded models are presented in the innovation process: the government-led core model, the government-led hybrid model, the government-supported hybrid model, and the government-supported peripheral model. The action characteristics of each model are reflected in regulation, planning, R&D, coordination, and demand-pull. Finally, there are multiple combinations and evolutions between models due to the complex situations and the dynamic process. • Governments intervene in innovation to address complexity challenges. • Integration of 28 cases into a meta-synthesis of interorganizational relationship. • Government views technical innovations as governance objects or tools. • Presenting four government-embedding models in the innovation process. • Inter-model evolution due to the complex situation and the dynamic process. [ABSTRACT FROM AUTHOR]

There has been a significant increase in the number of inpatient admissions for individuals with eating disorders and, with the most critical cases requiring inpatient treatment, it is essential that we continue to improve associated outcomes. The aim of the study was to synthesise the available qualitative literature on the experiences of inpatient admissions for eating disorders to understand individuals' experiences and identify areas that may require further research and/or service development. Searches were performed on the following online databases: PsycINFO, PsycArticles, PsycTherapy MEDLINE, Embase, CINAHL, ASSIA, Scopus and Proquest Open Access Theses. Only papers with qualitative data regarding individuals' experiences of inpatient eating disorder treatment were considered. The CASP qualitative checklist was used to assess studies and relevant data items were extracted. Thematic synthesis was used to integrate the findings in the identified studies. GRADE-CERQual was used to rate the confidence in the findings. Twenty-eight studies were identified which the CASP assessment considered to be adequate. The synthesis produced 5 main themes; 'Care and control', 'Inpatient bubble', 'Being supported and understood', 'Challenges of living with others' eating disorders' and finally 'Relationship to eating disorder'. The GRADE CERQual framework rated findings with high or moderate confidence. Findings reaffirmed the importance of patient-centred care and the significant impact of being separated from normal life with others also experiencing an eating disorder. [ABSTRACT FROM AUTHOR]

To describe the various teaching and learning modalities for the delivery of Continuing Professional Development activities for health care professionals in the long-term care sector. Continuing Professional Development is a key activity that organisations undertake to achieve effective workforce planning, recruitment, retention and upskilling strategies in long-term care settings. During the Covid-19 pandemic there was a rapid move to online modalities of Continuous Professional Development, but there is a paucity of evidence in relation to their effectiveness compared with face-to-face, or in-class learning. A rapid synthesis review. MEDLINE, CINAHL and HEALTH BUSINESS ELITE databases were used to identify relevant articles that were published between 2016 and 2022. Original studies of any design investigating Continuing Professional Development activities, with or without a comparison between interventions or activities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. The Kirkpatrick model was adopted as a globally recognised method for evaluating training programmes. After a full text analysis, 34 papers were included in the review. Face to face was the most common method of delivery followed by online, while blended (a mix of face-to-face and online delivery) was the least common method used. The teaching modalities were not associated with specific learning contents, but were used for a range of content. Most studies obtained positive outcomes following implementation of the educational interventions. Kirkpatrick Level 4 (results) was the most commonly measured outcome. While blended learning was the least common method of delivery, it was found to be more beneficial for learners than face-to-face or online exclusively. There are now new spaces to learn and new technologies that allow us to 'reimagine' where, when and how we teach. This requires Continuing Professional Development providers to design and tailor their courses according to health professionals' learning needs and the clinical contexts where they work. We recommend that Continuing Professional Development providers involve employers when designing teaching and learning activities for Long Term Care workers, to decide which modalities enable effective knowledge translation. [ABSTRACT FROM AUTHOR]

Social relationships are important in bolstering health and well-being for everyone in the general population. For transgender people, strong supportive social relationships may be paramount to their overall health and well-being due to their marginalised status in society. This review aimed to investigate what is currently known about the social relationship experiences of transgender people and their relational partners (e.g., family members, romantic partners). Thirty-nine qualitative papers were extracted from Web of Science, Scopus, Cochrane, and PubMed that related to social relationships of transgender people. These papers were analysed via a qualitative meta-synthesis. Forty-nine second-order themes were identified, initially organised into relational partner clusters (e.g., family, friends, work colleagues) for specific phenomena, then these were synthesized into five overarching conceptual themes: (1) Development of relationships through transition and beyond , (2) Coping strategies of transgender people and their relational partners , (3) Reciprocal support in social relationships , (4) Stigma enacted and ameliorated interpersonally , and (5) Influence of stigma on social health and well-being. These overarching themes show the potential characteristics that assist in the health-buffering role of social relationships for transgender people and their relational partners. Of particular note, stigma was reported as a common negative experience by transgender people and their relational partners, and open communicative social relationships had positive effects on self-conceptualisations of identity, which were inferred to protect against the damaging effects of stigma. We discuss the various implications and applications of this meta-synthesis to future research and clinical settings as well as how it can inform healthcare policy to support transgender people. • Synthesizes literature related to transgender people and their relational partners. • Five overarching conceptual themes emerged concerning these relationships. • The themes had an overarching focus on identity, support, and stigma. • Overall, building stable relationships improves health and well-being for all. • Themes have several implications for relationships as well as policy and practice. [ABSTRACT FROM AUTHOR]

• First comparative analysis of international and national city food networks. • Translocal governance analysis shows fluid policy processes and interactions. • Cross-scalar food policy alignment is key rather than coordination. • The metagovernance of networks reveals lower state involvement in scaling-up efforts. • New questions arise around processes of alignment/decision-making and justice outcomes. Hundreds of cities across the globe are mobilising the convening power of food to deliver food security and sustainability outcomes supported by an increasing number of national and international city food networks devoted to scale-up and out this urban food revolution. This paper presents the first comparative analysis of this increasingly networked urban foodscape based on data from 13 national and international initiatives which together represent more than 500 cities across the globe. By applying a translocal governance framework, the paper explores the different aims, structures and mechanisms activated by this complex landscape of networks and how these intrinsic characteristics endow them with diverse strengths and limitations. To examine further the role of networks in rescaling the impact urban food policies, I analyse the metagovernance of these initiatives exploring discourses around coordination of these networks and identifying potential convergence points. Results from this study are translated into policy recommendations aimed at unfolding further the transformative capacity of translocal networks and elevate their role in unfolding a more integrated and equitable new urban food agenda; mainly by proposing to reinforce the cross-scalar alignment of food policies, making the case to invest in connective infrastructure such as network and backbone organisations, work with a wider diversity of agents, and provide open spaces that democratise access to collective knowledge and capacities. c. As urban food policies become the new norm, this research stresses the need for rescaling food system interventions that effectively deliver social and spatial justice in an increasingly polarised word. [ABSTRACT FROM AUTHOR]

Background and Aim: The role of place in mental health recovery was investigated by synthesizing qualitative research on this topic.Methods: Using a meta-ethnographic approach, twelve research papers were selected, their data extracted, coded and synthesized.Findings: Place for doing, being, becoming and belonging emerged as central mechanisms through which place impacts recovery. Several material, social, natural and temporal characteristics appear to enable or constrain the potential of places to support recovery.Conclusions: The impact of place on recovery is multi-faceted. The multidimensional interactions between people, place and recovery can inform recovery-oriented practice. Further research is required to uncover the role of place in offering opportunities for active engagement, social connection and community participation. [ABSTRACT FROM AUTHOR]

Background The increasing prevalence of diabetes is well-documented along with the findings that some ethnic minorities have a higher prevalence than non-minority individuals. Along with possible biological differences between ethnicities, access to economic, social, cultural and symbolic capital may impact on the success of managing type-2 diabetes. Objectives To examine how people from ethnic minorities in Western countries describe their experiences of managing type-2 diabetes mellitus. Data sources PubMed and Ovid Medline databases. Eligibility criteria Studies between 1946 and July 2016 were included if they were qualitative in design and presented findings in relation to adults from ethnic minorities and their descriptions of self-managing type-2 diabetes mellitus. Study appraisal and synthesis The CASP evaluation for qualitative studies was used for quality appraisal and synthesis involved thematic analysis and evaluation of evidence using GRADE-CERQual approach. Findings Twenty-seven papers were included in the review. The primary studies were all conducted in middle-high income western countries with people from diverse ethnicities, although the majority were Black American. There was high confidence in the evidence that a sense of powerlessness, issues of treatment accessibility and acceptability, and the culturally defined roles within families impacted on how some participants managed their diabetes. There was moderate confidence in the evidence in relation to the cultural significance of food and for the cultural effect of stigma. Conclusion The potential for a sense of powerlessness to manage diabetes, the acceptability and accessibility of treatment, the significance of food, the impact of cultural roles and stigma needs to be pivotal to diabetes education for people from ethnic minorities in Western countries. [ABSTRACT FROM AUTHOR]

To conduct a meta-synthesis of qualitative studies on the post-traumatic growth experiences of childhood cancer survivors. Various databases, including PubMed, Cochrane Library, Web of Science, EMBASE, PsycInfo, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), and China Biology Medicine (CBM) were used to retrieve qualitative studies on childhood cancer survivors who experienced post-traumatic growth. Eight papers were included in this study, and similar fragments were combined to form eight categories, which were further combined into four synthesized findings: adjustment of cognitive system, enhancement of personal strength, improving relationships with others, resetting of life goals. Post-traumatic growth was observed in some childhood cancer survivors. The potential resources and positive forces contributing to this growth are of great significance in the fight against cancer, in tapping into individual and social resources to help survivors grow, and in improving their survival rates and quality of life. It also provides a new perspective for healthcare providers regarding the relevant psychological interventions. • PTG in childhood cancer survivors expands the perspective of trauma treatment and helps promoting real spiritual growth. • Enhancing the linkage of internal and external resources contributes to increase the likelihood of PTG in childhood cancer survivors. • Healthcare providers should recognize PTG in childhood cancer survivors to provide effective psychological interventions. [ABSTRACT FROM AUTHOR]

The culture of acute mental health wards is often dominated by medical models of care despite some patient dissatisfaction with care in these settings and a demand for increased access to psychosocial interventions. Research has found that psychosocial interventions can improve a number of patient and staff outcomes, however, implementation within these settings is often challenging. The aim of this review was to provide a comprehensive synthesis of the barriers and facilitators to implementing psychosocial interventions on acute wards, in order to develop a list of recommendations for embedding psychosocial interventions within the ward culture in acute settings. Databases were systematically searched using search terms related to acute mental health wards and psychosocial intervention implementation from inception to December 2019. Thirty-nine studies (forty-three papers) that explored the implementation of psychosocial interventions on adult acute mental health wards using qualitative methods met inclusion criteria. Data relating to barriers and facilitators to implementing psychosocial interventions extracted from the results sections of the papers were synthesised using the COM-B model. We conclude that to address barriers to the implementation of psychosocial interventions, services should provide clear information to patients regarding the benefits of engagement, and additional training for staff. A shift in ward culture is required and can be achieved through the recruitment of empathic implementers, together with providing staff with protected time for delivery of psychosocial interventions with clear accountability for intervention delivery through the provision of clearly defined roles. [ABSTRACT FROM AUTHOR]

Problem While studies have discussed the parenting practices and challenges of African immigrants, no paper has synthesized the results of these qualitative studies. We conducted a qualitative synthesis of the literature to summarize and interpret knowledge of African immigrants' parenting practices and challenges in destination countries to identify future directions for research, policy, and practice. Eligibility We used a qualitative research synthesis method involving meta-summary and meta-synthesis of the literature. A research librarian assisted in searching ten databases. Two members of the research team independently reviewed 1794 articles. We included articles that: (a) reported a qualitative research study; (b) was written in English; and (c) provided the perspective of African immigrant parents on their parenting practices and/or challenges. Sample A total of 24 articles met our inclusion criteria. Results Our results indicate that parenting practices of African immigrants include the following: changes in discipline practices across transnational borders and the use of physical discipline, respect as a deeply embedded value of parenting, integration of cultural values into parenting, and integration of religious practices into parenting. We also found gender differences in parenting. Challenges faced by African immigrants in parenting their children in destination countries include lack of informal/community support, access to services and lack of formal support, cultural conflict in parenting, fear related to social services, and language barriers. Conclusion and Implications Our study identifies a need for culturally appropriate policies and practices that build on the strengths of African immigrants in destination countries while addressing their unique challenges. [ABSTRACT FROM AUTHOR]

Background Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. Objective To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Methods Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. Results The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. Conclusion Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care. Methods Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. Data sources The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. Review methods A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. Findings A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land ; Encountering dysfunctional interactions ; and Suffering stereotyping and assumptions . These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. Conclusion The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care. [ABSTRACT FROM AUTHOR]

Background The use of complementary therapies is becoming increasingly prevalent. This has important implications for nurses in terms of patient care and safety. Objective The aim of this meta-synthesis is to review critically, appraise and synthesize the existing qualitative research to develop a new, more substantial interpretation of nurses' attitudes regarding the, use of complementary therapies by patients. Data sources A search of relevant articles published in English between, January 2000 and December 2015 was conducted using the following, electronic databases; MEDLINE, CINAHL and AMED. Reference lists of selected papers and grey literature were also interrogated for pertinent, studies. Design This review is reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Data were extracted and analysed using a thematic synthesis process. Results Fifteen articles were included in this review. Five analytical themes emerged from the data relating to nurses' attitude towards complementary therapies: the strengths and weaknesses of conventional medicine; Complementary therapies as a way to enhance nursing practice; patient empowerment and patient-centeredness; cultural barriers and enablers to integration; and structural barriers and enablers to integration. Discussion Nurses' support for complementary therapies is not an attempt to challenge mainstream medicine but rather an endeavour to improve the quality of care available to patients. There are, however, a number of barriers to nurses' support including institutional culture and clinical context, as well as time and knowledge limitations. Conclusion Some nurses promote complementary therapies as an opportunity to personalise care and practice in a humanistic way. Yet, nurses have very limited education in this field and a lack of professional frameworks to assist them. The nursing profession needs to consider how to address current deficiencies in meeting the growing use of complementary therapies by patients. [ABSTRACT FROM AUTHOR]

Background There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies. Objectives To examine how older people cope with non-malignant chronic pain. Design This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence. Data sources PubMed and Ovid Medline from 1995 to 2015. Review methods Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. Results Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: ‘adjusting to the inevitable’, ‘doing it my way without medication’ and ‘the importance of support in managing the struggle’. There was high confidence in the evidence for ‘doing it my way without medication’ and moderate confidence in the evidence for the other two meta-themes. Conclusion Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required. [ABSTRACT FROM AUTHOR]

In a dynamic environment, the data collected from real applications varies not only with the amount of objects but also with the number of features, which will result in continuous change of knowledge over time. The static methods of updating knowledge need to recompute from scratch when new data are added every time. This makes it potentially very time-consuming to update knowledge, especially as the dataset grows dramatically. Calculation of approximations is one of main mining tasks in rough set theory, like frequent pattern mining in association rules. Considering the fuzzy descriptions of decision states in the universe under fuzzy environment, this paper aims to provide an efficient approach for computing rough approximations of fuzzy concepts in dynamic fuzzy decision systems (FDS) with simultaneous variation of objects and features. We firstly present a matrix-based representation of rough fuzzy approximations by a Boolean matrix associated with a matrix operator in FDS. While adding the objects and features concurrently, incremental mechanisms for updating rough fuzzy approximations are introduced, and the corresponding matrix-based dynamic algorithm is developed. Unlike the static method of computing approximations by updating the whole relation matrix, our new approach partitions it into sub-matrices and updates each sub-matrix locally by utilizing the previous matrix information and the interactive information of each sub-matrix to avoid unnecessary calculations. Experimental results on six UCI datasets shown that the proposed dynamic algorithm achieves significantly higher efficiency than the static algorithm and the combination of two reference incremental algorithms. [ABSTRACT FROM AUTHOR]

Objective To explore barriers to nurses’ reporting of medication errors and near misses in hospital settings. Design Systematic review. Data sources Medline, CINAHL, PubMed and Cochrane Library in addition to Google and Google Scholar and reference lists of relevant studies published in English between January 1981 and April 2015 were searched for relevant qualitative, quantitative or mixed methods empirical studies or unpublished PhD theses. Papers with a primary focus on barriers to reporting medication errors and near misses in nursing were included. Review methods The titles and abstracts of the search results were assessed for eligibility and relevance by one of the authors. After retrieval of the full texts, two of the authors independently made decisions concerning the final inclusion and these were validated by the third reviewer. Three authors independently assessed methodological quality of studies. Relevant data were extracted and findings were synthesised using thematic synthesis. Results From 4038 identified records, 38 studies were included in the synthesis. Findings suggest that organizational barriers such as culture, the reporting system and management behaviour in addition to personal and professional barriers such as fear, accountability and characteristics of nurses are barriers to reporting medication errors. Conclusions To overcome reported barriers it is necessary to develop a non-blaming, non-punitive and non-fearful learning culture at unit and organizational level. Anonymous, effective, uncomplicated and efficient reporting systems and supportive management behaviour that provides open feedback to nurses is needed. Nurses are accountable for patients’ safety, so they need to be educated and skilled in error management. Lack of research into barriers to reporting of near misses’ and low awareness of reporting suggests the need for further research and development of educational and management approaches to overcome these barriers. [ABSTRACT FROM AUTHOR]

The meaning of dignity in health care has been primarily explored using interviews and surveys with various patient groups, as well as with health care practitioners. Philosophical analysis of dignity is largely avoided, as the existing philosophical literature is complex, multifaceted and of unclear relevance to health care settings. The aim of this paper is to develop a straightforward philosophical concept of dignity which is then applied to existing qualitative research. In health care settings, a patient has dignity when he or she is able to live in accordance with his or her standards and values. Accordingly, health care practitioners respect a patient's dignity when they refrain from transgressing the patient's standards and values, or refrain from forcing the patient to transgress his or her standards and values. This concept is shown to explain and illuminate most of the key qualitative findings. It therefore provides a more coherent and synthesised concept of dignity in health care. [ABSTRACT FROM AUTHOR]

Scholars have been exploring the social impacts of dams for over 50 years, but a lack of systematic approaches has resulted in many research gaps remaining. This paper presents the first systematic review of the literature on the social impacts of dams. For this purpose, we built a sample of 217 articles published in the past 25 years via key word searches, expert consultations and bibliography reviews. All articles were assessed against an aggregate matrix framework on the social impact of dams, which combines 27 existing frameworks. We find that existing literature is highly biased with regard to: perspective (45% negative versus 5% positive); dam size (large dams are overrepresented); spatial focus (on the resettlement area); and temporal focus (5–10 years ex-post resettlement). Additionally, there is bias in terms of whose views are included, with those of dam developers rarely examined by scholars. These gaps need to be addressed in future research to advance our knowledge on the social impact of dams to support more transparency in the trade-offs being made in dam development decisions. [ABSTRACT FROM AUTHOR]

Background High profile accounts of failures in patient care reflect an urgent need for transformational development in healthcare. Appreciative Inquiry is promoted as an approach to exploring and bringing about change in social systems. Appreciative Inquiry has been used extensively in North American business since the late 1980s. The application of Appreciative Inquiry may have merit in the complex world of human health experiences. Objectives To identify, evaluate and synthesise the evidence about the impact of Appreciative Inquiry on changing clinical nursing practice in in-patient settings. Design An integrative review and narrative synthesis. Setting In-patient settings including paediatrics, maternity and mental health. Participants Nurses of all grades, patients, carers, relatives, other healthcare professionals including allied healthcare staff, management and students. Data sources An electronic search of the following electronic databases was performed in January 2015 and updated in July 2015: MEDLINE, EMBASE, Cochrane Library (Cochrane database of systematic reviews), Cumulative Index of Nursing and Allied Health Literature, PsychINFO, PsychARTICLES, Amed, Assia, Scopus and Web of Science. Hand searching of reference lists of included studies was undertaken. Limits were set to include literature published in English only and publications from 1990 to July 2015. Review methods Three reviewers independently assessed eligibility for inclusion and extracted data. Full text articles were systematically appraised using a standardised data extraction instrument in conjunction with criteria to assess whether change using Appreciative Inquiry is transformational. Results Eight studies (reported in 11 papers) met the inclusion criteria. Overall, these studies demonstrate poor application of Appreciative Inquiry criteria in a nursing context. This makes judgement of the impact difficult. One study achieved transformation against agreed criteria for Appreciative Inquiry. Other included studies demonstrated that Appreciative Inquiry is being perceived as a gateway to knowledge translation rather than transformative change in practice. Conclusions Appreciative Inquiry offers potential for nurse practice development and change but not without cognisance of the pivotal components. If Appreciative Inquiry is to be perceived as a legitimate research endeavour, there must be engagement and attention to rigour. Findings suggest caution is required against the choreography of Appreciative Inquiry where participant experiences are moulded to fit a previously drafted master plan. Further research is needed to explore the role of expert facilitation in securing and sustaining successful outcomes of Appreciative Inquiry. [ABSTRACT FROM AUTHOR]

Feature selection in the data with different types of feature values, i.e., the heterogeneous or mixed data, is especially of practical importance because such types of data sets widely exist in real world. The key issue for feature selection in mixed data is how to properly deal with different types of the features or attributes in the data set. Motivated by the fuzzy rough set theory which allows different fuzzy relations to be defined for different types of attributes to measure the similarity between objects and in view of the effectiveness of entropy to measure information uncertainty, we propose in this paper a fuzzy rough set-based information entropy for feature selection in a mixed data set. It is proved that the newly-defined entropy meets the common requirement of monotonicity and can equivalently characterize the existing attribute reductions in the fuzzy rough set theory. Then, a feature selection algorithm is formulated based on the proposed entropy and a filter-wrapper method is suggested to select the best feature subset in terms of classification accuracy. An extensive numerical experiment is further conducted to assess the performance of the feature selection method and the results are satisfactory. [ABSTRACT FROM AUTHOR]

Rationale Physical activity can reduce the risk of chronic illnesses, frailty and deterioration of cognitive function in older adults yet few older adults meet recommended levels of physical activity. To increase engagement in physical activity, there is a need to better understand acceptability of physical activity interventions for this population. Objective This article presents a systematic review and meta-synthesis of qualitative studies of independently living older adults' (≥65 years old) experiences of physical activity interventions in non-clinical contexts. Methods A systematic search yielded 2612 papers, of which 14 met inclusion criteria, and were synthesised using Thematic Synthesis. Inductive line-by-line coding led to the derivation of descriptive themes. An overview of the coded text allowed cross-case and within-case comparisons where both patterns and anomalies became apparent, informing the generation of analytical themes. Findings Older adults emphasised fun and enjoyment of social interaction as a motivation to be physically active. Retaining these social bonds could be important for maintenance of physical activity beyond an intervention. Doubts about capabilities or the necessity of moderate physical activity in later life were dispelled through experience of valued short-term functional and psychosocial outcomes. Relating these positive outcomes to being more active increased the perceived value of physical activity. Increased awareness of own capabilities within physical activity interventions translated into older adults being more physically active in other areas of their lives. Focusing on the role of physical activity in improving long-term health is unlikely to encourage participation of many older adults. Conclusions To increase engagement, interventions should focus on physical activity as a fun, sociable, achievable pastime for older adults with relevant short-term benefits. [ABSTRACT FROM AUTHOR]

Document annotation and search are two important factors that need to be considered in data sharing platforms. A large unstructured text document contains substantial amount of structured attribute information. Important information is very difficult to find in these documents. Current ad-hoc or predefined annotation of the shared data causes inadequate search, retrieval and analysis capabilities. In this paper we propose a new approach that supports the generation of the structured annotation in the form of attribute name and attribute value pairs from unstructured document. A new data sharing platform DSPAA (Data Sharing Platform with Automated Annotation) is proposed, where the document annotation occurs when the author uploads a document and it is based on a probabilistic framework that considers the attributes in the document content and the query collection. The new system also performs semantic annotation of document using WordNet database. When a user submits a search query, then the system will search for documents in the annotation database and rank the selected documents by using Vector Space model. From experiment results it is clear that the system generates superior results at a rate faster than traditional document retrieval strategies. [ABSTRACT FROM AUTHOR]

Background: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. Objectives: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human suffering during life-threatening illness. Design: We conducted a meta-synthesis in which we collected, assessed, and analyzed published qualitative studies with the goal of synthesizing these findings into a new whole. Analysis was based on the scientific approach of Gadamerian hermeneutics. Settings: Nordic intensive care units. Participants: Patients in Nordic intensive care units. Methods: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and PsycINFO. Each original paper was assessed by all authors using the Critical Appraisal Skills Program instrument for qualitative research. We included 22 studies, all of which provided direct patient quotes. Results: The overarching theme was identified as: The patient experience when existence itself is at stake. We constructed an organizing framework for analysis using the main perspectives represented in the included studies: body, mind, relationships, and ICU-environment. Final analysis and interpretation resulted in the unfolding of four themes: existing in liminality, existing in unboundedness, existing in mystery, and existing on the threshold. Conclusions: Our main finding was that human suffering during intensive care is still evident although sedation is lighter and the environment is more humane. Our interpretation suggested that patients with life-threatening illness descend into a liminal state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life. [ABSTRACT FROM AUTHOR]