Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Background Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of 40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis and treatment for prolapse and their needs and priorities for improving person-centred care. Methods Twenty-two women receiving prolapse care through urogynaecology services across three purposefully selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed thematically. Results Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs. Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and involvement in treatment decision making was desired. Conclusions As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure, alongside a multi-professional team approach to treatment decision making. Women presenting with prolapse symptoms need to be listened to by the health care team, offered better information about treatment choices, and supported to make a decision that is right for them

Patient and public attitudes to and awareness of clinical practice guidelines : a systematic review with thematic and narrative syntheses

Article Accepted Date: 15 July 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 258583 (DECIDE project). The Health Services Research Unit, Aberdeen University, is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The authors accept full responsibility for this paper and the views expressed in it are those of the authors and do not necessarily reflect those of the Chief Scientist Office. NS receives funding through a Knowledge Translation Fellowship from the Canadian Institutes of Health Research. No funding bodies had a role in the manuscript. We would like to thank Healthcare Improvement Scotland and the University of Dundee for support, including access to literature. We would also like to thank Lorna Thompson (Healthcare Improvement Scotland), for her help with the protocol for this review.Peer reviewedPublisher PD

Scope for rotavirus vaccination in India: revisiting the scientific evidence.

Rotavirus vaccines have been developed to prevent deaths resulting from severe diarrhea of rotavirus origin. The use of vaccines as an intervention at scale to prevent and control the burden of rotavirus diarrhea is supported by the argument that prevailing public health measures such as hygiene and sanitation, breast feeding and use of ORS have failed to prevent severe dehydration resulting from diarrhea. The article reviews the existing evidence on the rationale of using rotavirus vaccine as against the feasibility of scaling it up in developing countries like India. The vaccines currently available may not cover the strains circulating in Indian population. The diversity of Rotavirus infection in the country is tremendous and since the safety, immunogenicity and efficacy data has not been collected for India, there is first a need to conduct studies to measure the extent of protection and cross-protection provided by the available vaccines for local strains, before venturing into Rotavirus vaccination program. The potential benefits of immunization have to be first vetted against the risks involved by the policymakers and other stakeholders

Implementing change in primary care practice: lessons from a mixed-methods evaluation of a frailty initiative

© 2018, BJGP Open. Background: The NHS is facing increasing needs from an aging population, which is acutely visible in the emerging problem of frailty. There is growing evidence describing new models of care for people living with frailty, but a lack of evidence on successful implementation of these complex interventions at the practice level. Aim: This study aimed to determine what factors enable or prevent implementation of a wholesystem, complex intervention for managing frailty (the PACT initiative) in the UK primary care setting. Design & setting: A mixed-methods evaluation study undertaken within a large clinical commissioning group (CCG). Design and analysis was informed by normalisation process theory (NPT). Method: Data collection from six sites included: observation of delivery, interviews with staff, and an online survey. NPT-informed analysis sought to identify enablers and barriers to implementation of change. Results: Seven themes were identified. PACT was valued by professionals and patients but a lack of clarity on its aims was identified as a barrier to implementation. Successful implementation relied on champions pushing the work forward, and dealing with unanticipated resistance. Contracts focused on delivery of service outcomes, but these were sometimes at odds with professional priorities. Implementation followed evidence-informed rather than evidence-based practice, requiring redesign of the intervention and potentially created a new body of knowledge on managing frailty. Conclusion: Successful implementation of complex interventions in primary care need inbuilt capacity for flexibility and adaptability, requiring expertise as well as evidence. Professionals need to be supported to translate innovative practice into practice-based evidence

Trust, choice and power in mental health

The original publication is available at www.springerlink.co

What do stroke survivors think about evidence based care they receive? Learning from insights at the periphery

Permission to archive the publisher pdf of this article was granted by the publisher in February 2012Rationale and aim of study: While exploring the experience of stroke survivors of secondary stroke prevention as part of a wider patient and public involvement service initiative, study participants willingly shared insights on other aspects of care that mattered to them. This is important as little is known about patients’ preferences for care. Methods: Data was generated from focus groups and semi-structured interviews that were held with 38 stroke survivors or their proxy respondents as part of an action research study. A framework analysis was used to examine data. Results: Our findings largely support current knowledge about the benefits of receiving evidence based stroke care. Although patients broadly appreciated being on a specialist unit, unexpectedly and contrary to best practice some expressed the wish to be treated elsewhere as they found the experience of being on a stroke unit difficult. Other findings included the need for more local peer support and difficulties surrounding transfer from hospital to home. Resultant actions included awareness training for staff about sensitively managing people’s perceptions about being on the stroke unit; development of shared computer based (IT) resources, and the establishment of a volunteer peer support system. Conclusion: The evidence base for the benefits of stroke unit care is unequivocal; however this model of care presents challenges for some. Involving patients in service development can inform small but key changes in practice that can help address inherent tensions in delivering evidence based services that are sensitive to patient preference.This project was funded by a grant from the Peninsula Primary Care Research Networ

Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews

Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care

Tailored retrieval of health information from the web for facilitating communication and empowerment of elderly people

A patient, nowadays, acquires health information from the Web mainly through a “human-to-machine” communication process with a generic search engine. This, in turn, affects, positively or negatively, his/her empowerment level and the “human-to-human” communication process that occurs between a patient and a healthcare professional such as a doctor. A generic communication process can be modelled by considering its syntactic-technical, semantic-meaning, and pragmatic-effectiveness levels and an efficacious communication occurs when all the communication levels are fully addressed. In the case of retrieval of health information from the Web, although a generic search engine is able to work at the syntactic-technical level, the semantic and pragmatic aspects are left to the user and this can be challenging, especially for elderly people. This work presents a custom search engine, FACILE, that works at the three communication levels and allows to overcome the challenges confronted during the search process. A patient can specify his/her information requirements in a simple way and FACILE will retrieve the “right” amount of Web content in a language that he/she can easily understand. This facilitates the comprehension of the found information and positively affects the empowerment process and communication with healthcare professionals

The lived experience of Dupuytren's disease of the hand

This article is made available through the Brunel Open Access Publishing Fund.Aims: To describe patients’ experiences of living with Dupuytren’s disease. Background. Dupuytren’s disease is a chronic, progressive deformity of the hand which limits active extension of the fingers due to advancing and irreversible flexion deformity. It is estimated that two million people are affected by the condition in the UK. Nurses may frequently encounter patients with this condition in a wide range of settings. However, the disease is neglected in the nursing literature and little is known about patients’ experience of living with the condition. Design: A phenomenological approach, using Coliazzi’s method, was employed. Method: Semi-structured interviews were conducted with six men and one woman diagnosed with Dupuytren’s disease. Results. Four interlinking themes emerged. Theme 1: Awareness of Dupuytren’s disease describes participants’ experiences of recognising and acknowledging the disease, which often did not occur until functional ability was restricted. Theme 2: Living with Dupuytren’s disease describes how patients coped with the disease and adapted their activities to maintain independence. Theme 3: Deciding on treatment illuminates how patients decided on treatment and highlights a lack of information and support from health professionals. Theme 4: Receiving treatment articulates participants’ experience of surgical treatment and post surgical rehabilitation. Conclusions: The findings revealed that people living with Dupuytren’s disease receive little information about their condition and possible treatment from health professionals yet high quality and accurate information is required for patients to understand their condition and the treatment options available. Relevance to clinical practice. People with Dupuytren’s disease do not always recognise their condition until it has significantly progressed. Following diagnosis they need accurate and up-to-date information about their condition and treatment options. Nurses have an important role to play in raising awareness of the disease, educating patients about its features and progression and enabling them to become active partners in decisions about treatment