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

Evaluation intégrée des mesures agro-environnementales territorialisées à enjeu "qualité des eaux" sur la période 2007 à 2011 : le projet MAEVEAU

The MAEVEAU project has developed an approach for an integrated assessment of effectiveness of regionalized Agro-Environmental Measures (MAET) intended to preserve water quality in relation to pesticides. This approach investigates the concept of efficiency through a triple analysis: the impact (net effects), the environmental cost-effectiveness and the role of organizational factors in the contracting process. The impact is assessed by a quasi-experimental approach by counterfactuals and examines adaptation of the matching method to the regionalized MAET. Cost-effectiveness analysis is based on integrated modeling spatially distributed coupling the agro-hydrological SWAT model, pesticides pressure indicators and a bio-economic model optimizing gross margin. The effectiveness of organizational factors focuses on transaction costs, the role of collective action and preferences for alternative contracts.La recherche conduite dans le projet MAEVEAU a développé une démarche d'évaluation intégrée de l'efficacité des Mesures Agro-Environnementales Territorialisées (MAET) à enjeu préservation de la qualité de l'eau vis-à-vis des pesticides sur la période 2007 à 2011. La question scientifique traite le concept d'efficacité de la politique en s'appuyant sur une triangulation des approches: une évaluation de l'impact (c'est-à-dire des effets propres de la politique), une évaluation coût-efficacité environnementale et une évaluation du rôle des facteurs organisationnels dans le processus d'adhésion. L'impact est évalué par une approche quasi-expérimentale par contrefactuel et questionne l'adaptation de la méthode du matching à la territorialisation des MAET. L'analyse coût-efficacité s'appuie sur une modélisation intégrée spatialisée couplant modèle agro-hydrologique, indicateurs pesticides spatialisés et optimisation économique des marges brutes. L'efficacité des facteurs organisationnels s'est intéressée aux coûts de transaction, au rôle de l'action collective et aux préférences pour des contrats alternatifs

A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases

Background: Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. Methods: We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. Results: Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography – determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. Conclusion: The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography

Reducing alcohol harms whilst minimising impact on hospitality businesses: ‘Sweetspot’ policy options

Background During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised ‘sweetspot’ policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. Methods We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible ‘sweetspot’ policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). Results Interventions that raise the price of cheaper shop-bought alcohol appear promising as ‘sweetspot’ policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. Conclusions Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as ‘sweetspot’ alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses

Reducing alcohol harms whilst minimising impact on hospitality businesses: ‘Sweetspot’ policy options

Background During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised ‘sweetspot’ policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. Methods We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible ‘sweetspot’ policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). Results Interventions that raise the price of cheaper shop-bought alcohol appear promising as ‘sweetspot’ policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. Conclusions Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as ‘sweetspot’ alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses

Developing meta-ethnography reporting guidance for research and practice

Background:Meta-ethnography is a commonly used methodology for qualitative evidence synthesis. Research has identified that the quality of reporting of published meta-ethnographies is often poor and this has limited the utility of meta-ethnography findings to influence policy and practice.Objective(s):To develop guidance to improve the completeness and clarity of meta-ethnography reporting.Methods / DesignThe eMERGe study followed the recommended approach for developing health research reporting guidelines and used a systematic mixed methods approach. It comprised of: (1) a methodological systematic review of guidance in the conduct and reporting of meta-ethnography; (2) a review and audit of published meta-thnographies, along with interviews with meta-ethnography end-users, to identify good practice principles; (3) A consensus workshop and two eDelphi studies to agree guidance content; (4) development of the guidance table and explanatory notes.ResultsResults from the methodological systematic review and the audit of published meta-ethnographies revealed that more guidance was required around the reporting of all phases of meta-ethnography conduct, and in particular, the synthesis phases 4-6 (relating studies, translating studies into one another and synthesising translations). Following the guidance development process, the eMERGe Reporting Guidance was produced, consisting of 19 items grouped into the 7 phases of meta-ethnography.LimitationsThe finalised Guidance has not yet been evaluated in practice, therefore it is not possible at this stage to comment on their utility. However, we look forward to evaluating their uptake and usability in the future. ConclusionsThe eMERGe Reporting Guidance has been developed following a rigorous process in line with guideline development recommendations. The guidance is intended to improve the clarity and completeness of reporting of meta-ethnographies, to facilitate use of their findings to inform the design and delivery of services and interventions in health, social care and other iv fields. The eMERGe project developed a range of training material to support use of the guidance, which is freely available at www.emergeproject.org.Future workMeta-ethnography is an evolving qualitative evidence synthesis methodology, and future research will refine the guidance to accommodate future methodological developments. We will also investigate the impact of the eMERGe reporting guidance with a view to updating the guidance

Determination de la nature et de la quantite des phases cristallisees formees au cours du recuit de verres complexes

SIGLEAvailable from CEN Saclay, Service de Documentation, 91191 - Gif-sur-Yvette Cedex (France) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc