What are the experiences of seeking, receiving and providing FGM-related healthcare?: perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence

Introduction: Female Genital Mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high income (OECD) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. Review methods: Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks. Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the JBI-QARI appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the GRADE-CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. Dissemination: The syntheses will be reported as per the ENTREQ statement. Two reviews will be published in peer-reviewed journals and an integrated report disseminated at stakeholder engagement events

Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

Limited evidence suggests experiences of immigrant women accessing and using UK maternity services were mixed but largely poor, and there were few rigorously evaluated interventions focused on improving care

To what extent do water reuse treatments reduce antibiotic resistance indicators? A comparison of two full-scale systems

Water reuse is an essential strategy for reducing water demand from conventional sources, alleviating water stress, and promoting sustainability, but understanding the effectiveness of associated treatment processes as barriers to the spread of antibiotic resistance is an important consideration to protecting human health. We comprehensively evaluated the reduction of antibiotic resistance genes (ARGs) and antibiotic-resistant bacteria (ARB) in two field-operational water reuse systems with distinct treatment trains, one producing water for indirect potable reuse (ozone/biologically-active carbon/granular activated carbon) and the other for non-potable reuse (denitrification-filtration/chlorination) using metagenomic sequencing and culture. Relative abundances of total ARGs/clinically-relevant ARGs and cultured ARB were reduced by several logs during primary and secondary stages of wastewater treatment, but to a lesser extent during the tertiary water reuse treatments. In particular, ozonation tended to enrich multi-drug ARGs. The effect of chlorination was facility-dependent, increasing the relative abundance of ARGs when following biologically-active carbon filters, but generally providing a benefit in reduced bacterial numbers and ecological and human health resistome risk scores. Relative abundances of total ARGs and resistome risk scores were lowest in aquifer samples, although resistant Escherichia coli and Klebsiella pneumoniae were occasionally detected in the monitoring well 3-days downgradient from injection, but not 6-months downgradient. Resistant E. coli and Pseudomonas aeruginosa were occasionally detected in the nonpotable reuse distribution system, along with increased levels of multidrug, sulfonamide, phenicol, and aminoglycoside ARGs. This study illuminates specific vulnerabilities of water reuse systems to persistence, selection, and growth of ARGs and ARB and emphasizes the role of multiple treatment barriers, including aquifers and distribution systems

Women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour

© 2019 Objective: To explore and synthesise evidence of women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour. Design: A systematic review following the Joanna Briggs Institute (JBI) meta-aggregative approach to qualitative evidence synthesis. Relevant databases were searched for literature published in English between 2000–19. Study quality was assessed using the JBI quality assessment tool for qualitative studies. Setting: Qualitative research conducted in OECD countries describing women's information needs, decision-making and/or experiences of membrane sweeping to promote spontaneous labour. Findings: One article met the criteria for inclusion. This article describes the experience of a membrane sweep given without consent. Key conclusions and Implications for practice: There is a lack of evidence around women's information needs, decision-making and experiences of membrane sweeping. This is concerning, especially in the context of rising rates of formal induction of labour. Further research is needed to investigate how women are being offered membrane sweeping and what information women need to make informed choices about membrane sweeping to promote spontaneous labour

A systematic review of supportive interventions to promote women's comfort and well-being during induction of labour

© 2020 John Wiley & Sons Ltd Aims: To evaluate the effectiveness of non-pharmacological non-invasive supportive interventions for impacts on women's comfort and well-being during induction of labour. Design: A quantitative systematic review without meta-analysis. Data Sources: Databases were searched for primary research published in English between 2000–2019: AMED, CINAHL, Medline, Maternity and Infant Care database, PsycINFO, and ProQuest. The quality of studies was evaluated using JBI levels of evidence and established critical appraisal tools. Studies describing measures of comfort, coping, and well-being for women during induction of labour were included. Results: Two articles met the criteria for inclusion. There is limited evidence to suggest that women having outpatient cervical priming were more satisfied with their experience than women having inpatient cervical priming and that outpatient cervical priming did not increase women's anxiety. A specifically designed information brochure explaining the induction process improved women's knowledge and understanding. Review Methods: The quantitative systematic review followed the Centre for Reviews and Dissemination guidelines and Cochrane Effective Practice and Organisation of Care guidance. Quality appraisal was conducted using JBI levels of evidence, Cochrane Risk of Bias, and other established tools. A narrative description of the quantitative data was undertaken. There was insufficient evidence to perform a narrative synthesis or meta-analysis due to the nature of the study designs and insufficient outcome data. Conclusions: Globally, the number of women having an induction of labour is increasing and there is a lack of evidence on the effectiveness of supportive interventions. Components of supportive care for women having induction of labour require urgent evaluation. Measurement tools which capture the complexity of supportive care for women having induction of labour need to be developed and validated. Impact: This is the first review to evaluate non-pharmacological, non-invasive supportive interventions for women having induction of labour. The findings of this review identify the urgent need to develop an evidence base for effective supportive

Mixed-methods systematic review: Childbearing women's views, experiences, and decision-making related to epidural analgesia in labour

© 2020 John Wiley & Sons Ltd Aims: To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour. Design: Mixed-methods systematic review. Data Sources: A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected. Results: Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent. Review Methods: Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE-CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed-methods synthesized findings was produced. Conclusion: Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth. Impact: The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision-making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high-income countries

Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn’s disease?: a systematic review

Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn’s disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn’s disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn’s disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC

Strategic engagement: new models of relationship management for academic librarians

How do we best bridge the gap between the Library and the diverse academic communities it serves? Librarians need new strategies for engagement. Traditional models of liaison, aligning solutions to disciplines, are yielding to functional specialisms, including a focus on building partnerships. This paper offers a snapshot of realignment across the Russell Group from subject support to relationship management. It then follows the journey of a newly-formed Faculty and School Engagement Team. Techniques are explored for building relationship capital, anchored to a model Strategic Engagement Cycle. Theory is contrasted with the challenges of securing real buy-in to new ways of working amid diverging agendas and assumptions, notably within the Library itself. Consideration is given to the retention of aspects of subject librarian roles. Investment in a relationship management function demands staunch and ongoing commitment to fulfil its promise, not only from its performers but from across the library community

Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: A cluster randomised controlled trial of knowledge transfer

Background: Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke. Methods and design: Metropolitan acute stroke units (ASUs) located in New South Wales, Australia will be stratified by service category (A or B) and, within strata, by baseline patient recruitment numbers (high or low) in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT). ASUs then will be randomised independently to either intervention or control groups. ASUs allocated to the intervention group will receive: unit-based workshops to identify local barriers and enablers; a standardised core education program; evidence-based clinical treatment protocols; and ongoing engagement of local staff. Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management. The following outcome measures will be collected at 90 days post-hospital admission: patient death, disability (modified Rankin Score); dependency (Barthel Index) and Health Status (SF-36). Additional measures include: performance of swallowing screening within 24 hours of admission; glycaemic control and temperature control. Discussion: This is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services

Data visualisation tools--a perspective from the pharmaceutical industry

This article is based on some general overviews gained from my own and AstraZeneca colleagues' experiences of data visualisation tools and techniques, as applied to chemical and patent information, with some suggestions on how commercially available tools might be improved. Examples of the tools to be discussed include the visualisation components of programs used to process search results, particularly for chemical information and patents data, as well as specific packages targeted as mining and analysis tools, and also reminders of some of the simpler, but still effective, options available to assist in identifying patterns and relationships in data, even without integration with the more sophisticated programs now available. Comments are included on development suggestions and possible reasons for limited take up of these tools are offered.Data visualisation tools Chemical information Patent information Competitive intelligence Intellectual property analysis