What if something goes wrong? A grounded theory study of parents’ decision-making processes around mode of breech birth at term gestation

Objective. To explore factors that influence parents' decision-making for mode of breech birth at term gestation. Design. A grounded theory study conducted using a constructivist approach. Semi-structured telephone interviews were recorded and transcribed verbatim and analysed using the software NVivo for Mac version 11.4.0. Setting. England, UK. Participants. Twelve parents with breech presentation confirmed by ultrasound at ≥36+0 weeks gestation were recruited from several UK social media forums. Findings. Two core themes impacting on a parent's decision-making process for term breech birth were identified. Firstly, a framework of potential influences including partner and relationship, family and friends, health professionals, own birth culture, self, shared experiences and the time available for decision-making. Secondly, mortality salience, or parental focus on risk of potential injury or death associated with birth, was found to be central to every participant's narrative. Key conclusions. This study highlights the individuality and wider framework of parent's decision-making influences for term breech birth, and demonstrates to care providers the conflicted emotions that may be experienced. The findings of this study may guide midwives and other professionals in providing person-centered, non-judgmental, balanced and evidence-based mode of term breech birth counselling. Implications for practice. Health professionals should adopt a parentcentred approach to counselling for mode of term breech birth, considering parents' wider influences in their decision-making and the fear of injury or death surrounding both vaginal breech birth and caesarean section. They can also facilitate parents to understand the influences that might be guiding their own decision-making

Exploring the lived experience of having a hip fracture : identifying patients’ perspectives on their health care needs

Hip fracture is one of the most common, serious injuries in old people in England, and with a growing older population it is increasingly important to understand the impact of hip fracture from the patient perspective in order to develop relevant and appropriate healthcare services. The aim of this study was to explore the lived experience of hip fracture in older people in England to inform service development. A scoping review of the literature highlighted the lack of current evidence for hip fracture experience in England, with a particular dearth of evidence concerning the lived experience of hip fracture following discharge from hospital. However, the reviewed highlighted some international evidence around the lived experience of hip fracture while in hospital, and during initial rehabilitation. A meta-synthesis of the data was therefore conducted providing a more interpretive approach to analysing this data, and establishing a better understanding of the current literature on hip fracture patient experiences. The gaps in the evidence reported in the current evidence base provided a rationale for a qualitative study. Hip fracture patients were interviewed at their place of residence 12 to 16 weeks after surgery. Interpretative phenomenological analysis methodology was used for 24 interviews, and patient and public involvement was integral to the study. The study reported the impact on self, and the role of biographical disruption in triggering feelings of incompetency and frustration, particularly in those who had been relatively active prior to hip fracture. Participants perceived that others labelled them as ‘old’ and ‘disabled’ as they became less mobile and more dependent on those around them. Macro health care policies limited individualised care practices, and a greater emphasis is needed on discharge planning and continuity of care after discharge home. The study also reported the need for improved information provision and verbal communication throughout the care trajectory, and a key worker to co-ordinate their care to provide realistic expectations, reassurance and support throughout the recovery period is recommended. A model of continuity of care is presented to provide insight for the development of patient centred health care for this population

Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK

Written information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online Patient Information Materials (PIMs) in relation to diet and nutrition for pelvic cancer patients. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through Patient and Public Involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) Vs 23 (11), P<0.001]. Seventy-three percent of PIMs had a readability score within acceptable levels (6th-8th grade; reading ability of 11-14 year-olds). PPI contributors found most PIMs useful and comprehensive but lacking specific information needed to meet individual needs. There is limited availability of online PIMs for cancer survivors and even fewer tailored to pelvic cancers. Most materials have comprehensive content and acceptable readability. Some PIMs may require improvemen

Optimisation of Mass Transport Parameters in a Polymer Electrolyte Membrane Electrolyser Using Factorial Design-of-Experiment

Optimised mass transport is crucial for high current density operations in Polymer Electrolyte Membrane Water Electrolysers (PEMWEs). This study investigates the effect and interactions of mass transport parameters on the performance of a PEMWE using a 2 full-factorial Design-of-Experiments (DoE) approach with replication. The effects of anode flow-field design, anode porous transport layer (PTL) and water flow rate on the cell performance were studied. At 95% confidence level, the result shows that all three factors and their two-way interactions significantly affect the cell performance. Among them, the water flow rate showed the most significant contribution, followed by the interaction between the flow-field and the PTL. A regression model was developed to relate the cell performance and the mass transfer parameters. Results of analysis of variance (ANOVA), regression analysis and R test indicated good accuracy of the model. The best PEMWE cell performance was obtained with a parallel flow-field configuration, a small average pore diameter of PTL and high anode water flow rate. The DoE is shown to be a suitable method for investigating interactions and optimising the operating conditions to maximise PEMWE performance

Development of an e-health app to support women prescribed adjuvant endocrine therapy after treatment for breast cancer

Background. Adjuvant endocrine therapy (AET) is prescribed to women for 5–10 years after treatment for estrogen receptor positive (ER+ve), early-stage breast cancer. AET has proven effectiveness in reducing the risk of recurrence of breast cancer and mortality. However, adherence is known to be suboptimal with around 20% discontinuing by 2 years and up to 50% discontinuing by 5 years. Interventions are needed to support women taking AET after breast cancer. The aim of this study was to develop and pilot test an e-health app for this population. Methods. Two focus groups (n=15) and five interviews were conducted with women following treatment for early-stage breast cancer to assess the likely acceptability of an e-health app and to inform the content (Phase I). Following development of a prototype e-health app, a simple heuristic usability test was completed by five women in order to identify any design usability problems (Phase II). A further 18 women used the app for 1 month between July and August 2016, after which they were interviewed by telephone to collect their experiences and views of the app (Phase III). Results. The prototype e-health app included evidence-based information on effectiveness of AET, an electronic side-effects diary, a peer support forum, a repeat prescription reminder, suggested strategies for facilitating adherence and managing any side effects that occur, and a link to further evidence and useful organizations for further information and support. The app was received positively by women. Women found the app useful as it emphasized the importance of taking AET, helped them manage their side effects and provided details of support organizations, while offering empathy and exchange of suggestions for self-management strategies through the peer support forum. Conclusion. Overall, findings suggest that this novel e-health app has potential as a feasible medium for promoting adherence to AET. Future research should evaluate the efficacy of the app in supporting women and promoting adherence

Pre‐emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery

Background: Postoperative pain is a common consequence of surgery and can have deleterious effects. It has been suggested that the administration of opioid analgesia before a painful stimulus may improve pain control. This can be done in two ways. We defined 'preventive opioids' as opioids administered before incision and continued postoperatively, and 'pre‐emptive opioids' as opioids given before incision but not continued postoperatively. Both pre‐emptive and preventive analgesia involve the initiation of an analgesic agent prior to surgical incision with the aim of reducing intraoperative nociception and therefore postoperative pain.Objectives: To assess the efficacy of preventive and pre‐emptive opioids for reducing postoperative pain in adults undergoing all types of surgery.Search methods: We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED, and CINAHL (up to 18 March 2018). In addition, we searched for unpublished studies in three clinical trial databases, conference proceedings, grey literature databases, and reference lists of retrieved articles. We did not apply any restrictions on language or date of publication.Selection criteria: We included parallel‐group randomized controlled trials (RCTs) only. We included participants aged over 15 years old undergoing any type of surgery. We defined postincision opioids as the same intervention administered after incision whether single dose (as comparator with pre‐emptive analgesia) or continued postoperatively (as comparator with preventive analgesia) (control group). We considered studies that did and did not use a double‐dummy placebo (e.g. intervention group received active drug before incision and placebo after incision; control group received placebo before incision and active drug after incision).Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were: early acute postoperative pain (measured within six hours and reported on a 0‐to‐10 scale) and respiratory depression. Our secondary outcomes included: late acute postoperative pain (24 to 48 hours and reported on a 0‐to‐10 scale), 24‐hour morphine consumption, and adverse events (intraoperative bradycardia and hypotension). We used GRADE to assess the quality of the evidence for each outcome.Main results: We included 20 RCTs, including one unpublished study with 1343 participants. Two studies were awaiting classification as the full text for these studies was not available. One study evaluated pre‐emptive opioids, and 19 studies evaluated preventive opioids. We considered only one study to be at low risk of bias for most domains. The surgeries and opioids used varied, although roughly half of the included studies were conducted in abdominal hysterectomy, and around a quarter used morphine as the intervention. All studies were conducted in secondary care.Pre‐emptive opioids compared to postincision opioidsFor pre‐emptive opioids in dental surgery, there may be a reduction in early acute postoperative pain (mean difference (MD) ‐1.20, 95% confidence interval (CI) ‐1.75 to ‐0.65; 40 participants; 1 study; low‐quality evidence). This study did not report on adverse events (respiratory depression, bradycardia, or hypotension). There may be a reduction in late acute postoperative pain (MD ‐2.10, 95% CI ‐2.57 to ‐1.63; 40 participants; 1 study; low‐quality evidence). This study did not report 24‐hour morphine consumption.Preventive opioids compared to postincision opioidsFor preventive opioids, there was probably no reduction in early acute postoperative pain (MD 0.11, 95% CI ‐0.32 to 0.53; 706 participants; 10 studies; I2 = 61%; moderate‐quality evidence). There were no events of respiratory depression in four studies (433 participants). There was no important reduction in late acute postoperative pain (MD ‐0.06, 95% CI ‐0.13 to 0.01; 668 participants; 9 studies; I2 = 0%; moderate‐quality evidence). There may be a small reduction in 24‐hour morphine consumption (MD ‐4.91 mg, 95% CI ‐9.39 mg to ‐0.44 mg; 526 participants; 11 studies; I2 = 82%; very low‐quality evidence). There may be similar rates of bradycardia (risk ratio (RR) 0.33, 95% CI 0.01 to 7.88; 112 participants; 2 studies; I2 = 0%; low‐quality evidence) and hypotension (RR 1.08, 95% CI 0.25 to 4.73; 88 participants; 2 studies; I2 = 0%; low‐quality evidence).Authors' conclusions: Due to the low quality of the evidence, we are uncertain whether pre‐emptive opioids reduce postoperative pain. Based on the trials conducted thus far, there was no clear evidence that preventive opioids result in reductions in pain scores. It was unclear if there was a reduction in morphine consumption due to very low‐quality of evidence. Too few studies reported adverse events to be able to draw any definitive conclusions. Once assessed, the two studies awaiting classification may alter the conclusions of the review

Temporal Changes in Cd Sorption and Plant Bioavailability in Compost-Amended Soils

The application of Cd-contaminated phosphate fertiliser has enriched concentrations of this non-essential element in many agricultural soils. Consequently, concentrations of the metal in some agricultural products exceed the Maximum Limit in foods. Composts can reduce the transfer of Cd from soil to plants; however, it is unclear how long this beneficial effect endures. We aimed to determine temporal changes of phytoavailable Cd in two market garden soils (an Allophanic Orthic Granular Soil and a Recent Silt Loam). Soils were amended with either municipal green waste compost or sawdust and animal waste compost at a rate of 2.5% w/w under three incubation regimes: at 19 °C, at 30 °C, and at 30 °C with additional N added as urea at 0.6 g urea/kg soil added over 1 year. Each replicate was sampled after 1, 5, 9, 13, 21, 31, and 49 weeks, and phytoavailable Cd was estimated through 0.05 M Ca(NO3)2 extraction. Seed potato (Solanum tuberosum), ‘Nadine’ variety, was grown in the Pukekohe Allophanic Orthic Granular Soil, freshly amended with municipal compost and the same soil aged for one year. The concentration of Cd in all samples was analysed using an ICP-OES (Inductively Coupled Plasma-Optical Emission Spectrometer). The C concentration in the soil—compost mixtures decreased over the year, with the greatest decreases occurring in the soils incubated at 30 °C with added N. Unexpectedly, the concentration of Ca(NO3)2-extractable Cd in the compost-amended soils did not increase over time and in some cases even decreased. This was confirmed through a pot experiment, which showed the Cd concentration in potato was reduced by 50% in both the freshly amended soil and the amended soil aged for one year. Cadmium immobilisation in soils might be due to both the sorption of Cd by organic matter and the occlusion of sorbed Cd by oxy-hydroxides of iron and aluminium. Over 49 weeks, soluble Cd does not increase as organic matter oxidises. The application of municipal compost to soil will reduce both plant Cd solubility and plant Cd uptake for at least one year in the soils tested

The psychosocial experiences of human papillomavirus (HPV) positive oropharyngeal cancer patients following (chemo)radiotherapy : a systematic review and meta-ethnography

Objective. The UK incidence of oropharyngeal cancer has risen sharply over the last 30 years with an increase in human papillomavirus (HPV) associated diagnoses, most prevalent in younger, working age populations. This meta-ethnography explores the psychosocial needs of HPV+ve oropharyngeal cancer patients during early recovery following (chemo)radiotherapy. Methods. Meta-ethnography methods were used, based on the approach of Noblit and Hare. Systematic searches for relevant qualitative studies were conducted in five electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane database) between 2010 and 2021, followed by citation searching. Results. Twenty-three papers exploring the psychosocial needs of HPV+ve oropharyngeal cancer patients after treatment were included. Findings were synthesised to develop five constructs: ‘gaps in continuity of support from healthcare professionals’ reflecting unmet needs; ‘changes to self-identity’ revealing the comprehensive disruption of this disease and treatment; ‘unrealistic expectations of recovery’ highlighting the difficulty of preparing for the impact of treatment; ‘finding ways to cope’ describing the distinct complexity of this experience; and ‘adjusting to life after the end of treatment’ exploring how coping strategies helped patients to regain control of their lives. Conclusions. Completing (chemo)radiotherapy signalled a transition from hospital-based care to home-based support, challenging patients to address the constructs identified. An unexpectedly difficult and complex recovery meant that despite a favourable prognosis, poor psychosocial well-being may threaten a successful outcome. The provision of tailored support is essential to facilitate positive adjustment