The lived experience of working with people with eating disorders: A meta-ethnography

Objective Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. Method A meta‐synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta‐ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. Results Thirty‐seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: “Coping with caring without curing.” This was underpinned by the following third‐order concepts: (a) “The dissonance and discomfort of being a helper struggling to help,” (b) “Defending against the dissonance,” and (c) “Accepting the dissonance to provide safe and compassionate care.” These concepts were used to develop a line‐of‐argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. Discussion Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness

The views and experiences of patients and health‐care professionals on the disclosure of adverse events: A systematic review and qualitative meta‐ethnographic synthesis

Objective: To synthesize the literature on the views and experiences of patients/family members and health-care professionals (HCPs) on the disclosure of adverse events. Methods: Systematic review of qualitative studies. Searches were conducted in MEDLINE, Embase, PubMed, CINAHL and PsycINFO. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Qualitative data were analysed using a meta-ethnographic approach, comprising reciprocal syntheses of ‘patient’ and ‘health-care professional’ studies, combined to form a lines-of-argument synthesis embodying both perspectives. Results: Fifteen studies were included in the final syntheses. The results highlighted that there is a difference in attitudes and expectations between patients and HCPs regarding the disclosure conversation. Patients/family members expressed a need for information, the importance of sincere regret and a promise of improvement. However, HCPs faced several barriers, which hindered appropriate disclosure practices. These included difficulty of disclosure in a blame culture, avoidance of litigation, lack of skills on how to conduct disclosure and inconsistent guidance. A lines-of-argument synthesis is presented that identified both the key elements of an ideal disclosure desired by patients and the facilitators for HCPs, which can increase the likelihood of this taking place. Conclusions: Although patients/family members and HCPs both advocate disclosure, several barriers prevent HCPs from conducting disclosure effectively. Both groups have different needs for disclosure. To meet patients’ requirements, training on disclosure for HCPs and the development of an open, transparent culture within organizations are potential areas for intervention

Challenges and support needs of parents and children when a parent is at end of life: A systematic review

Background: Preparing children for the death of a parent is challenging. Parents are often uncertain if and how to communicate and support their children. Many parents feel it is protecting their children by not telling them about the prognosis. Children less prepared for parental death from a terminal illness are more susceptive to later adversities. To facilitate coping and moderate for such adversities, there is a need to gain insight and understand the experience and challenges confronted by families. Aim: This review synthesised evidence on the experiences of parents and children when a parent is at end of life to discern their challenges, support needs and factors that facilitated good practice. Design: Mixed-methods systematic review. Data sources: Four electronic databases (CINAHL, PubMed, PsycINFO and Ovid MEDLINE) using MeSH terms and word searches in October 2018. Studies were not limited by year of publication, language or country. Grey literature searches were also completed on Google Scholar and OpenGrey. Results: In all, 7829 records were identified; 27 qualitative and 0 quantitative studies met the inclusion criteria. Eight descriptive themes were identified, further categorised into two broad themes: (1) barriers and facilitators in sharing the news that a parent is dying and (2) strategies to manage the changing situation. Conclusion: Lack of understanding in relation to the parent’s prognosis, denial and feeling ill-equipped were suggested as barriers for parents to share the news with their children. Engagement with social networks, including extended family relatives and peers, and maintaining routines such as attending school were suggested supportive by parents and children. Findings are limited primarily to White, middle-class two-parent families. A number of areas for future research are identified.</p

Artificial Intelligence and Liver Transplant:Predicting Survival of Individual Grafts

The demand for liver transplantation far outstrips the supply of deceased donor organs, and so, listing and allocation decisions aim to maximize utility. Most existing methods for predicting transplant outcomes use basic methods, such as regression modeling, but newer artificial intelligence (AI) techniques have the potential to improve predictive accuracy. The aim was to perform a systematic review of studies predicting graft outcomes following deceased donor liver transplantation using AI techniques and to compare these findings to linear regression and standard predictive modeling: donor risk index (DRI), Model for End‐Stage Liver Disease (MELD), and Survival Outcome Following Liver Transplantation (SOFT). After reviewing available article databases, a total of 52 articles were reviewed for inclusion. Of these articles, 9 met the inclusion criteria, which reported outcomes from 18,771 liver transplants. Artificial neural networks (ANNs) were the most commonly used methodology, being reported in 7 studies. Only 2 studies directly compared machine learning (ML) techniques to liver scoring modalities (i.e., DRI, SOFT, and balance of risk [BAR]). Both studies showed better prediction of individual organ survival with the optimal ANN model, reporting an area under the receiver operating characteristic curve (AUROC) 0.82 compared with BAR (0.62) and SOFT (0.57), and the other ANN model gave an AUC ROC of 0.84 compared with a DRI (0.68) and SOFT (0.64). AI techniques can provide high accuracy in predicting graft survival based on donors and recipient variables. When compared with the standard techniques, AI methods are dynamic and are able to be trained and validated within every population. However, the high accuracy of AI may come at a cost of losing explainability (to patients and clinicians) on how the technology works

Communities of practice: a systematic review and meta-synthesis of what it means and how it really works among nursing students and novices

Aims and Objectives: To evaluate the enablers, barriers and impact that communities of practice have on novice nurses and students learning to become registered nurses.Background: Communities of practice have formed the basis for conceptualising the process of learning that occurs among groups of people within a place of work-a mainstay of healthcare practice. There is a dearth of literature that focuses specifically on the outcomes from student and novice engagement with existing communities of practice.Design: Systematic review and Meta-synthesis.Methods: MEDLINE, PubMed, EMBASE, CINAHL, ProQuest, Scopus and PsycINFO databases were accessed between 1997-2019. The screening and selection of studies were based on eligibility criteria and methodological quality assessment using the Critical Appraisal Skills Programme tool for qualitative research. Meta-synthesis was grounded in the original experiences and collectively synthesised into meaningful themes. The review follows the PRISMA reporting guidelines and PRISMA checklist.Results: The findings highlight three major themes and included enablers for successful communities of practice, barriers to successful communities of practice, and success in action as described by students and novice nurses.Discussion: We suggest successful communities of practice occur when safe and supported spaces ensure students and novices feel comfortable to experiment with their learning, and we emphasise the benefits of having more novice nurses situated within close proximity and under the direct influence of the established practices of more experienced or core group of peers.Relevance to Clinical Practice: Communities of practice that function successfully create an environment that prioritises the embedding of novices into the broader group. In so doing, students and novice nurses feel supported, welcomed, empowered, and able to make the transition from student to colleague and novice nurse to more experienced nurse. It allows them to experiment with ever new ways of fulfilling the role, while aiding better clinical outcomes

Relaxation and chronic pain: A critical review

YesChronic non-malignant pain is a global condition with a complex biopsychosocial impact on the sufferers. Relaxation skills are commonly included as part of a pain management programme, which is currently the recommended evidence-based intervention for this group of patients. However, there is little evidence behind the choice of relaxation method implemented, or their effectiveness. The aim of this study was to investigate the effectiveness of relaxation skills in the management of chronic non-malignant pain, related to pain intensity and health-related quality of life. A systematic literature review was conducted using MEDLINE, CINAHL, AMED, PEDro and PsycARTICLES. The Cochrane, DARE and Trip databases were also accessed, and searches were carried out using the terms (relaxation OR relaxation therapy OR relaxation training) AND (pain OR chronic pain). Following critical appraisal, ten studies met the inclusion criteria. Three studies reported a decrease in pain intensity as a result of the relaxation intervention, whilst only one study reported an improvement in health-related quality of life. Progressive muscle relaxation was the most commonly implemented method throughout, although its method of delivery differed between studies. There is little evidence for the use of relaxation as a stand-alone intervention for pain intensity and health-related quality of life for patients with musculoskeletal chronic non-malignant pain. More research is needed to determine its effectiveness

Patient-Reported Outcome Measures for Abdominal Aortic Aneurysm: A systematic review and qualitative evidence synthesis

Background: The aim was to identify and evaluate existing patient reported outcome measures (PROMs) for use in patients with an abdominal aortic aneurysm (AAA) to inform the selection for use in surgical practice. Methods: Two systematic reviews were conducted: a systematic review to identify valid, reliable and acceptable PROMs for patients with AAA and a qualitative evidence synthesis to assess the relevance to patients of the identified PROMs items. PROMs studies were evaluated for their psychometric properties using established assessment criteria and their methodological quality using the COSMIN checklist. Qualitative studies were synthesised using framework analysis and identified concepts were then triangulated using a triangulation protocol with the item concepts of the identified PROMs. Results: Four PROMs from three studies were identified in the first review; the SF-36, the Australian Vascular Quality of Life Index, the AneurysmDQoL and AneurysmSRQ. None of the identified PROMs had undergone a rigorous psychometric evaluation within the AAA population. Four studies were included in the qualitative synthesis, from which 28 concepts important to patients with an AAA were identified. The AneurysmDQoL and the AneurysmSRQ together provided the most comprehensive assessment of these concepts. Fear of rupture, control, ability to forget about the condition and size of aneurysm were all concepts identified in the qualitative studies but not covered by items on the identified PROMs. Conclusion: Further research is needed to develop PROMs that are reliable, valid and acceptable to patients for use in surgical practice for AAA

A systematic scoping review and textual narrative synthesis of long-term health-related quality of life outcomes for adolescent idiopathic scoliosis

Introduction Idiopathic scoliosis is a musculoskeletal condition leading to deformity of the spinal column. There is a strong evidence reporting short term health-related quality of life outcomes, but less is known about the longer-term impact of adolescent idiopathic scoliosis (AIS). This paper reports the current evidence on long-term non-clinical outcomes of AIS. Method A systematic scoping literature review, combining descriptive and textual narrative synthesis was undertaken. Studies were included if they sampled or followed up participants at least 10 years after diagnosis and / or treatment, contained health-related quality of life data that could be extracted, where the intervention (or diagnosis in the case of untreated) occurred after 1980 and where data was extractable for modern rod and screw or fusion techniques, non-surgical interventions or untreated patients. Results Twenty-three studies were included. Overall, the HRQOL measures utilised by these studies suggest that HRQOL is not related to participant demographic or AIS characteristics or type or extent of surgical intervention. Some studies suggest that those with AIS scored worse than controls. Discussion Results suggest that AIS participants had a generally good quality of life, although this was often worse than those without AIS. No other clear relationships were found. Importantly, the available literature fails to address more fundamental questions about how HRQOL is conceptualised for those with AIS, and there is value in pursuing qualitative inquiry in this area

The impact of the arts in social work education: a systematic review

Evidence on the effectiveness of arts-based approaches in professional education has been gathering momentum in the last decade embracing disciplines such as medicine, the allied professions, social work and social care. Key texts have emerged promoting the use of the arts in professional education and there have been some attempts to capture empirical evidence on its value. This paper reports on a systematic review of the current body of knowledge on the impact of the arts in social work education. We introduce the rationale for undertaking a systematic review and the methodology and approach used. We then discuss the three significant themes from our synthesis of the evidence reviewed. These were; positioning social work practice through linking micro and macro thinking; the cultivation of leadership beyond verbal reasoning and art as pedagogy. The findings are discussed in the context of what the arts can offer challenges in social work education