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A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services and treatments
Get PDFBACKGROUND: Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them.OBJECTIVES: 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services?SEARCH METHODS: Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022.SELECTION CRITERIA: To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families.DATA COLLECTION AND ANALYSIS: We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain.MAIN RESULTS: We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work.AUTHORS' CONCLUSIONS: We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.</p
Relational values in locally adaptive farmer-to-farmer extension: how important?
Get PDFValues held in agricultural extension systems determine which extension goals can be reached. Globally changing socio-ecological contexts require a paradigm shift in agricultural extension systems from a top-down approach dominated by instrumental values to achieve the primary goal of increasing yields, to a more site-specific relational and participatory approach that induces locally adaptive use of sustainable agricultural practices. A literature review was conducted to understand how relational values in farmer-to-farmer extension align with participatory agricultural extension systems. Relevance, trust, and place attachment are the main relational values expressed in farmer-to-farmer extension where participatory processes incorporate farmers' livelihood outcomes in the transformational goals of agricultural extension. Recognizing and strengthening the relational values in farmer-to-farmer extension, based on different contexts, will likely support the development of locally adapted knowledge and innovations, and provide a basic rationale for building communication strategies, colearning, and supporting behavioral change of all agricultural extension actors
Governing health care:the uses and limits of governmentality in the National Health Service in England
Get PDFUsing examples from the National Health Service in England, this paperillustrates key features of contemporary healthcare governance: theway decisions are hidden in places that are ‘in between’ and ‘out ofreach’; the enrolment of doctors in governing; and the important roleplayed by ‘boring things’, such as power point slides, flow charts, andforms. The essay shows how anthropological proximity and perspectivescan extend and deepen understanding of contemporary politicalpower. It does this firstly by showing the importance of agency in theoperation of governmentality, and secondly by illuminating the limitsof governmentality. The different elements of governing assemblages,such as global management experts, medical leaders, forms of knowledgeand analytical technologies, are brought together through thestrategic act of framing. Frames are contested and resisted, requiringmore visible forms of control
What bit the Ancient Egyptians? Niche modelling to identify the snakes described in the Brooklyn medical papyrus
Get PDFThe Brooklyn Papyrus is a medical treatise from Ancient Egypt (~660-330 BCE)focusing on snakebite. Herpetologists have proposed identifications for many of the animals it describes, but some remain uncertain partly because the species no longer live in Egypt. This paper uses niche modelling to predict the palaeodistributions of ten of these snake species, to test some proposed identifications. Occurrence records and environmental variables were used to generate maximum entropy models for each species in the present day and the mid-Holocene (~4,000 BCE). Our models performed very well, generating AUC scores ≥0.867 and successfully predicting species’ current ranges. Nine species’ predicted palaeodistributions included areas within Ancient Egypt, and four (Bitis arietans, Dolichophis jugularis, Macrovipera lebetina and Daboia mauritanica) were within modern Egypt. Daboia palaestinae was also predicted to occupy a patch of suitable habitat inside modern Egypt, but separate from the species’ core range. The tenth species, Causus rhombeatus, would have been present in kingdoms that were the Ancient Egyptians’ regular trading partners. We therefore conclude that all ten species modelled in this study could have bitten Ancient Egyptian people. Our study demonstrates the usefulness of niche modelling ininforming debates about the species ancient cultures may have interacted with
Best step-up treatments for children with uncontrolled asthma: A systematic review and network meta-analysis of individual participant data
Get PDFIntroduction: There is uncertainty about the best treatment option for children/adolescents with uncontrolled asthma despite inhaled corticosteroids, and international guidelines make different recommendations.Objectives: We evaluated the pharmacological treatments to reduce asthma exacerbations and symptoms in uncontrolled patients Methods: We searched MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Embase, the Web of Science platform, NICE Technology Appraisals, the NIHR HTA series, the WHO International Clinical Trials Registry Platform, conference abstracts and internal clinical trial registers (1 July 2014 to 5 May 2023) for randomised controlled trials of participants screening. Studies before July 2014 were retrieved from previous systematic reviews/contact with authors. Patients had to be randomised to any dose of ICS alone or combined with long-acting β2-agonists (LABAs) or combined with leukotriene receptor antagonists (LTRAs); LTRAs alone; theophylline; placebo. Primary outcomes were exacerbation and asthma control. The interventions evaluated were ICS (Low/Medium/High dose); ICS+LABA; ICS+LTRA; LTRA alone; theophylline; placebo.Results: Of the 4708 publications identified, 144 trials were eligible. Individual participant data were obtained from 29 trials, and aggregate data from 19 trials. Compared to ICS Low, ICS Medium+LABA was associated with the lowest odds of exacerbation (OR 0.44 [95% CrI 0.19–0.90]) and with an increased FEV1 (MD 0.71 [95% CrI 0.35–1.06]). Treatment with LTRA was the least preferred. No apparent differences were found for asthma control.Conclusion: Uncontrolled children/adolescents on low-dose ICS should be recommended a change to medium-dose ICS+LABA to reduce the risk for exacerbation and improve lung function
Health economics of health justice partnerships: A rapid review of the economic returns to society of promoting access to legal advice
Get PDFBackground: Welfare legal problems and inadequate access to support services follow both the socioeconomic and the health inequalities gradients. Health Justice Partnership (HJP) is an international practitioner-led movement which brings together legal and healthcare professionals to address the root causes of ill health from negative social determinants. The aim of this paper was to identify the current evidence base for the cost-effectiveness of HJP or comparable welfare advice services.Methods: A rapid review format was used, with a literature search of PubMed, CINAHL, ASSIA, PsycINFO, Medline, Cochrane Library, Global Health and Web of Science identifying 496 articles. After removal of duplicates, 176 papers were screened on titles and abstracts, and 20 papers met the eligibility criteria. Following a full-text screening, a further 14 papers were excluded due to lack of economic evaluations. Excluded papers' reference lists were scanned, with a further 3 further papers identified which met the inclusion criteria. A final pool of nine studies were included in this review.Results: Studies focused on the financial benefit to service users, with only three studies reporting on cost effectiveness of the interventions. Only one study reported on the economic impact of change of health in service users and one study reported on changes in health service use.Conclusion: This review highlights the current evidence gap in evaluating the cost-effectiveness of adequate access to free legal welfare advice and representation. We propose that an interdisciplinary research agenda between health economics and legal-health services is required to address this research gap
Delivery of antimicrobial stewardship competencies in UK pre-registration nurse education programmes: a national cross-sectional survey
Get PDFBackgroundRegistered nurses perform numerous functions critical to the success of antimicrobial stewardship but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards highlight nurses require antimicrobial stewardship knowledge and skills.AimTo explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes.MethodA cross-sectional survey design. Data were collected between March and June 2021.FindingsLecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes with competencies in infection prevention and control, patient centred care, and interprofessional collaborative practice taking precedent over those pertaining to the use, management, and monitoring of antimicrobials. On-line learning and teaching surrounding hand hygiene, personal protective equipment, and immunisation theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups.ConclusionThere is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skill in order to practice collaboratively.<br/
Enhancing fishery-dependent information in data-poor fisheries; integrating gear-in–gear-out sensors and mobile reporting technology in a mixed Irish Sea static-gear fishery
Get PDFInshore static gear fisheries such as those targeting predominately shellfish play an import socio-economic role across the northeast Atlantic. Despite this, assessment techniques are heavily reliant on fishery dependent data which is typically aggregated over large spatial scales and lacking in key environmental and biotic data. In this study, we trialled the implementation of an enhanced electronic reporting system (EERS) and gear-in–gear-out (GIGO) technology in a data-limited, mixed species, static gear fishery for brown crab Cancer pagurus and European lobster Homarus gammarus. EERS/GIGO systems were deployed on two commercial vessels for 12 months and collected data from 812 strings, equating to 29826 pots, with precise geo-located landings per unit effort (LPUE) and environmental data. Cluster analysis identified spatially distinct patterns in fishing activity, corresponding to different target species. Generalized additive modelling was used to investigate the effect of environmental variables, inter-specific interactions and geo-location on LPUE in both species. Sea bottom temperatures had a significant positive effect on LPUE in both C. pagurus and H. gammarus. In addition, GAM analysis showed the importance of inter-specific interactions; increases in capture of competing non-target commercial species (H. gammarus/C. pagurus) resulted in the decreases in target species LPUE (C. pagurus/H. gammarus).The significant effect of environmental variables and inter-specific interactions demonstrate the value of understanding these interactions in order to produce robust standardized LPUE metrics. The EERS/GIGO system successfully demonstrated its application, and value in collecting geospatially defined fishery dependent data in historically data limited fisheries. Co-development of such an approach between fisheries administrations and industry has the potential to significantly enhance data collection and management in many data poor fisheries
Temporal Patterns of Honeybee Foraging in a Diverse Floral Landscape Revealed Using Pollen DNA Metabarcoding of Honey
Get PDFUnderstanding the plants pollinators use through the year is vital to support pollinator populations and mitigate for declines in floral resources due to habitat loss. DNA metabarcoding allows the temporal picture of nectar and pollen foraging to be examined in detail. Here, we use DNA metabarcoding to examine the forage use of honeybees (Apis mellifera L.) within a florally diverse landscape within the UK, documenting the key forage plants used and seasonal progression over two years. The total number of plant taxa detected in the honey was 120, but only 16 of these were found with a high relative read abundance of DNA, across the main foraging months (April–September). Only a small proportion of the available flowering genera in the landscape were used by the honeybees. The greatest relative read abundance came from native or near-native plants, including Rubus spp., Trifolium repens, the Maleae tribe including Crataegus, Malus, and Cotoneaster, and Hedera helix. Tree species were important forage in the spring months, followed by increased use of herbs and shrubs later in the foraging season. Garden habitat increased the taxon richness of native, near-native and horticultural plants found in the honey. Although horticultural plants were rarely found abundantly within the honey samples, they may be important for increasing nutritional diversity of the pollen forag