Tools for assessing the methodological limitations of a QES-a short note.

The increasing prevalence and application of qualitative evidence syntheses (QES) in decision-making processes underscore the need for robust tools to assess the methodological limitations of a completed QES. This commentary discusses the limitations of three existing tools and presents the authors' efforts to address this gap. Through a simple comparative analysis, the three tools are examined in terms of their coverage of essential topic areas. The examination finds that existing assessment tools lack comprehensive coverage, clarity, and grounding in qualitative research principles. The authors advocate for the development of a new collaboratively developed evidence-based tool rooted in qualitative methodology and best practice methods. The conclusion emphasizes the necessity of a tool that can provide a comprehensive judgement on the methodological limitations of a QES, addressing the needs of end-users, and ultimately enhancing the trustworthiness of QES findings in decision-making processes.

Patient's and healthcare provider's experiences with Opioid Maintenance Treatment (OMT): a qualitative evidence synthesis.

BACKGROUND: Opioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence. However, drop-out rates are high, and many patients do not reach desired outcomes. Understanding patients' and healthcare providers' experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore and synthesise the experiences of OMT among persons with opioid dependence and health care providers, to inform policy makers and practitioners on how to improve OMT outcomes. METHODS: We conducted a qualitative evidence synthesis. We systematically searched in electronic databases (CINAHL, Embase, MEDLINE, and nordic databases) and searched for grey literature. As we identified many studies that met our inclusion criteria, we purposively sampled a manageable number of studies to include in this review. Two researchers independently extracted and coded data from the included studies and used the Andersen's healthcare utilization model to organize and develop codes. We assessed the methodological limitations of the studies, and our confidence in the findings using GRADE CERQual. RESULTS: We retrieved 56 relevant studies and purposively sampled 24 qualitative studies of patients' and healthcare providers' experiences with OMT. Our analyses resulted in six main themes: (1) External stigma prevents engagement and retention in treatment, (2) Being identified as in OMT contributed to an increased experience of stigma (3) Inadequate knowledge and expertise among healthcare providers affected patients' treatment experiences, (4) Quality of communication between personnel and patients impacts patients' engagement with treatment and treatment outcomes, (5) Patients wanted help with many aspects of their lives not just medication, and (6) Balancing positive expectations of OMT with treatment stigma. We found that stigma was an overarching theme across these themes. CONCLUSION: Our findings suggest that OMT could be more beneficial for patients if treatment programs prioritize efforts to diminish societal and OMT provider stigma and find strategies to better address patient needs. Initiatives should focus on improving treatment knowledge among providers, encouraging the use of client perspectives, considering the context of family members, and establishing a more holistic and flexible treatment environment.

Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis.

BACKGROUND: Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS: We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS: All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS: These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.

Effect of nutritional and physical exercise intervention on hospital readmission for patients aged 65 or older: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Unplanned readmission may result in consequences for both the individual and society. The transition of patients from hospital to postdischarge settings often represents a discontinuity of care and is considered crucial in the prevention of avoidable readmissions. In older patients, physical decline and malnutrition are considered risk factors for readmission. The purpose of the study was to determine the effects of nutritional and physical exercise interventions alone or in combination after hospital admission on the risk of hospital readmission among older people. METHODS: A systematic review and meta-analysis of randomized controlled studies was conducted. The search involved seven databases (Medline, AMED, the Cochrane Library, CINAHL, Embase (Ovid), Food Science Source and Web of Science) and was conducted in November 2018. An update of this search was performed in March 2020. Studies involving older adults (65 years and above) investigating the effect of nutritional and/or physical exercise interventions on hospital readmission were included. RESULTS: A total of 11 randomized controlled studies (five nutritional, five physical exercise and one combined intervention) were included and assessed for quality using the updated Cochrane Risk of Bias Tool. Nutritional interventions resulted in a significant reduction in readmissions (RR 0.84; 95% CI 0.70-1.00, p = 0.049), while physical exercise interventions did not reduce readmissions (RR 1.05; 95% CI 0.84-1.31, p-value = 0.662). CONCLUSIONS: This meta-analysis suggests that nutrition support aiming to optimize energy intake according to patients' needs may reduce the risk of being readmitted to the hospital for people aged 65 years or older.

Older patients' and their family caregivers' perceptions of food, meals and nutritional care in the transition between hospital and home care: a qualitative study.

BACKGROUND: Older people have varying degrees of unmet nutritional needs following discharge from hospital. Inadequate involvement of the older person and his or her family caregivers in care and care planning, and inadequate support of self-management in the discharge process and follow-up care at home, negatively affects the quality of care. Research on older patients' and their family caregivers' experiences with nutritional care in hospital and home care and in the transition between these settings is limited. Thus, the aim of this study was to explore older patients' and their family caregivers' perceptions regarding the food, meals and nutritional care provided in the transition between hospital and home care services, focusing on the first 30 days at home. The overall aim of this study is to produce knowledge that can inform policy and clinical practice about how to optimise the care provided to older persons that are malnourished or at risk of malnutrition. METHODS: Using a qualitative interpretive descriptive design, we carried out face-to-face semi-structured interviews with 15 older patients, with documented risk of malnutrition or malnourishment (Mini Nutritional Assessment [MNA]), two and five weeks after hospital discharge. In addition, we interviewed nine family caregivers once during this five week period. The questions focused on perceptions of food, meals and nutritional care in hospital and home care and in the transition between these settings. We analysed the data thematically. RESULTS: Four overarching themes emerged from the material: 1) the need for a comprehensive approach to nutritional care, 2) non-individualised nutritional care at home, 3) lack of mutual comprehension and shared decision making and 4) the role of family caregivers. CONCLUSION: The organisation of nutritional care and food provision to older people, depending on care, lack consideration for the individual's values, needs and preferences. Older patients' and their family caregivers' needs and preferences should guide how nutritional care is provided.

Healthcare professionals' experiences of providing individualized nutritional care for Older People in hospital and home care: a qualitative study.

BACKGROUND: Recent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person's needs and preferences. There is limited research exploring health professionals' views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals' experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care. METHODS: Semi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis. RESULTS: Two main themes and six sub-themes emerged from the material. Theme 1: 'Meeting patients with complex nutritional problems' with the sub-themes: 'It is much more complex than just not eating' and 'seeing nutrition as a part of the whole'. Theme 2: 'The structure of the nutritional care', with the sub-themes: 'Nutritional routines: Much ado, but for what?', 'lack of time to individualize nutritional care', 'lack of interdisciplinary collaboration in nutritional care' and 'meeting challenging situations with limited resources in home care'. CONCLUSIONS: The healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients' nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients' preferences for care and nutritional care practice.

Older persons' experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary.

BACKGROUND: Researchers have shown that hospitalisation can decrease older persons' ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons' experiences adapting to daily life at home after hospital discharge. METHODS: A metasummary of qualitative findings using Sandelowski and Barroso's method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. RESULTS: Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. CONCLUSIONS: The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations.

Improving Documentation of Nutritional Care in A Nursing Home: An Evaluation of A Participatory Action Research Project.

BACKGROUND: Nursing home patients at nutritional risk are often not identified, nor given entitled nutritional treatment. One approach proven suitable to facilitate change in clinical practise is participatory action research (PAR). This is a process which involves research participants in reflection, planning, action, observation, assessing and re-planning, targeted to bring about change. The aim of the present study was to evaluate whether a PAR project resulted in improved documentation of nutritional care in a nursing home ward. Method and sample: A quantitative evaluation. Documentation of the nutritional information was collected from medical records of residents in a nursing home ward at baseline and five months into the project period. RESULTS: Increased documentation of individual nutritional treatment measures was found from baseline to the follow-up. The number of residents with a nutritional care plan (NCP) also increased significantly. On the other hand, the study identified a significant decrease in the proportion of residents with documented weight and nutritional status. CONCLUSION: The evaluation found several improvements in the documentation of nutritional care practice in the nursing home ward as a result of the PAR project, indicating that a PAR approach is suitable to bring about change in practice.