Exploring adults' experiences of sedentary behaviour and participation in non-workplace interventions designed to reduce sedentary behaviour: a thematic synthesis of qualitative studies.

BACKGROUND: Sedentary behaviour is any waking behaviour characterised by an energy expenditure of ≤1.5 metabolic equivalent of task while in a sitting or reclining posture. Prolonged bouts of sedentary behaviour have been associated with negative health outcomes in all age groups. We examined qualitative research investigating perceptions and experiences of sedentary behaviour and of participation in non-workplace interventions designed to reduce sedentary behaviour in adult populations. METHOD: A systematic search of seven databases (MEDLINE, AMED, Cochrane, PsychINFO, SPORTDiscus, CINAHL and Web of Science) was conducted in September 2017. Studies were assessed for methodological quality and a thematic synthesis was conducted. Prospero database ID: CRD42017083436. RESULTS: Thirty individual studies capturing the experiences of 918 individuals were included. Eleven studies examined experiences and/or perceptions of sedentary behaviour in older adults (typically ≥60 years); ten studies focused on sedentary behaviour in people experiencing a clinical condition, four explored influences on sedentary behaviour in adults living in socio-economically disadvantaged communities, two examined university students' experiences of sedentary behaviour, two on those of working-age adults, and one focused on cultural influences on sedentary behaviour. Three analytical themes were identified: 1) the impact of different life stages on sedentary behaviour 2) lifestyle factors influencing sedentary behaviour and 3) barriers and facilitators to changing sedentary behaviour. CONCLUSIONS: Sedentary behaviour is multifaceted and influenced by a complex interaction between individual, environmental and socio-cultural factors. Micro and macro pressures are experienced at different life stages and in the context of illness; these shape individuals' beliefs and behaviour related to sedentariness. Knowledge of sedentary behaviour and the associated health consequences appears limited in adult populations, therefore there is a need for provision of accessible information about ways in which sedentary behaviour reduction can be integrated in people's daily lives. Interventions targeting a reduction in sedentary behaviour need to consider the multiple influences on sedentariness when designing and implementing interventions.

Network support, technology use, depression, and ART adherence among HIV-positive MSM of color.

Depression is associated with poor antiretroviral therapy (ART) adherence among people living with HIV/AIDS. This relationship may be moderated by an individual's social network characteristics. Our study sought to examine social network correlates of treatment adherence among HIV-positive men recruited from social service agencies throughout Los Angeles County (N = 150) to inform technology-driven social support interventions for this population. We administered egocentric social network and computer-assisted survey interviews focused on demographic characteristics, health history, depressive symptoms, and ART adherence, where adherence was assessed by the number of reasons participants missed taking their medication, if ever. Significant univariate correlates of adherence were included in a multivariable regression analysis, where the moderating effect of having a network member who reminds participants to take their HIV medication on the relationship between depression and adherence was tested. Over 60% of participants reported clinically significant depressive symptoms; this was significantly associated with lower adherence among those without someone in their social network to remind them about taking their HIV medication, even after adjusting for covariates in an ordinary least squares regression (adjusted mean difference b = -1.61, SE = 0.42, p = 0.0003). Having a network member who reminds participants to take their ART medication significantly ameliorated the negative association between depression and treatment adherence, especially for those reporting greater depressive symptoms (p = 0.0394). Additionally, participants demonstrated high rates of technology use to communicate with social network members. In order to achieve the aims of the National HIV/AIDS Strategy, innovative interventions addressing mental health to improve ART adherence are needed. Network strategies that leverage technology may be helpful for improving ART adherence among HIV-positive men with comorbid depressive symptoms.

High subcortical sacrectomy: a novel approach to facilitate complete resection of locally advanced and recurrent rectal cancer with high (S1-S2) sacral extension.

AIM: R0 resection of locally advanced or recurrent rectal cancer is the key determinant of outcome. Disease extension high on the sacrum has been considered a contraindication to surgery because of associated morbidity and difficulty in achieving complete pathological resection. Total sacrectomy has a high morbidity with poor function. METHOD: We describe a novel technique of high subcortical sacrectomy (HiSS) to facilitate complete resection of disease extending to the upper sacrum at S1 and S2 to avoid high or total sacrectomy or a nonoperative approach to management. Details of patient demographics, radiology, operative details, postoperative histology, length of hospital stay and complications were entered into a prospectively maintained electronic patient database. All patients had had preoperative chemoradiotherapy. RESULTS: During 2013-2014, five patients, including three with advanced primary cancer and two with recurrent rectal cancer, underwent excision using this approach. All patients had an R0 resection. Four patients had a minor postoperative complication (Clavien-Dindo Grades I and II) and one had a major complication (Clavien-Dindo Grade IIIb). There was no mortality at 90 days, and four patients were disease free at a median of 18 months. CONCLUSION: Patients with locally advanced and recurrent rectal cancer involving the upper sacrum may be rendered suitable for potentially curative radical resection with a modified approach to sacral resection. This pilot series suggests that this novel technique results in a high rate of complete pathological resection with acceptable morbidity in patients for whom the alternatives would have been an incomplete resection, a total sacrectomy or nonoperative management.

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

OBJECTIVE: To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. DESIGN: Qualitative ethnographic study. SETTING: A maternity hospital, Afghanistan. POPULATION: Doctors, midwives and care assistants. METHODS: Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. MAIN OUTCOME MEASURES: The culture of care in an Afghan maternity hospital. RESULTS: A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. CONCLUSIONS: Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability.

The effect of anaesthesia on the bone blood flow of the rabbit.

The effect of anaesthesia on the rate of bone blood flow in the rabbit was studied. Two estimates of bone blood flow were performed, using 15 microns radioactively labelled microspheres, in three groups of rabbits. The first group was anaesthetised and the interval between the two estimates was 5 min. The second group was also anaesthetised but the interval between estimates was 60 min. The third group of rabbits was conscious and the interval between the two estimates was 4 h. In the first group, small uniform falls in whole bone blood flow were observed (mean change = -5%). In the second group, larger and less predictable reductions were observed (mean change = -24%). In the third group (conscious), little change was observed in whole bone blood flow during the 4-h experiment (mean change = +7%). It is concluded that substantial falls can occur in bone blood flow in the rabbit during a 1-h anaesthetic. If bone blood flow is to be monitored under anaesthesia, then the effect of the anaesthetic on bone blood flow must be accurately defined. In conscious rabbits, estimates of whole bone blood flow performed at an interval of 4 h under control conditions will give reproducible results.

Neutron uniformity studies related to clinical total body in vivo neutron activation analysis.

Methods of assessing the uniformity of thermal and fast neutron fluence in relation to total body in vivo neutron activation analysis are described. Results are presented for 14 MeV neutrons emitted by sealed tube generators housed in a massive concrete shield, representing a substantial source of neutrons degraded in energy. Optimisation of conditions for patient irradiations is discussed and it is shown that acceptable uniformity of fluence can be achieved with little or no premoderation of the incident neutrons.

A high sensitivity dual-detector shadow-shield whole-body counter with an 'invariant' response for total body in vivo neutron activation analysis.

The development of a dual-detector shadow-shield whole-body counting system of high sensitivity is described. The sensitivity and performance of the counter are analysed, with specific references to total body in vivo neutron activation analysis, and shown to be at least comparable with those of many conventional shielded-room counters.

'Practice professional development plans': general practitioners' perspectives on proposed changes in general practice education.

BACKGROUND: The Chief Medical Officer has presented a report proposing a change in general practitioners' education towards a 'Practice Professional Development Plan', which, in principle, is based around formal needs assessment, practice-based learning in areas identified by those involved, and with the potential for multi-professional learning. This aims to replace the present system of a financial allowance earned by attending a certain amount of educational activity. AIM: To study the opinions of a group of general practitioners attending a course that included workshops that introduced and considered this educational initiative. METHOD: Semi-structured interviews four weeks after the course. RESULTS: Educational benefits were clearly seen, while issues such as funding and time will present difficulties in implementation. CONCLUSIONS: This proposal was seen as an improvement to the existing postgraduate educational allowance system. To maintain enthusiasm, successful introduction will depend on the issues of support and resources.

Learners' experience of continuing medical education events: a qualitative study of GP principals in Dorset.

BACKGROUND: General practitioners' (GPs') attendance at continuing medical education (CME) events has increased since the introduction of the Post Graduate Educational Allowance (PGEA) in 1990. However, few studies have examined doctors' perceptions about their continuing education, and explored their views in depth. AIM: To investigate general practitioners' experience of CME events, what personal impact they had, and how the GPs perceived the influence of CME in their professional practice and patient care. METHOD: A qualitative study, with in-depth semi-structured interviews, of a purposive sample of 25 general practitioners in Dorset was conducted. Content analysis was used to identify major themes from the transcripts. RESULTS: GPs perceived CME events as beneficial. Confidence levels rose, and the events provided a break from practice that refreshed and relaxed, thus indirectly benefiting patients. The opportunities provided by formal events for informal learning and exchange of ideas, with both peers in general practice and consultant colleagues, were highly valued. The relevance of the subject to general practice, and the appropriateness of the educational format, were considered of paramount importance. Few responders identified major changes in their practice as a result of formal CME events, and information was seldom disseminated among practice colleagues. CONCLUSION: The results of this study challenge GP educators to provide CME that is relevant, to recognize the value of peer contact, and to facilitate the incorporation of new information into practice.

'They know best': women's perceptions of midwifery care during labour and childbirth.

The aims of the study were to examine women's experiences of their labour and the birth of their baby. The use of qualitative method ensured that the research focused on the perspectives of the participants. The purposive sample consisted of 11 women volunteers in a maternity unit of a general hospital. Unstructured, tape-recorded interviews provided an opportunity for the informants to express their thoughts and feelings. The constant comparative method, a feature of Grounded Theory, was used to analyse the data. The research demonstrated that women trust midwives because the latter are seen as experts who 'know best'. In doing so, women place themselves in the hands of professionals giving them the authority to make decisions about procedures, drugs and types of care. This belief in the professionals' expertise influences the type of relationship between the women and midwives. Nevertheless, women also want to take an active part in the control of labour. The study identified a need for a flexible relationship between women in labour and their midwives.

Staying in control: women's experiences of labour in water.

AIM: To examine women's attempts at control during labour in water. DESIGN: An exploratory design consisting of tape-recorded, in-depth interviews using the grounded theory approach. SETTING: A medium sized town in the south of England. The data were collected in the maternity unit of a local general hospital set in a semi-rural location. PARTICIPANTS: Nine women who had chosen to spend their labour process in water. The participants selected had experienced a normal pregnancy and given birth to a healthy baby at term. FINDINGS: Labour in water was seen by all but one of the participants as beneficial, particularly as they felt that this gave them more control over the process. They valued their own involvement in determining the outcome of their care. The support of the midwife in making decisions was seen as necessary to remain in control. CONCLUSIONS: Labour in water was a positive experience for this group of healthy women. The feeling of freedom to make decisions, however, was balanced with a wish for the support of the midwife.

Fitting in: maintaining a sense of self during hospitalisation.

In this study the patients' perspective of 'fitting in' was gained through participant observation and interviews. Eleven patients' stories confirmed that while hospitalisation can alleviate the suffering caused by illness, it may cause distress. In order to minimise this threat to self patients adjust to hospital life. They are supported by family, friends and health professionals in interpreting the social rules of the ward by conforming to, circumventing and challenging them.

Fibrolamellar hepatocellular carcinoma: results of partial liver resection.

AIM: To assess the results of partial hepatic resection in the treatment of fibrolamellar hepatocellular carcinoma. PATIENTS AND RESULTS: We present six cases of Fibrolamellar hepatocellular carcinoma treated by partial hepatic resection. There were five females and one male with a mean age of 20 (2.6) yr. Five patients were stage IVA and 1 IVB based on the Union International Against Cancer Classification. Two patients, due to recurrent disease, needed further pulmonary resection and a hilar lymphadenectomy. All six cases underwent major resection, three with vascular reconstruction. No operative mortality was recorded; half of the patients displayed some degree of morbidity. One patient died six months after the operation and the rest are alive at 78, 41, 24, 12 and 9 months. We believe that even in advanced cases, an aggressive surgical policy even with vascular reconstruction is justified in patients with fibrolamellar hepatocellular carcinoma.

Introduction of a thermal response to the DSTL PADC personal neutron dosemeter.

The response of the Defence Science and Technology Laboratory (DSTL) PADC personal neutron dosemeter is strongly dependent upon neutron energy, with a range of 300-500 tracks per cm2 per mSv for energies between 1 and 5 MeV. Below 1 MeV the response drops off sharply. This lack of sensitivity is undesirable when the dosemeter is employed with the softened fission spectra encountered in the workplace. In order to incorporate a thermal response, a polypropylene converter doped with LiF has been placed directly in front of the PADC elements. Tritons produced in the thermal neutron reaction 6Li (n,t)alpha at 2.7 MeV will then penetrate the PADC, leaving a trail of damage. The reaction rate within the converter has been calculated using MCNP for thermal neutrons and a range of higher energies, while transport of the tritons is modelled using the SRIM/TRIM package to determine the resultant track density and depth distribution. The modelling and experimental work have demonstrated that a concentration of 0.2% natural lithium by weight results in a track density in a thermal field comparable with that produced per unit personal dose equivalent by neutrons greater than 1 MeV in the standard dosemeter. Additional MCNP modelling has demonstrated that the dosemeters' albedo response to intermediate energy neutrons can be enhanced considerably by placing a boron-doped shield in front of the converter and increasing its lithium concentration.

Interaction in the classroom: district nurse students and their teachers.

This research project aimed to investigate interaction in the classroom between district nurse students and their teachers and to identify some characteristics of effective teaching and learning. The research explored events in the classroom and relationships between students and teachers, and students and their peers. Symbolic Interactionism was used as the theoretical framework. Ethnographic methods within qualitative research focused on the ways in which teachers and students organise themselves and their environment through roles, rules and procedures.

Mental health day units: users' views.

This article describes clients' perspectives on psychiatric day care units in an area in the South of England. The results of a small-scale research project show that clients from different localities have similar perspectives and feelings about the units. It is demonstrated that, in the clients' view, the units achieve many of their aims and fulfil needs that supersede the initial purpose.

Compression bandaging improves mobility following total knee replacement in an enhanced recovery setting.

The early functional outcome was assessed in 180 patients undergoing total knee replacement (TKR) using compression bandaging versus standard crepe bandaging. Patients with a compression bandage following TKR were significantly more likely to be discharged with a walking stick (p=0.002) and less likely to be discharged with a rollator frame (p=0.001). These patients demonstrated an improved range of knee flexion and ability to straight leg raise at discharge.

Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery.

We evaluated the quality of guidelines on thromboprophylaxis in orthopaedic surgery by examining how they adhere to validated methodological standards in their development. A structured review was performed for guidelines that were published between January 2005 and April 2013 in medical journals or on the Internet. A pre-defined computerised search was used in MEDLINE, Scopus and Google to identify the guidelines. The AGREE II assessment tool was used to evaluate the quality of the guidelines in the study. Seven international and national guidelines were identified. The overall methodological quality of the individual guidelines was good. 'Scope and Purpose' (median score 98% interquartile range (IQR)) 86% to 98%) and 'Clarity of Presentation' (median score 90%, IQR 90% to 95%) were the two domains that received the highest scores. 'Applicability' (median score 68%, IQR 45% to 75%) and 'Editorial Independence' (median score 71%, IQR 68% to 75%) had the lowest scores. These findings reveal that although the overall methodological quality of guidelines on thromboprophylaxis in orthopaedic surgery is good, domains within their development, such as 'Applicability' and 'Editorial Independence', need to be improved. Application of the AGREE II instrument by the authors of guidelines may improve the quality of future guidelines and provide increased focus on aspects of methodology used in their development that are not robust.

Women's preferences for testing and management of sexually transmitted infections among low-income New York City family planning clients.

High prevalence of chlamydia in the USA persists despite efforts to annually screen women under the age of 26. Tailoring sexually transmitted infection (STI) services to client preferences may strengthen existing programmes. We report women's preferences for STI services from a family planning clinic in New York City serving low-income women. Seventy-eight percent (995/1275) of eligible women participated, with a mean age of 26 (SD±7). Ninety-one percent self-identified as Latina. Nineteen percent reported a past STI. Women preferred self-collection (65%) for testing to a speculum exam (20%); 15% had no preference. Women with a previous STI were more likely to prefer a pelvic exam to women with no previous STI (50% versus 32%, P < 0.01). Nearly all women (94%) preferred informing a sex partner about a positive STI test themselves, but 88% were willing to bring expedited partner therapy to a partner. Women were more likely to prefer third party partner notification if their last partner was casual rather than a main partner (14% versus 3%, respectively, P < 0.01). Forty-four percent of participants worried about physical violence after partner notification. Self-collecting specimens for screening was widely acceptable. Partner notification strategies should be based on understanding partnership status, including fears of violence.

A cluster randomised controlled trial and economic evaluation of a structured training programme for caregivers of inpatients after stroke: the TRACS trial.

BACKGROUND: The majority of stroke patients are discharged home dependent on informal caregivers, usually family members, to provide assistance with activities of daily living (ADL), including bathing, dressing and toileting. Many caregivers feel unprepared for this role and this may have a detrimental effect on both the patient and caregiver. OBJECTIVE: To evaluate whether or not a structured, competency-based training programme for caregivers [the London Stroke Carer Training Course (LSCTC)] improved physical and psychological outcomes for patients and their caregivers after disabling stroke, and to determine if such a training programme is cost-effective. DESIGN: A pragmatic, multicentre, cluster randomised controlled trial. SETTING: Stratified randomisation of 36 stroke rehabilitation units (SRUs) to the intervention or control group by geographical region and quality of care. PARTICIPANTS: A total of 930 stroke patient and caregiver dyads were recruited. Patients were eligible if they had a confirmed diagnosis of stroke, were medically stable, were likely to return home with residual disability at the time of discharge and had a caregiver available, willing and able to provide support after discharge. The caregiver was defined as the main person--other than health, social or voluntary care provider--helping with ADL and/or advocating on behalf of the patient. INTERVENTION: The intervention (the LSCTC) comprised a number of caregiver training sessions and competency assessment delivered by SRU staff while the patient was in the SRU and one recommended follow-up session after discharge. The control group continued to provide usual care according to national guidelines. Recruitment was completed by independent researchers and participants were unaware of the SRUs' allocation. MAIN OUTCOME MEASURES: The primary outcomes were self-reported extended ADL for the patient and caregiver burden measured at 6 months after recruitment. Secondary outcomes included quality of life, mood and cost-effectiveness, with final follow-up at 12 months. RESULTS: No differences in primary outcomes were found between the groups at 6 months. Adjusted mean differences were -0.2 points [95% confidence interval (CI) -3.0 to 2.5 points; p = 0.866; intracluster correlation coefficient (ICC) = 0.027] for the patient Nottingham Extended Activities of Daily Living score and 0.5 points (95% CI -1.7 to 2.7 points; p = 0.660; ICC = 0.013) for the Caregiver Burden Scale. Furthermore, no differences were detected in any of the secondary outcomes. Intervention compliance varied across the units. Half of the participating centres had a compliance rating of > 60%. Analysis showed no evidence of higher levels of patient independence or lower levels of caregiver burden in the SRUs with better levels of intervention compliance. The economic evaluation suggests that from a patient and caregiver perspective, health and social care costs, societal costs and outcomes are similar for the intervention and control groups at 6 months, 12 months and over 1 year. CONCLUSIONS: We have conducted a robust multicentre, cluster randomised trial, demonstrating for the first time that this methodology is feasible in stroke rehabilitation research. There was no difference between the LSCTC and usual care with respect to improving stroke patients' recovery, reducing caregivers' burden, or improving other physical and psychological outcomes, nor was it cost-effective compared with usual care. Compliance with the intervention varied, but analysis indicated that a dose effect was unlikely. It is possible that the immediate post-stroke period may not be the ideal time for the delivery of structured training. The intervention approach might be more relevant if delivered after discharge by community-based teams. TRIAL REGISTRATION: Current Controlled Trials ISRCTN49208824. FUNDING: This project was funded by the MRC and is managed by the NIHR (project number 09/800/10) on behalf of the MRC-NIHR partnership, and will be published in full in Health Technology Assessment; Vol. 17, No. 46. See the NIHR Journals Library website for further project information.