Exploring the experiences of people with urogynaecology conditions in the UK: a reflexive thematic analysis and conceptual model.

BACKGROUND: Urogynaecological conditions, such as pelvic organ prolapse, urinary incontinence, and urinary tract infection, can have a profound impact on people's lives. The Independent Medicines and Medical Devices Safety Review highlights missed opportunities to prevent harm when patient voices are not incorporated into healthcare policy and practice. This resonates with the Women's Health Strategy for England. The National Institute for Health and Care Research (NIHR) Policy Research Programme funded this in-depth qualitative exploration of people's experiences of living with urogynaecological conditions, and of seeking healthcare treatment, to inform health and social care improvements in the UK. METHODS: We conducted in-depth interviews online or by telephone (April 2021-December 2021) and used reflexive thematic analysis to develop themes that cut across urogynaecological conditions. RESULTS: We spoke to seventy-four adults aged 22-84 across a range of backgrounds and lived experiences of urogynaecological conditions, including pelvic organ prolapse, urinary incontinence and persistent or recurring urinary tract infection. Eight themes were developed: [1] I get no respite from my own body; [2] I feel confined and separated; [3] I can no longer be 'me'; [4] I am constrained by stigma, shame and silence; [5] I feel fragmented and lost in the healthcare system; [6] I need to be heard, believed, and valued; [7] I need respect as an equal partner in healthcare; and [8] (Re)connected to a more open community. CONCLUSIONS: High quality care focuses on the whole person rather than their body parts. Openness and candour support a shared decision-making model of care. A culture of shame can have a negative impact on access to health care and recovery.

Men's experiences of having osteoporosis vertebral fractures: a qualitative study using interpretative phenomenological analyses.

Men and women with vertebral fractures due to osteoporosis are treated differently by society and health care professionals. This can lead to inequalities in health care and affects how men with fractures view themselves as people. We need to raise awareness that men get these fractures as well as women. INTRODUCTION: There is a lack of research exploring the experience of osteoporosis from the male perspective. This study was undertaken to explore and describe the experiences of men with vertebral fractures due to osteoporosis, including their perceptions of diagnosis, treatment and changes in their sense of self. METHODS: The study consists of in-depth semi-structured interviews with nine male participants of the PROVE (Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture) study. Interviews were digitally audio recorded and fully transcribed. Data were coded in accordance with an interpretative phenomenological analysis approach to analyses. RESULTS: Three main themes are presented. (i) Osteoporosis is considered an old women's disease. (ii) Men are diagnosed and treated differently than women in the NHS. Health care inequalities exist. (iii) Changes in self can occur in men after vertebral fracture/s due to osteoporosis. CONCLUSIONS: Greater awareness that men get this condition is needed in both society in general and also by health care professionals who often do not expect osteoporosis to affect men. Approaches to diagnosis and treatment need to be considered and improved to ensure that they become appropriate and effective for men as well as women.

A qualitative systematic review of patients' experience of osteoporosis using meta-ethnography.

We aimed to systematically review qualitative studies exploring the experience of living with osteoporosis to develop new conceptual understanding. We identified themes about the invisibility/visibility of osteoporosis, the experience of uncertainty of living with osteoporosis (OP) and living with an ageing body and the place of gender. PURPOSE: The aim of this review was to systematically review the body of qualitative studies exploring the experience of living with either osteoporosis or osteopenia and to use meta-ethnography to develop new conceptual understanding. METHODS: We systematically reviewed and integrated the findings of qualitative research from four bibliographic databases (Medline, Embase, Cinahl, Psychinfo) to September 2015 in order to increase our conceptual understanding of the lived experience of osteoporosis and osteopenia. Articles were appraised for quality; each was independently read by two researchers to identify concepts which were compared and developed into a conceptual model. RESULTS: Our findings demonstrate that coming to terms with a diagnosis of osteoporosis is linked to its relative visibility or invisibility. For some, OP has not become manifest and self-identity is intact (biographical integrity). For others, OP is profoundly manifest and self-identity is no long intact (biographical fracture). We also demonstrate that overwhelming uncertainty pervades the experience of OP. Our final theme demonstrates how the experience of OP is set within a cultural context with certain views about ageing and gender. CONCLUSIONS: Our synthesis has highlighted the wealth of qualitative data about osteoporosis and osteopenia. Despite the increasing body of literature on the subject, there remains a need to adjust our interactions with patients. This will allow clinicians to understand how patients can be helped to receive and understand their diagnosis and move forward in partnership with healthcare providers to promote optimal management of the disease.

Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response.

AIMS: To establish (1) the efficacy of a six-week chronic disease management programme for knee osteoarthritis and (2) whether previous physiotherapy or being wait listed for surgery moderated the outcome of the programme. DESIGN: A pretest, posttest design with multivariate statistical modelling. PARTICIPANTS: One hundred and twenty-one people with severe osteoarthritis who were waiting, or being considered, for surgery. METHODS AND MEASURES: Western Ontario Osteoarthritis Index (WOMAC) scores, arthritis self-efficacy, distress and a patient-rated global indicator of response were collected at baseline, 6 and 12 weeks. History of previous physiotherapy, waiting list status, symptom duration, New Zealand disease severity score, radiographic changes and self-perceived need for surgery were recorded at baseline. RESULTS: There were moderate improvements in most outcomes; WOMAC function decreased by 0.29, WOMAC pain by 0.27, pain self-efficacy by 4.4, function self-efficacy by 5.6 and visual analogue scale (VAS) distress by 0.2 (effect sizes ranging from 0.3 to 0.5 at 12 weeks). Waiting list status was a significant modifier for function, pain, distress and self-related outcomes. Participants on the waiting list for surgery experienced lesser improvements. Previous physiotherapy was associated with greater improvements in WOMAC scores at six weeks, but not at 12 weeks. CONCLUSION: The chronic disease management programme could be considered for people with severe knee osteoarthritis, but should be given prior to referral and placement on the waiting list for surgery. Previous physiotherapy should not preclude people from participating in a chronic disease management programme.

Clinical experience with percutaneous tracheostomy and cricothyroidotomy in 100 patients.

Ninety-four cases of percutaneous tracheostomy and six cases of percutaneous cricothyroidotomy are reported in this study. There was one death attributable to the use of the device. A complication rate of 14% is reported. Clinical use for the adult and pediatric patient is reported. The procedure is compared to the standard dissection tracheostomy method of Chevalier Jackson. This procedure has several advantages over the standard dissection method, the most significant of which appears to be the speed with which it can be performed. It can be done in 30 seconds, as opposed to the dissection procedure which requires 3 minutes or more for a surgeon to complete it. Autopsies on 14 of these patients are discussed. Long-term followup, that is for 1 year and more, is reported in 19 cases. Advantages of the percutaneous technique over the standard dissection technique are detailed.

Nitrogen balance in patients with chronic renal failure on diets containing varying quantities of protein.

Twenty-four nitrogen balances have been performed in 16 patients with chronic renal failure, with a protein intake of 0.23 to 1.0 g./kg./day. The results show that most patients with chronic renal failure require about 0.5 g./kg./day (35 g. for a 70-kg. man) to remain in nitrogen balance. The proportion of high-quality protein in the diets varied from 40 to 98% and the calorie intake from 23.6 to 59.0 calories/kg./day (1,330 to 3,310 calories/day). Within these ranges the proportion of high-quality protein and the calorie content did not have a detectable effect on the nitrogen balance.It is concluded that when other forms of treatment for renal failure are available, reduced protein diets should be used for only short periods, and that the protein intake should be 0.5 g./kg./day to maintain the patient in nitrogen balance.