J Health Serv Res Policy. <javascript:AL_get(this, 'jour', 'J Health Serv Res Policy.');> 2010 Jan;15(1):47-55. Community professionals' management of client care: a mixed-methods systematic review. Kolehmainen N </pubmed?term=%22Kolehmainen%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Francis J </pubmed?term=%22Francis%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Duncan E </pubmed?term=%22Duncan%20E%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Fraser C </pubmed?term=%22Fraser%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Health Services Research Unit, University of Aberdeen, Aberdeen, UK. [log in to unmask] OBJECTIVES: To review the literature on individual community professionals' caseload management (behaviours related to assessment, treatment and discharging of clients) to identify the main themes and concepts, and to synthesize the findings to inform practice, policy and research. METHODS: Publications were systematically identified from electronic databases, hand searches of bibliographies, and contact with professional organizations. There were no restrictions on language, the nature of publications or publication year. Procedures were systematically applied for quality appraisal and data extraction. Qualitative and descriptive quantitative methods were used for data analysis and synthesis. RESULTS: Search criteria yielded 2048 papers of which 42 papers met the inclusion criteria. Thirty-five percent of these were based on research, the rest on professionals' experiences. The papers covered 16 professional and 20 client populations, and their quality was generally poor. Analysis identified six broad themes: definitions of caseload management, caseload measurement and 'tools', models of caseload management practice, client-professional relationship, discharging and professional guidance. Six papers presented issues that related to but did not fit within these themes. Current caseload management tools and models of caseload management practice had a poor evidence base. Five papers described benefits of team-based approaches. Professional guidance for caseload management is limited in detail and relevance to daily practice. CONCLUSIONS: Although there is a considerable literature on caseload management, it is not possible to make summative conclusions. Policy-makers and professional bodies should encourage and support development of research evidence about the ways to achieve effective, efficient and equitable caseload management. Health and social care services considering implementing caseload management tools or models of practice should critically appraise their basis, and consider their potential advantages as well as disadvantages. PMID: 20071502 [PubMed - in process] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- BMC Public Health. <javascript:AL_get(this, 'jour', 'BMC Public Health.');> 2009 Dec 11;9:458. The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. Drachler Mde L </pubmed?term=%22Drachler%20Mde%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Leite JC </pubmed?term=%22Leite%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Hooper L </pubmed?term=%22Hooper%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Hong CS </pubmed?term=%22Hong%20CS%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Pheby D </pubmed?term=%22Pheby%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Nacul L </pubmed?term=%22Nacul%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Lacerda E </pubmed?term=%22Lacerda%20E%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Campion P </pubmed?term=%22Campion%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Killett A </pubmed?term=%22Killett%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, McArthur M </pubmed?term=%22McArthur%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Poland F </pubmed?term=%22Poland%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK. [log in to unmask] BACKGROUND: We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS: Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS: Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs. PMID: 20003363 [PubMed - in process] PMCID: PMC27994 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Acad Med. <javascript:AL_get(this, 'jour', 'Acad Med.');> 2009 Dec;84(12):1775-87. Residents' and attending physicians' handoffs: a systematic review of the literature. Riesenberg LA </pubmed?term=%22Riesenberg%20LA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Leitzsch J </pubmed?term=%22Leitzsch%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Massucci JL </pubmed?term=%22Massucci%20JL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Jaeger J </pubmed?term=%22Jaeger%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Rosenfeld JC </pubmed?term=%22Rosenfeld%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Patow C </pubmed?term=%22Patow%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Padmore JS </pubmed?term=%22Padmore%20JS%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Karpovich KP </pubmed?term=%22Karpovich%20KP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Christiana Care Health System, Newark, Delaware 19718, USA. [log in to unmask] PURPOSE: Effective communication is central to patient safety. There is abundant evidence of negative consequences of poor communication and inadequate handoffs. The purpose of the current study was to conduct a systematic review of articles focused on physicians' handoffs, conduct a qualitative review of barriers and strategies, and identify features of structured handoffs that have been effective. METHOD: The authors conducted a thorough, systematic review of English-language articles, indexed in PubMed, published between 1987 and June 2008, and focused on physicians' handoffs in the United States. The search strategy yielded 2,590 articles. After title review, 401 were obtained for further review by trained abstractors. RESULTS: Forty-six articles met inclusion criteria, 33 (71.7%) of which were published between 2005 and 2008. Content analysis yielded 91 handoffs barriers in eight major categories and 140 handoffs strategies in seven major categories. Eighteen articles involved research on handoffs. Quality assessment scores for research studies ranged from 1 to 13 (possible range 1-16). One third of the reviewed research studies obtained quality scores at or below 8, and only one achieved a score of 13. Only six studies included any measure of handoff effectiveness. CONCLUSIONS: Despite the negative consequences of inadequate physicians' handoffs, very little research has been done to identify best practices. Many of the existing peer-reviewed studies had design or reporting flaws. There is remarkable consistency in the anecdotally suggested strategies; however, there remains a paucity of evidence to support these strategies. Overall, there is a great need for high-quality handoff outcomes studies focused on systems factors, human performance, and the effectiveness of structured protocols and interventions. PMID: 19940588 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- J Gen Intern Med. <javascript:AL_get(this, 'jour', 'J Gen Intern Med.');> 2010 Jan;25(1):72-8. Epub 2009 Nov 19. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. Sambunjak D </pubmed?term=%22Sambunjak%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Straus SE </pubmed?term=%22Straus%20SE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Marusic A </pubmed?term=%22Marusic%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Croatian Medical Journal, Zagreb, Croatia. BACKGROUND: Mentorship is perceived to play a significant role in the career development and productivity of academic clinicians, but little is known about the characteristics of mentorship. This knowledge would be useful for those developing mentorship programs. OBJECTIVE: To complete a systematic review of the qualitative literature to explore and summarize the development, perceptions and experiences of the mentoring relationship in academic medicine. DATE SOURCES: Medline, PsycINFO, ERIC, Scopus and Current Contents databases from the earliest available date to December 2008. REVIEW METHODS: We included studies that used qualitative research methodology to explore the meaning and characteristics of mentoring in academic medicine. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. No restrictions were placed on the language of articles. RESULTS: A total of 8,487 citations were identified, 114 full text articles were assessed, and 9 articles were selected for review. All studies were conducted in North America, and most focused on the initiation and cultivation phases of the mentoring relationship. Mentoring was described as a complex relationship based on mutual interests, both professional and personal. Mentees should take an active role in the formation and development of mentoring relationships. Good mentors should be sincere in their dealings with mentees, be able to listen actively and understand mentees' needs, and have a well-established position within the academic community. Some of the mentoring functions aim at the mentees' academic growth and others at personal growth. Barriers to mentoring and dysfunctional mentoring can be related to personal factors, relational difficulties and structural/institutional barriers. CONCLUSIONS: Successful mentoring requires commitment and interpersonal skills of the mentor and mentee, but also a facilitating environment at academic medicine's institutions. PMID: 19924490 [PubMed - in process] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Acad Med. <javascript:AL_get(this, 'jour', 'Acad Med.');> 2009 Dec;84(12):1765-74. "Renters" or "owners"? Residents' perceptions and behaviors regarding error reduction in teaching hospitals: a literature review. Padmore JS </pubmed?term=%22Padmore%20JS%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Jaeger J </pubmed?term=%22Jaeger%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Riesenberg LA </pubmed?term=%22Riesenberg%20LA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Karpovich KP </pubmed?term=%22Karpovich%20KP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Rosenfeld JC </pubmed?term=%22Rosenfeld%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Patow CA </pubmed?term=%22Patow%20CA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. MedStar Health, Columbia, Maryland 21044, USA. [log in to unmask] PURPOSE: Residents' attitudes, practices, and behaviors vary in response to medical error within the context of the culture of their institutions. The purpose of this study was to conduct a systematic review of the literature focused on residents' attitudes and behaviors regarding medical errors in teaching hospitals, including a qualitative review of barriers and proposed countermeasures related to residents' engagement in patient safety. METHOD: The electronic literature databases of MEDLINE, CINAHL, and ERIC were searched for articles published between January 1988 and June 2008. The search strategy yielded 124 articles. A scoring system was developed to assess the quality of the overall literature. RESULTS: Nineteen studies met eligibility criteria, with 17 published since 2005. There were 12 cross-sectional, 5 qualitative, 1 cohort and 1 pre-post intervention study. Quality assessment scores ranged from 5.5 to 12.5 (possible range 1.0-16.0). Three studies obtained a score of < or = 8.0, 5 obtained scores of 8.5 to 10.5, and 11 studies had scores of 11.0 to 12.5. Personal, environmental, and system barriers, and environmental and system countermeasures, were identified. CONCLUSIONS: Although the published literature on this topic is limited, those articles that exist identify barriers that make residents reluctant to engage in institutional error identification and/or reduction. Key factors identified included a fear of retribution and the perception of residents as transient care providers. Whereas several countermeasures have been promulgated, the literature reveals scant evidence of their effectiveness. Institutions should recognize and capitalize on the unique experiences of residents and their potential to become owners in patient safety initiatives. PMID: 19940587 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- JOURNAL OF CLINICAL NURSING VOL 19; NUMBER 3-4 (2010) pp. 447-460 A systematic review and meta-ethnography of the qualitative literature: experiences of the menarche Chang, Y. T.; Hayter, M.; Wu, S. C. KEYWORDS adolescent health • menarche • nurses • reproductive health • school nursing • systematic review ABSTRACT Aim. This article is a report of a systematic review and meta-ethnography of women's experience of menarche. Background. Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood. Design. Systematic review and meta-ethnography. Methods. Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women's experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography. Results. Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women's experience of menarche. These included: menarche preparation, significant others' response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche. Conclusions. Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education. Relevance to clinical practice. The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Int J Nurs Stud. <javascript:AL_get(this, 'jour', 'Int J Nurs Stud.');>. [Epub ahead of print] The user experience of critical care discharge: A meta-synthesis of qualitative research. Bench S </pubmed?term=%22Bench%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Day T </pubmed?term=%22Day%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Florence Nightingale School of Nursing and Midwifery, King's College, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom. OBJECTIVES: This review identifies the most significant factors, which impact upon the user experience of progress and recovery from critical illness during the first month after discharge from critical care, and discusses these in relation to the development of effective critical care discharge support strategies. DESIGN: Meta-synthesis of qualitative primary research. DATA SOURCES: Qualitative research published in English between 1990 and 2009 was identified using online databases: CINAHL, MEDLINE, EMBASE, British Nursing Index, CDSR, ACP Journal Club, Cochrane library, Social Policy and Practice and PsycInfo. Studies of adult patients, relatives/carers/significant others, which focused on experiences after discharge from an intensive care or high dependency unit to a general ward were retrieved. REVIEW METHODS: Following screening against inclusion/exclusion criteria, methodological appraisal of studies was conducted using a published framework. Ten studies met the criteria for inclusion. RESULTS: Five key themes emerged from the meta-synthesis: physical and psychological symptoms; making progress; the need to know; and safety and security. CONCLUSIONS: Findings from this meta-synthesis and other related literature supports the existence of physical and psychological problems in the immediate period following discharge from critical care to the ward, and suggests that patients and their families have a desire for more control over their recovery. However, this desire is countered by a need to feel safe and protected, culminating in an expression of dependence on healthcare staff. Any effective support strategy needs to take account of these findings. PMID: 20004396 [PubMed - as supplied by publisher] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- BMC Health Serv Res. <javascript:AL_get(this, 'jour', 'BMC Health Serv Res.');> 2009 Dec 10;9:226. Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence. Dowrick C </pubmed?term=%22Dowrick%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Gask L </pubmed?term=%22Gask%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Edwards S </pubmed?term=%22Edwards%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Aseem S </pubmed?term=%22Aseem%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Bower P </pubmed?term=%22Bower%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Burroughs H </pubmed?term=%22Burroughs%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Catlin A </pubmed?term=%22Catlin%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Chew-Graham C </pubmed?term=%22Chew-Graham%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Clarke P </pubmed?term=%22Clarke%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Gabbay M </pubmed?term=%22Gabbay%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Gowers S </pubmed?term=%22Gowers%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,Hibbert D </pubmed?term=%22Hibbert%20D%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Kovandzic M </pubmed?term=%22Kovandzic%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Lamb J </pubmed?term=%22Lamb%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Lovell K </pubmed?term=%22Lovell%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Rogers A </pubmed?term=%22Rogers%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Lloyd-Williams M </pubmed?term=%22Lloyd-Williams%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Waheed W </pubmed?term=%22Waheed%20W%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>; AMP Group </pubmed?term=%22AMP%20Group%22%5BCorporate%20Author%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Primary Care Research Group, University of Manchester, Oxford Road, Manchester, M13 9PL, UK. [log in to unmask] BACKGROUND: Common mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care. METHODS: We began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers.We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users. CONCLUSIONS: Our methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served groups. PMID: 20003275 [PubMed - in process] PMCID: PMC2799397 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Harm Reduct J. <javascript:AL_get(this, 'jour', 'Harm Reduct J.');> 2009 Nov 20;6:32. Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes. Sword W </pubmed?term=%22Sword%20W%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Jack S </pubmed?term=%22Jack%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Niccols A </pubmed?term=%22Niccols%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Milligan K </pubmed?term=%22Milligan%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Henderson J </pubmed?term=%22Henderson%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Thabane L </pubmed?term=%22Thabane%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. School of Nursing, McMaster University, Hamilton, Ontario, Canada. [log in to unmask] BACKGROUND: There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. METHODS: A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. RESULTS: A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. CONCLUSION: A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting. PMID: 19930575 [PubMed] PMCID: PMC2789048 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Int J Nurs Stud. <javascript:AL_get(this, 'jour', 'Int J Nurs Stud.');> 2010 Jan;47(1):89-107. Epub 2009 Oct 24. Older people's and relatives' experiences in acute care settings: systematic review and synthesis of qualitative studies. Bridges J </pubmed?term=%22Bridges%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Flatley M </pubmed?term=%22Flatley%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Meyer J </pubmed?term=%22Meyer%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. City University London, School of Community and Health Sciences, Philpot Street, Whitechapel London E1 2EA, UK. [log in to unmask] OBJECTIVE: To explore older people's and their relatives' views on and experiences of acute health care. DESIGN: Systematic procedures were used for study selection and data extraction and analysis. A comparative thematic approach to synthesis was taken with a number of features adopted from the literature on meta-ethnography. DATA SOURCES: Worldwide grey and published literature written in English between January 1999 and June 2008 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo. REVIEW METHODS: We conducted a systematic review and synthesis of qualitative studies describing older patients' and/or their relatives' experiences of care in acute hospital settings. 42 primary studies and 1 systematic review met the inclusion criteria. RESULTS: A number of themes emerged. The quality of technical care is often taken for granted by older patients, and good or bad experiences are described more in terms of relational aspects of care. Older patients in hospital may feel worthless, fearful or not in control of what happens, especially if they have impaired cognition, or communication difficulties. Three key features of care consistently mediated these negative feelings and were linked to more positive experiences: "creating communities: connect with me", "maintaining identity: see who I am" and "sharing decision-making: include me". CONCLUSION: These findings highlight the perspectives of older people and their relatives on the delivery of personalized and dignified care in acute settings. They lend support to previous calls for relationship-centred approaches to care and provide a useful experience-based framework for practice for those involved in care for older people. PMID: 19854441 [PubMed - in process] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- BMJ. <javascript:AL_get(this, 'jour', 'BMJ.');> 2010 Jan 19;340:c112. doi: 10.1136/bmj.c112. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. Morton RL </pubmed?term=%22Morton%20RL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Tong A </pubmed?term=%22Tong%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Howard K </pubmed?term=%22Howard%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Snelling P </pubmed?term=%22Snelling%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Webster AC </pubmed?term=%22Webster%20AC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia. [log in to unmask] OBJECTIVE: To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. DESIGN: Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies. DATA SOURCES: Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes. RESULTS: 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life or death, being a burden, living in limbo), lack of choice (medical decision, lack of information, constraints on resources), gaining knowledge of options (peer influence, timing of information), and weighing alternatives (maintaining lifestyle, family influences, maintaining the status quo). CONCLUSIONS: The experiences of other patients greatly influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy. PMID: 20085970 [PubMed - in process] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Transplantation. <javascript:AL_get(this, 'jour', 'Transplantation.');> 2010 Jan 19. [Epub ahead of print] Community Preferences for the Allocation of Solid Organs for Transplantation: A Systematic Review. Tong A </pubmed?term=%22Tong%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Howard K </pubmed?term=%22Howard%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Jan S </pubmed?term=%22Jan%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Cass A </pubmed?term=%22Cass%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Rose J </pubmed?term=%22Rose%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Chadban S </pubmed?term=%22Chadban%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Allen RD </pubmed?term=%22Allen%20RD%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>, Craig JC </pubmed?term=%22Craig%20JC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>. 1Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia. 2School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. 3Renal Division, The George Institute for International Health, Camperdown, Sydney, NSW, Australia. 4The Poche Centre for Indigenous Health, The University of Sydney, Sydney, NSW, Australia. 5Faculty of Economics and Business, Institute of Transport and Logistics Studies, The University of Sydney, Sydney, NSW, Australia. 6Central Clinical School, Bosch Institute, The University of Sydney, Sydney, NSW, Australia. 7Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia. BACKGROUND.: Organs for transplantation are a scarce community resource but community preferences and how they are incorporated into allocation policies are unclear. This systematic review aimed to ascertain community preferences for organ allocation and the principles underpinning these preferences. METHODS.: Medline, Embase, PsycINFO, EconLit, and gray literature databases were searched. Quantitative data were extracted, and a qualitative textual synthesis of the results and conclusions reported in each included study was performed. RESULTS.: Fifteen studies involving more than 5563 respondents were included. Seven themes describing community preferences for organ allocation were identified: (1) maximum benefit, to achieve maximum health gain in recipient survival and quality of life; (2) social valuation, to base preferences on societal gain; (3) moral deservingness, to consider the "worthiness" of recipients based on their social standing and lifestyle decisions; (4) prejudice, to make a judgement based on personal ideologic viewpoints; (5) "fair innings," to provide an organ preferentially to the younger recipient giving opportunity for a "normal" life span and to those waiting for a first organ rather than a retransplant; (6) "first come, first served," to allocate the organ to recipients wait-listed the longest; and (7) medical urgency, to allocate based on illness severity and saving life. CONCLUSIONS.: Community preferences for organ allocation hinge on a complex balance of efficiency, social valuation, morality, fairness, and equity principles. Being a community-held resource, effective ways to identify and incorporate community preferences into allocation algorithms for solid organ transplantation are warranted. PMID: 20090570 [PubMed - as supplied by publisher] -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CLINICAL PSYCHOLOGY REVIEW VOL 30; NUMBER 1 (2010) pp. 113-126 The impact of dementia on self and identity: A systematic review Caddell, L. S.; Clare, L. Abstract There is much debate in the literature as to the extent to which self and identity persist in people with dementia. The aim of this systematic review was to examine methods currently used to investigate self and identity in people with dementia, and the resulting evidence as to the persistence of self and identity throughout the course of the disease. Thirty-three studies were reviewed, which showed that many approaches have been taken to studying aspects of self and identity in dementia, including both quantitative and qualitative methods. This appears to be partly due to the differing underlying concepts of self that have been used as a basis for these studies. Consequently, results obtained from these studies are somewhat disparate, although it is possible to draw some tentative conclusions from the available evidence. Almost all of the studies suggest that there is at least some evidence for persistence of self in both the mild and moderate to severe stages of the illness, although many studies record some degree of deterioration in aspects of self or identity. Further research is required to clarify existing evidence and to address outstanding questions regarding self and identity in dementia. *Keywords: *Alzheimer's disease; Vascular dementia; Fronto-temporal dementia; Personhood; Self-concept; Selfhood -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS VOL 29; NUMB 4 (2009) pp. 235-241 UK health-care professionals experience of on-line learning techniques: A systematic review of qualitative data Carroll, C.; Booth, A.; Papaioannou, D.; Sutton, A.; Wong, R. INTRODUCTION: Continuing professional development and education is vital to the provision of better health services and outcomes. The aim of this study is to contribute to the evidence base by performing a systematic review of qualitative data from studies reporting health professionals' experience of e-learning. No such previous review has been published. METHOD: A systematic review of qualitative data reporting UK health professionals' experiences of the ways in which on-line learning is delivered by higher education and other relevant institutions. Evidence synthesis was performed with the use of thematic analysis grounded in the data. RESULTS: Literature searches identified 19 relevant studies. The subjects of the studies were nurses, midwives, and allied professions (8 studies), general practitioners and hospital doctors (6 studies), and a range of different health practitioners (5 studies). The majority of courses were stand-alone continuing professional development modules. Five key themes emerged from the data: peer communication, flexibility, support, knowledge validation, and course presentation and design. DISCUSSION: The effectiveness of on-line learning is mediated by the learning experience. If they are to enhance health professionals' experience of e-learning, courses need to address presentation and course design; they must be flexible, offer mechanisms for both support and rapid assessment, and develop effective and efficient means of communication, especially among the students themselves. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- EVIDENCE AND POLICY VOL 5; NUMB 4 (2009) pp. 399-428 Secondary school teachers' and pupils' definitions of bullying in the UK: a systematic review O Brien, N. **Abstract: **The aim of the systematic review (SR) reported in this article was to compare how UK secondary school pupils and teachers define bullying, using the analytical framework proposed by Naylor et al (2006). Findings were drawn from five major studies - two quantitative, two qualitative and one using mixed methods - and suggest that teachers are much more likely than pupils to employ broader definitions and to include indirect forms of bullying. Possible additions to Naylor et al's framework are highlighted. The SR encompassed views from 3,283 pupils and 225 teachers, and a number of modest implications for policy and practice are identified. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- JOURNAL OF COMMUNITY PSYCHOLOGY VOL 38; NUMBER 1 (2010) pp. 99-114 Conceptualization and measurement of the neighborhood in rural settings: a systematic review of the literature De Marco, A.; De Marco, M. **Abstract:** *I*nterest in the effects of neighborhood context on individual wellbeing has increased in recent years. We now know that neighborhood conditions, such as poverty and deprivation, negatively impact residents. However, most of the extant work has taken an urban focus. Less is known about these processes in rural settings. Neighborhood conceptualizations, such as Census tracts and block groups, are standard in the urban neighborhood effects literature. Yet, rural neighborhoods differ from those in urban regions making it unclear how these conceptualizations would fit. This systematic review seeks to summarize how researchers have conceptualized and measured rural neighborhoods. Keyword searches were performed in a variety of databases to compile all relevant peer-reviewed articles. After examination, 19 articles fit the review criteria. Conceptualizations fell into five categories: administrative units, distance from home, town segments, local-actor mapped regions, and nongeographical self-definitions. Discussion of the merits of each for rural community research is provided. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- HEALTH POLICY AND PLANNING VOL 25; NUMBER 1 (2010) pp. 1-14 A systematic review of the evidence on integration of targeted health interventions into health systems Atun, R.; de Jongh, T.; Secci, F.; Ohiri, K.; Adeyi, O. *A* l*on*gst*a*nding deb*a*te *on* *health* *systems* org*a*niz*a*ti*on* rel*a*tes^ to benefits *of*integr*a*ting *health* progr*a*mmes th*a*t emph*a*size^ specific *interventions* *into*m*a*instre*a*m *health* *systems* to incre*a*se^ *a*ccess *a*nd improve *health* outcomes. This deb*a*te h*a*s l*on*g been^ ch*a*r*a*cterized by pol*a*riz*a*ti*on* *of* views *a*nd ideologies, with^ prot*a*g*on*ists for *a*nd *a*g*a*inst *integration* *a*rguing *the* rel*a*tive^ merits *of* e*a*ch*a*ppro*a*ch. However, *a*ll too frequently *the*se *a*rguments^ h*a*ve not been b*a*sed *on*h*a*rd *evidence*. *The* presence *of* both integr*a*ted^ *a*nd n*on*-integr*a*ted progr*a*mmes in m*a*ny countries suggests *the*re^ m*a*y be benefits to ei*the*r*a*ppro*a*ch, but *the* rel*a*tive merits^ *of* *integration* in v*a*rious c*on*texts *a*nd for different *interventions*^ h*a*ve not been *systematic**a*lly *a*n*a*lysed *a*nd documented. In this p*a*per we present findings *of* *a* *systematic* *review* th*a*t^ explores *a* bro*a*d r*a*nge *of* *evidence* *on*: (i) *the* extent*a*nd n*a*ture^ *of* *the* *integration* *of* *targeted* *health* progr*a*mmes th*a*t emph*a*size^ specific *interventions* *into* critic*a*l* health* *systems* functi*on*s,^ (ii) how *the* *integration* or n*on*-*integration* *of* *health* progr*a*mmes^ *into* critic*a*l *health**systems* functi*on*s in different c*on*texts^ h*a*s influenced progr*a*mme success, (iii) how c*on*textu*a*l f*a*ctors^ h*a*ve *a*ffected *the*extent to which *the*se progr*a*mmes were integr*a*ted^ *into* critic*a*l *health* *systems* functi*on*s.Our *a*n*a*lysis shows few inst*a*nces where *the*re is full *integration*^ *of* *a* *health* interventi*on* or where *a*n interventi*on* is completely^ n*on*-integr*a*ted. Inste*a*d, *the*re exists *a* highly heterogeneous^ picture both for *the* n*a*ture *a*nd *a*lso for *the*extent *of* *integration*.^ *Health* *systems* combine both n*on*-integr*a*ted *a*nd integr*a*ted *interventions*,^ but *the* b*a*l*a*nce *of**the*se *interventions* v*a*ries c*on*sider*a*bly. *Key Words:* *Health* *systems*, *targeted* progr*a*mmes, *integration*, vertic*a*l progr*a*mmes, horiz*on*t*a*l progr*a*mmes -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- WORK -ANDOVER MEDICAL PUBLISHERS INCORPORATED THEN IOS PRESS- VOL 34; NUMB 1 (2010) pp. 33-44 Disruption, disbelief and resistance: A meta-synthesis of disability in the workplace Gewurtz, R.; Kirsh, B. Abstract This article presents the findings from a meta-synthesis of qualitative research on the experiences of persons with disabilities in the workplace. The purpose of this review was to explore how organizational culture influences the experiences of people with disabilities in the workplace, and the impact of disability on organizational culture. Findings from seven qualitative peer-reviewed studies on the experiences of people with disabilities at work and organizational culture published between 1995 and 2006 were synthesized using the meta-ethnography approach. The findings highlight how experiences of people with disabilities and organizational culture intersect in the workplace. Specifically, accessibility in the workplace involves more than removing physical barriers. People with disabilities are affected by the degree of acceptance and flexibility in the workplace, and relationships with co-workers and supervisors. However, the presence of disability may be perceived as disruptive to the organization, operation and structure of the workplace, resulting in disbelief and resistance. The findings suggest that attention and resources should be directed supporting the implementation of disability and human rights legislation and increasing tolerance for diversity in the workplace. Keywords Organizational culture, disability in the workplace, qualitative research, meta-synthesis -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- SOUTH AFRICAN JOURNAL OF EDUCATION VOL 29; NUMB 4 (2009) pp. 445-460 Meta-synthesis on learners' experience of aggression in secondary schools in South Africa Myburgh, C.; Poggenpoel, M. This meta-synthesis is on research conducted by different researchers in a team research project on learners’ experience of aggression in secondary schools in South Africa. The objective was to obtain a broader understanding of their experience of aggression in different contexts in South Africa, as well as possible ways to assist learners to address the experienced aggression. Eleven completed research projects were purposively sampled. Data were collected utilising the following headings: objectives, sampling, research design, research method, and research results, and guidelines. At the end of the meta- synthesis process the results are described, with supporting direct quotations from participants and a literature control. Guidelines for learners to cope with aggression are described. http://www.sajournalofeducation.co.za/index.php/saje/article/viewFile/290/174 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- <!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html> <head> <title></title> </head> <body bgcolor="#ffffff" text="#000000"> Andrew Booth BA Dip Lib MSc MCLIP<br> Reader in Evidence Based Information Practice &<br> Director of Information<br> School of Health & Related Research (ScHARR)<br> University of Sheffield, Regent Court,<br> 30 Regent Street, SHEFFIELD<br> S1 4DA<br> Tel: +44(0)114 244 3622<br> Fax: +44(0)114 272 4095<br> Email: [log in to unmask]<br> <br> <span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;"><span class="Apple-style-span" style="font-family: arial,sans-serif; font-size: 12px; text-align: left;">First you're an unknown, then you write one book and you move up to obscurity.<br> -<span class="Apple-converted-space"> </span><b><span style="color: rgb(28, 70, 128);">Martin Myers</span></b></span></span><br> </body> </html>