Thematic analysis is widely used in qualitative psychology research, and in this article

The value of qualitative evidence synthesis for informing healthcare policy and practice within evidence-based medicine is increasingly recognised. However, there is a lack of consensus regarding how to judge the methodological quality of qualitative studies being synthesised and debates around the extent to which such assessment is possible and appropriate. The Critical Appraisal Skills Programme (CASP) tool is the most commonly used tool for quality appraisal in health-related qualitative evidence syntheses, with endorsement from the Cochrane Qualitative and Implementation Methods Group. The tool is recommended for novice qualitative researchers, but there is little existing guidance on its application. This article considers issues related to the suitability and usability of the CASP tool for quality appraisal in qualitative evidence synthesis in order to support and improve future appraisal exercises framed by the tool. We reflect on our practical experience of using the tool in a systematic review and qualitative evidence synthesis. We discuss why it is worth considering a study’s underlying theoretical, ontological and epistemological framework and how this could be incorporated into the tool by way of a novel question. We consider how particular features of the tool may impact its interpretation, the appraisal results and the subsequent synthesis. We discuss how to use quality appraisal results to inform the next stages of evidence synthesis and present a novel approach to organising the synthesis, whereby studies deemed to be of higher quality contribute relatively more to the synthesis. We propose tool modifications, user guidance, and areas for future methodological research.

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BackgroundIndividual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome.MethodsSemi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n = 5 dyads). Data were analysed using template analysis.ResultsSignificant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness.ConclusionsThe findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation.

Nutritional interactions among invertebrates at 3 vent sltes on the Galapagos R~ft are examined through the use of stable carbon and nitrogen Isotopes. A large number of indviduals of several vent species were analyzed and this provides previously unavailable ins~ghts into the vanability within various groups. Stable nitrogen isotope contents [6I5N values) of vent ~nvertebrates are below 11 %. This is significantly lower than all non-vent deep-sea fauna examined to date, which makes 6ISN values an excellent tool in identifying vent-dependent fauna. However, the large range in 6I5N values among both primary producers and many vent consumer species renders it of limited use in determining either the trophic level of most individual species or the total number of trophic levels in vent communities. Stable carbon isotope content (6I3C values) in vent invertebrates from the Galapagos Rift range from -9 to -37x0, which encompasses the range of non-vent deep-sea fauna (-17 to -22%0) and extends significantly beyond it. Many vent invertebrates have 6I3C values which overlap that of ambient deep-sea fauna, however in several cases the extreme values can be linked to specific endogenous vent sources. When both nitrogen and carbon are taken together, robust trophic links can be established between several vent taxa, and considerable nutritional plasticity in other taxa becomes evident.

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BackgroundPrevious research has demonstrated that the significant others of individuals with persistent back pain may have important influences on work participation outcomes. The aim of this study was to extend previous research by including individuals who have remained in work despite persistent back pain in addition to those who had become incapacitated for work, along with their significant others. The purpose of this research was to explore whether the illness beliefs of significant others differed depending on their relative’s working status, and to make some preliminary identification of how significant others may facilitate or hinder work participation for those with persistent back pain.MethodsInterviews structured around the Illness Perception Questionnaire (chronic pain version) were conducted with back pain patients recruited from a hospital pain management clinic along with their significant others. Some patients had remained in work despite their back pain; others had ceased employment. Data were analysed using template analysis.ResultsThere were clear differences between beliefs about, and reported responses to, back pain symptoms amongst the significant others of individuals who had remained in employment compared with the significant others of those who had ceased work. Three overarching themes emerged: perceived consequences of back pain, specific nature of employment and the impact of back pain on patient identity.ConclusionsSignificant others of employed individuals with back pain focused on the extent to which activity could still be undertaken despite back pain symptoms. Individuals out of work due to persistent back pain apparently self-limited their activity and were supported in their beliefs and behaviours by their significant others. To justify incapacity due to back pain, this group had seemingly become entrenched in a position whereby it was crucial that the individual with back pain was perceived as completely disabled. We suggest that significant others are clearly important, and potentially detrimental, sources of support to individuals with back pain. The inclusion of significant others in vocational rehabilitation programmes could potentially be a valuable way of mobilising readily accessible resources in a way that supports optimal functioning.