Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.

BackgroundThere are very few data on objectively assessed long-term compliance with continuous positive airway pressure (CPAP). No single factor has been consistently identified as predictive of continued CPAP use. Methods Adherence to and associations with objective CPAP use were examined in 639 of 3900 patients in whom CPAP treatment was started between 1994 and 2005. KaplaneMeier survival analyses were used to estimate the proportion of patients still on CPAP. Cox regression models were used to explore the effects of covariates on continued use of CPAP. Results The median (IQR) follow-up time after initiating CPAP therapy was 3.9 (1.5e6.9) years and the average use of CPAP was 6.2 (4.5e7.3) h/night. The percentage of patients adherent to CPAP after 5 and 10 years was 81% and 70%, respectively. Multivariate analysis, including gender, age, neck circumference, Epworth Sleepiness Score, oxygen desaturation index (ODI) and research study participation, indicated that ODI was the only clinical variable independently associated with long-term adherence to CPAP (HR per 1 event¼0.97, p<0.001, 95% CI 0.96 to 0.98). ODI categories were significantly associated with the risk for stopping CPAP in multivariate analysis (using ODI group 0e15/h as reference, HR for ODI group >15e30/h¼0.68, p¼0.100, 95% CI 0.43 to 1.08; for ODI group >30e60/h¼0.37, p<0.001, 95% CI 0.22 to 0.60; and for ODI group >60/h¼0.17, p¼0.001, 95% CI 0.06 to 0.48). Conclusions The majority of patients with sleep-disordered breathing are using CPAP in the long term and the severity of sleep-disordered breathing rather than sleepiness determines long-term adherence to CPAP therapy.

Obstructive sleep apnoea (OSA) is associated with high cardiovascular morbidity and mortality. Several randomised controlled trials have shown that continuous positive airway pressure (CPAP) treatment of OSA reduces blood pressure (BP). This randomised, sham-placebo controlled crossover trial assesses whether CPAP produces a similar clinically significant fall in BP in hypertensive OSA patients, but without hypersomnolence.Thirty-five, nonsleepy, hypertensive patients with OSA were treated with CPAP for 1 month, randomised first to either therapeutic or sham-placebo (subtherapeutic CPAP, about 1 cmH 2 O pressure). The second months' alternative treatment followed a 2-week washout period. BP was measured over 24 h, before and at the end of the two treatment periods: mean 24-h BP was the primary outcome variable.There was no overall significant difference in mean 24-h BP: the change in mean 24-h BP on therapeutic CPAP was -2.1 mmHg (SD 8.1), and -1.1 mmHg (SD 8.1) on subtherapeutic CPAP, with a difference of 0.7 mmHg (95% confidence interval (CI) +2.9--4.4). There was a small significant fall in Epworth Sleepiness Score, therapeutic (-1.4) versus sham (-0.3), and difference -1.2 (95% CI -2.0--0.4), but no change in objective sleepiness.In nonhypersomnolent hypertensive patients with obstructive sleep apnoea, there is no significant fall in mean 24-h blood pressure with continuous positive airway pressure, in contrast to the fall seen in hypersomnolent patients with obstructive sleep apnoea.

BackgroundPregnancy-related physical changes can have a significant impact on a woman’s body image. There is no synthesis of existing literature to describe the intricacies of women’s experiences of their body, and relevant clinical implications.MethodsFour electronic databases were searched in February 2014 using predefined search terms. English-language, qualitative studies published between January 1992 and December 2013 exploring pregnancy and postpartum body image were included. Following quality appraisal, 17 papers were synthesised using the interpretive thematic synthesis approach within a social constructionist framework.ResultsThree themes were highlighted: “Public Event: ‘Fatness’ vs. Pregnancy”, “Control: Nature vs. Self”, and “Role: Woman vs. Mother”. Women perceived the pregnant body to be out of their control and as transgressing the socially constructed ideal, against which they tried to protect their body image satisfaction. Women perceived the physical manifestation of the mothering role as incongruent to their other roles as a wife or partner, or working woman. Body dissatisfaction dominated the postpartum period.ConclusionsWomen’s perception of their pregnancy body image is varied and depends on the strategies they use to protect against social constructions of female beauty. Women have unrealistic expectations for their postpartum body, highlighting this as an area where women need better support. Attending to women’s narratives about their pregnant body may identify at-risk women and provide an opportunity for health professionals to provide support to either address or accept body image dissatisfaction. Clinical communication training may enable health professionals to explore body image concerns with women and guide them in identifying ways of accepting or reducing any dissatisfaction.

Background Maternal obesity (body mass index, BMI ‡ 30 kg/m 2 ) is a global public health issue. There is a dearth of evidence regarding an effective maternal care pathway for pregnant women with a BMI ‡ 30 kg/m 2 .Objectives This meta-synthesis aims to increase our understanding of the maternity experience for pregnant women with a BMI ‡30 kg/m 2 .Search strategy Six electronic databases were searched using predefined search terms.Selection criteria English-language studies using qualitative data to explore the maternity experience for women with a BMI ‡ 30 kg/m 2 were included (defined by a quality appraisal framework).Data collection and analysis An interpretative approach was taken and the constructivist framework was central to the synthesis. Searches were conducted in September 2010, and resulted in six papers being synthesised.Main results Three cluster themes (eight initial themes) were highlighted: acceptance and inevitability of weight gain in pregnancy; depersonalisation of care as a result of medicalisation; and healthy lifestyle benefits for self and baby.Author's conclusions Pregnancy is an ideal period for health professionals to intervene, as women with a BMI ‡ 30 kg/m 2 perceive their weight as more acceptable than when they were not pregnant, and are aware of the benefits of having a healthy lifestyle. Antenatal care should include postnatal weight management advice, as this is the period when women with a BMI ‡ 30 kg/m 2 want to lose weight; this may enable subsequent pregnancies to start with a lower BMI. Such advice should be sensitive and tailored to the individual. Social representations theory provides a framework for understanding maternal obesity.Keywords Maternal obesity, pregnancy, qualitative and metasynthesis.Please cite this paper as: Smith D, Lavender T. The maternity experience for women with a body mass index ‡ 30 kg/m 2 : a meta-synthesis. BJOG 2011;118: 779-789.