Summary Guidelines and evidence suggest primary care clinicians should give opportunistic interventions to motivate weight loss, but these rarely occur in practice. We sought to examine why by systematically reviewing qualitative research examining general practitioners' (‘GPs’) and nurses' views of discussing weight with patients. We systematically searched English language publications (1945‐2018) to identify qualitative interview and focus group studies. Thematic methods were used to synthesise the findings from these papers. We synthesised the studies by identifying second‐order themes (explanations offered by the original researchers) and third‐order constructs (new explanations which went beyond those in the original publications). Quality assessment using the Joanna Briggs checklist was undertaken. We identified 29 studies (>601 GPs, nurses and GP trainees) reporting views on discussing weight with patients. Key second‐order themes were lack of confidence in treatments and patients' ability to make changes, stigma, interactional difficulty of discussing the topic and a belief of a wider societal responsibility needed to deal with patients with overweight and obesity. The third‐order analytical theme was that discussions about weight were not a priority, and other behavioural interventions, including those relating to smoking, often took precedent. GPs and nurses reported that noting body mass index measurements at every consultation alongside a framework to deliver interventions would likely increase the frequency and perceived efficacy of behavioural weight interventions. GPs and nurses acknowledge the importance of obesity as a health issue, but this is insufficient, particularly amongst GPs, for them to construe this as a medical problem to address with patients in consultations. Strategies to implement clinical guidelines need to make tackling obesity a clinical priority. Training to overcome interactional difficulties, regular weighing of patients and changing expectations and understanding of weight loss interventions are also probably required.

No abstract

No abstract

INTRODUCTION Chiari malformation I (CM-1) is a posterior fossa structural abnormality, characterized by caudal displacement of cerebellar tonsils, through the foramen magnum. Posterior fossa decompression (PFD), involving a suboccipital craniectomy and C1 laminectomy, remains the definitive treatment. Both PFD alone (PFDO) and PFD with additional duraplasty (PFDD) are used in surgical practices. This review evaluates the current literature comparing outcomes of CM-1 treatment using PFDO and PFDD. METHODS A literature search of EMBASE and MEDLINE was conducted. References from January 1980 to January 2018 were retrieved. Only papers containing original data, comparing the use of PFDD and PFDO in paediatric CM-1 patients, were included. RESULTS Eighteen relevant papers were identified, with a resulting cohort of 4030 patients, 46.1% underwent PFDD and 53.9% PFDO. PFDD was associated with 60 min longer mean operation duration, and longer mean hospital stays by 0.7 d. PFDD provided greater symptomatic improvement (OR: 2.13; 95% CI: 1.31-3.45; P = .002). However, PFDD was also associated with increased postoperative complications (OR: 1.71, 95% CI: 1.41-2.08; P = .0001), in particular CSF leak and meningitis. PFDD was not significantly associated with incidence of syrinx improvement or revision surgery, relative to PFDO. CONCLUSION From the current literature, PFDD is associated with greater clinical improvement but higher risk of postsurgical complications, in comparison to PFDO for the treatment of paediatric CM-1. The requirement for a large cohort prospective study, adjusting for case-mix, which evaluates the relative efficacy of these 2 techniques have been identified. Current evidence is low quality, with limited statistical power.