Background the perceptions and experiences of care home residents and their families are important for understanding and improving the quality of emergency care. Methods we conducted a systematic review and metasynthesis to understand the perceptions and experiences of care home residents and their family members who experienced medical emergencies in a care home setting. The review protocol was registered in PROSPERO (CRD42020167018). We searched five electronic databases, MEDLINE, CINAHL, PubMed, Cochrane Library and PsycINFO, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of studies included in this review. Results of the 6,140 references retrieved, 10 studies from four countries (Australia, Canada, UK and USA) were included in the review and metasynthesis. All the included studies were assessed as being of good quality. Through an iterative approach, we developed six analytical themes: (i) infrastructure and process requirements in care homes to prevent and address emergencies; (ii) the decision to transfer to hospital; (iii) experiences of transfer and hospitalisation for older patients; (iv) good communication is vital for desirable outcomes; (v) legal, regulatory and ethical concerns and (vi) trusting relationships enabled residents to feel safe. Conclusions the emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care and trusting relationships between staff, patients and relatives, underpinned by good communication and attention to ethical practice.

Introduction Variations in endometrial carcinoma awareness among postmenopausal women may explain the variations in care seeking pattern for symptoms associated with endometrial carcinoma. Objectives To describe the awareness and care seeking pattern for symptoms associated with endometrial carcinoma among postmenopausal women in the district of Colombo. Methods A community based descriptive cross sectional study was conducted among 1168 postmenopausal women in the district of Colombo, using multistage cluster sampling technique. A pre-tested interviewer administered questionnaire was used. Descriptive statistics were used to describe the awareness and care seeking pattern. Results Of the sample, 83.6% (95% CI: 81.5-85.7, n=977) had heard about endometrial carcinoma. About 56% of women (n=654) were aware that postmenopausal bleeding was a suggestive symptom of endometrial carcinoma. Only 24.0% (n=280) knew that never conceived was a risk factor, 20.6% and 20.9% knew that physical inactivity and obesity were risk factors respectively and 28.0% knew that hormone replacement therapy was a risk factor, for endometrial carcinoma. Of the women, 26.6% (n=311) had experienced some gynaecological symptoms similar to symptoms of endometrial carcinoma during their postmenopausal period. Majority of them had disclosed to the children (n=155, 49.8%) about the symptoms, 70.7% (n=220) had sought treatment, and the most common reason for seeking treatment was physical discomfort (n=83, 37.8%). A majority had gone to the government hospital (n=75, 34%) to get treatment.

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