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      The experiences of caring for someone with dementia and a learning disability: A qualitative systematic review

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          Abstract

          Background

          The life expectancy of people with a learning disability is increasing and with this comes a greater risk of developing dementia. Dementia poses new challenges for both family and formal learning disability carers as they try to support dementia’s progressive nature and quality of life for their care recipient. This qualitative systematic review explores the evidence base of family and formal carers’ experiences and needs of caring for someone with both a learning disability and dementia.

          Methods

          Six electronic databases (PubMed, PsycINFO, Cochrane Library, Prospero, Scopus, CINAHL), were searched in May 2022, utilising a predefined search strategy. Thirteen papers fulfilled inclusion criteria and were included in in the review.

          Results

          Thematic synthesis was used to explore and synthesise the qualitative findings of the studies. Four conceptual themes were identified following analysis: Knowledge and skills, Accessing support, Repercussions of dementia for carers, Influences of continuity of caring role .

          Conclusion

          There are significant training and educational needs for all carers who support the dual diagnosis of dementia and learning disability. Differences between family and formal carers relate to the organisational support and process available to formal carers. Parity across services combined with sufficiently trained carers may support dementia diagnosis and improve quality of care provided. Further research is needed to address environmental, and economic barriers carers face to facilitate ageing in place for their care recipients.

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          Most cited references80

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          Rayyan—a web and mobile app for systematic reviews

          Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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            Methods for the thematic synthesis of qualitative research in systematic reviews

            Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.
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              The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

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                Author and article information

                Journal
                Dementia (London)
                Dementia (London)
                spdem
                DEM
                Dementia (London, England)
                SAGE Publications (Sage UK: London, England )
                1471-3012
                1741-2684
                3 January 2024
                July 2024
                : 23
                : 5
                : 817-849
                Affiliations
                [1-14713012231225797]Department of Primary Care and Mental Health, Ringgold 4591, universityUniversity of Liverpool; , UK
                [2-14713012231225797]School of Health Sciences, Ringgold 4591, universityUniversity of Liverpool; , UK
                [3-14713012231225797]Department of Primary Care and Mental Health, Ringgold 4591, universityUniversity of Liverpool; , UK
                [4-14713012231225797]Ringgold 4586, universityMersey Care NHS Trust; , UK
                [5-14713012231225797]Department of Primary Care and Mental Health, Ringgold 4591, universityUniversity of Liverpool; , UK; universityNIHR Applied Research Collaboration North West Coast; , UK
                Author notes
                [*]Clarissa Giebel, Department of Primary Care and Mental Health, University of Liverpool, Brownlow Street, Waterhouse Building, Liverpool L69 3GL, UK. Email: clarissa.giebel@ 123456liverpool.ac.uk
                Author information
                https://orcid.org/0000-0001-7357-7749
                https://orcid.org/0000-0002-0746-0566
                Article
                10.1177_14713012231225797
                10.1177/14713012231225797
                11163849
                38172089
                076d0910-d945-4900-82c9-3cabe987d9b4
                © The Author(s) 2024

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Funding
                Funded by: National Institute for Health and Care Research, FundRef https://doi.org/10.13039/501100000272;
                Award ID: ARC NWC
                Categories
                Review Articles
                Custom metadata
                ts10

                dementia,learning disabilities,workforce,caregiver
                dementia, learning disabilities, workforce, caregiver

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