Wednesday exploration: methods@manchester

This week a resource which is an excellent starting place for anyone wanting to increase their understanding of research methods via methods@manchester. This initiative has been undertaken by the Faculty of Humanities at the University of Manchester and whilst it showcases methods expertise at the university the resource is so much more than that, is freely available and worth exploring.

The resources section is easy to navigate and is sub-divided into Methods categories and Methods resources. These are the topics included in the methods categories and as you can see they cover a wide range of categories of relevance to health researchers.

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Each of the topics is then sub-divided and so for example these are some of the sub-categories within survey and statistical methods category

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Within each of these sub-categories you will find an overview of the topic, key references and PDF slides and links to the academics at Manchester University with expertise in the topic.

The methods resources section is a smaller section and divided into external resources with links to other methods resources such as the Centre for Longitudinal Studies and Manchester resources which links to the main research groups within the University. 

The methods@manchester resource is well worth exploring and bookmarking. It is helpful as a quick reference for anyone wanting an introduction to a specific topic, the slides and PDFs will take your further into the subject as will the links and references.

As with previous weeks if you have found an online resource that you think will be helpful to other health researchers please let me know it would be great to share with other people and build up our collective knowledge.

Develop skills by implementing research

unspecifiedAs with previous posts linked to components of the EPIC model an exploration of the research skills which can be developed through implementation are located within the domains of the Vitae researcher development framework. Whilst the framework is aimed at supporting personal development for people undertaking doctoral level study and beyond it also has utility in demonstrating how engaging in activities within a clinical setting can start to develop transferable skills for anyone seeking to develop research expertise at earlier stages of their research journey.

Domain C, focused on research governance and organisation, is less pertinent to this component and is omitted.

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The skills outlined within Domain A are especially relevant if you are required to undertake a critical appraisal and synthesis of evidence to inform an aspect of practice development. The skills should be familiar to all from undergraduate study and continue to be key skills to maintain and develop.

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unspecified-3.png It takes confidence to question our practice and, inherently, the practice of our colleagues, and requires resilience to lead an implementation project. As highlighted previously implementation is a complex process with many confounding variables. Therefore the implementation of research within a practice context draws heavily on personal effectiveness, influence and engagement as it is usually focused on driving change within a team, system or organisation calling for teamwork, collaboration and effective communication.

Implementation: moving forward into action.

To complete this section of the EPIC model here are some suggestions to support you in moving forward with implementation.

The Critical Appraisal Skills Programme. CASP has developed workshops and tools, including interactive and e-learning resources to support critical appraisal. CASP provides links to Health Knowledge whose focus is on public health however one of the resources they support is a video course taking you through the process of finding and assessing the quality of evidence. The resource is free and comprises a number of learning units including finding the evidence, RCTs, systematic reviews, economic evaluations, making sense of results. This is a tool you could work through with colleagues or on your own.

The Cochrane Library. The Cochrane Library now contains over 9,000 high quality systematic reviews and is a key resource from which to explore the current state of evidence base for your practice. There are many ways of getting involved with the work of the Cochrane Collaboration which will develop your skills including suggesting ideas for reviews via the topic specific Review Groups, being part of a review group and helping to screen health research records with the EMBASE project. This project provides an opportunity for new and potential contributors to get involved with Cochrane work by screening records for potential inclusion in Cochrane’s trials register, CENTRAL. Important point to note here: No prior experience is necessary and novice screeners are welcome.

Your clinical librarian. In the first component of the EPIC model Explore I described the importance of getting to know different aspects of the research community within your  organisation flagging up clinical librarians as a key resource, if you are in a Trust, or subject librarians if you are linked with a University. The role of clinical librarians is changing rapidly to support the focus on evidence informed practice. If you are unfamiliar with the range of services your library provides make it a priority to find out how they can support you in developing evidence informed practice.

Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) have also been flagged up previously as organisations to link with. If you are not sure if you have a CLAHRC in your area you can find out here. As an example of the work they are undertaking the North West Coast CLAHRC is offering currently for its member organisations a workshop on Finding evidence: informing practice which aims to provide participants with: an understanding of how evidence can inform practice; an opportunity to refine and develop a search question; an overview of search strategies and processes; an opportunity to design and implement an evidence search with the support of an expert; access to IT within the workshop to commence your evidence search. The range of support offered by CLAHRCs varies but a key area of their expertise resides in the implementation of applied research.

The School for Health Care Radicals. If you are in the position of leading a change in practice the 2016 School for Health and Care radicals, led by Helen Bevan and her team at the NHS Horizons Group, has just started. It is a free online learning programme comprising webinars, handbook, study guide and guided social learning. The reason I’m flagging this up is that it is a high quality programme focused on leading radical change within the NHS. It is well worth exploring as it is not only highly informative but also highly motivating and designed to develop your expertise as an agent for change.

Implementation Research. If you are at the point of exploring potential topics for a Masters or Doctoral dissertation this new and growing area of research may be of interest. As noted in the first post about implementation it is a focus for some medical research charities and NIHR have a specific fellowship programme aimed at knowledge mobilisation. Significant contributions to providing high quality evidence informed care can be made by understanding how to facilitate more effectively the mobilisation of knowledge from research into practice contexts.

 

Wednesday exploration: The James Lind Alliance

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Having focused for the last two weeks on aspects of writing a change in topic this week, the work of the James Lind Alliance and the Priority Setting Partnerships they facilitate to prioritise unanswered research questions about the effects of treatment in specific conditions.

The James Lind Alliance (JLA), established in 2004, is funded by NIHR and based in the NIHR Evaluation, Trials and Studies Co-ordinating Centre at the University of Southampton. The rationale informing its work is the need to ensure that questions important to patients, carers and healthcare professionals working clinically are not neglected by researchers and that when research is focused on questions of clinical importance the results are transferable to practice. This is achieved through Priority Setting Partnerships(PSPs)

JLA has developed a robust approach to PSPs and publish a guidebook detailing the processes and protocol followed. Facilitated by JLA but funded and organised by the group commissioning the PSP the partnerships bring together clinicians, patients and carers to identify and prioritise important uncertainties about the effects of treatment that could be answered by research. Whilst people from a non-clinical background may be involved in the process they are not involved in voting on the priority questions to ensure that the priorities are firmly based on the priorities of patients, carers and service providers.

The output from each PSP is a list of jointly agreed research priorities, usually Top 10s, which are published and disseminated widely. PSPs have been undertaken on topics including depression, autism, dementia, Parkinson’s disease, palliative and end of life care, multiple sclerosis and schizophrenia.

To illustrate the process a PSP on palliative and end of life care was initiated by Marie Curie working in partnership with 30 other organisations.  Over 1,400 people, including those in the last years of life, carers, and health and social care professionals participated in the PSP and the top 10 priorities, along with another 18 ranked priorities were published in 2015.

To give you an insight into the process in this instance a steering group was convened in 2013 and undertook a period of consultation to request questions and uncertainties of clinical importance relating to the care, support and treatment of people who are likely to be in the last few years of life including questions about care and support for carers and families. The consultation methods included membership meetings, emails, postal and web-based questionnaires, social media and focus group work.

The questions generated by the initial consultation were collated into indicative questions and, a crucial step in the process, a review of current literature was undertaken to ensure that the questions had not already been answered. Once it was established which questions were unanswered a final prioritisation process was undertaken to reach the final top 10 list.

Details of all of the PSPs can be found on the JLA website and, where appropriate links to specific sites that were established as part of the process. If you are developing a research proposal it is well worth becoming familiar with the outputs of any relevant PSPs as they not only influence the funding streams of NIHR and major medical research charities but they also provide strong evidence to justify the focus of your proposal. Similarly if you are interested in priority setting partnerships the guidebook and templates produced by JLA will be of interest.

A little bit of history to end with. James Lind was a scottish naval surgeon who in the 1700s pioneered the first clinical trail in his work on the prevention of scurvy. Twelve scorbutic sailors were divided into 6 groups, all had the same diet but they were given different ‘supplements’ cider, sulphuric acid, vinegar, seawater, a spicy paste and barley water or 2 oranges and 1 lemon. His results showed that oranges and lemons were better than other treatments.

What does it mean for academic papers to be available freely?

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To me? A great deal. In December I started to work in independent practice and in December, for the first time in  many years I lost the ability to access freely academic journals. An interesting position to be in and one experienced by the majority of healthcare professionals working outside of academia or the NHS. Even within the NHS reduced  access is a frustration for healthcare professionals who, on completion of postgraduate studies linked with a University, are more limited in what they can access.

Therefore it was with real interest that I followed up a number of tweets last week about Sci-Hub which was established in 2011 and, until now, has passed me by completely. What follows is a precis of the story published in sciencealert.com, and bigthink.com.  Sci-Hub was created by Russian neuroscientist Alexandra Elbakyan as a consequence of her frustration at her inability to access articles without having to pay. Does this resonate with you? You find an abstract that looks promising, follow the link and are met with a request for payment?

Here is something I have been reflecting on prompted by this story. I was looking for a paper last week and to access it for 24 hours would have cost me $40 (£27.57p). Now here’s the thing – I receive fairly regular request from said journal to carry out article reviews. I am required to do this free of charge within 10 working days. During those 10 days I receive reminders of the approaching deadline and if I miss it I receive an email pointing out how I am holding up the review process. If I decline to undertake the review I am automatically directed to a webpage asking me to suggest alternative reviewers from my professional network. Hmmm.

Alexandra Elbakyan moved way beyond my frustration and established what is in effect a pirate repository of over 48 million journal articles. How does it work? You type in the URL of the paper you are seeking and the full text of the paper appears – it works I searched for one of my papers and the full text was there in seconds.

Behind the scenes your request is first routed to similar pirate site LibGen and if they don’t have it… well you know you are told to never share logins or password – anonymous academics have donated theirs to Sci-Hub enabling it to access journals that otherwise sit behind paywalls. The neat thing is that if it accesses a paper in this way Sci-hub then sends a copy of the paper to LibGen to increase their repository.

Needless to say Alexandra Elbankyan is the subject to a law suit  in the US brought by Elsevier and was ordered to close the site down in December. However it is still up and running. In fighting the injunction Alexandra has cited article 27 of the UN Declaration of Human Rights which states that: ‘everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits’.

The points made in her letter to the judge in her defence are really worth reading. Having published in academic journals, chaired an editorial board of a professional journal and published books I understand the different perspectives. However it is my current position of being effectively locked out of the world of academic publishing that makes me cheer for the tenacity of Alexandra Elbankyan and what she is fighting for – the democratisation of knowledge.

Some of the greatest beneficiaries of this fight will be people in developing countries but a thought I will share which is closer to home and focused on practice rather than academic publishing- if we are committed to evidence informed practice and the rapid translation of research into practice what will happen within an increasingly fragmented health economy where no one working in the independent or voluntary sectors, like me, has access to the evidence?

The photo used in this post was taken by Aleski Tappura and downloaded from Unsplash.com

 

Wednesday exploration: pomodoro & shut up & write

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People writing together. Image shared via Stock Snap

Writing is finally about one thing: going into a room and doing it. William Goldman.

The bottom line is that we all know this but if you have a paper or report to write, a thesis to complete or a proposal to develop how good are you at actually getting down to writing? Are you disciplined about sitting down and getting on with the task in hand or do you find a hundred and one more important things to do?

When you settle down with your computer to write if you need to look something up on the internet do you, 10 clicks later, find yourself engrossed in some amazing website that has absolutely nothing to do with what you were looking up? Then the things being shared in this weeks exploration may be of interest.

The first is PhD2Published which I discovered last November when I came across academic writing month (#AcWriMo). PhD2Published organises AcWriMo and describes it as an annual academic write-a-thon held every November which unites people by the common goal of developing better and more sustainable writing habits. Over 1000 people participate  and, if you want to be part of a writing community, it is a fun way to feel connected as part of a global community with other academics who are in supportive, writing mode. At the start of November you declare publicly your writing goal and throughout the month a range of social media are used to help you to keep motivated and on target and to share your ups and downs. If you want to find out more here is the link and I have put a reminder in my diary to flag it up again as the time approaches.

As well as AcWriMo the PhD2Published site comprises a compilation of hundreds of blog posts organised under the headings of journal articles, books, conference papers, grants, digital publishing, academic practice and resources (websites and tools). In terms of supporting your writing whether it is an abstract for a conference, a chapter in a book or a grant application it is worth exploring this site and the resources and tools it links you to.

It was whilst I was following academic writing month that I came across 2 other writing strategies which caught my attention Pomodoro and Shut up and Write. 

The Pomodoro Technique is a time management technique which can be used as a strategy to help you maintain focus when you sit down to write. The basic principle is to work in 25 minute blocks. You set a timer for 25 minutes (and yes you can actually buy a bright red pomodoro) and write without distraction for this length of time. When time is up get up and have a 5 minute break. At the end of 5 minutes reset the timer and continue writing for another 25 minutes. If you are on a roll and string 4 pomodoros together at the end of the fourth you take a 30 minute break. There is a little more to it than that, but not much, and all of the details are on the site.

Shut up and Write Tuesdays are based around the pomodoro technique and have been developed to help academics not only structure their writing time but also connect with others. Writing can be a lonely activity and this approach, started in San Fransisco,  aims to bring people together to write. The idea is to identify a suitable location and space, meet together and write in silence for an hour with a 5 minute break (2 pomodoros) and then socialise over coffee after. The rationale is that, the discipline and shared sense of purpose that comes from writing with others also keeps you accountable and reminds you that you aren’t alone. So here is a pretty straight forward idea for setting up a writing group with colleagues or fellow students.

If the  shut up and write approach appeals but you don’t have a group to write with there is also a virtual Shut up and Write group on the first and third Tuesday of each month @SUWTUK. If the time for the UK session doesn’t suit check out the other times zones as there are 3 virtual groups running in different time zones.

Three resources to support your writing. As always it would be great to hear about the things you have found useful so please share.

 

Wednesday exploration: sketchnotes and leadership.

DSCN0662Having changed jobs recently I was faced with a pile of old notebooks. Pages of written text with no visual clues regarding the content, often lacking headings and dates. I’m sure this reveals something about my unsystematic approach to dealing with notes but I’m hoping this may resonate with others because if you are studying or conducting research you will take notes, lots of notes.

The question I have been exploring is, is there a better way of making notes more accessible? Over the last few years there has been a growth in the utilisation of visual note takers to summarise and communicate key messages from workshops and meetings. If you haven’t come across them have a look at the website of Morethanminutes.

I have watched Claire and her colleagues at work in awe not only of their artistic talent but also of their ability to listen, distil and draw at the same time. Something which has felt unobtainable to me as my inner critic tells me constantly that I cannot draw.

Over the last month I have started to follow Tanmay Vora’s blog which is focused on ‘Leadership, Learning and Raising the Bar in a Constantly Changing World’. If you are seeking to develop your leadership skills this blog is well worth exploring. Recent posts include Leadership: start with trust exploring how leaders need to connect with people before they can lead, When does real learning happen which explores exactly that and Leaders need 3 kinds of focus which identifies 3 foci for leaders, the needs of the context, their own needs and the needs of others.

What you will see if you explore these posts is that the written content is fairly short but the visual note at the end of each post summarises and communicates concepts and ideas very effectively. There is something compelling in the way the visual notes invite you to think in a different way.

Looking at Tanmay’s visual notes, and reading about his journey into visual note taking, made me think more about this approach and how my pages of notes would have been more accessible and probably more focused if I had included visuals.

Feeling a little more confident I have been exploring ‘The Sketchnote Handbook. The illustrated guide to visual note taking” by Mike Rohde, one of several introductory texts on visual note taking. Whilst contributors include professional skektchnote takers, the basic premise is that if you can draw a circle, square, triangle, line and dot you can draw sketchnotes. The book provides an insight into the theory behind sketchnotes, the processes involved in taking sketchnotes and practical exercises to help you develop your skills.

The focus of the book is on sketchnote taking in presentations but as you can see in Tanmay’s blog the technique can also be used to summarise texts and convey your thought processes. I also think it would be helpful in analysing qualitative data.

As part of my coaching practice I keep a reflective diary and have started to experiment with including sketchnotes. It certainly makes my notes more accessible and quicker to reference and it has made me think more about the key points I want to highlight. Before supervision it is now easy to pick out the focus for discussion and, when preparing for new coaching sessions, I can connect with things far more quickly. How am I getting on? Well I am not about to launch my sketchnotes on the world but they are definitely improving.

Maybe sketches and leadership appear as strange bed fellows but this is how different things connect when you go exploring.

The EPIC Model: implementing research in practice

unspecifiedNot exactly a leap into the New Year with this component of the EPIC framework, more of a splutter. Having covered Explore and Promote in previous posts attention turns to the third component Implement which is proving to be a bit of a slippery character.

Before we progress any further let’s clarify what we mean by implementation, defined in the Oxford English dictionary as, ‘the process of putting a decision or plan into effect’. Within a health context this can be seen as the process of transferring knowledge from a research setting into mainstream clinical practice.

I have been pondering why this component has caused a writing block and much procrastination. On reflection I think it’s because on one level the implementation of research is so fundamental to 21st century clinical practice that saying that it needs to be done feels a bit like teaching your grandmother to suck eggs; people undertake research to increase knowledge and improve patient care and therefore once we have a robust evidence base we transfer that knowledge into practice. Given that all healthcare professionals enter clinical practice with the requisite skills and expertise to undertake evidence informed practice this should be straightforward and yet on another level we all know that it is so much more complex.

We know that the process can be long, we know that it is complex and we know that multiple factors influence it at the levels of individuals, teams, organisations and systems. It cuts across behaviour and attitudinal change, skills and expertise, access to resources and infrastructure. Add into the mix the fact that many interventions delivered by healthcare professionals have a limited evidence base and the challenge becomes even greater.

The consequences of failing to implement research are that: patients not benefiting from advances in healthcare; they are exposed to unnecessary risks of iatrogenic harm; healthcare systems are exposed to unnecessary expenditure, Grimshaw et al.

The imperative to speed up the adoption and spread of research, and indeed innovation, across a whole system is a major policy agenda which informs the work of the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) and the Academic Health Science Networks (ASHNs).

The recognised need to understand the process of implementation and how it can be facilitated better has led to the development of a field of research in its own right called implementation research whose focus is described as being: to understand what, why and how interventions work in ‘real world’ settings and to test approaches to improve them. It has also led to the emergence of personal knowledge mobilisation fellowships from NIHR and in some medical research charities like Alzheimers Society funding stream focused specifically on implementation research.

As healthcare professionals and service users we all understand the need to ensure that practice is based on the best possible evidence but we may not be so familiar with some of the financial implications. I want to flag up just one.

In 2015 the UK Clinical Research Collaboration published UK Health Research Analysis 2014 (a good resource for anyone wanting to find out detailed information about expenditure on health research in the UK). The analysis identifies that £8.5bn was spent on health research in the UK and whilst a proportion of this was allocated to basic research significant funds were allocated also to prevention, detection and diagnosis, treatment, disease management and welfare, economic and policy issues. It is worth pausing for a moment and thinking about this a little more. Of the £8.5bn £1.2bn was generated by medical research charities.

If, as a healthcare professional you are involved with supporting a medical research charity you will appreciate what this means in terms of the time and effort put into fund raising activities. Of course the funds raised contribute also to providing welfare services and educational material and of course some of the £1.2bn will have come from returns on investment but even so significant funds will have been raised by individuals running marathons, families and friends holding coffee mornings and undertaking all kinds of fund raising activities.

The motivating force for many? The aspiration that the money raised for research will make a difference and guess what that relies – not only researchers undertaking robust high quality research but also practitioners being prepared to drive change in service delivery when evidence becomes available.

The bottom line is that one of the most effective ways of engaging with research as a healthcare professional is to ensure that your practice is evidence informed, that where national guidance does not exist you use your skills to evaluate what evidence is available  and that by doing so you deliver on the NHS Constitutional commitment to ‘use research’.

The raison d’etre for people funding, conducting and participating in applied research is to improve patient care. Healthcare professionals are the linchpin to making this a reality.