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  • Dr QI - A quality improvement (QI) approach to designing and delivering QI training

    Krishnan, Deepa B.; Ohize, Victor; Baumber, Luke (2021)
    Aims To develop and implement a QI training programme for trainees, Trust grade doctors and Consultants in Nottinghamshire Healthcare NHS Trust (NHFT) to enable them to deliver change in practice through acquisition of new knowledge and practical application of skills in QI projects using Model for Improvement. Background QI is crucial to improve patient care. Doctors are uniquely placed to input into patient safety and service delivery of healthcare. The skills required to be future clinical leaders and undertake improvement work are not innate and formal teaching and support is required. What is DrQI? DrQI is a trainee-led QI teaching programme developed in collaboration with Trainees improving patient safety through QI (TIPSQI) in North West deanery. Method A pre-implementation survey amongst doctors in NHFT in February 2019 (33 responses) suggested that 90% of doctors were interested in learning QI and about 48% preferred face-face workshops with support from the QI team. A list of change ideas were created using a driver diagram with QI education and project support identified as key primary drivers. PDSA cycles Nine interactive workshops teaching key QI concepts (based on model for improvement) in NHFT, training more than 100 doctors. A workshop in Derbyshire Healthcare NHS Foundation Trust (70 doctors) and Nottingham University Hospital (20 doctors). Workshops were continually adapted based on qualitative and quantitative feedback. Different formats were tried including virtual sessions, game-based and problem-based learning approaches using small group activities. Result Pre-course and post-course questionnaires were used to assess change in understanding of individual components of QI methodology (SMART Aim, Driver diagram, PDSA cycles, outcome and process measures and run charts). Mean pre-course self-assessment score collated from seven QI workshops in NHFT (2019-2020) was 3.3 and mean post-course score was 7.68, showing an improvement in understanding of QI methodology. Participants were asked to score the relevance (8.4) and quality of teaching (8.4) and the support from the QI team (7.4) on a scale of 1-10 (1 = poor and 10 = excellent). Additional free text feedback was obtained to help us improve the teaching programme. Conclusion Collaborative leadership trainee-led initiative to increase the QI capacity. A bottom up approach to complement the top down approach from the Trust QI team. Future steps include further collaboration and expansion of the scheme to other Trusts, Train the trainer sessions and building a network of QI champions.
  • Cochrane Schizophrenia Group's study-based register of randomized controlled trials: Development and content analysis

    Shokraneh, Farhad; Adams, Clive E. (2020)
    Background: Study-based registers facilitate systematic reviews through shortening the process for review team and reducing considerable waste during the review process. Such a register also provides new insights about trends of trials in a sub-specialty. This paper reports development and content analysis of Cochrane Schizophrenia Group’s Study-Based Register. Methods: The randomized controlled trials were collected through systematic searches of major information sources. Data points were extracted, curated and classified in the register. We report trends using regression analyses in Microsoft Excel and we used GIS mapping (GunnMap 2) to visualize the geographical distribution of the origin of schizophrenia trials. Results: Although only 17% of trials were registered, the number of reports form registered trials is steadily increasing and registered trials produce more reports. Clinical trial registers are main source of trial reports followed by sub-specialty journals. Schizophrenia trials have been published in 23 languages from 90 countries while 105 nations do not have any reported schizophrenia trials. Only 9.7% of trials were included in at least one Cochrane review. Pharmacotherapy is the main target of trials while trials targeting psychotherapy are increasing in a continuous rate. The number of people randomized in trials is on average 114 with 60 being the most frequent sample size. Conclusions: Curated datasets within the register uncover new patterns in data that have implications for research, policy, and practice for testing new interventions in trials or systematic reviews.
  • Are researchers getting the terms used to denote different types of recreational cannabis right?-a user perspective

    Sami, Musa (2021)
    BACKGROUND: While current cannabis research has advanced our understanding into the effects of its individual components, there is a pressing need to identify simple terminology that is understood in the same way by researchers and users of cannabis. Current categorisation in research focuses on the two main cannabinoids: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD); and two different species of cannabis: indica and sativa. Recreational cannabis has also been categorised by researchers as 'skunk' or 'hash'. Focusing on individuals who use cannabis frequently, this study aimed to identify views on current terms used to denote different types of cannabis and to identify terms validated by participants. These views were extracted from responses of the Cannabis Experiences Questionnaire (CEQ), a widely used instrument in the literature. METHODS: We qualitatively analysed 236 free-text responses from Question 23 of the CEQ survey (using Iterative Categorisation) relating to categorization and consumption methods. Data was used from a previous study (Sami et al., Psychol Med 49:103-12, 2019), which recruited a convenience sample of 1231 participants aged 18 years and above who had previously used cannabis. RESULTS: Regarding type of cannabis used, specific strain names (n = 130), concentrates (n = 37), indica/sativa (n = 22) and THC/CBD terms (n = 22) were mentioned. Other terms used were hybrids (n = 10), origins of specific strains (n = 17), edibles (n = 8), and herbal cannabis (n = 7). Regarding problems with specific terms, participants were skeptical about terms such as skunk and super skunk (n = 78) preferring terms like THC/CBD, indica/sativa, specific marketed strains and references to preparation methods. CONCLUSIONS: The results suggest a disparity between the common terms used by researchers in academia and those used by cannabis consumers. While there are advantages and limitations of using these terms to bridge views of researchers and individuals who use cannabis, this study underscores the importance of formally assessing chemical constituents rather than relying on self-report data and of incorporating cannabis user views on current terms used in research, potentially also incorporating descriptors of preparation and consumption methods.
  • Principles for the production and dissemination of recruitment material for three clinical trials of an online intervention

    Rennick-Egglestone, Stefan (2021)
    Some health research studies recruit participants through electronic mechanisms such as the placement of messages on social media platforms. This raises questions for ethics committee oversight, since effective social media campaigns might involve the production and dissemination of hundreds of contemporaneous messages. For the Narrative Experiences Online (NEON) study, we have developed nine principles to control the production and dissemination of promotional material. These have been approved by an ethics committee and enable the audit of our recruitment work. We propose that the drafting for approval of recruitment principles by health research studies may, in many cases, strike an appropriate balance between enabling ethical oversight of online recruitment work and the potential burden of message review.
  • Identification of surveys in major biomedical bibliographic databases

    Dib, Joseph E.; Adams, Clive E. (2020)
    This is a letter to the editor.
  • Assessing the quality of meta-analyses in systematic reviews in pharmaceutical research in Iran by 2016: A systematic review

    Shokraneh, Farhad (2020)
    Background: Meta-analyses, like all other studies, may be poorly designed and implemented. This study was designed to determine the quality of meta-analyses in systematic reviews in the field of pharmaceutical research in Iran. Methods: Web of Science Core Collection, EMBASE, Ovid Medline, CINAHL, Scopus, and PubMed were systematically searched on June 4, 2017. The search was limited to the researches in the field of pharmaceutical studies. Based on inclusion criteria, 104 systematic reviews with meta-analysis (SRMA) were selected and assessed using quality assessment tools introduced by Higgins. Results: Participants, experimental interventions, and outcomes were reported in all the articles. Comparator intervention and study design were correctly reported in 103 (99.04%) and 101 (97.12%) articles, respectively. The comprehensive search strategy was available only in 48 articles (46.16%), and there was no evidence of a comprehensive search in 56 articles (53.84%). Risk of bias was investigated in 78 articles (75%). Also, funnel plots were the most commonly used method for reporting the bias in 64 articles (46.42%). Conclusion: In many of the meta-analyses, several items of the tool that represented a high-quality meta-analysis were absent. According to the findings, the comprehensive search and quality assessment were not at an appropriate level. Thus, the importance of reproducibility of information and quality assessment of included studies should be emphasized. © Iran University of Medical Sciences.
  • Keeping up with studies on covid-19: systematic search strategies and resources

    Shokraneh, Farhad (2020)
    The reason I write this letter is to take a small step towards helping readers with evidence based decision making by keeping them up to date with the rapidly growing number of covid-19 studies in PubMed and other resources.1 Many studies are not going to be visible in PubMed or Embase in the next few months because of indexing and content policy in bibliographic databases that avoids indexing preprint and unpublished studies, including registered clinical trials.
  • Lessons from COVID-19 to future evidence synthesis efforts: First living search strategy and out of date scientific publishing and indexing industry

    Shokraneh, Farhad (2020)
    Nussbaumer-Streit et al. [1] reported a timely study on the exclusion of non-English language reports in systematic reviews but cautiously generalized the implications to rapid reviews rather than systematic reviews. The results complement the guidance in the new edition of the Cochrane Handbook [2]. However, the time of publication of this report coincides with the COVID-19 outbreak that introduces a geographical bias toward the inclusion of non-English literature. Although many researchers will try to publish in English, literature in non-English should not be ignored. We also thought it will be an added value to share our other experiences on literature search for evidence synthesis on COVID-19
  • Classification of interventions in Traditional Chinese Medicine

    Adams, Clive E.; Shokraneh, Farhad (2018)
    OBJECTIVETo describe the key systems used for Traditional Chinese Medicine (TCM) classification.METHODSThe TCM classifications used in the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) volume 3, the ICD-10 Procedure Coding System, the International Classification of Health Interventions, and the Medical Subject Headings (MeSH) and Chinese Traditional Medicine and Materia Medica Subject Headings (TCMeSH) thesauruses were compared regarding descriptive terms, structure, and features of TCM interventions.RESULTSThe National Library of Medicine's MeSH thesaurus is ubiquitous. The ICD-9-CM (volume 3), ICD-10 Procedure Coding System, and International Classification of Health Interventions cover insufficient concepts of TCM, and cannot be used directly as classification systems for TCM interventions. In contrast, the TCM contents of the TCMeSH thesaurus are complete, systematic, and detailed, and its hierarchical structure can be used for effective TCM classification.CONCLUSIONTCM classification is very limited and flawed. The MeSH thesaurus helps decrease the detrimental effect of the language barrier. Similarly, the TCMeSH thesaurus can help those without full command of the Mandarin language to access Chinese literature, but the value of searches using TCMeSH could be improved by collaborative working with Information Specialists who are fluent in Mandarin and understand TCM.
  • Machine learning as a diagnostic decision aid for patients with transient loss of consciousness

    Jamnadas-Khoda, Jennifer; Broadhurst, Mark (2020)
    BackgroundTransient loss of consciousness (TLOC) is a common reason for presentation to primary/emergency care; over 90% are because of epilepsy, syncope, or psychogenic non-epileptic seizures (PNES). Misdiagnoses are common, and there are currently no validated decision rules to aid diagnosis and management. We seek to explore the utility of machine-learning techniques to develop a short diagnostic instrument by extracting features with optimal discriminatory values from responses to detailed questionnaires about TLOC manifestations and comorbidities (86 questions to patients, 31 to TLOC witnesses).MethodsMulti-center retrospective self- and witness-report questionnaire study in secondary care settings. Feature selection was performed by an iterative algorithm based on random forest analysis. Data were randomly divided in a 2:1 ratio into training and validation sets (163:86 for all data; 208:92 for analysis excluding witness reports).ResultsThree hundred patients with proven diagnoses (100 each: epilepsy, syncope and PNES) were recruited from epilepsy and syncope services. Two hundred forty-nine completed patient and witness questionnaires: 86 epilepsy (64 female), 84 PNES (61 female), and 79 syncope (59 female). Responses to 36 questions optimally predicted diagnoses. A classifier trained on these features classified 74/86 (86.0% [95% confidence interval 76.9%-92.6%]) of patients correctly in validation (100 [86.7%-100%] syncope, 85.7 [67.3%-96.0%] epilepsy, 75.0 [56.6%-88.5%] PNES). Excluding witness reports, 34 features provided optimal prediction (classifier accuracy of 72/92 [78.3 (68.4%-86.2%)] in validation, 83.8 [68.0%-93.8%] syncope, 81.5 [61.9%-93.7%] epilepsy, 67.9 [47.7%-84.1%] PNES).ConclusionsA tool based on patient symptoms/comorbidities and witness reports separates well between syncope and other common causes of TLOC. It can help to differentiate epilepsy and PNES. Validated decision rules may improve diagnostic processes and reduce misdiagnosis rates.Classification of evidenceThis study provides Class III evidence that for patients with TLOC, patient and witness questionnaires discriminate between syncope, epilepsy and PNES.
  • Not the story you want? Assessing the fit of a conceptual framework characterising mental health recovery narratives

    Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan; Hui, Ada; Morgan, Kate; Slade, Mike (2019)
    PURPOSE Narratives of recovery have been central to the development of the recovery approach in mental health. However, there has been a lack of clarity around definitions. A recent conceptual framework characterised recovery narratives based on a systematic review and narrative synthesis of existing literature, but was based on a limited sample. The aims of this study were to assess the relevance of the framework to the narratives of more diverse populations, and to develop a refined typology intended to inform narrative-based research, practice and intervention development. METHOD 77 narrative interviews were conducted with respondents from four under-researched mental health sub-populations across England. Deductive and inductive analysis was used to assess the relevance of the dimensions and types of the preliminary typology to the interview narratives. RESULTS Five or more dimensions were identifiable within 97% of narratives. The preliminary typology was refined to include new definitions and types. The typology was found not to be relevant to two narratives, whose narrators expressed a preference for non-verbal communication. These are presented as case studies to define the limits of the typology. CONCLUSION The refined typology, based on the largest study to date of recovery narratives, provides a defensible theoretical base for clinical and research use with a range of clinical populations. Implications for practice include ensuring a heterogeneous selection of narratives as resources to support recovery, and developing new approaches to supporting non-verbal narrative construction.
  • Introducing RAPTOR: RevMan Parsing Tool for Reviews

    Shokraneh, Farhad; Adams, Clive E. (2019)
    BACKGROUND: Much effort is made to ensure Cochrane reviews are based on reliably extracted data. There is a commitment to wide access to these data-for novel processing and/or reuse-but delivering this access is problematic. AIM: To describe a proof-of-concept programme to extract, curate and structure data from Cochrane reviews. METHODS: One student of Applied Sciences (16 weeks full time), access to pre-publication review files and use of 'Eclipse' to create an open-access tool (RAPTOR) using the programming language Java. RESULTS: The final software batch processes hundreds of reviews in seconds, extracting all study data and automatically tidying and unifying presentation of data for return into the source review, reuse, or export for novel analyses. CONCLUSIONS: This software, despite being limited, illustrates how the efforts of reviewers meticulously extracting study data can be improved, disseminated and reused with little additional effort.
  • Study-based registers reduce waste in systematic reviewing: discussion and case report

    Shokraneh, Farhad; Adams, Clive E. (2019)
    BACKGROUND: Maintained study-based registers (SBRs) have, at their core, study records linked to, potentially, multiple other records such as references, data sets, standard texts and full-text reports. Such registers can minimise and refine searching, de-duplicating, screening and acquisition of full texts. SBRs can facilitate new review titles/updates and, within seconds, inform the team about the potential workload of each task. METHODS: We discuss the advantages/disadvantages of SBRs and report a case of how such a register was used to develop a successful grant application and deliver results-reducing considerable redundancy of effort. RESULTS: SBRs saved time in question-setting and scoping and made rapid production of nine Cochrane systematic reviews possible. CONCLUSION: Whilst helping prioritise and conduct systematic reviews, SBRs improve quality. Those funding information specialists for literature reviewing could reasonably stipulate the resulting SBR to be delivered for dissemination and use beyond the life of the project.
  • A simple formula for enumerating comparisons in trials and network meta-analysis

    Shokraneh, Farhad; Adams, Clive E. (2019)
    We present use of a simple formula to calculate the number of pairwise comparisons of interventions within a single trial or network meta-analyses. We used the data from our previous network meta-analysis to build a study-based register and enumerated the direct pairwise comparisons from the trials therein. We then compared this with the number of comparisons predicted by use of the formula and finally with the reported number of comparisons (indirect or direct) within the network meta-analysis. A total of 133 trials of 8 interventions were selected which included 163 comparisons. The network of these showed 16 unique direct comparisons. The formula predicted an expected 28 indirect or direct comparisons and this is the number that were indeed reported. The formula produces an accurate enumeration of the potential comparisons within a single trial or network meta-analysis. Its use could help transparency of reporting should a shortfall occur between comparisons actually used and the potential total.
  • A visual approach to query formulation for systematic search

    Shokraneh, Farhad (2019)
    Knowledge workers (such as healthcare information professionals, patent agents and legal researchers) need to create and execute search strategies that are accurate, repeatable and transparent. The traditional solution offered by most database vendors is to use proprietary line-by-line 'query builders'. However, these offer limited support for error checking or query optimisation, and their output can often be compromised by errors and inefficiencies. Using the healthcare domain for context, we demonstrate a new approach to search strategy formulation in which concepts are expressed as objects on a two-dimensional canvas, and relationships are articulated using direct manipulation. This approach eliminates many sources of syntactic error, makes the query semantics more transparent, and offers new ways to optimise, save and share search strategies and best practices. © 2019 Copyright held by the owner/author(s).
  • Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

    Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan; Crawford, Paul; Hui, Ada; Manley, David S.; Wright, Nicola; Slade, Mike (2019)
    BACKGROUND: Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives. METHOD: A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188). RESULTS: 8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies. CONCLUSIONS: Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.
  • Web application development with R using Shiny

    Beeley, Chris (2018)
    Web Application Development with R Using Shiny helps you become familiar with the complete R Shiny package. The book starts with a quick overview of R and its fundamentals, followed by an exploration of the fundamentals of Shiny and some of the things it can help you do. You'll learn about the wide range of widgets and functions within Shiny and how they fit together to make an attractive and easy-to-use application. Once you have learned the basics, you'll move on to study more advanced UI features, including how to style apps in detail using the Bootstrap framework and Shiny's built in layout functions. You'll learn how to enhance Shiny with JavaScript, ranging from adding simple interactivity with JavaScript right through to using JavaScript to enhance the reactivity between your app and UI. You'll learn more advanced Shiny features, such as uploading and downloading data and reports, and how to interact with tables and link reactive outputs. Lastly, you'll learn how to deploy Shiny applications over the internet, as well as how to handle storage and data persistence within Shiny applications, including the use of relational databases. By the end of this book, you'll be ready to create responsive, interactive web applications using the complete R (v 3.4) Shiny (1.1.0) suite.
  • Making progress with the automation of systematic reviews: Principles of the International Collaboration for the Automation of Systematic Reviews (ICASR)

    Adams, Clive E.; Xia, Jun (2018)
    Systematic reviews (SR) are vital to health care, but have become complicated and time-consuming, due to the rapid expansion of evidence to be synthesised. Fortunately, many tasks of systematic reviews have the potential to be automated or may be assisted by automation. Recent advances in natural language processing, text mining and machine learning have produced new algorithms that can accurately mimic human endeavour in systematic review activity, faster and more cheaply. Automation tools need to be able to work together, to exchange data and results. Therefore, we initiated the International Collaboration for the Automation of Systematic Reviews (ICASR), to successfully put all the parts of automation of systematic review production together. The first meeting was held in Vienna in October 2015. We established a set of principles to enable tools to be developed and integrated into toolkits.
  • Supporting effective recruitment in a large rehabilitation trial through a research assistant network

    Robinson, Katie R. (2018)
    Introduction: Falls in Care Home (FinCH) is a large rehabilitation trial evaluating a falls management approach for care home residents with 10 sites across the UK participating. Recruitment is vital to the success of FinCH to ensure an appropriate and sufficient sample of care home staff and residents are included. The challenges of recruitment in the acute setting are widely acknowledged, however recruitment of care homes and residents in care homes is relatively new.

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