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1.  Core outcome sets for use in effectiveness trials involving people with bipolar and schizophrenia in a community-based setting (PARTNERS2): study protocol for the development of two core outcome sets 
Trials  2015;16:47.
In the general population the prevalence of bipolar and schizophrenia is 0.24% and 1.4% respectively. People with schizophrenia and bipolar disorder have a significantly reduced life expectancy, increased rates of unemployment and a fear of stigma leading to reduced self-confidence. A core outcome set is a standardised collection of items that should be reported in all controlled trials within a research area. There are currently no core outcome sets available for use in effectiveness trials involving bipolar or schizophrenia service users managed in a community setting.
A three-step approach is to be used to concurrently develop two core outcome sets, one for bipolar and one for schizophrenia. First, a comprehensive list of outcomes will be compiled through qualitative research and systematic searching of trial databases. Focus groups and one-to-one interviews will be completed with service users, carers and healthcare professionals. Second, a Delphi study will be used to reduce the lists to a core set. The three-round Delphi study will ask service users to score the outcome list for relevance. In round two stakeholders will only see the results of their group, while in round three stakeholders will see the results of all stakeholder group by stakeholder group. Third, a consensus meeting with stakeholders will be used to confirm outcomes to be included in the core set. Following the development of the core set a systematic literature review of existing measures will allow recommendations for how the core outcomes should be measured and a stated preference survey will explore the strength of people’s preferences and estimate weights for the outcomes that comprise the core set.
A core outcome set represents the minimum measurement requirement for a research area. We aim to develop core outcome sets for use in research involving service users with schizophrenia or bipolar managed in a community setting. This will inform the wider PARTNERS2 study aims and objectives of developing an innovative primary care-based model of collaborative care for people with a diagnosis of bipolar or schizophrenia.
PMCID: PMC4334396  PMID: 25887033
2.  Editorial opposes social justice and equal opportunity 
BMJ : British Medical Journal  2008;336(7656):1264.
PMCID: PMC2413347  PMID: 18535042
3.  Acute dysphagia: an unusual treatable cause 
BMJ Case Reports  2009;2009:bcr11.2008.1270.
Bariatric surgery is a rapidly expanding surgical sub-speciality, with a large proportion of the relevant surgical procedures being performed in the private sector. Acute complications of newer surgical procedures can lead to emergency department presentation, with which the staff may be unfamiliar. A 34-year-old woman was seen in the emergency department with acute total dysphagia following laparoscopic adjustable gastric banding, which was treated successfully by a simple bedside procedure.
PMCID: PMC3027954  PMID: 21686381
4.  Family history in primary care: understanding GPs' resistance to clinical genetics — qualitative study 
The British Journal of General Practice  2010;60(574):e221-e230.
National and local evaluations of clinical genetics service pilots have experienced difficulty in engaging with GPs.
To understand GPs' reluctance to engage with clinical genetics service developments, via an examination of the role of family history in general practice.
Design of study
Qualitative study using semi-structured one-to-one interviews.
The West Midlands, UK.
Interviews with 21 GPs working in 15 practices, based on a stratified random sample from the Midlands Research Practices Consortium database. Thematic analysis proceeded alongside data generation. Framework grids were constructed for comparative analytical questioning. Interpretation was framed by two explanatory models: a knowledge deficit model, and practice and professional identity model.
There is a clear distinction between the routine use and function of family history in GPs' clinical decision making, and contrasting conceptualisations of genetics and ‘genetic conditions’. Although genetics is clearly a part of current GP practice, with acknowledgement of genetic components to multifactorial disease, this is distinguished from ‘genetic conditions’ which are seen as rare, complex single-gene disorders. Importantly, family history takes its place within a broader notion of the ‘family doctor’ that interviewees identified as a key aspect of their role. In contrast, clinical genetics was not identified as a core component of generalist practice.
The likely effectiveness of educational policy interventions aimed at GPs that focus solely on knowledge deficit models, is questionable. There is a need to acknowledge how appropriate practice is constructed by GPs, within the context of accepted generalist roles and related identities.
PMCID: PMC2858554  PMID: 20423577
genetics; physicians, family; qualitative research
5.  Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6 
Objective To determine whether new programmes developed to widen access to medicine in the United Kingdom have produced more diverse student populations.
Design Population based cross sectional analysis.
Setting 31 UK universities that offer medical degrees.
Participants 34 407 UK medical students admitted to university in 2002-6.
Main outcome measures Age, sex, socioeconomic status, and ethnicity of students admitted to traditional courses and newer courses (graduate entry courses (GEC) and foundation) designed to widen access and increase diversity.
Results The demographics of students admitted to foundation courses were markedly different from traditional, graduate entry, and pre-medical courses. They were less likely to be white and to define their background as higher managerial and professional. Students on the graduate entry programme were older than students on traditional courses (25.5 v 19.2 years) and more likely to be white (odds ratio 3.74, 95% confidence interval 3.27 to 4.28; P<0.001) than those on traditional courses, but there was no difference in the ratio of men. Students on traditional courses at newer schools were significantly older by an average of 2.53 (2.41 to 2.65; P<0.001) years, more likely to be white (1.55, 1.41 to 1.71; P<0.001), and significantly less likely to have higher managerial and professional backgrounds than those at established schools (0.67, 0.61 to 0.73; P<0.001). There were marked differences in demographics across individual established schools offering both graduate entry and traditional courses.
Conclusions The graduate entry programmes do not seem to have led to significant changes to the socioeconomic profile of the UK medical student population. Foundation programmes have increased the proportion of students from under-represented groups but numbers entering these courses are small.
PMCID: PMC3043108  PMID: 21343208
6.  Acute dysphagia: an unusual treatable cause 
Bariatric surgery is a rapidly expanding surgical sub‐speciality, with a large proportion of the relevant surgical procedures being performed in the private sector. Acute complications of newer surgical procedures can lead to emergency department presentation, with which the staff may be unfamiliar. A 34‐year‐old woman was seen in the emergency department with acute total dysphagia following laparoscopic adjustable gastric banding, which was treated successfully by a simple bedside procedure.
PMCID: PMC2658340  PMID: 17954850
7.  Use of health impact assessment in incorporating health considerations in decision making 
Study aim
The aim of this project is to identify from a range of sources the factors associated with the success of a health impact assessment (HIA) in integrating health considerations into the final decision and implementation of a planned policy, programme, or project.
Three methods were adopted: (a) a review of HIA case studies; (b) a review of commentaries, reviews and discussion papers relating to HIA and decision making; and (c) an email survey of a purposive sample of HIA academics, HIA practitioners, and policymakers. Information was captured on the following characteristics: information on the year undertaken; geopolitical level; setting; sector; HIA type; methods and techniques used; identification of assessors.
Main results
Two groups of factors were identified relating to the decision making environment and to the technical conduct of the HIA. With regard to the environment, striking a balance between decision maker ownership and HIA credibility; organisational, statutory and policy commitment to HIA, and the provision of realistic, non‐controversial recommendations were cited as enablers to the integration of HIA findings into the decision making process. Barriers included a lack of knowledge of the policymaking environment by those conducting HIA. Regarding factors relating to the conduct of the HIA: use of a consistent methodological approach; inclusion of empirical evidence on health impacts; timing of the HIA congruent with the decision making process; involvement of expert HIA assessors; and shaping of recommendations to reflect organisational priorities were cited as enablers while lack of a standardised methodology; lack of resources and use of jargon were cited as barriers.
The findings emphasise the importance of considering the politico‐administrative environment in which HIA operates. The extent to which HIA fits the requirements of organisations and decision makers may be as important as the technical methods adopted to undertake it.
PMCID: PMC2465566  PMID: 16476747
health impact assessment; review; decision making
8.  Admissions processes for five year medical courses at English schools: review 
BMJ : British Medical Journal  2006;332(7548):1005-1009.
Objective To describe the current methods used by English medical schools to identify prospective medical students for admission to the five year degree course.
Design Review study including documentary analysis and interviews with admissions tutors.
Setting All schools (n = 22) participating in the national expansion of medical schools programme in England.
Results Though there is some commonality across schools with regard to the criteria used to select future students (academic ability coupled with a “well rounded” personality demonstrated by motivation for medicine, extracurricular interests, and experience of team working and leadership skills) the processes used vary substantially. Some schools do not interview; some shortlist for interview only on predicted academic performance while those that shortlist on a wider range of non-academic criteria use various techniques and tools to do so. Some schools use information presented in the candidate's personal statement and referee's report while others ignore this because of concerns over bias. A few schools seek additional information from supplementary questionnaires filled in by the candidates. Once students are shortlisted, interviews vary in terms of length, panel composition, structure, content, and scoring methods.
Conclusion The stated criteria for admission to medical school show commonality. Universities differ greatly, however, in how they apply these criteria and in the methods used to select students. Different approaches to admissions should be developed and tested.
PMCID: PMC1450044  PMID: 16543300

Results 1-8 (8)