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1.  Anyone for Club Med? 
BMJ : British Medical Journal  2008;337(7662):178.
PMCID: PMC2483874  PMID: 18614468
2.  Campaign for real lectures 
BMJ : British Medical Journal  2008;336(7655):1252.
PMCID: PMC2405873
3.  Benchmarking the turf 
BMJ : British Medical Journal  2008;336(7648):836.
PMCID: PMC2292340
4.  The business of health 
BMJ : British Medical Journal  2008;336(7641):450.
PMCID: PMC2249689
5.  Development lesson 
BMJ : British Medical Journal  2008;336(7635):100.
PMCID: PMC2190273
6.  George's last stand 
BMJ : British Medical Journal  2007;335(7628):1048.
PMCID: PMC2078659
7.  Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace 
Objective To evaluate the policy making process, implementation by NHS organisations, and patients’ and carers’ experiences of efforts to introduce an internet accessible personal electronic health record (HealthSpace) in a public sector healthcare system.
Design Mixed method, multilevel case study.
Setting English National Health Service; the basic HealthSpace technology (available throughout England) and the advanced version (available in a few localities where this option had been introduced) were considered.
Main outcome measures National statistics on invitations sent, HealthSpace accounts created, and interviews and ethnographic observation of patients and carers. Data analysis was informed by a socio-technical approach which considered macro and micro influences on both adoption and non-adoption of innovations, and by the principles of critical discourse analysis.
Participants 56 patients and carers (of whom 21 opened a basic HealthSpace account, 20 had diabetes but were not initially using HealthSpace, and 15 used advanced HealthSpace accounts to exchange messages with their general practitioner), 3000 pages of documents (policies, strategies, business plans, minutes of meetings, correspondence), observational field notes, and 160 interviews with policy makers, project managers, and clinical staff.
Results Between 2007 and October 2010, 172 950 people opened a basic HealthSpace account. 2913 (0.13% of those invited) opened an advanced account, compared with 5-10% of the population anticipated in the original business case. Overall, patients perceived HealthSpace as neither useful nor easy to use and its functionality aligned poorly with their expectations and self management practices. Those who used email-style messaging were positive about its benefits, but enthusiasm beyond three early adopter clinicians was low, and fewer than 100 of 30 000 patients expressed interest. Policy makers’ hopes that “deploying” HealthSpace would lead to empowered patients, personalised care, lower NHS costs, better data quality, and improved health literacy were not realised over the three year evaluation period.
Conclusion Unless personal electronic health records align closely with people’s attitudes, self management practices, identified information needs, and the wider care package (including organisational routines and incentive structures for clinicians), the risk that they will be abandoned or not adopted at all is substantial. Conceptualising such records dynamically (as components of a socio-technical network) rather than statically (as containers for data) and employing user centred design techniques might improve their chances of adoption and use. The findings raise questions about how eHealth programmes in England are developed and approved at policy level.
PMCID: PMC2982892  PMID: 21081595
8.  Realist review to understand the efficacy of school feeding programmes  
BMJ : British Medical Journal  2007;335(7625):858-861.
A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. Trisha Greenhalgh,Elizabeth Kristjansson, and Vivian Robinson look more closely at the highly heterogeneous trials to see what works, for whom, and in what circumstances
PMCID: PMC2043412  PMID: 17954518
9.  Dear Ofcare . . . 
BMJ : British Medical Journal  2007;335(7622):724.
PMCID: PMC2001065
10.  Trouble down under  
BMJ : British Medical Journal  2007;335(7615):350.
PMCID: PMC1949430
11.  Lecturing by remote 
BMJ : British Medical Journal  2007;335(7610):100.
PMCID: PMC1914483
12.  Barefoot doctor 
BMJ : British Medical Journal  2007;334(7604):1168.
PMCID: PMC1885350
13.  Doing medicine 
BMJ : British Medical Journal  2007;334(7598):854.
PMCID: PMC1853192
14.  Let's talk about critical consciousness 
BMJ : British Medical Journal  2007;334(7592):490.
PMCID: PMC1819551  PMID: 17347198
15.  Best wishes for your incurable illness 
BMJ : British Medical Journal  2007;334(7592):538.
PMCID: PMC1819525
16.  The new jetsetting 
BMJ : British Medical Journal  2007;334(7586):210.
PMCID: PMC1781995
17.  Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives 
Objective To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community.
Design Qualitative study (focus groups and semistructured interviews).
Setting Tower Hamlets, a socioeconomically deprived London borough, United Kingdom.
Participants Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3).
Methods 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis.
Results Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding.
Conclusion Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.
PMCID: PMC2659954  PMID: 18984633
18.  Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study 
Objective To explore ethnic stereotypes of UK medical students in the context of academic underachievement of medical students from ethnic minorities.
Design Qualitative study using semistructured one to one interviews and focus groups.
Setting A London medical school.
Participants 27 year 3 medical students and 25 clinical teachers, purposively sampled for ethnicity and sex.
Methods Data were analysed using the theory of stereotype threat (a psychological phenomenon thought to negatively affect the performance of people from ethnic minorities in educational contexts) and the constant comparative method.
Results Participants believed the student-teacher relationship was vital for clinical learning. Teachers had strong perceptions about “good” clinical students (interactive, keen, respectful), and some described being aggressive towards students whom they perceived as quiet, unmotivated, and unwilling. Students had equally strong perceptions about “good” clinical teachers (encouraging, interested, interactive, non-aggressive). Students and teachers had concordant and well developed perceptions of the “typical” Asian clinical medical student who was considered over-reliant on books, poor at communicating with patients, too quiet during clinical teaching sessions, and unmotivated owing to being pushed into studying medicine by ambitious parents. Stereotypes of the “typical” white student were less well developed: autonomous, confident, and outgoing team player. Direct discrimination was not reported.
Conclusions Asian clinical medical students may be more likely than white students to be perceived stereotypically and negatively, which may reduce their learning by jeopardising their relationships with teachers. The existence of a negative stereotype about their group also raises the possibility that underperformance of medical students from ethnic minorities may be partly due to stereotype threat. It is recommended that clinical teachers be given opportunities and training to encourage them to get to know their students as individuals and thus foster positive educational relationships with them.
PMCID: PMC2517162  PMID: 18710846
19.  Patients’ attitudes to the summary care record and HealthSpace: qualitative study 
BMJ : British Medical Journal  2008;336(7656):1290-1295.
Objective To document the views of patients and the public towards the summary care record (SCR, a centrally stored medical record drawn from the general practice record) and HealthSpace (a personal health organiser accessible through the internet from which people can view their SCR), with a particular focus on those with low health literacy, potentially stigmatising conditions, or difficulties accessing health care.
Design 103 semistructured individual interviews and seven focus groups.
Setting Three early adopter primary care trusts in England where the SCR and HealthSpace are being piloted. All were in areas of relative socioeconomic deprivation.
Participants Individual participants were recruited from general practice surgeries, walk-in centres, out of hours centres, and accident and emergency departments. Participants in focus groups were recruited through voluntary sector organisations; they comprised advocates of vulnerable groups and advocates of people who speak limited English; people with HIV; users of mental health services; young adults; elderly people; and participants of a drug rehabilitation programme.
Methods Participants were asked if they had received information about the SCR and HealthSpace and about their views on shared electronic records in different circumstances.
Results Most people were not aware of the SCR or HealthSpace and did not recall receiving information about it. They saw both benefits and drawbacks to having an SCR and described a process of weighing the former against the latter when making their personal choice. Key factors influencing this choice included the nature of any illness (especially whether it was likely to lead to emergency care needs); past and present experience of healthcare and government surveillance; the person’s level of engagement and health literacy; and their trust and confidence in the primary healthcare team and the wider NHS. Overall, people with stigmatising illness were more positive about the SCR than people who claimed to speak for “vulnerable groups.” Misconceptions about the SCR were common, especially confusion about what data it contained and who would have access to it. Most people were not interested in recording their medical data or accessing their SCR via HealthSpace, but some saw the potential for this new technology to support self management and lay care for those with chronic illness.
Conclusion Despite an extensive information programme in early adopter sites, the public remains unclear about current policy on shared electronic records, though most people view these as a positive development. The “implied consent” model for creating and accessing a person’s SCR should be revisited, perhaps in favour of “consent to view” at the point of access.
PMCID: PMC2413413  PMID: 18511764
20.  Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial 
BMJ : British Medical Journal  2008;336(7644):598-600.
Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.
Design Randomised controlled trial.
Setting Five general practices in Hertfordshire, England.
Participants 561 current smokers aged over 35.
Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of “lung age” (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.
Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.
Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at £280 (€366, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.
Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.
Trial registration National Research Register N0096173751.
PMCID: PMC2267989  PMID: 18326503
21.  GP or travel agent? 
BMJ : British Medical Journal  2006;333(7579):1179.
PMCID: PMC1676143
22.  War 
BMJ : British Medical Journal  2006;333(7575):977.
PMCID: PMC1633750
23.  How to formulate research recommendations 
BMJ : British Medical Journal  2006;333(7574):917.
PMCID: PMC1626288  PMID: 17068044
24.  Dominoes 
BMJ : British Medical Journal  2006;333(7571):761.
PMCID: PMC1592445
25.  Busman's holiday 
BMJ : British Medical Journal  2006;333(7566):505.
PMCID: PMC1557918

Results 1-25 (130)