Recruitment to trials in primary care is often difficult, particularly when practice staff need t... more Recruitment to trials in primary care is often difficult, particularly when practice staff need to identify study participants with acute conditions during consultations. The Scottish Acute Recruitment Management Application (SARMA) system is linked to general practice electronic medical record (EMR) systems and is designed to provide recruitment support to multi-centre trials by screening patients against trial inclusion criteria and alerting practice staff if the patient appears eligible. For patients willing to learn more about the trial, the software allows practice staff to send the patient's contact details to the research team by text message. To evaluate the ability of the software to support trial recruitment. Software evaluation embedded in a randomised controlled trial. Five general practices in Tayside and Fife, Scotland. SARMA was used to support recruitment to a feasibility trial (the Response to Oral Agents in Diabetes, or ROAD trial) looking at users of oral ther...
Objective To systematically review the literature on the implementation of e-health to identify: ... more Objective To systematically review the literature on the implementation of e-health to identify: (1) barriers and facilitators to e-health implementation, and (2) outstanding gaps in research on the subject.
Methods MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.
Findings Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (1) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (2) factors promoting or inhibiting engagement and participation; (3) effects on roles and responsibilities; (4) risk management, and (5) ways in which implementation processes might be reconfigured by user-produced knowledge.
Conclusion The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardio... more ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardiography also provides information about valvular disease and LVH. We assessed how good these screening tests are in identifying whether the subsequent echocardiogram will have any significant abnormality. To re-appraise the ECG and BNP as screening tests for echocardiography since there are important practical deficiencies in our current knowledge in this area. General practitioners referred suspected heart failure patients for clinical assessment, echocardiography, electrocardiography, and BNP measurement. The accuracy of each screening test and combinations of screening tests were calculated for LVSD, heart failure, valvular disease, and LVH. The sensitivities of the ECG for LVSD, heart failure, LVH and valvular disease were 97%, 95%, 76%, and 69%, respectively. The corresponding figures for BNP were 86%, 82%, 59%, and 48%, respectively. When patients with atrial fibrillation and murmurs were excluded, the values for ECG were 94%, 87%, 53%, and 55%, while for BNP they were 83%, 73%, 50%, and 32%. ECG interpretation and BNP are adequate screening tests to detect LVSD or heart failure but fail to screen for other echocardiographic abnormalities, like valvular disease and LVH. This remains the case even if patients with atrial fibrillation or heart murmurs are excluded on the basis that they require echocardiography anyway.
... training 401 Communication failures in patient sign out and suggestions for improvement: a cr... more ... training 401 Communication failures in patient sign out and suggestions for improvement: a critical incident analysis V Arora, J Johnson ... compare and communicate: designing control charts to summarise efficiently data from multiple quality indicators B Guthrie, T Love, T Fahey ...
Clinical data are collected for routine care in family practice; there are also a growing number ... more Clinical data are collected for routine care in family practice; there are also a growing number of genetic and cancer registry data repositories. The Translational Research and Patient Safety in Europe (TRANSFoRm) project seeks to facilitate research using linked data from more than one source. We performed a requirements analysis which identified a wide range of data and business process requirements that need to be met before linking primary care and either genetic or disease registry data. To develop a survey to assess the readiness of data repositories to participate in linked research - the Transform International Research Readiness (TIRRE) survey. We develop the questionnaire based on our requirement analysis; with questions at micro-, meso- and macro levels of granularity, study-specific questions about diabetes and gastro-oesophageal reflux disease (GORD), and research track record. The scope of the data required was extensive. We piloted this instrument, conducting ten preliminary telephone interviews to evaluate the response to the questionnaire. Using feedback gained from these interviews we revised the questionnaire; clarifying questions that were difficult to answer and utilising skip logic to create different series of questions for the various types of data repository. We simplified the questionnaire replacing free-text responses with yes/no or picking list options, wherever possible. We placed the final questionnaire online and encouraged its use (www.clininf.eu/jointirre/info.html). Limited field testing suggests that TIRRE is capable of collecting comprehensive and relevant data about the suitability and readiness of data repositories to participate in linked data research.
Eighteen general practitioner trainers participated in the study. Each used two consulting sessio... more Eighteen general practitioner trainers participated in the study. Each used two consulting sessions for the study. One was videotaped after obtaining appropriate consent, the other was not. After each consultation patients were asked to complete a validated and reliable satisfaction ...
Background: Recruiting participants to trials can be extremely difficult. Identifying strategies ... more Background: Recruiting participants to trials can be extremely difficult. Identifying strategies that improve trial recruitment would benefit both trialists and health research. Objectives: To quantify the effects of strategies to improve recruitment of participants to randomised ...
In order to provide evidence-based secondary prevention of coronary heart disease (CHD) in genera... more In order to provide evidence-based secondary prevention of coronary heart disease (CHD) in general practice, eligible patients need to be identified. The optimal strategy is one in which all appropriate patients are identified with the least effort. The purpose of the study was to determine the optimal strategy to identify subjects with a myocardial infarction (MI) from general practice records using different search criteria. The study was a cross-sectional survey of 10 general practices in Tayside, Scotland. A random sample of all subjects aged over 35 (n = 5061) and registered with the general practices was obtained. The main outcome measures were sensitivity, specificity, positive predictive value (PPV) and yield (the number of records that need to be examined to detect a "true case"). Of the sample of 5061, 207 (4.1%) were defined to have had a "gold standard" MI. A Read code for ischaemic heart disease (IHD) had the highest sensitivity (95%) but with a poor PPV (52%). All searches had high specificities. The addition of a record of hospitalization for MI to the Read code for MI gave 100% sensitivity and high yield (1 in 1.11). In situations where the Read coding is of poor quality, the alternative search strategy of a hospital record of MI or receiving aspirin or nitrates was optimum. Patients who had experienced an MI can be easily identified from a combination of a Read code for MI and a record of hospitalization for an MI giving 100% sensitivity and specificity with a yield of 1 in 1.11.
Recruitment to trials in primary care is often difficult, particularly when practice staff need t... more Recruitment to trials in primary care is often difficult, particularly when practice staff need to identify study participants with acute conditions during consultations. The Scottish Acute Recruitment Management Application (SARMA) system is linked to general practice electronic medical record (EMR) systems and is designed to provide recruitment support to multi-centre trials by screening patients against trial inclusion criteria and alerting practice staff if the patient appears eligible. For patients willing to learn more about the trial, the software allows practice staff to send the patient's contact details to the research team by text message. To evaluate the ability of the software to support trial recruitment. Software evaluation embedded in a randomised controlled trial. Five general practices in Tayside and Fife, Scotland. SARMA was used to support recruitment to a feasibility trial (the Response to Oral Agents in Diabetes, or ROAD trial) looking at users of oral ther...
Objective To systematically review the literature on the implementation of e-health to identify: ... more Objective To systematically review the literature on the implementation of e-health to identify: (1) barriers and facilitators to e-health implementation, and (2) outstanding gaps in research on the subject.
Methods MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.
Findings Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (1) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (2) factors promoting or inhibiting engagement and participation; (3) effects on roles and responsibilities; (4) risk management, and (5) ways in which implementation processes might be reconfigured by user-produced knowledge.
Conclusion The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardio... more ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardiography also provides information about valvular disease and LVH. We assessed how good these screening tests are in identifying whether the subsequent echocardiogram will have any significant abnormality. To re-appraise the ECG and BNP as screening tests for echocardiography since there are important practical deficiencies in our current knowledge in this area. General practitioners referred suspected heart failure patients for clinical assessment, echocardiography, electrocardiography, and BNP measurement. The accuracy of each screening test and combinations of screening tests were calculated for LVSD, heart failure, valvular disease, and LVH. The sensitivities of the ECG for LVSD, heart failure, LVH and valvular disease were 97%, 95%, 76%, and 69%, respectively. The corresponding figures for BNP were 86%, 82%, 59%, and 48%, respectively. When patients with atrial fibrillation and murmurs were excluded, the values for ECG were 94%, 87%, 53%, and 55%, while for BNP they were 83%, 73%, 50%, and 32%. ECG interpretation and BNP are adequate screening tests to detect LVSD or heart failure but fail to screen for other echocardiographic abnormalities, like valvular disease and LVH. This remains the case even if patients with atrial fibrillation or heart murmurs are excluded on the basis that they require echocardiography anyway.
... training 401 Communication failures in patient sign out and suggestions for improvement: a cr... more ... training 401 Communication failures in patient sign out and suggestions for improvement: a critical incident analysis V Arora, J Johnson ... compare and communicate: designing control charts to summarise efficiently data from multiple quality indicators B Guthrie, T Love, T Fahey ...
Clinical data are collected for routine care in family practice; there are also a growing number ... more Clinical data are collected for routine care in family practice; there are also a growing number of genetic and cancer registry data repositories. The Translational Research and Patient Safety in Europe (TRANSFoRm) project seeks to facilitate research using linked data from more than one source. We performed a requirements analysis which identified a wide range of data and business process requirements that need to be met before linking primary care and either genetic or disease registry data. To develop a survey to assess the readiness of data repositories to participate in linked research - the Transform International Research Readiness (TIRRE) survey. We develop the questionnaire based on our requirement analysis; with questions at micro-, meso- and macro levels of granularity, study-specific questions about diabetes and gastro-oesophageal reflux disease (GORD), and research track record. The scope of the data required was extensive. We piloted this instrument, conducting ten preliminary telephone interviews to evaluate the response to the questionnaire. Using feedback gained from these interviews we revised the questionnaire; clarifying questions that were difficult to answer and utilising skip logic to create different series of questions for the various types of data repository. We simplified the questionnaire replacing free-text responses with yes/no or picking list options, wherever possible. We placed the final questionnaire online and encouraged its use (www.clininf.eu/jointirre/info.html). Limited field testing suggests that TIRRE is capable of collecting comprehensive and relevant data about the suitability and readiness of data repositories to participate in linked data research.
Eighteen general practitioner trainers participated in the study. Each used two consulting sessio... more Eighteen general practitioner trainers participated in the study. Each used two consulting sessions for the study. One was videotaped after obtaining appropriate consent, the other was not. After each consultation patients were asked to complete a validated and reliable satisfaction ...
Background: Recruiting participants to trials can be extremely difficult. Identifying strategies ... more Background: Recruiting participants to trials can be extremely difficult. Identifying strategies that improve trial recruitment would benefit both trialists and health research. Objectives: To quantify the effects of strategies to improve recruitment of participants to randomised ...
In order to provide evidence-based secondary prevention of coronary heart disease (CHD) in genera... more In order to provide evidence-based secondary prevention of coronary heart disease (CHD) in general practice, eligible patients need to be identified. The optimal strategy is one in which all appropriate patients are identified with the least effort. The purpose of the study was to determine the optimal strategy to identify subjects with a myocardial infarction (MI) from general practice records using different search criteria. The study was a cross-sectional survey of 10 general practices in Tayside, Scotland. A random sample of all subjects aged over 35 (n = 5061) and registered with the general practices was obtained. The main outcome measures were sensitivity, specificity, positive predictive value (PPV) and yield (the number of records that need to be examined to detect a "true case"). Of the sample of 5061, 207 (4.1%) were defined to have had a "gold standard" MI. A Read code for ischaemic heart disease (IHD) had the highest sensitivity (95%) but with a poor PPV (52%). All searches had high specificities. The addition of a record of hospitalization for MI to the Read code for MI gave 100% sensitivity and high yield (1 in 1.11). In situations where the Read coding is of poor quality, the alternative search strategy of a hospital record of MI or receiving aspirin or nitrates was optimum. Patients who had experienced an MI can be easily identified from a combination of a Read code for MI and a record of hospitalization for an MI giving 100% sensitivity and specificity with a yield of 1 in 1.11.
This talk provides an overview of key findings from an SDO commissioned study of e-Health led by ... more This talk provides an overview of key findings from an SDO commissioned study of e-Health led by Mair along with colleagues from Newcastle, UCL, and Dundee Universities which was concluded in 2009. The full report is in press at present.
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Papers by Frank Sullivan
Methods MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.
Findings Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (1) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (2) factors promoting or inhibiting engagement and participation; (3) effects on roles and responsibilities; (4) risk management, and (5) ways in which implementation processes might be reconfigured by user-produced knowledge.
Conclusion The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
Methods MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.
Findings Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (1) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (2) factors promoting or inhibiting engagement and participation; (3) effects on roles and responsibilities; (4) risk management, and (5) ways in which implementation processes might be reconfigured by user-produced knowledge.
Conclusion The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.