391 results on '"Britten, N"'
Search Results
102. Early respiratory experience and subsequent cough and peak expiratory flow rate in 36 year old men and women.
- Author
-
Britten, N, primary, Davies, J M, additional, and Colley, J R, additional
- Published
- 1987
- Full Text
- View/download PDF
103. Pharmaceuticals and society: critical discourses and debates.
- Author
-
Britten N
- Published
- 2010
- Full Text
- View/download PDF
104. Keep taking the tablets: balancing the pros and cons when deciding to take blood pressure treatment.
- Author
-
Benson J and Britten N
- Published
- 2003
- Full Text
- View/download PDF
105. Medication change as an outcome: developing the Medication Change Questionnaire
- Author
-
Paterson, C, Symons, L, Britten, N, and Bargh, J
- Published
- 2003
- Full Text
- View/download PDF
106. Improving literature searching in systematic reviews : the application of tailored literature searching compared to 'the conventional approach'
- Author
-
Cooper, C., Garside, R., Britten, N., and Booth, A.
- Subjects
610.72 - Abstract
Background Literature searching is acknowledged as a crucial step in a systematic review. Information professionals, in response to the needs of intervention effectiveness systematic reviews, have developed a systematic process of literature searching which aims to be comprehensive, transparent and reproducible, and to minimise the introduction of bias in systematic reviews. The process which has evolved has not been examined in detail before but it has been adopted as the principal approach to literature searching in other types of systematic review. It is not clear if this is appropriate and if an alternative approach might be more effective. Thesis aims The aims of this thesis are to: 1) examine approaches to systematic literature searching for systematic reviews; and 2) propose and test a method of systematic literature searching for reviews which do not focus on the effectiveness of clinical interventions. Methods Two literature reviews, one systematic review and two comparative case studies were undertaken to meet the aims of the thesis. Results A critical literature review identified and described a conventional approach to literature searching common to nine leading handbooks of systematic review. An alternative, tailored approach to literature searching was developed. Two case studies illustrated that the tailored approach was more effective, and potentially offered better value, than the conventional approach. Conclusions Information professionals can develop tailored literature search approaches for use in systematic reviews and as a useful alternative to the conventional approach, particularly for reviews including study designs beyond controlled trials. The role of the information professional as decision maker, the involvement of the research team and experts, preparing for literature searching and the use of supplementary search methods, are important to the success of tailored literature search approaches.
- Published
- 2019
107. Qualitative research.
- Author
-
Britten, N
- Subjects
- *
RESEARCH , *STATISTICS , *DATA analysis - Published
- 1996
- Full Text
- View/download PDF
108. Evidence‐based patient choice in complementary therapy: myth or reality?
- Author
-
Richardson, J and Britten, N
- Published
- 2003
- Full Text
- View/download PDF
109. Users’ perspectives on the experience and effects of acupuncture treatment
- Author
-
Paterson, C and Britten, N
- Published
- 2002
- Full Text
- View/download PDF
110. Doctor-patient communication about drugs: the evidence for shared decision making.
- Author
-
Stevenson FA, Barry CA, Britten N, Barber N, and Bradley CP
- Abstract
The traditional paternalistic model of medical decision-making, in which doctors make decisions on behalf of their patients, has increasingly come to be seen as outdated. Moreover, the role of the patient in the consultation has been emphasised, notably through the adoption of 'patient-centred' strategies. Models that promote patients' active involvement in the decision-making process about treatment have been developed. We examine one particular model of shared decision making [Charles, C., Gafni, A., Whelan, T, 1997. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science & Medicine 44, 681-692.]. The model has four main characteristics. These are that (1) both the patient and the doctor are involved, (2) both parties share information, (3) both parties take steps to build a consensus about the preferred treatment and (4) an agreement is reached on the treatment to implement. Focusing on the first two of the four characteristics of the model, we use the findings from a study of 62 consultations, together with interviews conducted with patients and general practitioners, to consider participation in the consultation in terms of sharing information about, and views of, medicines. We found little evidence that doctors and patients both participate in the consultation in this way. As a consequence there was no basis upon which to build a consensus about the preferred treatment and reach an agreement on which treatment to implement. Thus even the first two of the four conditions said to be necessary for shared decision making were not generally present in the consultations we studied. These findings were presented in feedback sessions with participating GPs, who identified a number of barriers to shared decision making, as well as expressing an interest in developing strategies to overcome these barriers. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
111. Decision-making and hormone replacement therapy: a qualitative analysis.
- Author
-
Hunter MS, O'Dea I, and Britten N
- Abstract
Biomedical discourse dominates the research literature and media accounts of menopause. Middle aged women are increasingly faced with decisions about hormone replacement therapy (HRT) in the context of differing constructions of menopause and often inconclusive information. There is an apparent discrepancy between the beneficial claims made for HRT in the medical literature and the numbers of women who use it in the U.K. An educational approach has been advocated which assumes that with adequate information more women will take and adhere to HRT. Middle aged women's own views and opinions about medication, health and menopause have been relatively neglected. The extent to which women use medical discourse in discussions of menopause and the extent to which menopause has become 'medicalized' remain unclear. This is a descriptive study using in-depth interviews and a qualitative methodology to investigate women's accounts of their decisions relating to HRT use. Ninety-three 50 year old women were recruited from the age/sex register of a North London general practice; 45 women agreed to take part. Three main themes were identified in the women's accounts of their decisions: (1) the presence or absence of troublesome vasomotor symptoms, (2) doctors' views and advice, and (3) views toward menopause and medication. There was a general preference not to take medication, particularly for menopause, which was seen as a natural process unless severe symptoms were present. Women appeared to be considering different criteria from health professionals when making decisions about HRT. Whether these accounts are voiced in a medical consultation will partly depend upon the doctor's beliefs and communication skills as well as the assertiveness of the woman herself. [ABSTRACT FROM AUTHOR]
- Published
- 1997
- Full Text
- View/download PDF
112. Women's views of optimal risk communication and decision making in general practice consultations about the menopause and hormone replacement therapy.
- Author
-
Walter FM, Emery JD, Rogers M, and Britten N
- Published
- 2004
- Full Text
- View/download PDF
113. Environmental sustainability and ruminant production: A UK veterinary perspective.
- Author
-
Britten N and Mahendran S
- Abstract
Environmental sustainability is an issue of growing importance within the livestock industry, particularly for farmed ruminants. Changes to farming practices made to improve sustainability can have an impact on the health and welfare of animals, and so become the concern of veterinary practitioners. This review outlines the metrics used to measure sustainability and how sustainability interacts with ruminant health and welfare, allowing practitioners to incorporate environmental considerations into their existing livestock work. Topics covered include nutrition, disease control, genetics and stocking density., (© 2024 The Author(s). Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)
- Published
- 2024
- Full Text
- View/download PDF
114. Implementing a gerontological nursing competencies programme in aged care: Participant experiences.
- Author
-
Traynor V, Britten N, Gibson D, Munk S, Chenoweth L, Stokes J, Moroney T, Strickland K, Donaghy T, and Bail K
- Abstract
Aims: To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development., Background: The global population is ageing and needs a reliable aged-care nursing workforce., Introduction: Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation., Methods: Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria., Results: A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified., Discussion: The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care., Conclusion and Implications for Nursing and Health Policy: The evidence-based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged-care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements., (© 2024 The Author(s). International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)
- Published
- 2024
- Full Text
- View/download PDF
115. The effectiveness of a primary care-based collaborative care model to improve quality of life in people with severe mental illness: PARTNERS2 cluster randomised controlled trial.
- Author
-
Byng R, Creanor S, Jones B, Hosking J, Plappert H, Bevan S, Britten N, Clark M, Davies L, Frost J, Gask L, Gibbons B, Gibson J, Hardy P, Hobson-Merrett C, Huxley P, Jeffery A, Marwaha S, Rawcliffe T, Reilly S, Richards D, Sayers R, Williams L, Pinfold V, and Birchwood M
- Subjects
- Humans, Quality of Life, Cost-Benefit Analysis, Mental Disorders therapy, Mental Disorders complications, Bipolar Disorder psychology, Psychotic Disorders complications, Schizophrenia therapy, Schizophrenia complications
- Abstract
Background: Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components., Aims: We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses, compared with usual care., Method: We conducted a general practice-based, cluster randomised controlled superiority trial. Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person-centred coaching support and liaison work. The primary outcome was quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA)., Results: We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices, 116 participants) or control (19 practices, 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (intervention: 0.25, s.d. 0.73; control: 0.21, s.d. 0.86; estimated fully adjusted between-group difference 0.03, 95% CI -0.25 to 0.31; P = 0.819). Acute mental health episodes (safety outcome) included three crises in the intervention group and four in the control group., Conclusions: There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes.
- Published
- 2023
- Full Text
- View/download PDF
116. Do you trust me? Driver responses to automated evasive maneuvers.
- Author
-
Britten N, Johns M, Hankey J, and Kurokawa K
- Abstract
An increasing number of Conditionally Automated Driving (CAD) systems are being developed by major automotive manufacturers. In a CAD system, the automated system is in control of the vehicle within its operational design domain. Therefore, in CAD the vehicle is capable of tactical control of the vehicle and needs to be able to maneuver evasively by braking or steering to avoid objects. During these evasive maneuvers, the driver may attempt to take back control of the vehicle by intervening. A driver interrupting a CAD vehicle while properly performing an evasive maneuver presents a potential safety risk. To investigate this issue, 36 participants were recruited to participate in a Wizard-of-Oz research study. The participants experienced one of two evasive maneuvers of moderate intensity on a test track. The evasive maneuver required the CAD system to brake or steer to avoid the box placed in the lane of travel of the test vehicle. Drivers glanced toward the obstacle but did not intervene or prepare to intervene in response to the evasive maneuver. Importantly, the drivers who chose to intervene did so safely. These findings suggest that after experiencing a CAD vehicle for a brief period, most participants trusted the system enough to not intervene during a system-initiated evasive maneuver., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Britten, Johns, Hankey and Kurokawa.)
- Published
- 2023
- Full Text
- View/download PDF
117. The ROK kinase N-acetylglucosamine kinase uses a sequential random enzyme mechanism with successive conformational changes upon each substrate binding.
- Author
-
Roy S, Vivoli Vega M, Ames JR, Britten N, Kent A, Evans K, Isupov MN, and Harmer NJ
- Subjects
- Humans, Acetylglucosamine metabolism, Glucosamine, Metals, rho-Associated Kinases, Phosphotransferases (Alcohol Group Acceptor) metabolism, Plesiomonas enzymology
- Abstract
N-acetyl-d-glucosamine (GlcNAc) is a major component of bacterial cell walls. Many organisms recycle GlcNAc from the cell wall or metabolize environmental GlcNAc. The first step in GlcNAc metabolism is phosphorylation to GlcNAc-6-phosphate. In bacteria, the ROK family kinase N-acetylglucosamine kinase (NagK) performs this activity. Although ROK kinases have been studied extensively, no ternary complex showing the two substrates has yet been observed. Here, we solved the structure of NagK from the human pathogen Plesiomonas shigelloides in complex with GlcNAc and the ATP analog AMP-PNP. Surprisingly, PsNagK showed distinct conformational changes associated with the binding of each substrate. Consistent with this, the enzyme showed a sequential random enzyme mechanism. This indicates that the enzyme acts as a coordinated unit responding to each interaction. Our molecular dynamics modeling of catalytic ion binding confirmed the location of the essential catalytic metal. Additionally, site-directed mutagenesis confirmed the catalytic base and that the metal-coordinating residue is essential. Together, this study provides the most comprehensive insight into the activity of a ROK kinase., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest with the contents of the article., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
118. Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study.
- Author
-
Shields BM, Angwin CD, Shepherd MH, Britten N, Jones AG, Sattar N, Holman R, Pearson ER, and Hattersley AT
- Subjects
- Humans, Hypoglycemic Agents, Canagliflozin therapeutic use, Pioglitazone therapeutic use, Glycated Hemoglobin, Patient Preference, Sitagliptin Phosphate adverse effects, Treatment Outcome, Double-Blind Method, Drug Therapy, Combination, Diabetes Mellitus, Type 2 drug therapy, Metformin
- Abstract
Patient preference is very important for medication selection in chronic medical conditions, like type 2 diabetes, where there are many different drugs available. Patient preference balances potential efficacy with potential side effects. As both aspects of drug response can vary markedly between individuals, this decision could be informed by the patient personally experiencing the alternative medications, as occurs in a crossover trial. In the TriMaster (NCT02653209, ISRCTN12039221), randomized double-blind, three-way crossover trial patients received three different second- or third-line once-daily type 2 diabetes glucose-lowering drugs (pioglitazone 30 mg, sitagliptin 100 mg and canagliflozin 100 mg). As part of a prespecified secondary endpoint, we examined patients' drug preference after they had tried all three drugs. In total, 448 participants were treated with all three drugs which overall showed similar glycemic control (HbA1c on pioglitazone 59.5 sitagliptin 59.9, canagliflozin 60.5 mmol mol
-1 , P = 0.19). In total, 115 patients (25%) preferred pioglitazone, 158 patients (35%) sitagliptin and 175 patients (38%) canagliflozin. The drug preferred by individual patients was associated with a lower HbA1c (mean: 4.6; 95% CI: 3.9, 5.3) mmol mol-1 lower versus nonpreferred) and fewer side effects (mean: 0.50; 95% CI: 0.35, 0.64) fewer side effects versus nonpreferred). Allocating therapy based on the individually preferred drugs, rather than allocating all patients the overall most preferred drug (canagliflozin), would result in more patients achieving the lowest HbA1c for them (70% versus 30%) and the fewest side effects (67% versus 50%). When precision approaches do not predict a clear optimal therapy for an individual, allowing patients to try potential suitable medications before they choose long-term therapy could be a practical alternative to optimizing treatment for type 2 diabetes., (© 2022. The Author(s) under exclusive license to Springer Nature America, Inc.)- Published
- 2023
- Full Text
- View/download PDF
119. Exploring documentation in Person-centred care: A content analysis of care plans.
- Author
-
Lydahl D, Britten N, Wolf A, Naldemirci Ö, Lloyd H, and Heckemann B
- Subjects
- Aged, Delivery of Health Care, Documentation, Humans, Patient-Centered Care, Acute Coronary Syndrome, Nursing Care
- Abstract
Background: Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients' personally formulated goals and resources to secure a continuous partnership., Objectives: This study aimed to examine care plans produced within a randomised controlled trial that tested a person-centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person-centred care had written the care plans., Methods: We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person-centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life-world and medical/health resources and goals., Results: The analysis illustrates the differences and overlaps between life-world and medical/health goals and resources. The documented goals and resources change over time: life-world goals and resources decreased with time as medical/health goals and resources documentation increased., Conclusions: This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person-centred care recorded fewer life-world and more medical/health goals over time. Placing life-world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain., Trial Registration: Swedish registry, Researchweb.org, ID NR 65 791., (© 2022 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)
- Published
- 2022
- Full Text
- View/download PDF
120. Epistemic justice in public involvement and engagement: Creating conditions for impact.
- Author
-
Liabo K, Cockcroft EJ, Boddy K, Farmer L, Bortoli S, and Britten N
- Subjects
- Humans, Morals, Research Personnel, Knowledge, Social Justice
- Abstract
Introduction: Patient and public involvement in research is anchored in moral and epistemological rationales. Moral rationales relate to the public having a right to influence how knowledge about them is generated. Epistemological rationales relate to how research design and implementation can improve when informed by experiential, as well as technical, knowledge. In other words, public involvement can increase the epistemological resources of researchers, and contribute to research that is fit for purpose and has high external validity., Methods: This article presents an analysis of 3 meetings and 11 interviews with public collaborators and researchers in three UK-based health research studies. Data comprised transcripts of audio-recorded research meetings and interviews with public collaborators and researchers. Data were first analysed to develop a data-informed definition of experiential knowledge, then thematically to investigate how this experiential knowledge was considered and received within the research space., Results: At meetings, public collaborators shared their experiential knowledge as stories, comments, questions, answers and when referring to their own roles. They were aware of crossing a boundary from everyday life, and some adapted their contributions to fit within the research space. Although researchers and public collaborators made efforts to create an inclusive climate, obstacles to impact were identified., Conclusions: Considering experiential knowledge as a boundary object highlights that this knowledge has a different form to other kinds of knowledge that contribute to research. To enable impact from experiential knowledge, researchers need to create a space where public collaborators experience epistemic justice., Patient and Public Contribution: The Peninsula Public Engagement Group (PenPEG) was involved in the planning and conceptualization of the study, including the development of the ethics application and the interview schedules. One member of this group (Richard Fitzgerald) and one from outside the group (Leon Farmer), were full members of the author team and were involved in the data analysis. Leon Farmer has since become a member of PenPEG. Richard Fitzgerald and Leon Farmer were not involved in the three research studies sampled for this study. Sadly Richard Fitzgerald died during the course of this study., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
- Published
- 2022
- Full Text
- View/download PDF
121. Terms of engagement for working with patients in a person-centred partnership: A secondary analysis of qualitative data.
- Author
-
Westlake D, Ekman I, Britten N, and Lloyd H
- Subjects
- Health Personnel, Humans, Primary Health Care, Trust, Delivery of Health Care, Patient-Centered Care
- Abstract
Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care-based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2022
- Full Text
- View/download PDF
122. Testing cost containment of future healthcare with maintained or improved quality-The COSTCARES project.
- Author
-
Swedberg K, Cawley D, Ekman I, Rogers HL, Antonic D, Behmane D, Björkman I, Britten N, Buttigieg SC, Byers V, Börjesson M, Corazzini K, Fors A, Granger B, Joksimoski B, Lewandowski R, Sakalauskas V, Srulovici E, Törnell J, Wallström S, Wolf A, and Lloyd HM
- Abstract
Background: Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross-disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person-centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies., Method: In order to develop and test the roadmap, a COST Action project was initiated: COST-CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing., Conclusion: Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries., Competing Interests: None declared., (© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
- View/download PDF
123. A facilitated home-based cardiac rehabilitation intervention for people with heart failure and their caregivers: a research programme including the REACH-HF RCT
- Author
-
Dalal HM, Taylor RS, Wingham J, Greaves CJ, Jolly K, Lang CC, Davis RC, Smith KM, Doherty PJ, Miles J, van Lingen R, Warren FC, Sadler S, Abraham C, Britten N, Frost J, Hillsdon M, Singh S, Hayward C, Eyre V, and Paul K
- Abstract
Background: Rates of participation in centre (hospital)-cardiac rehabilitation by patients with heart failure are suboptimal. Heart failure has two main phenotypes differing in underlying pathophysiology: heart failure with reduced ejection fraction is characterised by depressed left ventricular systolic function (‘reduced ejection fraction’), whereas heart failure with preserved ejection fraction is diagnosed after excluding other causes of dyspnoea with normal ejection fraction. This programme aimed to develop and evaluate a facilitated home-based cardiac rehabilitation intervention that could increase the uptake of cardiac rehabilitation while delivering the clinical benefits of centre-based cardiac rehabilitation., Objectives: To develop an evidence-informed, home-based, self-care cardiac rehabilitation programme for patients with heart failure and their caregivers [the REACH-HF (Rehabilitation Enablement in Chronic Heart Failure) intervention]. To conduct a pilot randomised controlled trial to assess the feasibility of a full trial of the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in addition to usual care in patients with heart failure with preserved ejection fraction. To assess the short- and long-term clinical effectiveness and cost-effectiveness of the REACH-HF intervention in addition to usual care in patients with heart failure with reduced ejection fraction and their caregivers., Design: Intervention mapping to develop the REACH-HF intervention; uncontrolled feasibility study; pilot randomised controlled trial in those with heart failure with preserved ejection fraction; randomised controlled trial with a trial-based cost-effectiveness analysis in those with heart failure with reduced ejection fraction; qualitative studies including process evaluation; systematic review of cardiac rehabilitation in heart failure; and modelling to assess long-term cost-effectiveness (in those with heart failure with reduced ejection fraction)., Setting: Four centres in England and Wales (Birmingham, Cornwall, Gwent and York); one centre in Scotland (Dundee) for a pilot randomised controlled trial., Participants: Adults aged ≥ 18 years with heart failure with reduced ejection fraction (left ventricular ejection fraction < 45%) for the main randomised controlled trial ( n = 216), and those with heart failure with preserved ejection fraction (left ventricular ejection fraction ≥ 45%) for the pilot randomised controlled trial ( n = 50)., Intervention: A self-care, facilitated cardiac rehabilitation manual was offered to patients (and participating caregivers) at home over 12 weeks by trained health-care professionals in addition to usual care or usual care alone., Main Outcome Measures: The primary outcome was disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure Questionnaire at 12 months. Secondary outcomes included deaths and hospitalisations., Results: The main randomised controlled trial recruited 216 participants with heart failure with reduced ejection fraction and 97 caregivers. A significant and clinically meaningful between-group difference in the Minnesota Living with Heart Failure Questionnaire score (primary outcome) at 12 months (–5.7 points, 95% confidence interval –10.6 to –0.7 points) favoured the REACH-HF intervention ( p = 0.025). Eight (4%) patients (four in each group) had died at 12 months. There was no significant difference in hospital admissions, at 12 months, with 19 participants in the REACH-HF intervention group having at least one hospital admission, compared with 24 participants in the control group (odds ratio 0.72, 95% confidence interval 0.35 to 1.51; p = 0.386). The mean cost of the intervention was £418 per participant with heart failure with reduced ejection fraction. The costs at 12 months were, on average, £401 higher in the intervention group than in the usual care alone group. Model-based economic evaluation, extrapolating from the main randomised controlled trial in those with heart failure with reduced ejection fraction over 4 years, found that adding the REACH-HF intervention to usual care had an estimated mean cost per participant of £15,452 (95% confidence interval £14,240 to £16,780) and a mean quality-adjusted life-year gain of 4.47 (95% confidence interval 3.83 to 4.91) years, compared with £15,051 (95% confidence interval £13,844 to £16,289) and 4.24 (95% confidence interval 4.05 to 4.43) years, respectively, for usual care alone. This gave an incremental cost per quality-adjusted life-year of £1721. The probabilistic sensitivity analysis indicated 78% probability that the intervention plus usual care versus usual care alone has a cost-effectiveness below the willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained. The intervention was well received by participants with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction, as well as their caregivers. Both randomised controlled trials recruited to target, with > 85% retention at follow-up., Limitations: Key limitations included (1) lack of blinding – given the nature of the intervention and the control we could not mask participants to treatments, so our results may reflect participant expectation bias; (2) that we were not able to capture consistent participant-level data on level of intervention adherence; (3) that there may be an impact on the generalisability of findings due to the demographics of the trial patients, as most were male (78%) and we recruited only seven people from ethnic minorities., Conclusions: Evaluation of the comprehensive, facilitated, home-based REACH-HF intervention for participants with heart failure with reduced ejection fraction and caregivers indicated clinical effectiveness in terms of health-related quality of life and patient self-care but no other secondary outcomes. Although the economic analysis conducted alongside the full randomised controlled trial did not produce significant differences on the EuroQol-5 Dimensions or in quality-adjusted life-years, economic modelling suggested greater cost-effectiveness of the intervention than usual care. Our REACH-HF intervention offers a new evidence-based cardiac rehabilitation option that could increase uptake of cardiac rehabilitation in patients with heart failure not attracted to or able to access hospital-based programmes., Future Work: Systematic collection of real-world data would track future changes in uptake of and adherence to alternative cardiac rehabilitation interventions in heart failure with reduced ejection fraction and increase understanding of how changes in service delivery might affect clinical and health economic outcomes. The findings of our pilot randomised controlled trial in patients with heart failure with preserved ejection fraction support progression to a full multicentre randomised controlled trial., Trial Registration: Current Controlled Trials ISRCTN86234930 and ISRCTN78539530., Funding Details: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 9, No. 1. See the NIHR Journals Library website for further project information., (Copyright © 2021 Dalal et al. This work was produced by Dalal et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.)
- Published
- 2021
- Full Text
- View/download PDF
124. A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation.
- Author
-
Fellenor J, Britten N, Courtenay M, Payne RA, Valderas J, Denholm R, Duncan P, McCahon D, Tatnell L, Fitzgerald R, Warmoth K, Gillespie D, Turner K, and Watson M
- Subjects
- Consensus, Humans, Primary Health Care, Research Design, Health Personnel, Polypharmacy
- Abstract
Background: Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is 'a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines'. The purpose of this exercise was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, researcher, public and health professionals) approach., Methods: A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3)., Results: In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of priority during stage 3. Questions were categorised into four areas: 'Patient Concerns' [e.g. is there a shared decision (with patients) about using each medicine?], 'Polypharmacy' [e.g. how to design health services to cope with the challenge of multiple medicines use?], 'Non-Medical Prescribing' [e.g. how can the contribution of non-medical prescribers be optimised in primary care?], and 'Deprescribing' [e.g. what support is needed by prescribers to deprescribe?]. A significant number of the 92 questions were generated by Patient and Public Involvement representatives, which demonstrates the importance of including this stakeholder group when identifying research priorities., Conclusions: A wide range of research questions was generated reflecting concerns which affect patients, practitioners, the health service, as well the ethical and philosophical aspects of the prescribing and deprescribing of medicines. These questions should be used to set future research agendas and funding commissions.
- Published
- 2021
- Full Text
- View/download PDF
125. Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care.
- Author
-
Naldemirci Ö, Britten N, Lloyd H, and Wolf A
- Subjects
- Communication, Focus Groups, Humans, Knowledge, Patient-Centered Care, Delivery of Health Care, Narration
- Abstract
The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing., (© 2020 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL).)
- Published
- 2021
- Full Text
- View/download PDF
126. Dumping adherence: a person-centred response for primary care.
- Author
-
Granger BB, Britten N, Swedberg K, and Ekman I
- Subjects
- Anxiety, Cohort Studies, Cross-Sectional Studies, Humans, Patient-Centered Care, Primary Health Care, Depression, Heart Failure
- Published
- 2020
- Full Text
- View/download PDF
127. Response to: Goldberg et al "Who are the researchers? Where are the librarians?"
- Author
-
Booth A, Cooper C, Garside R, and Britten N
- Subjects
- Humans, Research Personnel, Librarians
- Published
- 2020
- Full Text
- View/download PDF
128. Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol.
- Author
-
Parker H, Frost J, Britten N, Robinson S, and Mattick K
- Subjects
- Anti-Bacterial Agents therapeutic use, Delivery of Health Care, Humans, Qualitative Research, Systematic Reviews as Topic, Anthropology, Cultural, Hospitals
- Abstract
Background: Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB amongst surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research., Methods: The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or 'piles' which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful., Discussion: This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care., Systematic Review Registration: PROSPERO CRD42020184343.
- Published
- 2020
- Full Text
- View/download PDF
129. "It has no meaning to me." How do researchers understand the effectiveness of literature searches? A qualitative analysis and preliminary typology of understandings.
- Author
-
Cooper C, Garside R, Varley-Campbell J, Talens-Bou J, Booth A, and Britten N
- Subjects
- Data Collection methods, Humans, Reproducibility of Results, Surveys and Questionnaires, Treatment Outcome, Publications, Qualitative Research, Research Design, Research Personnel, Search Engine, Systematic Reviews as Topic
- Abstract
This study aimed to address the question: what does "effectiveness" mean to researchers in the context of literature searching for systematic reviews? We conducted a thematic analysis of responses to an e-mail survey. Eighty-nine study authors, whose studies met inclusion in a recent review (2018), were contacted via e-mail and asked three questions; one directly asking the question: in literature searching, what does effective (or effectiveness in) literature searching mean to you? Thirty-eight (46%) responses were received from diverse professional groups, including: literature searchers, systematic reviewers, clinicians and researchers. A shared understanding of what effectiveness means was not identified. Instead, five themes were developed from data: (a) effectiveness is described as a metric; (b) effectiveness is a balance between metrics; (c) effectiveness can be categorized by search purpose; (d) effectiveness is an outcome; and, (e) effectiveness is an experimental concept. We propose that these themes constitute a preliminary typology of understandings. No single definition of effectiveness was identified. The proposed typology suggests that different researchers have differing understandings of effectiveness. This could lead to uncertainty as to the aim and the purpose of literature searches and confusion about the outcomes. The typology offers a potential route for further exploration., (© 2020 John Wiley & Sons, Ltd.)
- Published
- 2020
- Full Text
- View/download PDF
130. Learning from Gothenburg model of person centred healthcare.
- Author
-
Britten N, Ekman I, Naldemirci Ö, Javinger M, Hedman H, and Wolf A
- Subjects
- Change Management, Humans, Patient-Centered Care organization & administration, Professional-Patient Relations, Sweden, Patient-Centered Care methods
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare that NB is a member of the scientific advisory board of GPCC and a visiting professor at the Institute of Health and Care Sciences at Gothenburg University. IE was the centre director of GPCC until March 2019. AW has several research projects that are partially funded by GPCC.
- Published
- 2020
- Full Text
- View/download PDF
131. A Prospective Cohort Study on the Development of Claw Horn Disruption Lesions in Dairy Cattle; Furthering our Understanding of the Role of the Digital Cushion.
- Author
-
Griffiths BE, Mahen PJ, Hall R, Kakatsidis N, Britten N, Long K, Robinson L, Tatham H, Jenkin R, and Oikonomou G
- Abstract
Claw horn disruption lesion (CHDL) is the collective term used to describe non-infectious foot lesions such as sole ulcers (SU), sole hemorrhage (SH), and white line disease (WLD) that commonly affect dairy cattle. The potential role of the bovine digital cushion, an anatomical structure located under the pedal bone and composed mostly of adipose and connective tissue, in the aetiopathogenesis of CHDL has recently been the subject of several studies. The aim of this prospective cohort study is to identify risk factors associated with the development of CHDL and to add further evidence regarding the role of the digital cushion. In order to achieve that we collected data from 500 lactations; 455 dairy cows from 3 farms were enrolled in this study. Data were collected from each animal on three occasions: 3-4 weeks before expected calving date, 1 week post calving, and 8-10 weeks post-calving. At each occasion, sole soft tissue thickness (the combined depth of the digital cushion and corium, SSTT) was measured using B-mode ultrasonography. At 8-10 weeks post-calving foot trimming was undertaken and the presence of CHDLs was recorded. Univariable analysis was undertaken between variables of interest, before multivariable regression models were constructed. Mixed effects multivariable linear regression models were created to describe the changes in SSTT and associations with various explanatory variables. Multivariable logistic regression models with the presence of SU, SH, or WLD as an outcome were also built. SSTT was shown to decrease from calving to early lactation (EL). Primiparous animals were found to have smaller SSTT, than multiparous animals. Animals with greater BCS had greater SSTT. Cows with a SU in early lactation had lower SSTT both at pre-calving and calving inspections comparing to cows without a SU. Cows that developed mastitis within 30 days of calving had approximately four times higher odds of developing SU compared to cows that did not develop mastitis. Our study advances our understanding of animal level risk factors associated with the development of CHDL and highlights the importance of the periparturient period., (Copyright © 2020 Griffiths, Mahen, Hall, Kakatsidis, Britten, Long, Robinson, Tatham, Jenkin and Oikonomou.)
- Published
- 2020
- Full Text
- View/download PDF
132. The value of social practice theory for implementation science: learning from a theory-based mixed methods process evaluation of a randomised controlled trial.
- Author
-
Frost J, Wingham J, Britten N, Greaves C, Abraham C, Warren FC, Dalal H, and Taylor RS
- Subjects
- Caregivers, Chronic Disease, Humans, Self Care, Heart Failure therapy, Implementation Science
- Abstract
Background: Although there is trial evidence that complex interventions are effective for the self-management of heart failure, little evidence supports their effectiveness in routine practice. We used Social Practice Theory to guide a Type 1 Hybrid Trial: a mixed methods process evaluation of a complex intervention for heart failure. The objective of this paper is to explore the value of Social Practice Theory for implementation science., Methods: Social Practice Theory informed a mixed methods process evaluation of a multi-centre randomised controlled trial of a 12 week home-based intervention to optimise self-care support for people with heart failure and their caregivers - Rehabilitation EnAblement in Chronic Heart Failure (REACH-HF). Interviews were conducted with 19 people with heart failure and 17 caregivers at 4 months and 12 months after recruitment into the trial. Cases were constructed at the level of the individual, couple, facilitator and centre; and included multi-modal process and outcome data. Evaluative coding and subsequent within- and cross-case analyses enabled the development of a typology of relationships linking fidelity of intervention delivery and tailoring of content to individual needs and concerns. Social Practice Theory was used to interrogate the relationships between elements of the intervention and their implementation., Results: Of 216 trial participants, 107 were randomised to the intervention (REACH-HF plus usual care). The intervention was most effective when fidelity was high and delivery was tailored to the individual's needs, but less effective when both tailoring and fidelity were low. Theory-based analysis enabled us to model complex relationships between intervention elements (competencies, materials and meanings) and social context. The findings illustrate how intervention fidelity and tailoring are contextual and how the effectiveness of the REACH-HF intervention depended on both optimal alignment and implementation of these elements., Conclusion: The study demonstrates the utility of theory-based analysis which integrates data from multiple sources to highlight contexts and circumstances in which interventions work best. Social Practice Theory provides a framework for guiding and analysing the processes by which a complex intervention is evaluated in a clinical trial, and has the potential to guide context-specific implementation strategies for clinical practice., Trial Registration: ISRCTN, IISRCTN86234930 . Registered 13th November 2014.
- Published
- 2020
- Full Text
- View/download PDF
133. Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy.
- Author
-
Lloyd HM, Ekman I, Rogers HL, Raposo V, Melo P, Marinkovic VD, Buttigieg SC, Srulovici E, Lewandowski RA, and Britten N
- Subjects
- Europe, Health Promotion, Humans, Patient-Centered Care, Self Care
- Abstract
The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing 'Exploratory Health Laboratories' to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the "Health Labs" towards innovative models of ethically grounded and evidenced-based PCC.
- Published
- 2020
- Full Text
- View/download PDF
134. How is knowledge shared in Public involvement? A qualitative study of involvement in a health technology assessment.
- Author
-
Cockcroft EJ, Britten N, Long L, and Liabo K
- Subjects
- Early Detection of Cancer, Humans, Qualitative Research, Research Personnel, Lung Neoplasms, Technology Assessment, Biomedical
- Abstract
Background: Public involvement in research is seen as a quality marker by funders. To understand the process and impact of involvement, more in-depth studies are needed on how members of the public contribute in meetings with researchers., Objectives: This study aimed to observe and reflect on what is said by public advisers in involvement. We wanted to understand (a) what knowledge and experience is shared during research meetings, and (b) how this knowledge is shared with researchers., Methods: Data were collected in November 2016 as part of the public involvement in a health technology assessment of lung cancer screening using low-dose computed tomography. Three meetings were audio recorded and observed with the purpose of understanding how members of the public contributed during the meetings. Audio recordings were transcribed verbatim and data analysed using a thematic approach, with the coding framework developed inductively. We also included reflections from a community drop-in session., Results: Members of the public brought three different 'sources' of knowledge and experience to meetings with researchers: direct lived personal experience; learnt knowledge; and the experience and values of others. The data suggest that group settings allow for dynamic discussions and sharing of different types of knowledge., Conclusion: Group-based involvement meetings allow for the synergistic combination of individual knowledge and experience. This gives researchers a broader understanding of the topic, which can be the vehicle for patient impact on the research. A combination of group meeting and community drop-in can enable more varied input into research planning and conduct., (© 2019 The Authors Health Expectations published by John Wiley & Sons Ltd.)
- Published
- 2020
- Full Text
- View/download PDF
135. Learning from a Feasibility Trial of a Simple Intervention: Is Research a Barrier to Service Delivery, or is Service Delivery a Barrier to Research?
- Author
-
Frost J and Britten N
- Abstract
(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced., Competing Interests: The authors declare no conflict of interest
- Published
- 2020
- Full Text
- View/download PDF
136. The potential and pitfalls of narrative elicitation in person-centred care.
- Author
-
Naldemirci Ö, Britten N, Lloyd H, and Wolf A
- Subjects
- Anthropology, Cultural, Focus Groups, Hospitals, Humans, Internal Medicine, Medical Records, Qualitative Research, Sweden, Goals, Narration, Patient-Centered Care
- Abstract
Background: Revitalized interest in narrative has informed some recent models of patient and person-centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person-centred care practice and in which ways it is incorporated into clinical routine., Aim: We aimed to identify facilitators and barriers for narrative elicitation and setting goals in a particular example of person-centred care practice (University of Gothenburg Centre for Person-centred Care, GPCC) where narrative elicitation is considered as a method of setting goals for the patient., Methods: Observation of 14 admission interviews including narrative elicitation on an internal medicine ward in Sweden where person-centred care was implemented. Five focus group vignette-based interviews with nurses (n = 53) were conducted to assess confirmation of the emerging themes., Results: The inductive analysis resulted in three themes about the strategies to elicit patients' narratives: (a) Preparing for narrative elicitation, (b) Lingering in the patient's narrative, and (c) Co-creating, that is, the practitioner's and third parties' engagement in the patient's narration. Even though there were obstacles to eliciting narratives and setting lifeworld goals in a medical setting, narrative elicitation was often useful to turn general and medical goals into more specific and personal goals., Conclusions: Narrative elicitation is neither a simple transition from traditional medical history taking nor a type of structured interview. It entails skills and strategies to be practiced. On the one hand, it revitalizes ethical considerations about clinical relationship building. On the other hand, it can help patients articulate lifeworld goals that are meaningful and important for themselves., (© 2019 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
- Published
- 2020
- Full Text
- View/download PDF
137. Clarifying the roles of patients in research.
- Author
-
Liabo K, Boddy K, Burchmore H, Cockcroft E, and Britten N
- Subjects
- Biomedical Research ethics, Humans, Qualitative Research, Sports Medicine ethics, Biomedical Research trends, Patient Participation, Sports Medicine trends
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
- Published
- 2019
- Full Text
- View/download PDF
138. Caregiver outcomes of the REACH-HF multicentre randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction.
- Author
-
Wingham J, Frost J, Britten N, Greaves C, Abraham C, Warren FC, Jolly K, Miles J, Paul K, Doherty PJ, Singh S, Davies R, Noonan M, Dalal H, and Taylor RS
- Subjects
- Adult, Aged, Aged, 80 and over, Chronic Disease nursing, Chronic Disease rehabilitation, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Caregivers psychology, Caregivers statistics & numerical data, Heart Failure nursing, Heart Failure rehabilitation, Home Nursing psychology, Home Nursing statistics & numerical data, Quality of Life psychology
- Abstract
Background: Caregivers frequently provide support to people living with long-term conditions. However, there is paucity of evidence of interventions that support caregivers in their role. Rehabilitation EnAblement in Chronic Heart Failure (REACH-HF) is a novel home-based, health-professional-facilitated, self-management programme for patients with heart failure (HF) and their caregivers., Methods: Based on the random allocation of individual adult patients with reduced ejection fraction (HFrEF) and left ventricular ejection fraction <45% within the past five years, the caregiver of patients was allocated to receive the REACH-HF intervention over 12 weeks (REACH-HF group) or not (control group). Caregiver outcomes were generic health-related quality of life (EQ-5D-5L), Family Caregiver Quality of Life Scale questionnaire (FamQol), Caregiver Burden Questionnaire HF (CBQ-HF), Caregiver Contribution to Self-care of HF Index questionnaire (CC-SCHFI) and Hospital Anxiety and Depression Scale (HADS). Outcomes were compared between groups at 4, 6 and 12 months follow-up. Twenty caregivers receiving REACH-HF were purposively selected for qualitative interviews at 4 and 12 months., Results: Compared with controls (44 caregivers), the REACH-HF group (53 caregivers) had a higher mean CC-SCHFI confidence score at 12 months (57.5 vs 62.8, adjusted mean difference: 9.3, 95% confidence interval: 1.8-16.8, p = 0.016). No significant between group differences were seen in other caregiver outcomes. Qualitative interviews showed that most caregivers who received the REACH-HF intervention made positive changes to how they supported the HF patient they were caring for, and perceived that they had increased their confidence in the caregiver role over time., Conclusion: Provision of the REACH-HF intervention for caregivers of HF patients improved their confidence of self-management and was perceived for some to be helpful in supporting their caregiver role.
- Published
- 2019
- Full Text
- View/download PDF
139. Home-based rehabilitation for heart failure with reduced ejection fraction: mixed methods process evaluation of the REACH-HF multicentre randomised controlled trial.
- Author
-
Frost J, Wingham J, Britten N, Greaves C, Abraham C, Warren FC, Jolly K, Doherty PJ, Miles J, Singh SJ, Paul K, Taylor R, and Dalal H
- Subjects
- Aged, Female, Heart Failure physiopathology, Humans, Interviews as Topic, Male, Middle Aged, Patient Compliance, Stroke Volume, Treatment Outcome, United Kingdom, Heart Failure rehabilitation, Self Care methods
- Abstract
Objective: To identify and explore change processes explaining the effects of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention taking account of reach, amount of intervention received, delivery fidelity and patient and caregiver perspectives., Design: Mixed methods process evaluation parallel to a randomised controlled trial using data from the intervention group (REACH-HF plus usual care)., Setting: Four centres in the UK (Birmingham, Cornwall, Gwent and York)., Participants: People with heart failure with reduced ejection fraction (HFrEF) and their caregivers., Methods: The REACH-HF intervention consisted of a self-help manual for patients with HFrEF and caregivers facilitated over 12 weeks by trained healthcare professionals. The process evaluation used multimodal mixed methods analysis. Data consisted of audio recorded intervention sessions; demographic data; intervention fidelity scores for intervention group participants (107 patients and 53 caregivers); qualitative interviews at 4 and 12 months with a sample of 19 patients and 17 caregivers., Outcome Measures: Quantitative data: intervention fidelity and number, frequency and duration of intervention sessions received. Qualitative data: experiences and perspectives of intervention participants and caregivers., Results: Intervention session attendance with facilitators was high. Fidelity scores were indicative of adequate quality of REACH-HF intervention delivery, although indicating scope for improvement in several areas. Intervention effectiveness was contingent on matching the intervention implementation to the concerns, beliefs and goals of participants. Behaviour change was sustained when shared meaning was established. Respondents' comorbidities, socio-economic circumstances and existing networks of support also affected changes in health-related quality of life., Conclusions: By combining longitudinal mixed methods data, the essential ingredients of complex interventions can be better identified, interrogated and tested. This can maximise the clinical application of research findings and enhance the capacity of multidisciplinary and multisite teams to implement the intervention., Trial Registration Number: ISRCTN25032672; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
140. Proxy administration: A proxy for whom?
- Author
-
Britten N
- Subjects
- Caregivers psychology, Humans, Medication Adherence psychology, Prescription Drug Misuse nursing, Self Care
- Published
- 2019
- Full Text
- View/download PDF
141. Does a simple web-based intervention facilitate the articulation of patients' unvoiced agenda for a consultation with their diabetologists? A qualitative study.
- Author
-
Frost J, Gibson A, Ukoumunne O, Vaidya B, and Britten N
- Subjects
- Consultants, Diabetes Mellitus, Type 1 epidemiology, Diabetes Mellitus, Type 1 psychology, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 psychology, England epidemiology, Female, Humans, Male, Middle Aged, Patient Participation psychology, Physician-Patient Relations, Qualitative Research, Video Recording, Diabetes Mellitus, Type 1 therapy, Diabetes Mellitus, Type 2 therapy, Internet-Based Intervention statistics & numerical data, Patient Participation statistics & numerical data, Patient Satisfaction statistics & numerical data, Referral and Consultation
- Abstract
Objective: To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist., Methods and Design: A qualitative study embedded in a pragmatic pilot randomised controlled trial., Setting: Two city outpatient departments in England., Participants: 25 patients attending a follow-up consultation and 6 diabetologists., Intervention: The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist., Data Collection: 25 participants had their consultation with their diabetologist audio-recorded: 12 in the control arm and 13 in the intervention arm; 12 of the latter also had their PACE-D intervention session and a consultation recorded. Semi-structured interviews with 6 diabetologists, and 12 patients (6 in the intervention group and 6 in the control group)., Analysis: Thematic discourse analysis undertaken with patient representatives trained in qualitative data analysis techniques., Results: We identified four consultation types: diabetologist facilitated; patient identified; consultant facilitated and patient initiated and patient ignored. We also identified three critical aspects that explained the production and utilisation of the agenda form: existing consultative style; orientation to the use of the intervention and impact on the consultation. Where patients and diabetologists have a shared preference for a consultant-led or patient-led consultation, the intervention augments effective communication and shared decision making. However, where preferences diverge (eg, there is a mismatch in patients' and diabetologists' preferences and orientations), the intervention does not improve the potential for shared decision making., Conclusion: A simple web-based intervention facilitates the articulation of patients' unvoiced agenda for a consultation with their diabetologist, but only when pre-existing consultation styles and orientations already favour shared decision making. More needs to be done to translate patient empowerment in the consultation setting into genuine self-efficacy., Trial Registration Number: ISRCTN75070242., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
142. Improving reporting of meta-ethnography: The eMERGe reporting guidance.
- Author
-
France EF, Cunningham M, Ring N, Uny I, Duncan EA, Jepson RG, Maxwell M, Roberts RJ, Turley RL, Booth A, Britten N, Flemming K, Gallagher I, Garside R, Hannes K, Lewin S, Noblit GW, Pope C, Thomas J, Vanstone M, Higginbottom GMA, and Noyes J
- Subjects
- Humans, Qualitative Research, Anthropology, Cultural standards, Biomedical Research standards, Guidelines as Topic, Research Design standards, Research Report standards
- Abstract
Aims: The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting., Background: Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality., Design: The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes., Methods: The study, conducted from 2015 - 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes., Findings: Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance., Conclusion: The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology., (© 2019 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
143. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial.
- Author
-
Dalal HM, Taylor RS, Jolly K, Davis RC, Doherty P, Miles J, van Lingen R, Warren FC, Green C, Wingham J, Greaves C, Sadler S, Hillsdon M, Abraham C, Britten N, Frost J, Singh S, Hayward C, Eyre V, Paul K, Lang CC, and Smith K
- Subjects
- Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Health Care Costs, Heart Failure diagnosis, Heart Failure economics, Heart Failure physiopathology, Humans, Male, Middle Aged, Quality of Life, Recovery of Function, Time Factors, Treatment Outcome, United Kingdom, Cardiac Rehabilitation economics, Heart Failure rehabilitation, Home Care Services economics, Self Care economics, Stroke Volume, Ventricular Function, Left
- Abstract
Background: Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low., Design and Methods: The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone., Results: The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of -5.7 points (95% confidence interval -10.6 to -0.7) in favour of the REACH-HF intervention group ( p = 0.025). With the exception of patient self-care ( p < 0.001) there was no significant difference in other secondary outcomes, including clinical events ( p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant., Conclusions: The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.
- Published
- 2019
- Full Text
- View/download PDF
144. Refining a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses in England: a qualitative formative evaluation.
- Author
-
Baker E, Gwernan-Jones R, Britten N, Cox M, McCabe C, Retzer A, Gill L, Plappert H, Reilly S, Pinfold V, Gask L, Byng R, and Birchwood M
- Subjects
- Adult, Bipolar Disorder epidemiology, Bipolar Disorder psychology, Caregivers psychology, England epidemiology, Female, Health Personnel psychology, Humans, Male, Middle Aged, Primary Health Care methods, Psychotic Disorders epidemiology, Psychotic Disorders psychology, Schizophrenia epidemiology, Schizophrenic Psychology, Bipolar Disorder therapy, Intersectoral Collaboration, Psychotic Disorders therapy, Qualitative Research, Schizophrenia therapy
- Abstract
Background: Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been trialled specifically with this service user group in England. Collaborative care for other mental health conditions has not been widely implemented despite evidence of its effectiveness. We carried out a formative evaluation of the PARTNERS model of collaborative care, with the aim of establishing barriers and facilitators to delivery, identifying implementation support requirements and testing the initial programme theory., Methods: The PARTNERS intervention was delivered on a small scale in three sites. Qualitative data was collected from primary and secondary care practitioners, service users and family carers, using semi-structured interviews, session recordings and tape-assisted recall. Deductive and inductive thematic analysis was carried out; themes were compared to the programme theory and used to inform an implementation support strategy., Results: Key components of the intervention that were not consistently delivered as intended were: interaction with primary care teams, the use of coaching, and supervision. Barriers and facilitators identified were related to service commitment, care partner skills, supervisor understanding and service user motivation. An implementation support strategy was developed, with researcher facilitation of communication and supervision and additional training for practitioners. Some components of the intervention were not experienced as intended; this appeared to reflect difficulties with operationalising the intervention. Analysis of data relating to the intended outcomes of the intervention indicated that the mechanisms proposed in the programme theory had operated as expected., Conclusions: Additional implementation support is likely to be required for the PARTNERS model to be delivered; the effectiveness of such support may be affected by practitioner and service user readiness to change. There is also a need to test the programme theory more fully. These issues will be addressed in the process evaluation of our full trial., Trial Registration: ISRCTN95702682 , 26 October 2017.
- Published
- 2019
- Full Text
- View/download PDF
145. Patient involvement in qualitative data analysis in a trial of a patient-centred intervention: Reconciling lay knowledge and scientific method.
- Author
-
Frost J, Gibson A, Harris-Golesworthy F, Harris J, and Britten N
- Subjects
- Clinical Trials as Topic, Humans, Physician-Patient Relations, Pilot Projects, Qualitative Research, Research Personnel, Data Analysis, Knowledge, Patient Participation, Research Design
- Abstract
Background: We conducted a pilot study of an intervention to facilitate patients' agenda setting in clinical consultations. The primary aim of the study was to test the feasibility of running the randomized controlled trial. A secondary objective was to assess the extent to which patient and public involvement (PPI) could contribute to the process of qualitative data analysis (QDA)., Aims: To describe a novel approach to including patient partners in QDA; to illustrate the kinds of contribution that patient partners made to QDA in this context; and to propose a characterization of a process by which patient involvement can contribute to knowledge production., Methods: Six patient and public representatives were supported to contribute to data analysis via a range of modalities. During a series of QDA workshops, experienced research staff role-played consultations and interviews, and provided vignettes. Workshop data and PPI diaries were analysed using thematic discourse analysis., Results: We characterized a process of thesis, antithesis and synthesis. This PPI group contributed to the rigour and validity of the study findings by challenging their own and the researchers' assumptions, and by testing the emerging hypotheses. By training PPI representatives to undertake qualitative data analysis, we transformed our understanding of doctor-patient consultations., Conclusions: This research required changes to our usual research practices but was in keeping with the objective of establishing meaningful patient involvement for a future definitive trial. This work was informed by concepts of critical humility, and a process of knowledge production enabled via the construction of a knowledge space., (© 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
146. Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography.
- Author
-
Germeni E, Frost J, Garside R, Rogers M, Valderas JM, and Britten N
- Subjects
- Attitude of Health Personnel, Clinical Protocols, Health Knowledge, Attitudes, Practice, Humans, Inappropriate Prescribing prevention & control, Qualitative Research, Anthropology, Cultural, Anti-Bacterial Agents therapeutic use, Inappropriate Prescribing statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Primary Health Care, Respiratory Tract Infections drug therapy
- Abstract
Background: Reducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections., Aim: The authors sought to update a 2011 qualitative synthesis of GPs' experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists)., Design and Setting: Systematic review and meta-ethnography of qualitative studies., Method: A systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed., Results: In all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, 'supportive aids', source of distress, and unnecessary)., Conclusion: Contrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs' varying roles and changing priorities., (© British Journal of General Practice 2018.)
- Published
- 2018
- Full Text
- View/download PDF
147. Defining the process to literature searching in systematic reviews: a literature review of guidance and supporting studies.
- Author
-
Cooper C, Booth A, Varley-Campbell J, Britten N, and Garside R
- Subjects
- Databases, Bibliographic classification, Databases, Bibliographic standards, Guidelines as Topic standards, Humans, Information Storage and Retrieval methods, Information Storage and Retrieval standards, Review Literature as Topic, Databases, Bibliographic statistics & numerical data, Information Storage and Retrieval statistics & numerical data, Systematic Reviews as Topic
- Abstract
Background: Systematic literature searching is recognised as a critical component of the systematic review process. It involves a systematic search for studies and aims for a transparent report of study identification, leaving readers clear about what was done to identify studies, and how the findings of the review are situated in the relevant evidence. Information specialists and review teams appear to work from a shared and tacit model of the literature search process. How this tacit model has developed and evolved is unclear, and it has not been explicitly examined before. The purpose of this review is to determine if a shared model of the literature searching process can be detected across systematic review guidance documents and, if so, how this process is reported in the guidance and supported by published studies., Method: A literature review. Two types of literature were reviewed: guidance and published studies. Nine guidance documents were identified, including: The Cochrane and Campbell Handbooks. Published studies were identified through 'pearl growing', citation chasing, a search of PubMed using the systematic review methods filter, and the authors' topic knowledge. The relevant sections within each guidance document were then read and re-read, with the aim of determining key methodological stages. Methodological stages were identified and defined. This data was reviewed to identify agreements and areas of unique guidance between guidance documents. Consensus across multiple guidance documents was used to inform selection of 'key stages' in the process of literature searching., Results: Eight key stages were determined relating specifically to literature searching in systematic reviews. They were: who should literature search, aims and purpose of literature searching, preparation, the search strategy, searching databases, supplementary searching, managing references and reporting the search process., Conclusions: Eight key stages to the process of literature searching in systematic reviews were identified. These key stages are consistently reported in the nine guidance documents, suggesting consensus on the key stages of literature searching, and therefore the process of literature searching as a whole, in systematic reviews. Further research to determine the suitability of using the same process of literature searching for all types of systematic review is indicated.
- Published
- 2018
- Full Text
- View/download PDF
148. Systematic review identifies six metrics and one method for assessing literature search effectiveness but no consensus on appropriate use.
- Author
-
Cooper C, Varley-Campbell J, Booth A, Britten N, and Garside R
- Subjects
- Consensus, Data Accuracy, Information Storage and Retrieval standards, Reproducibility of Results, Sensitivity and Specificity, Efficiency, Information Storage and Retrieval methods
- Abstract
Objectives: To identify the metrics or methods used by researchers to determine the effectiveness of literature searching where supplementary search methods are compared to bibliographic database searching. We also aimed to determine which metrics or methods are summative or formative and how researchers defined effectiveness in their studies., Study Design and Setting: Systematic review. We searched MEDLINE and Embase to identify published studies evaluating literature search effectiveness in health or allied topics., Results: Fifty studies met full-text inclusion criteria. Six metrics (sensitivity, specificity, precision, accuracy, number needed to read, and yield) and one method (capture recapture) were identified., Conclusion: Studies evaluating effectiveness need to identify clearly the threshold at which they will define effectiveness and how the evaluation they report relates to this threshold. Studies that attempt to investigate literature search effectiveness should be informed by the reporting of confidence intervals, which aids interpretation of uncertainty around the result, and the search methods used to derive effectiveness estimates should be clearly reported and validated in studies., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
149. Quality after the QOF? Before dismantling it, we need a redefined measure of 'quality'.
- Author
-
Close J, Byng R, Valderas JM, Britten N, and Lloyd H
- Subjects
- Delivery of Health Care organization & administration, Health Services Accessibility, Humans, Outcome and Process Assessment, Health Care, Practice Patterns, Physicians', Quality Indicators, Health Care statistics & numerical data, Reimbursement, Incentive standards, United Kingdom, Delivery of Health Care standards, General Practice organization & administration, Patient-Centered Care organization & administration, Quality of Health Care standards
- Published
- 2018
- Full Text
- View/download PDF
150. Clarifying the roles of patients in research.
- Author
-
Liabo K, Boddy K, Burchmore H, Cockcroft E, and Britten N
- Subjects
- Humans, Patient Participation, Terminology as Topic, Biomedical Research ethics, Patient Rights ethics, Research Subjects classification
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.