Developing methods for the overarching synthesis of quantitative and qualitative evidence: the interweave synthesis approach

This is the author accepted manuscript. The final version is available on open access from Wiley via the DOI in this recordThe incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful and insightful. Methodological guidance for mixed-methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel or convergent approach according to the degree of independence between individual syntheses before they are combined.We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequentialor convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed-methods synthesis methods: i)The use of intersubjective questions to understand the findings of the individual reviews through different lenses, ii)Immersion of key reviewers in the entirety of the evidence base, and iii)Commencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings. Underlying our approachis the process of exploration and identification of links between and across review findings; an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable.NIHR Health Technology Assessment Programm

Negotiation in strategy making teams : group support systems and the process of cognitive change

This paper reports on the use of a Group Support System (GSS) to explore at a micro level some of the processes manifested when a group is negotiating strategy-processes of social and psychological negotiation. It is based on data from a series of interventions with senior management teams of three operating companies comprising a multi-national organization, and with a joint meeting subsequently involving all of the previous participants. The meetings were concerned with negotiating a new strategy for the global organization. The research involved the analysis of detailed time series data logs that exist as a result of using a GSS that is a reflection of cognitive theory

Crowdsourcing for translational research: analysis of biomarker expression using cancer microarrays

Background: Academic pathology suffers from an acute and growing lack of workforce resource. This especially impacts on translational elements of clinical trials, which can require detailed analysis of thousands of tissue samples. We tested whether crowdsourcing – enlisting help from the public – is a sufficiently accurate method to score such samples. Methods: We developed a novel online interface to train and test lay participants on cancer detection and immunohistochemistry scoring in tissue microarrays. Lay participants initially performed cancer detection on lung cancer images stained for CD8, and we measured how extending a basic tutorial by annotated example images and feedback-based training affected cancer detection accuracy. We then applied this tutorial to additional cancer types and immunohistochemistry markers – bladder/ki67, lung/EGFR, and oesophageal/CD8 – to establish accuracy compared with experts. Using this optimised tutorial, we then tested lay participants’ accuracy on immunohistochemistry scoring of lung/EGFR and bladder/p53 samples. Results: We observed that for cancer detection, annotated example images and feedback-based training both improved accuracy compared with a basic tutorial only. Using this optimised tutorial, we demonstrate highly accurate (>0.90 area under curve) detection of cancer in samples stained with nuclear, cytoplasmic and membrane cell markers. We also observed high Spearman correlations between lay participants and experts for immunohistochemistry scoring (0.91 (0.78, 0.96) and 0.97 (0.91, 0.99) for lung/EGFR and bladder/p53 samples, respectively). Conclusions: These results establish crowdsourcing as a promising method to screen large data sets for biomarkers in cancer pathology research across a range of cancers and immunohistochemical stains

What are the risk factors for hearing loss and how are they related to socio-economic inequalities? An annotated bibliography of systematic reviews. Final report

This is the final versionData-sharing statement: Requests for access to data should be addressed to the corresponding author.In this report, we undertook an annotated bibliography of systematic reviews evaluating potential risk factors for hearing loss, and related these to socio-economic inequalities where these data were reported. Our annotated bibliography drew on a search of five bibliographic databases and a range of additional search methods (e.g. topically relevant websites) to identify systematic reviews of behavioural, demographic, environmental, genetic and physiological risk factors published in English as a full-text record since 2018. We focused on systematic reviews of studies undertaken in World Bank high-income countries. After rigorous selection, we appraised each systematic review and categorised risk factors, including mapping these by socio-economic inequalities using the PROGRESS-Plus criteria. In total, we identified 64 systematic reviews. We deprioritised eight scoping reviews as these did not synthesise studies, and six systematic reviews focusing on genetic risk factors as these are not readily modifiable. We categorised the remaining systematic reviews into four categories of risk factor: behavioural, demographic, environmental and physiological. Systematic reviews could address more than one type of risk factor. We wrote a brief annotation for each of these systematic reviews to summarise their focus and main findings. We also summarised data relating to socio-economic inequalities.National Institute for Health and Care Research (NIHR

Primary care clinicians' perspectives on interacting with patients with gynaecological conditions: a systematic review

This is the author accepted manuscript. The final version is available on open access from the Royal College of General Practitioners via the DOI in this recordData availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable requestBACKGROUND: Studies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians. Less understood is whether primary care clinicians perceive that there are challenges around listening to and interacting with this patient group. AIM: This study aims to understand primary care clinicians' perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms. DESIGN & SETTING: Systematic review METHOD: We searched ASSIA, CINAHL, Embase, HMIC and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data-extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. "Best-fit" framework synthesis was used to synthesise findings around themes which explore the challenges of patient-clinician interaction. RESULTS: We identified 25 relevant papers. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four 'levels': Individual clinician factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to socio-cultural factors affecting the consultation experience; the need for further education, training or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation. CONCLUSIONS: Primary care clinicians acknowledge that empathy, respect and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.National Institute for Health and Care Research (NIHR

Optimising the prescribing of drugs that may cause dependency: An evidence and gap map of systematic reviews.

This is the final version. Available from SAGE Publications via the DOI in this record. OBJECTIVES: We set out to map the quantitative and qualitative systematic review evidence available to inform the optimal prescribing of drugs that can cause dependency (benzodiazepines, opioids, non-benzodiazepine hypnotics, gabapentinoids and antidepressants). We also consider how this evidence can be used to inform decision-making in the patient care pathway for each type of medication. METHODS: Eight bibliographic databases were searched for the period 2010 to 2020. All included reviews were initially appraised using four items from the Collaboration for Environmental Evidence Synthesis Assessment Tool, with reviews that scored well on all items proceeding to full quality appraisal. Key characteristics of the reviews were tabulated, and each review was incorporated into an evidence and gap map based on a patient care pathway. The care pathway was based upon an amalgamation of existing NICE guidelines and feedback from clinical and patient stakeholders. RESULTS: We identified 80 relevant reviews and displayed them in an evidence and gap map. The evidence included in these reviews was predominantly of low overall quality. Areas where systematic reviews have been conducted include barriers and facilitators to the deprescribing of drugs that may cause dependency, although we identified little evidence exploring the experiences or evaluations of specific interventions to promote deprescribing. All medications of interest, apart from gabapentinoids, were included in at least one review. CONCLUSIONS: The evidence and gap map provides an interactive resource to support (i) policy developers and service commissioners to use evidence in the development and delivery of services for people receiving a prescription of drugs that may cause dependency, where withdrawal of medication may be appropriate, (ii) the clinical decision-making of prescribers and (iii) the commissioning of further research. The map can also be used to inform the commissioning of further systematic reviews. To address the concerns regarding the quality of the existing evidence based raised in this report, future reviews should be conducted according to best-practice guidelines. Systematic reviews focusing on evaluating interventions to promote deprescribing would be particularly beneficial, as would reviews focusing on addressing the paucity of evidence regarding the deprescription of gabapentinoids.National Institute for Health Research (NIHR

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordData sharing: For access to documentation supporting this review, please contact L. Shaw.Objectives: We aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication. Design: Systematic umbrella review and evidence and gap map (EGM). Data sources: Eight bibliographic databases (Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Health Management Information Consortium, MEDLINE ALL, PsychInfo, Conference Proceedings Citation Index – Science and Science Citation Index) were searched from 2010 to 11th August 2020. Update searches conducted in MEDLINE ALL 2nd August 2022. We searched relevant websites and conducted backwards citation chasing. Eligibility criteria for selecting studies: We sought systematic reviews of quantitative or qualitative research where adults 16 years+ were currently receiving, or being considered for, a prescription of statin or anti-hypertensive medication. Eligibility criteria were applied to the title and abstract and full text of each article independently by two reviewers. Data extraction and synthesis: Quality appraisal was completed by one reviewer and checked by a second. Review characteristics were tabulated and incorporated into an EGM based on a patient care pathway. Patients with lived experience provided feedback on our research questions and evidence and gap map. Results: Sixty-eight reviews were included within the EGM. The highest quantity of evidence focused on evaluating interventions to promote patient adherence to antihypertensive medication. Key gaps included a lack of reviews synthesising evidence on experiences of specific interventions to promote patient adherence or improve prescribing practice. The evidence was predominantly of low quality, limiting confidence in the findings from individual reviews. Conclusions: This EGM provides an interactive, accessible format for policy developers, service commissioners and clinicians to view the systematic review evidence available relevant to optimising the prescribing of statin and antihypertensive medication. To address the paucity of high-quality research, future reviews should be conducted and reported according to existing guidelines and address the evidence gaps identified above.National Institute for Health and Care Research (NIHR