A meta-narrative review of electronic patient records

This session comprises four papers that consider how systematic review methods may be developed in order to make the best use of complex evidence in education and health. The methods and approaches reflected upon in these papers are not drawn from a single research tradition, but share a common goal of broadening the methodological scope of systematic reviews and better understanding the utilisation of knowledge produced in this way. The first paper (Henry Potts) reports an ongoing review using a meta-narrative approach to make sense of the diverse sources of knowledge regarding electronic patient records. The review method has stressed the importance of understanding knowledge from within the research tradition in which it was produced; it is argued that this has important implications for the way that evidence is utilised in the policy making process. The second paper (Geoff Wong) reflects upon the experience of using an explicit realist approach in the synthesis of the evidence in Internet based learning. This realist synthesis offers a method of making sense of the highly heterogeneous and context dependent evidence which exists in this field thus enabling greater insights into what makes such educational interventions ‘work’. The third paper (Rod Sheaff) reports a review of the predominantly qualitative research literature on organisational structures and their impacts upon policy outcomes in health systems. A scoping study found 14389 relevant papers of which 1568 were selected for review. These studies were very variable in the amount and quality of the qualitative data, hence 'evidence', which they reported. The paper describes an attempt to adapt realist methods so as to synthesise such bodies of research in ways which take account of this variation in the strength of qualitative evidence. The fourth paper (Mark Pearson) draws upon the work of Donald Campbell and colleagues in order to gain a fuller understanding of how systematic reviews are utilised in the policy making process. It is argued that interpretive approaches to understanding policy making (such as rhetorical analysis) need to be tempered with a more nuanced understanding of research validity. The case is made that interpretive approaches not only can, but should, be melded with research validity to increase understanding of the policy making process

An examination of business occupier relocation decision making : distinguishing small and large firm behaviour

This paper explores how business occupiers decide whether and where to relocate. It captures the experience and behaviour of a range of sizes and types of business occupier and subjects their decision-making processes to detailed scrutiny. A linear three-stage decision model is used to sequence and structure interviews with individuals who have intimate involvement with the relocation of 28 firms and organizations in Tyne and Wear, in the north-east of England. The 'constant comparative' method is used to analyse the interview data, from which emerges 18 key concepts, comprising 51 characteristic components. Using an axial approach, these are organized into 10 cross-cutting themes that represent the main areas of consideration or influence on the thinking of the people involved in determining whether a firm or organization should relocate and, if so, where to. The resulting analysis finds that organizations adopt varying degrees of sophistication when making relocation decisions; small firms are more inclined to make decisions based on constrained information; larger organizations adopt a more complex approach. Regardless of firm size, key individuals exert considerable influence over the decision-making process and its outcome

Caring for the patient, caring for the record: an ethnographic study of 'back office' work in upholding quality of care in general practice

© 2015 Swinglehurst and Greenhalgh; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Additional file 1: Box 1. Field notes on summarising (Clover Surgery). Box 2. Extract of document prepared for GPs by summarisers at Clover Surgery. Box 3. Fieldnotes on coding incoming post, Clover (original notes edited for brevity).This work was funded by a research grant from the UK Medical Research Council (Healthcare Electronic Records in Organisations 07/133) and a National Institute of Health Research doctoral fellowship award for DS (RDA/03/07/076). The funders were not involved in the selection or analysis of data nor did they make any contribution to the content of the final manuscript

The impact of genetic counselling on risk perception in women with a family history of breast cancer.

Women with a family history of breast cancer generally self-refer because they have a feeling that their risk is high. However, they have, in general, only a hazy notion of the population risk of breast cancer and their own risk in relation to this. It is probable that they are helped by genetic counselling and, if at substantial risk, by annual mammography. However, the psychological impact of assigning true risk and the value of mammography need to be evaluated. We have assessed risk perception by questionnaire in 517 new referrals to a family history clinic and 200 women returning to the clinic at least 1 year after counselling. Correct assignment of population lifetime risk of breast cancer was 16% in the uninformed precounsel group and 33% in the post-counsel group, likewise personal risk was correct in 11% and 41% respectively. Post-counsel women were significantly more likely to retain information if they were sent a post-clinic letter or if they assessed their personal risk as too high initially

A systematic review of electronic patient records using the meta-narrative approach: Empirical findings and methodological challenges.

Systematic reviews are central to the enterprise of evidence-based medicine (EBM). However, traditional ‘Cochrane’ reviews have major limitations, especially when dealing with heterogeneous methodologies or an applied setting. The meta-narrative review (see Soc Sci Med 2005; 61: 417-30) is one of several new methods that seek to address pragmatic policy-level questions via broad-based literature reviews. Inspired by Kuhn, meta-narrative review takes a historical and paradigmatic approach to considering different areas of research activity. As an interpretive tool, the approach seeks distinct research traditions, each with its own meta-narrative. We then use these ‘stories of how research unfolded’ as a way of making sense of a diverse literature. Incommensurability between different traditions is seen not as a problem to be lamented or resolved but as a window to higher-order explanations about the nuances of empirical data and what these nuances mean for different applied situations. Having originally developed the meta-narrative method for a study of the diffusion of innovations in healthcare, we are now applying it in a review of the electronic patient record (EPR) in an organizational context. We have collated some 600 papers and books across multiple research traditions including health informatics, information systems research, computer-supported cooperative work (CSCW) and sociology. This very contemporary topic area is raising interesting methodological questions. For example, the EPR literature does not comprise as cleanly delineable traditions for four main reasons: 1. Information and communications technology research is a particularly fast-moving field, so paradigm shifts are relatively common (e.g. the rise of CSCW out of human-computer interaction research). 2. In the electronic age, it is easy for researchers to explore beyond their own discipline and ‘borrow’ theories, ideas and methods from elsewhere. Journal editors may commission overviews from experts in another tradition; authors may explicitly address an audience in another tradition. Research traditions can begin to converge (e.g. papers bringing together CSCW, information systems research and STS). 3. Some researchers are adept ‘boundary spanners’, writing for a number of different academic audiences and adapting their theoretical pedigree to fit (e.g. Marc Berg). 4. Some traditions are characterized not by a single unified paradigm but by active dialogue between competing paradigms (e.g. ‘hard’ versus ‘soft’ perspectives on knowledge management). This work contributes to the STS literature by critically questioning the nature of rigour in secondary research. The EBM movement values ‘Cochrane’ reviews because they meet positivist criteria (e.g. they are rational, objective, replicable, data-led, and transferable across contexts). In contrast, the meta-narrative review is interpretive, reflexive, problem-oriented and work-led, and makes no claim to either replicability or transferability. Rigour is redefined in terms of plausibility, authenticity and usefulness – raising the radical suggestion that the evidence base for key policy decisions can never be set in stone. Systematic reviews are central to the enterprise of evidence-based medicine (EBM). However, traditional ‘Cochrane’ reviews have major limitations, especially when dealing with heterogeneous methodologies or an applied setting. The meta-narrative review (see Soc Sci Med 2005; 61: 417-30) is one of several new methods that seek to address pragmatic policy-level questions via broad-based literature reviews. Inspired by Kuhn, meta-narrative review takes a historical and paradigmatic approach to considering different areas of research activity. As an interpretive tool, the approach seeks distinct research traditions, each with its own meta-narrative. We then use these ‘stories of how research unfolded’ as a way of making sense of a diverse literature. Incommensurability between different traditions is seen not as a problem to be lamented or resolved but as a window to higher-order explanations about the nuances of empirical data and what these nuances mean for different applied situations. Having originally developed the meta-narrative method for a study of the diffusion of innovations in healthcare, we are now applying it in a review of the electronic patient record (EPR) in an organizational context. We have collated some 600 papers and books across multiple research traditions including health informatics, information systems research, computer-supported cooperative work (CSCW) and sociology. This very contemporary topic area is raising interesting methodological questions. For example, the EPR literature does not comprise as cleanly delineable traditions for four main reasons: 1. Information and communications technology research is a particularly fast-moving field, so paradigm shifts are relatively common (e.g. the rise of CSCW out of human-computer interaction research). 2. In the electronic age, it is easy for researchers to explore beyond their own discipline and ‘borrow’ theories, ideas and methods from elsewhere. Journal editors may commission overviews from experts in another tradition; authors may explicitly address an audience in another tradition. Research traditions can begin to converge (e.g. papers bringing together CSCW, information systems research and STS). 3. Some researchers are adept ‘boundary spanners’, writing for a number of different academic audiences and adapting their theoretical pedigree to fit (e.g. Marc Berg). 4. Some traditions are characterized not by a single unified paradigm but by active dialogue between competing paradigms (e.g. ‘hard’ versus ‘soft’ perspectives on knowledge management). This work contributes to the STS literature by critically questioning the nature of rigour in secondary research. The EBM movement values ‘Cochrane’ reviews because they meet positivist criteria (e.g. they are rational, objective, replicable, data-led, and transferable across contexts). In contrast, the meta-narrative review is interpretive, reflexive, problem-oriented and work-led, and makes no claim to either replicability or transferability. Rigour is redefined in terms of plausibility, authenticity and usefulness – raising the radical suggestion that the evidence base for key policy decisions can never be set in stone

RAMESES publication standards: realist syntheses

PMCID: PMC3558331This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

A residual performance methodology to evaluate multifunctional systems

The development of multifunctional materials and structures is receiving increasing interest for many applications and industries; it is a promising way to increase system-wide efficiency and improve the ability to meet environmental targets. However, quantifying the advantages of a multifunctional solution over monofunctional systems can be challenging. One approach is to calculate a reduction in mass, volume or other penalty function. Another approach is to use a multifunctional efficiency metric. However, either approach can lead to results that are unfamiliar or difficult to interpret and implement for an audience without a multifunctional materials or structures background. Instead, we introduce a comparative metric for multifunctional materials that correlates with familiar design parameters for monofunctional materials. This metric allows the potential benefits of the multifunctional system to be understood easily without needing a holistic viewpoint. The analysis is applied to two different examples of multifunctional systems; a structural battery and a structural supercapacitor, demonstrating the methodology and its potential for state-of-the-art structural power materials to offer a weight saving over conventional systems. This metric offers a new way to communicate research on structural power which could help identify and prioritise future research

Topical Nutrients Promote Engraftment and Inhibit Wound Contraction of Cultured Skin Substitutes in Athymic Mice

Routine treatment of burns with cultured skin substitutes (CSS) has been limited by poor engraftment and by scarring. Hypothetically, topical application of essential nutrients and/or growth factors may support epithelial survival temporarily during graft vascularization, CSS, composed of human epidermal keratinocytes and dermal fibroblasts attached to collagen-glycosaminoglycan substrates, were incubated for 19 d in media optimized for keratinocytes. CSS, human xenografts, murine autografts, or no grafts were applied orthotopically to full-thickness skin wounds (2 × 2 cm) in athymic mice. Wounds were irrigated for 14 d with 1 ml/d modified cell culture medium or with saline containing epidermal growth factor, or were treated with dry dressings. After 6 weeks, treated sites were scored for percentage original wound area (mean ± SEM) and percentage HLA- ABC-positive healed wounds [(number positive/n) × 100], and tested for significance (analysis of variance, p < 0.0001; Tukey test, p < 0.05). The data showed that CSS irrigated with nutrient medium were not statistically different in wound area (67.8 ± 5.1%) from murine autografts (63.3 ± 2.9%) but were statistically larger than human xenograft, no graft, or CSS treated with saline irrigation or dry dressings. HLA- ABC expression was 100% in CSS with nutrient irrigation, 86% in CSS with saline irrigation, 83% In CSS without irrigation, and 75% in xenografts with nutrient irrigation. These findings suggest that availability of essential nutrients supports keratinocyte viability during graft vascularization of CSS

TMEDA in Iron‐Catalyzed Hydromagnesiation: Formation of Iron(II)‐Alkyl Species for Controlled Reduction to Alkene‐Stabilized Iron(0)

N,N,N’,N’‐Tetramethylethylenediamine (TMEDA) has been one of the most prevalent and successful additives used in iron‐catalysis, finding application in reactions as diverse as cross‐coupling, C‐H activation and borylation. However, the role that TMEDA plays in these reactions remains largely undefined. Herein, studying the iron‐catalyzed hydromagnesiation of styrene derivatives using TMEDA has provided molecular‐level insight into the role of TMEDA in achieving effective catalysis. Key is the initial formation of TMEDA‐iron(II) alkyl species which undergo a controlled reduction to selectively form catalytically active styrene‐stabilized iron(0)‐alkyl complexes. While TMEDA is not bound to the catalytically active species, these active iron(0) complexes cannot be accessed in the absence of TMEDA. This mode of action, allowing for controlled reduction and access to iron(0) species, represents a new paradigm for the role of this important reaction additive in iron catalysis