Assessing contrasting strategies for ensuring ethical practice within evaluation: institutional review boards and professionalisation

This paper explores the application of ethics in two contrasting approaches to evaluation: one that views evaluation as essentially a research project, and the other that sees evaluation as an extension of project management. We argue that the growth in so-called rigorous impact evaluation, characterised by practitioners as evaluation using experimental or quasi-experimental methods, has seen evaluation treated increasingly as a subset of research. This has entailed greater use of ethical committees, and specifically institutional review boards (IRBs), as many academics promoting the use of experimental methods are based in the USA. Elsewhere, evaluation is treated more as a management activity, with professionalisation initiatives such as membership standards and ethical guidance often used in the place of formal review. In this paper, we question whether the simultaneous growth in usage of IRBs and professionalisation addresses the ethical issues faced by evaluators

Contribution Analysis and Estimating the Size of Effects: Can We Reconcile the Possible with the Impossible?

While contribution analysis provides a step-by-step approach to verify whether and why an intervention is a contributory factor to development impact, most contribution analysis studies do not quantify the ‘share of contribution’ that can be attributed to a particular support intervention. Commissioners of evaluations, however, often want to understand the size or importance of a contribution, not least for accountability purposes. The easy (and not necessarily incorrect) response to this question would be to say that it is impossible to do so. However, in this CDI Practice Paper written by Giel Ton, John Mayne, Thomas Delahais, Jonny Morell, Barbara Befani, Marina Apgar and Peter O’Flynn, we explore how contribution analysis can be stretched so that it can give some sense of the importance of a contribution in a quantitative manner. The first part of the paper introduces the approach of contribution analysis and presents ideas to capture the change process in theories of change and system maps. The second part presents research design elements that include ranking or quantitative measures of impact in the verification of the theory of change and resulting contribution story

Multivariate calibration of energy-dispersive X-ray diffraction data for predicting the composition of pharmaceutical tablets in packaging

A system using energy-dispersive X-ray diffraction (EDXRD) has been developed and tested using multivariate calibration for the quantitative analysis of tablet-form mixtures of common pharmaceutical ingredients. A principal advantage of EDXRD over the more traditional and common angular dispersive X-ray diffraction technique (ADXRD) is the potential of EDXRD to analyse tablets within their packaging, due to the higher energy X-rays used. In the experiment, a series of caffeine, paracetamol and microcrystalline cellulose mixtures were prepared and pressed into tablets. EDXRD profiles were recorded on each sample and a principal component analysis (PCA) was carried out in both unpackaged and packaged scenarios. In both cases the first two principal components explained >98% of the between-sample variance. The PCA projected the sample profiles into two dimensional principal component space in close accordance to their ternary mixture design, demonstrating the discriminating potential of the EDXRD system. A partial least squares regression (PLSR) model was built with the samples and was validated using leave-one-out cross-validation. Low prediction errors of between 2% and 4% for both unpackaged and packaged tablets were obtained for all three chemical compounds. The prediction capability through packaging demonstrates a truly non-destructive method for quantifying tablet composition and demonstrates good potential for EDXRD to be applied in the field of counterfeit medicine screening and pharmaceutical quality control

Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factorsassociated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome

Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study

Background: Cluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity. Aim: To explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists. Design and setting: Qualitative interview study in primary care surgeries and neurology departments in the north of England. Method: Semi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset. Results: Sixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients' mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients' anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals. Conclusion: Clinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.This article is available to RD&E staff via NHS OpenAthens (subject to any publisher embargo). Click on the Publisher URL, and log in with NHS OpenAthens if prompted.accepted version (12 month embargo

The University of Limerick education and research network for general practice (ULEARN-GP): practice characteristics and general practitioner perspectives

Background: A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement. Method: A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results: All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion: This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process

Career destinations of graduates from a medical school with an 18-week longitudinal integrated clerkship in general practice: a survey of alumni 6 to 8 years after graduation

Background There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerk ships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice. Aim The aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice. Design and setting This study was conducted in a single graduate entry medical school at the University of Limerick, Ireland. Participants Medical school alumni 6–8 years after graduation. Method A survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone. Results There were a total of 175 alumni for the period 2011 to 2013. Data was collected on 92% (161/175) through an online survey, follow-up email and telephone interview, and was triangulated with searches of professional registration databases and information from key informants. Between 6 and 8 years after graduation, a total of 43% of alumni were engaged in general practice as a career