Development of the Knee Quality of Life (KQoL-26) 26-item questionnaire: data quality, reliability, validity and responsiveness

Background This article describes the development and validation of a self-reported questionnaire, the KQoL-26, that is based on the views of patients with a suspected ligamentous or meniscal injury of the knee that assesses the impact of their knee problem on the quality of their lives. Methods Patient interviews and focus groups were used to derive questionnaire content. The instrument was assessed for data quality, reliability, validity, and responsiveness using data from a randomised trial and patient survey about general practitioners' use of Magnetic Resonance Imaging for patients with a suspected ligamentous or meniscal injury. Results Interview and focus group data produced a 40-item questionnaire designed for self-completion. 559 trial patients and 323 survey patients responded to the questionnaire. Following principal components analysis and Rasch analysis, 26 items were found to contribute to three scales of knee-related quality of life: physical functioning, activity limitations, and emotional functioning. Item-total correlations ranged from 0.60–0.82. Cronbach's alpha and test retest reliability estimates were 0.91–0.94 and 0.80–0.93 respectively. Hypothesised correlations with the Lysholm Knee Scale, EQ-5D, SF-36 and knee symptom questions were evidence for construct validity. The instrument produced highly significant change scores for 65 trial patients indicating that their knee was a little or somewhat better at six months. The new instrument had higher effect sizes (range 0.86–1.13) and responsiveness statistics (range 1.50–2.13) than the EQ-5D and SF-36. Conclusion The KQoL-26 has good evidence for internal reliability, test-retest reliability, validity and responsiveness, and is recommended for use in randomised trials and other evaluative studies of patients with a suspected ligamentous or meniscal injury

Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

Background: Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of 5 pound for the completion of postal questionnaires. Methods: We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of 5 pound to patients for the completion and return of questionnaires. The first 105 patients did not receive the 5 pound incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results: The response rate following reminders for the historical controls was 78.1% ( 82 of 105) compared with 88.0% ( 389 of 442) for those patients who received the 5 pound payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response ( adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial - the extra cost per additional respondent was almost 50 pound. Conclusion: The direct payment of 5 pound significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study

X-ray crystallographic study of DNA duplex cross-linking: simultaneous binding to two d(CGTACG)(2) molecules by a bis(9-aminoacridine-4-carboxamide) derivative

Acridine-4-carboxamides form a class of known DNA mono-intercalating agents that exhibit cytotoxic activity against tumour cell lines due to their ability to inhibit topoisomerases. Previous studies of bis-acridine derivatives have yielded equivocal results regarding the minimum length of linker necessary between the two acridine chromophores to allow bis-intercalation of duplex DNA. We report here the 1.7 angstrom resolution X-ray crystal structure of a six-carbon-linked bis(acridine-4-carboxamide) ligand bound to d(CGTACG)(2) molecules by non-covalent duplex cross-linking. The asymmetric unit consists of one DNA duplex containing an intercalated acridine-4-carboxamide chromophore at each of the two CG steps. The other half of each ligand is bound to another DNA molecule in a symmetry-related manner, with the alkyl linker threading through the minor grooves. The two crystallographically independent ligand molecules adopt distinct side chain interactions, forming hydrogen bonds to either O6 or N7 on the major groove face of guanine, in contrast to the semi-disordered state of mono-intercalators bound to the same DNA molecule. The complex described here provides the first structural evidence for the non-covalent cross-linking of DNA by a small molecule ligand and suggests a possible explanation for the inconsistent behaviour of six-carbon linked bis-acridines in previous assays of DNA bis-intercalation

Exchanging knowledge through healthcare manager placements in research teams

This study contributes to service industry theory by revealing how employers in the health service understand knowledge exchange as ‘transaction’. Although under pressure to deliver better services without additional resource, health service providers do not seek customers, making them unlike commercial service industries. This paper reports a UK knowledge exchange programme designed to bring together healthcare managers and researchers. Case study data were gathered from 36 semi-structured interviews with health services managers (Fellows) embedded in research teams, research team leads, and Fellows' workplace line-managers. Interviews were analysed thematically using a coding frame. The importance of personal contact in knowledge exchange mechanisms was confirmed but the knowledge model varied by interaction pairings (Fellow/research team; Fellow/health service). When with researchers, an exchange model was commonly in operation, marked by collaborative engagement. In contrast, line-managers tended to adopt a transactional approach, driven by instrumental motives. This transactional model merits further research

Developing engagement, linkage and exchange between health services managers and researchers: Experience from the UK

Objectives The UK National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) Management Fellowship programme enabled health services managers and university researchers to collaborate on research projects with the aim of improving research, managers’ research knowledge and skills, and the use of research in management. Our aim was to evaluate whether the programme encouraged greater engagement, linkage and exchange between researchers and managers. Methods A case-study approach with each case-study centred on 11 health care managers appointed as Fellows, chief investigators (n = 13) and Fellows’ line managers (n = 12). Data were collected through semi-structured face-to-face and telephone interviews. Interviews were analysed thematically to explore the impact of the programme, reported issues and to identify any lessons learned. Results Researchers benefited from the flow of (insider) knowledge and contacts from the workplace via the Fellow to the project. Engagement, linkage and exchange as a result of the Fellowship were less developed for the workplace. Reasons for this related to the fit of the research project with workplace interests, Fellows’ contact with the health care organization, feedback structures and training. The potential for co-production of knowledge was under-developed. A transactional notion of exchange was found in operation in workplaces. Conclusions The programme’s aim to enhance engagement, linkage and exchange was largely achieved, although exchange tended to be narrowly conceived. Knowing how models of exchange work in practice can ensure effort is put to best use

Collaboration between health services managers and researchers: making a difference?

Objective Our aim was to evaluate whether the involvement of health care managers in research projects improves the quality and relevance of research, and whether collaboration builds capacity in the managerial community. Methods The NIHR Service Delivery and Organization Management Fellowship programme supports the direct involvement of health care managers in research projects. Data were collected from face-to-face interviews with management fellows and chief investigators of research projects at 10 case study sites. Data were analysed thematically using an adapted Kirkpatrick framework for programme evaluation. Results Management fellows improved the relevance and quality of research through enhancing its validity, efficiency and credibility. This was achieved by: using their contextual understanding to enable and support access and recruitment participants, data collection tools, processes and analysis; supporting dissemination activities; and undertaking additional work which was complementary to the main project. Capacity was developed through formal courses and exposure to new knowledge, ideas and practices. Factors found to enable or impede improvements in research included management fellows' knowledge and experience of the NHS, their background and personal characteristics, mutual respect, timing and flexibility. Consequences were not always predictable. Costs for management fellows included foregone opportunities, specifically for promoted posts. Researchers reported time-costs associated with administering the fellowship. Conclusions Collaborations between managers and researchers can improve research relevance and quality and research capacity development. Factors critical to success relate to the fit between the project and the management fellow and how clearly the purpose is understood

A qualitative study of the assessment and treatment of incontinence in primary care

Background. Although incontinence is a common condition, previous studies have suggested that access to appropriate treatment is variable. Recent guidelines recommend initial conservative treatment in primary care and this study explores GPs management practices and the feasibility of applying guidelines. Objectives. To describe the assessment and management practices of incontinence by GPs in primary care. Methods. Semi-structured interviews were carried out with 32 GPs practicing in South East Wales. Sampling was purposive to include a range of characteristics such as gender, age and size and location of practice. Interviews were audio taped and transcribed and a thematic analysis carried out using a grounded theory approach. Results. The extent to which GPs felt adequately informed to carry out assessment and treatment of incontinence was varied. While most were aware of appropriate assessment and investigation, none felt in a position to undertake conservative treatments such as bladder training or to monitor pelvic floor therapy either due to lack of knowledge or organizational constraints. Access to specialist continence services was also variable across different localities with many GPs being unaware of the remit of specialist nurses. However, there was a high rate of referral to secondary care which will result in high cost to the National Health Service. Conclusions. There are a number of barriers to provision of first-line treatments in primary care, including variability in training and knowledge of GPs, as well as practical barriers (such as time resource) to carrying out assessments and treatment in routine surgeries. This results in increased likelihood of referral to secondary care

Anatomical variation in juvenile Eucalyptus leaves accounts for differences in specific leaf area and CO2 assimilation rates

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