Examining What We Know in Relation to How We Know It: A Team-Based Reflexivity Model for Rapid Qualitative Health Research

Reflexivity constitutes a core component of qualitative research and has been actively integrated into long-term and “lone ranger” approaches to qualitative research. However, its application to team-based approaches and particularly to rapid qualitative team-based approaches continues to lag behind. In this article, we introduce a reflexivity model we developed for teams undertaking rapid qualitative studies. Utilizing our most recent application of this model to a rapid qualitative appraisal of health care workers’ experiences delivering care during the COVID-19 pandemic as a case study, we identify the steps to put this model into practice and its main outcomes. Our application of the model revealed that the team’s practices could be grouped along four dimensions: design assumptions, data collection and analysis processes, multidisciplinary collaboration, and responsible dissemination. Reflexivity can improve the relations within the team and the quality of the research output, if it is implemented as a continuous and iterative process

The effect of time constraint on anticipation, decision making, and option generation in complex and dynamic environments

Researchers interested in performance in complex and dynamic situations have focused on how individuals predict their opponent(s) potential courses of action (i.e., during assessment) and generate potential options about how to respond (i.e., during intervention). When generating predictive options, previous research supports the use of cognitive mechanisms that are consistent with long-term working memory (LTWM) theory (Ericsson and Kintsch in Phychol Rev 102(2):211–245, 1995; Ward et al. in J Cogn Eng Decis Mak 7:231–254, 2013). However, when generating options about how to respond, the extant research supports the use of the take-the-first (TTF) heuristic (Johnson and Raab in Organ Behav Hum Decis Process 91:215–229, 2003). While these models provide possible explanations about how options are generated in situ, often under time pressure, few researchers have tested the claims of these models experimentally by explicitly manipulating time pressure. The current research investigates the effect of time constraint on option-generation behavior during the assessment and intervention phases of decision making by employing a modified version of an established option-generation task in soccer. The results provide additional support for the use of LTWM mechanisms during assessment across both time conditions. During the intervention phase, option-generation behavior appeared consistent with TTF, but only in the non-time-constrained condition. Counter to our expectations, the implementation of time constraint resulted in a shift toward the use of LTWM-type mechanisms during the intervention phase. Modifications to the cognitive-process level descriptions of decision making during intervention are proposed, and implications for training during both phases of decision making are discussed

Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers.

BACKGROUND: Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer. METHODS: Data from the Routes to Diagnosis project on 749,645 patients (2006-2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined. RESULTS: The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39-1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32-0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35-44- vs 65-74-year-olds, 2.01; 95% CI 1.76-2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin's lymphoma (e.g., melanoma specific odds ratio in 35-44- vs 65-74-year-olds, 0.20; 95% CI 0.12-0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers. CONCLUSIONS: Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.We acknowledge the authors of previous studies that led to the creation and curation of the Routes to Diagnosis project and data set. The work presented here is a collaboration between Public Health England’s National Cancer Intelligence Network and the Cambridge Centre for Health Services Research of the University of Cambridge. GL was supported by a post-doctoral fellowship by the National Institute for Health Research (PDF-2011-04-047) to the end of 2014 and by a Cancer Research UK Clinician Scientist Fellowship award (A18180) from 2015.This is the final version of the article. It first appeared from NPG via http://dx.doi.org/10.1038/bjc.2015.5

Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers

This is the final version. Available on open access from Springer nature via the DOI in this recordBACKGROUND: Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer. METHODS: Data from the Routes to Diagnosis project on 749,645 patients (2006-2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined. RESULTS: The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39-1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32-0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35-44- vs 65-74-year-olds, 2.01; 95% CI 1.76-2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin’s lymphoma (e.g., melanoma specific odds ratio in 35-44- vs 65-74-year-olds, 0.20; 95% CI 0.12-0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers. CONCLUSIONS: Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.National Institute for Health Research (NIHR)Cancer Research U

The Narrated, Nonnarrated, and the Disnarrated: Conceptual Tools for Analyzing Narratives in Health Services Research

While analyzing the narratives of children receiving pediatric oncology treatment and their parents, we encountered three ways to look at their narratives: what was narrated, nonnarrated, and disnarrated. The narrated refers to the actors (characters) and events (scenes) individuals decided to include in the narration of their experiences, the nonnarrated are everything not included in narration, and the disnarrated are elements that are narrated in the story but did not actually take place. We use our reflection to illustrate how an integrative analysis of these different forms of narration can allow us to produce a holistic interpretation of people’s experiences of illness. This approach is still in the early stages of development, but we hope this article can promote a debate in the field and lead to the refinement of an important tool for narrative analysis. Storytellers shape the world according to the narratives they tell. In health services research, these stories describe the complex constellations of beliefs, values, emotions, intentions, identities, attitudes, and motivations that research participants use to express themselves as individuals and embed themselves within the illness narratives they enact and tell. The research we present here is based on narrative data collected from pediatric oncology patients and their families in Buenos Aires, Argentina. We analyzed the interviews by identifying the primary actors within the illness narrative (i.e., characters) and dominant scenes of activity, organized thematically, based on treatment trajectories. During the analysis process, we encountered three ways to analyze the narratives of the children and their parents. These included searching for the following: (a) who and what is present in narratives (i.e., narrated), (b) who and what is not present within the story (i.e., nonnarrated), and (c) what is alluded to in the text, yet did not actually happen (i.e., disnarrated). This article presents a reflection of this approach, the contributions it made to the interpretation of the data collected in this study, and its potential application in other research projects

Vaccinomics and Personalized Vaccinology: Is Science Leading Us Toward a New Path of Directed Vaccine Development and Discovery?

As is apparent in many fields of science and medicine, the new biology, and particularly new high-throughput genetic sequencing and transcriptomic and epigenetic technologies, are radically altering our understanding and views of science. In this article, we make the case that while mostly ignored thus far in the vaccine field, these changes will revolutionize vaccinology from development to manufacture to administration. Such advances will address a current major barrier in vaccinology—that of empiric vaccine discovery and development, and the subsequent low yield of viable vaccine candidates, particularly for hyper-variable viruses. While our laboratory's data and thinking (and hence also for this paper) has been directed toward viruses and viral vaccines, generalization to other pathogens and disease entities (i.e., anti-cancer vaccines) may be appropriate

Comparing the penetrative stab performance of the UK HOSDB P1/B and Stanley Tools 1992 trimming blades on certified body armour specimens

This body of research assessed the penetrative stab performance of the United Kingdom Home Office Scientific Development Branch’s (HOSDB) P1/B certified blades against the readily accessible Stanley Tools 1992 trimming blade. All tests were performed against the HOSDB KR1-E1 impact energy of 24 Joules on HOSDB KR1 certified body armour specimens. Results demonstrated that the Stanley 1992 trimming blade posed a 30% greater stab threat in comparison to the HOSDB P1/B blade. This paper demonstrates the threat imposed by readily available utility blades and a requirement to enhance existing body stab resistant body armour test procedures testing procedures