Inspiring People: Doug Altman

Doug Altman

Today whilst scrolling mindlessly through Twitter I saw a post that began, “So sorry to hear of Doug Altman’s passing.” At first I didn’t really believe it – it was like the first time someone told me that Michael Jackson or David Bowie had died, I didn’t think it was real. I scrolled a bit more and saw more posts echoing the same sentiment. Today, we lost Doug Altman.

I was sat in my Mum’s kitchen when I found out. I told her and she asked who Doug Altman was, and I found it genuinely difficult to put into words, ‘Er.. he, well he’s a statistician, a really good one. A lot of the work that I do has his ideas entrenched in it. He’s a big deal, medical-research-wise.’ Shortly after that conversation I left my Mum’s to drive back to my home in Aberdeen. The journey took about 4 and a half hours, and between podcasts and Jon Ronson’s audiobook of ‘So You’ve Been Publicly Shamed‘, I was thinking about Doug Altman and how I wished more people knew who he was. Clearly, in the medical research world we know that we’ve lost a giant, but there are people in other areas of research and in other walks of life that haven’t yet had the joy of discovering Doug’s work. So, Doug Altman is my first entry in a new blog post series called ‘Inspiring People’, where I’ll be sharing details of the people that inspire me – whether in my working life or in my personal life.

So, where do I start with someone like this?

According to Wikipedia..

Douglas Altman FMedSci (born London, UK, 12 July 1948) was an English statistician best known for his work on improving the reliability and reporting of medical research and for highly cited papers on statistical methodology. He is professor of statistics in medicine at the University of Oxford, founder and Director of Centre for Statistics in Medicine and Cancer Research UK Medical Statistics Group, and co-founder of the international EQUATOR Network for health research reliability.

Why did he inspire me?

On the first day on my PhD, my supervisor furnished me with a large pile of papers, links and books to get my teeth into. He drew particular attention to the Testing Treatments book, and a paper titled ‘The scandal of poor medical research‘. I read that paper multiple times, I’ve cited it multiple times in my thesis, and it’s something that I frequently refer to when constructing arguments about the work that I do. Medical research can be done better, and my PhD is taking a tiny, tiny piece of the medical research landscape, and working to improve it. ‘The scandal of poor medical research’ hasn’t just inspired me, it was voted as the paper that the British Medical Journal should be most proud of publishing.

He wasn’t only a ridiculously intelligent man and a brilliant writer, he was a brilliant colleague. I’ve never worked directly with Doug Altman, but everything I’ve heard about him suggests that he was a fantastic person to work with; down to Earth, funny, sarcastic, kind and supportive.

My first big conference presentation was at the Evidence Live conference in 2016. I was presenting work from the Trial Forge group (the wider group that my PhD is set within), but it wasn’t entirely my work, so I was pretty nervous. Before I got up to the lectern I saw Doug Altman. I knew it was Doug Altman, I knew he was about to watch me give my first ever conference presentation, and my nerves escalated. A few minutes into the presentation I remember looking out into the audience and seeing Doug laugh at one of my ‘medical research is not doing it’s job’ related jokes (I know, major nerd alert), after he stopped laughing I saw him nodding along with my points. That tiny interaction is something he likely didn’t even note, but it boosted my confidence more than anything else had when it came to giving presentations. I still think about it now when I get nervous before a talk, I tell myself ‘well if Doug Altman got my joke and liked what I had to say, I must be doing something right’.

I won’t ramble on any more, I’ll just leave with you a list of further reading so you can find out about Doug’s ideas from the man himself.

Doug Altman’s Google Scholar Profile – detailing the papers that have so far earned him 360,483 citations
Practical Statistics for Medical Research (book)
Research Methods for Postgraduates (book)
Absence of evidence is not evidence of absence
Evaluating non-randomised intervention studies
Methodological issues in the design and analysis of randomised trials
Importance of the distinction between quality of methodology and quality of reporting
Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide
A history of the evolution of guidelines for reporting medical research: the long road to the EQUATOR Network
The COMET initiative database: progress and activities update (2014)

Doug Altman – Scandal of Poor Medical Research (filmed at Evidence Live 2017 – I blogged about Doug’s talks at that conference too, see here and here)

We’ve lost a brilliant, inspiring mind today.
In the words of NDORMS (the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences where Doug worked), ‘Thank you, Doug, for all you gave to research and the world.’

An Evening With Bill Nye – Portland, Oregon

Last night I went to see Bill Nye Live in Portland. If you were at school in the 1990s, you probably recognise that name from the TV show ‘Bill Nye the Science Guy’ – it ran between 1993 and 1998 saved many, many science teachers from terrible hangovers as Bill took over teaching for a lesson.

Now, Bill Nye is not only a science educator – he’s the CEO of the Planetary Society, he provided consultancy on scientific matters to Barrack Obama when he was in office (ahh, the good old days..), he’s written multiple books, and he’s even been on Dancing with the Stars. Most relevant to last night’s event is that’s he’s a board member of the Mount St. Helens Institute, a non-profit aiming to ‘advance understanding and stewardship of the Earth through science, education, and exploration of volcanic landscapes’.

Ticket sales for ‘Bill Nye Live: An Evening of Seismic Importance’ were in support of the Mount St Helens Institute, and on the 38th anniversary of its eruption, Bill Nye and the Institute aimed to educate and entertain on the topic of climate change, the effects of the 1998 eruption, and how we can all work together to, quite literally, save the world.

I wasn’t really sure what to expect from the event in terms of the level of seriousness in the way the content was presented – Bill Nye has always been funny, but this topic is serious, especially given that it was in honour of the 38th anniversary of the Mount St Helens eruption. 57 people died as a result of the eruption, so I was a bit weary of Bill’s jokey side.

To be honest, there were parts of Bill’s presentation that did make me feel a bit uncomfortable. I agreed with just about everything that he said, but the way that he repeatedly described the eruption as ‘amazing’, whilst only mentioning the victims of it once or twice, and in quite derogatory ways (Harry Truman was one resident who refused to leave despite being told to evacuate the Mount St Helens site; he was killed by the pyroclastic flow that overtook his lodge and buried the site under 150ft of volcanic debris), didn’t sit well with me. I get that he was playing things up for the audience, but Mount St Helens is less than 2 hours away, and given that the eruption was only 38 years ago, it’s feasible that people can remember the devastation that it caused; it seemed insensitive.

Mount St Helens before and after the 1980 eruption.

That said, overall I thought the event was really well done. The audience was very mixed – lots of families with very young children, large groups of adults and older couples wanting to learn more about the volcano, so I thought the way Bill managed to communicate such complicated science was brilliant. I’m not a geologist, and haven’t studied volcanoes since I was about 12 (I think it was in a Geography class with a teacher I didn’t like..), and I followed the graphs and statistics that were presented pretty easily. There was a young boy sat next to me who seemed to follow along easily enough too, and as we got up to leave I heard him say to his Mum, ‘how do you be a geologist then?’ which was a heart-warming end to the evening.

Find out more about the Mount St Helens Institute here, and watch Bill Nye’s latest Netflix series ‘Bill Nye Saves the World’ here.

Some Things I Learned From Taking a #DigitalDetox

Helloooooo internet! It’s weird being back after that little break I had. After a really hectic week back at work it almost feels like I never took the break at all, but I have kept up some of the habits I developed over the course of the week and I’ve felt much more able to deal with my workload. I figured it might be helpful to share those with you.
For anyone that is super stressed out, feeling a bit anxious or unmotivated (Katie’s most recent post is what triggered me to write this one..), these tips are really simple and should hopefully help.

Disclaimer: Some of these tips are embarrassingly simple, so much so that I’m shocked that I didn’t implement them earlier on in this PhD process. Still, if I wasn’t doing them before then I’d guess that lots of other PhD students aren’t doing them now.

1. Turn your notifications off

Before last week just about every app on my phone had notifications switched on; WhatsApp, Facebook, Facebook Messenger, Twitter, Instagram, LinkedIn, Goodreads, WordPress, Etsy, the news, even when Podcasts updated each week. I (naively) didn’t think that these notifications had much of an impact on me, but switching them off has cleared out a tonne of background noise that I didn’t even realise was there. Previously, there were always notifications waiting for me on my phone, always something to think about, catch up on, acknowledge. Now, there’s nothing. Obviously I get texts and calls like normal, but notifications from apps are strictly off. I check apps when I have time to deal with the stuff that they contain, rather than constantly being aware of what I need to deal with later on in the day. Terrifyingly simple, shockingly effective.

2. Stop checking your email all the time

As with notifications, my emails are on my iPhone (seriously, iPhones are the best and worst things ever), so with one quick click and swipe I’d have checked emails from my personal account, my work account, and the account I have that’s based with one of my freelance clients. It was pretty rare that there were no emails in any of those 3 accounts; now let’s be clear, I’m not saying I’m super popular or important, 80% of those emails were likely from mailing lists or companies trying to get me to buy stuff, but still. Not checking emails was the thing I found most difficult last week – I’m a big fan of getting, and staying, at inbox zero, and I knew in the back of my mind that when I went back that would not be the case. I stuck with it though, and I check them much less often now – I’m not important enough for the world to implode if someone needs to wait an extra hour or two to get a reply from me, and it clears up head space and helps me to stay focussed on what I’m actually doing.

3. If it takes less than 5 minutes, do it now

Previously, my to do list was clogged up with tiny, tiny things. ‘Book dentist appointment’, ‘sort laundry out’, ‘clear desk’, ‘go to the Post Office’, ‘print handouts for talk’, ‘make Doodle poll for meeting’ etc etc – these things are the easiest wins to make on a to do list, so I would allow them to build up and then do them as a form of ‘productive procrastination’. No longer! Holy cow, last week I got through all these tiny little things and my to do list is about a third of the length it once was – and it’s staying that way. If it takes less than 5 minutes, it gets done there and then. This not only means I’m getting more stuff done, but it removes the clutter from a to do list and enables me to focus on the stuff I actually have to do; i.e. write thesis.

I need this print from Sighh Designs.
4. Empty time is not wasted time
How could any of my time be wasted with this little pup around? (Note – that is the feeling of true joy you see on my face).

At this point I need to get this sentence tattooed on my arm. Or printed across my laptop screen, whatever. I was thinking about what I’d done with my week off, and I couldn’t remember what I’d done on Monday and Tuesday. All I could think was that I’d looked after Milo (excellent puppy that I’ve been borrowing), given myself a pedicure, got a hair cut, read my book and watched Netflix (if you haven’t watched Queer Eye yet then oh my god, it’s the best feel good TV ever, it totally didn’t make me cry, nope not at all). That small list of things was all that I did over 2 days, and it was bloody brilliant. I just had a slow few days, I wasn’t running around like a headless chicken trying to get emails sent or writing done – it was totally relaxed. This week when I came back to work I was able to work way more efficiently so that I could then take some time away at lunch, or finish work and not be glued to my laptop long into the evening.

So yep, that’s it! I’m back and feeling super motivated for the next 10 weeks or so. Yhere is so much happening, but I’m feeling excited for it rather than nervous or anxious, it looks like that little break did exactly what I needed it to do – hoorah!

I’m Taking a Week’s Holiday 11 Weeks Before My Thesis Is Due

As you’re reading this, it’s 11 weeks until I submit my PhD thesis. 11 weeks. A decent amount of time, but it’s becoming more real by the day now. I’m writing this post in advance and scheduling it to be posted – I’m taking a break. From Monday 9th April until Monday 16th April I will be intentionally forgetting about my thesis, turning all notifications off on my phone, and logging out of Facebook, Twitter and Instagram.

I am taking an entire week to sort my head out. I’ve mentioned before that I have depression, and I really didn’t realise how how much of an impact that writing my thesis would have on my mental health. It’s not that I’ve been particularly ‘depressed’ if you know what I mean, I’ve just been a bit mopey for a few weeks; nothing major, just a bit numb and unmotivated. I’m getting better at recognising when things aren’t feeling so good, and now is one those times when I need a bit of time to myself.

I miss the feeling of being super motivated and excited to sit down and write (honestly, that was a thing a few months ago!), and this week’s holiday has come at the perfect time. I’d booked it off ages ago because I’m going to see Bastille in Edinburgh on Wednesday night (a Christmas present from my boyfriend), and then I’m going to Brussels with my best friend Friday to Monday to see Air Traffic. Initially I’d thought about just taking the days off that I needed to, but the past few weeks have made it really clear that I need to take the full week.  I need some time to sort my head out so that I can finish the PhD with the same feelings of motivation and enthusiasm that I started with. I want my thesis to be the best piece of writing I can possibly produce, and my brain is too mushy to do it justice right now.

This week I’m avoiding the internet, I’m unchaining myself from my desk and I’m going to have an entire week of doing stuff that I enjoy. Catch up with friends, read, go to the cinema, do some yoga, cook food from scratch (I’m an expert in Tesco ready meals at this point), spend time with my partner (this guy genuinely deserves a medal, I have been a true JOY to live with for the past few weeks), and actually make time to find out how my best friend’s first teaching job is going (I have been the worst friend recently, sorry everyone).

Credit: Pauline Kebuck

There will be no more blog posts from me for the next little while – I’ll be back once my head is feeling less like cotton wool and my thesis is feeling more like it will be something that I’m really proud of when it’s done.

Thesis Writing Full Time #3: No Pressure, No Work

This is a super quick check-in so that I can look back at the poor choices I have made with regards to time allocation when I’m stress-crying in the middle of June.

I’m at the point of thesis writing now where I really, really need someone to shout at me and force me to write. See my last thesis update post to see just how brilliant I’ve become at procrastination…
I’ve always been someone that works to a deadline, and if there is no pressure to get things done then I tend to leave work until the last minute. Saying that, I always get the work done – I’ve never missed a deadline – it just makes period of time closest to the deadline unnecessarily stressful.

This week instead of doing all of the thesis writing, I’ve done a million other things; so not entirely unproductive. I’ve been doing some work for Soapbox Science’s first event in Aberdeen, organising training and scouting out suppliers for various things  – finding a joiner to make 4 wooden soapboxes to very specific measurements and a limited budget is not the easiest of tasks. I also gave a talk about blogging for the University of Aberdeen’s Qualitative Research Network, and I’ve been doing some serious travel research for my Winston Churchill Memorial Fellowship (I know, it’s a tough life..).

Over the next few weeks I’m going to take part in some #remoteretreats. I think that will help me to focus. In the grand scheme of things I don’t actually have a huge amount of work left to do; the majority of the words are written, it’s about improving them and making sure all of the loose ends are tied up now.

Credit: Anna Borges / Buzzfeed

Academic Blogging – Why and How?

This afternoon I gave a talk about academic blogging for the University of Aberdeen’s Qualitative Research Network. I promised I’d share the slides from the session, so here they are (blogging about blogging.. #meta)

Links to the various people/blogs/resources that I referenced during the talk:

My Twitter: www.twitter.com/heidirgardner
The Winston Churchill Memorial Trust: www.wcmt.org.uk
Soph Arthur: www.twitter.com/sophtalkssci / www.sophtalksscience.wordpress.com
Rebecca Hall: www.twitter.com/RebeccaJHall13 / www.biologybex.wordpress.com
Andrea H.: www.twitter.com/phd_fashionista / www.phdfashionista.com
Alex Fitzpatrick: www.twitter.com/ArchaeologyFitz / www.animalarchaeology.com
Nicola: www.twitter.com/fresh_science / www.freshscience-nicola.blogspot.co.uk/
That Biologist: www.twitter.com/thatbiologist / www.thatbiologist.wordpress.com
Michelle: www.twitter.com/Silli_Scientist / www.alloksci.com
Scientific Beauty: www.twitter.com/sciencebeaut / www.thescientificbeauty.com
Arts & Humanities Research Council’s North West Consortium Doctoral Training Partnership blog: www.nwcdtpblog.wordpress.com
Research the Headlines (The contributors to Research the Headlines are all current or former members of the Royal Society of Edinburgh‘s Young Academy of Scotland): www.researchtheheadlines.org
Students 4 Best Evidence: www.students4bestevidence.net
Let’s Talk Academia: www.letstalkacademia.blogspot.com
Goop (please, please only use this as a guide for what not to do with blogging – keep your integrity and blog about topics with evidence behind them!): www.goop.com
Jade Eggs for Your Yoni: www.goop.com/wellness/sexual-health/better-sex-jade-eggs-for-your-yoni
Dr Jen Gunter: www.drjengunter.wordpress.com
Dear Gwyneth Paltrow, I’m a GYN and your vaginal jade eggs are a bad idea: www.drjengunter.wordpress.com/2017/01/17/dear-gwyneth-paltrow-im-a-gyn-and-your-vaginal-jade-eggs-are-a-bad-idea
12 (More) Reasons to Start a Jade Egg Practice: www.goop.com/wellness/sexual-health/12-more-reasons-to-start-a-jade-egg-practice
If Gwyneth Paltrow is so effing tired maybe she shouldn’t put jade eggs in her vagina: www.drjengunter.wordpress.com/2017/03/09/if-gwyneth-paltrow-is-so-effing-tired-maybe-she-shouldnt-put-jade-eggs-in-her-vagina
Gwyneth Paltrow and GOOP still want you to put a jade egg in your vagina. It’s still a bad idea.: www.drjengunter.wordpress.com/2017/05/11/gwyneth-paltrows-jade-eggs-again
Do Story: How to Tell Your Story So the World Listens: www.amazon.co.uk/Do-Story-World-Listens-Books/dp/1907974059
Science Blogging: The Essential Guide: www.amazon.co.uk/Science-Blogging-Essential-Christie-Wilcox/dp/0300197551
Don’t be SUCH a Scientist: www.amazon.co.uk/Dont-Be-Such-Scientist-Substance/dp/1597265632
(I also reviewed this book – take a look here)
Information is Beautiful: www.amazon.co.uk/Information-Beautiful-David-McCandless/dp/0007294662 / www.informationisbeautiful.net
Knowledge is Beautiful: www.amazon.co.uk/Knowledge-Beautiful-David-McCandless/dp/0007427921
The Conversation: www.theconversation.com
Mona Chalabi: www.twitter.com/MonaChalabi / www.instagram.com/monachalabi

Thesis Update – T-Minus 3 Months

I’m now 3 months away from handing in my thesis. 3 months sounds a lot friendlier than 12/13 weeks, so I’ve going with that. I’m coming strangely close to the end of the PhD process, and to be honest I am feeling a bit sad about the whole thing. This PhD has been brilliant – even the bits that have been tedious or boring, I’ve enjoyed because I’ve found a subject I’m passionate about. It will be very, very strange to have this thesis done and handed in, but I’m lucky in that I’ve managed to secure a short term contract that will keep me working with the wonderful team at HSRU until the end of 2018 at least. That’s a big weight off my shoulders, and means that my thesis needs to be done! Anyway, here’s an update with 3 months to go; I wrote a blog post with 6 months to go and said “there’s work to be done but I think it’s doable!” – that’s where I’m still sitting now, I know that I can get this done and handed in on time, I just need to really knuckle down for the next 3 months.

So, how far have I got?

Literature Review

In my last update post, I aimed to:

  • Sort out the categories of papers into more manageable subsections, and work them into a sensible order. Get at least 3,000 words written.

I’ve sorted the categories of papers into various folders that will help me to write sections of the literature review, and they are in some sort of sensible order. Confession time – I have not written 3,000 words. To be honest, I have done absolutely everything in my power to avoid writing this literature review; my flat is spotless, there is no dirty laundry at all, I’ve seen all the films that I’m interested in that are currently showing at the cinema, and I’ve found complete strangers to puppy-sit for on Borrow my Doggy (if you don’t know what this is and you really like dogs, I suggest you go and sign up asap) – proof below.

There’s also an unfinished 3,000 piece jigsaw puzzle taking over my living room floor. Seriously, the jigsaw thing isn’t a joke. It’s been there for over a week now.

ANYWAY. This week I’m locking myself in my office at home, and I’m getting a first draft of this literature review written. I am done messing around, avoiding it and finding literally anything else in the world to do instead – this thing is getting done this week – pinky promise.

Now, moving on to a more positive part of thesis progression..

Systematic Review

Last time I checked in, my systematic review was sitting at 33,496 words, and it had gone to my primary supervisor for comments. The comments were pretty limited, which I was pleasantly surprised about. The majority of the comments were related to changing the presentation of the results section to cut down words and make the chapter as a whole flow more easily. I made those changes and the chapter is pretty much done – it’s now 25,387 words which I’m much happier with.

I’ll have a final read through it when I put all of the thesis chapters together to ensure there’s no repetition in the introduction/background sections etc, but for now, it’s off my to do list (hoorah!).

Qualitative Study

I’m pretty happy with where I’m at with this – I handed in a first draft and got comments back from both of my PhD supervisors with lots of brilliant pointers of how to build on what I’ve already got, expand my points and set my findings in context with the wider literature. Next steps are to go through these comments and make improvements etc. I feel pretty confident with that though, which is nice; I had a meeting with my supervisors to talk through changes etc and they were really helpful so it’s just a matter of me making time to do it, and getting on with it.

Currently, it’s sitting at 15,610 words and it will undoubtedly grow by another thousand of two by the time it’s finished.

User-testing Study

In my last update I mentioned that the qualitative document that I had then, needed to be split up into 2 separate chapters – I’ve now done this, and I have a ‘qualitative study’ chapter, and a ‘user-testing study’ chapter. I used the writing retreat that I went on at the beginning of March to work exclusively on this user-testing chapter, and I made some really good progress. I handed in a first draft to my supervisors in the middle of March, and already have comments back to work on (side note: having supervisors that actually engage with my work and want to help me develop my skills is the absolute best thing; if you’re looking for PhDs at the moment, please, please make supervisor choice a priority – it makes a huge difference to your experience).

This chapter is currently sitting at 8,384 words, and I expect it to increase to ~9,500 words or so once I’ve gone through and addressed comments etc.

Aims for the next 2 months
  • Literature review – STOP MESSING ABOUT AND WRITE THE BLOODY THING!
  • Systematic review – Slot into final thesis structure.
  • Qualitative study – Address comments and slot into final thesis structure.
  • User-testing study – Address comments and slot into final thesis structure.
  • Thesis introduction – Get a first draft written for the beginning of May.
  • Thesis conclusions – Get a first draft written for the middle of May.

I want an entire working thesis draft by the end of May – that’ll give me a month before hand-in to ready through it a million times, tweak things, ensure I haven’t repeated myself a million times, and then make sure that the formatting and referencing is correct. Phew. This is all getting, very, very real.

Thesis Writing Full Time #2: Creating Structure

I’ve now been thesis writing pretty much full time for about 7 weeks. I’ve still been dipping in and out of work for other projects, leading the organisation of a new local branch of Soapbox Science (our speakers have just been announced – see the brilliant lineup we’ve secured for Aberdeen here!), designing new products for Science On A Postcard, and flitting about at Buckingham Palace.. so it’s not all been thesis-based. Anyway, I feel like I’ve finally got into a routine so thought I’d share that – hopefully it’ll be useful for those of you also writing up and struggling to find your groove.

I said in my last ‘thesis writing full time’ post, that the most productive times for me were between 3 and 6pm, and after dinner until I go to bed. As it turns out, that estimation was wildly wrong, and I just happened to be most productive during those times because I forced myself to focus during those times (that said, I am writing this blog post at ten past 9 on a Wednesday night, so many the night owl thing has some truth to it..). I’ve now found a much better routine, and it involves just getting on with work no matter what time it is. Sounds simple, right? Wrong. This structure thing takes time and dedication, and it’s actually quite difficult to force yourself out of bed an hour earlier just because you ‘should’.
I went on my first writing retreat last December and thought it was brilliant, so brilliant that my parents gifted me another one for Christmas, but it was the second one that I went on (March), that really forced the need to create structure into my brain.

As I said in a blog post about that first writing retreat, Rowena Murray’s retreats rely on a set structure made up of writing blocks, non-negotiable break times, and a distinct lack of distractions (the health app on my iPhone genuinely thought I’d been asleep for 3 days because my phone hadn’t moved from my bag during the entire retreat). During my first retreat I thought I’d got a lot done, but knowing what was ahead of me meant that I prepared much more effectively for the second, and I finished a thesis chapter a week in advance of the deadline (I know, shocking!).

This writing retreat structure is brilliant, it forces productivity, and in the words of Rowena herself, it forces ‘self-efficacy’. So, how have I managed to translate this seemingly magical structure into real life? I’ve been using the Forest App to force myself to focus (I see the irony of needing an app to reduce my ability to be distracted by technology, but it works for me), and I’ve been blocking out writing slots (an hour or an hour and a half depending on how much I want to achieve), and then.. just getting on with it. That’s been great, but it’s easy to find something to creep in and take that time away from me.

Enter, the wonderful Lucy Hinnie. I met Lucy at the March writing retreat where we bonded over a shared love of the fact that Rowena Murray was actually making us more productive, baked goods at break times, and RuPaul’s Drag Race (do not judge us, that show is a cultural masterpiece and I will hear nothing against Mama Ru).
Anyway, she’s continued to be fabulous from afar, and today she ran the first #remoteretreat via Twitter. This took the same structure as Rowena’s retreats, and judging by the response online, it was bloody brilliant. I didn’t manage to make this one, but Lucy is forcing our productivity again next Wednesday (28th March), so I wanted to draw attention to it.
I’ll be joining next week’s #remoteretreat but will need to skip out for an afternoon meeting – join us at 9.15am (GMT) to set goals, and then get writing!

Publication Explainer: The PRioRiTy Study

Today I had a new publication come out – hoorah! Told you that all the effort I put towards my 2017 goals would pay off eventually 🙂 This is the second in my ‘Publication Explainer’ series, and there are at least another 2 that I already need to write, read the first one here. As I said in that post, these explainers are a place for me to answer 3 of the most common questions I’ve been asked by the people around me (usually my boyfriend, friends, or colleagues that haven’t been involved with the project).

This post focusses on the paper below: Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership – the PRioRiTy (Prioritising Recruitment in Randomised Trials) study. Read the full paper here.

Why prioritise research questions about recruitment to trials?

Research around recruitment strategies for randomised trials is super important – though it is the premise of my entire PhD project so I would say that. Recruitment to trials is difficult, and many trials (estimates differ but average around the 45-50% mark) fail to recruit enough participants to hit their targets. Targets are not just numbers plucked from thin air, they’re based on detailed calculations performed by trained Statisticians – target figures are designed to enable researchers and trialists to see real differences in the various arms of trials. If we don’t hit target, then results of the research could be vulnerable to something called a type 2 error – which is most simply explained by the image below; it’s a false negative, meaning that we could be telling people that an intervention is effective when it isn’t, or that it isn’t effective when it is.

Clearly, recruitment is as area that requires research, but because there is so much work to be done, we are at risk of being a bit everywhere (just to be clear, ‘being a bit everywhere’ is not the technical term for this…) when it comes to focussing and making substantial progress with improving the way we do research. Going through a formal prioritisation process for the squillions of research questions that surround the process of recruitment, will enable researchers to coordinate the research that they’re doing, plan more effectively, and work together to ensure that we are answering the questions that are most important to the various stakeholder groups involved.

How did the prioritisation process work?

The process of prioritisation that enabled this project to go ahead was a development with the James Lind Alliance – the JLA works with clinicians, patients and carers ensure that all voices are heard, and that prioritisation of research questions reflects the requirements of all of these groups. The James Lind Alliance works on the premise that:

  • addressing uncertainties about the effects of a treatment should become accepted as a routine part of clinical practice
  • patients, carers and clinicians should work together to agree which, among those uncertainties, matter most and deserve priority attention.

The prioritisation process begins with getting partners involved with the PRioRiTy project – this isn’t a project that can be done by one person!The stakeholders involved with this priority setting partnership were:

  • Members of the public who had been invited to participate in a randomised trial or participated in Trial Steering Committees (TSCs). They could be an individual or representing a patient organisation;
  • Front line clinical and research staff who were or had been involved in recruitment to randomised trials (e.g. postdoctoral researchers, clinicians, nurses, midwives, allied health professionals);
  • People who had established expertise in designing, conducting, analysing and reporting randomised trials (e.g. Principal Investigators/Chief Investigators);
  • People who are familiar with the trial methodology research landscape (e.g. funders, programme managers, network coordinators).

Once relevant stakeholders were identified, an initial survey with just 5 questions (below in Table 1 which is taken from the original paper) was developed and distributed to the stakeholders involved.

Responses were collated, organised, coded and analysed in order to generate a full list of research questions. This was a massive part of the work; 1,880 questions came from the 790 respondents to the initial survey. The figure below shows the process of whittling down this huge pile of questions to a manageable – and useful – top 20.

As you can see, this was an iterative process involving lots of people, views, questions – and work! I’ll just make it clear here – I was involved in a small part of this process, and the team working on the project was large; as I said before, with projects like this it’s important to involve people from lots of different backgrounds and with various levels/areas of expertise. The team was led by Prof Declan Devane and Dr Patricia Healy, both from NUI Galway, they kept the rest of us on track!

What next?

In terms of next steps for the team involved in the PRioRiTy project, it’s really important that we work to disseminate our results; after all, if no ones knows what the final list of prioritised questions is, then there was really no point in doing the project. So – with that in mind, here’s the final top 10!

To give these questions some context I wanted to talk through a few of them to go through my thoughts on what types of research may be required to answer them, and why they’re important.I’ll stick to the top 3 for this part:

Understanding how randomised trials can become part of routine care is, unsurprisingly, the top question from this entire project. Knowing how we can use clinical care pathways to ensure that patients are given the opportunity to take part in trials is a hugely important part of normalising trial recruitment, and spreading awareness of trials more generally. There is a tonne of research to be done in this area, and in my opinion, this question will need a diverse range of research angles and methods in order to answer it in a variety of ways.

This question is interesting – what information should trialists be giving to members of the public that are being invited to take part in trials? That seems like something we should have evidence for, but in actual fact we are working from hunches, experiences, and anecdote. I think this question will rightfully fuel a lot of research projects over the coming years, we need to be looking at what information potential participants want, as well as what they need form an ethical/regulatory stand point – at the moment I get the impression that we’re being driven by ethics committees and regulators, and we’re often putting in a lot of information that participants don’t want/need/find useful, because we feel it’s better to give them everything, rather than risk missing something out. I suspect that if we reduce the amount of information we provide, the understanding of that information would increase because participants are able to focus on specific pieces of information more effectively. I say that because I know that if I get a huge leaflet, I’m much more likely to avoid the entire thing because it looks overwhelming, or I don’t think I have time to get through all the information in front of me.

This question is one that I’ve been asked, and I myself have asked, numerous times over the course of my PhD. Public engagement and patient involvement are both areas of academic life that are getting increased focus; we know that involving patients and members of the public in our research can strengthen it, make the work we’re doing more relevant to the people that we’re doing it for, but could this involvement impact on recruitment rates too? I’m not sure, but I’m really interested to see the results of a few projects that are linked to this question that are currently ongoing – the PIRRIST study led by Dr Joanna Crocker is one I’ll be keeping an eye out for. The PIRRIST protocol was presented as a poster at a conference I went to in 2015, that information is published here if you’re interested in learning more.

Something to note

The appendix of the paper contains a full version of the table below, this provides details on the evidence that we already have available to us to help answer each of the top 10 questions. The top 3, which I’ve discussed above, have no evidence available – which really drives home the importance of a formal prioritisation process in highlighting where the gaps are in research evidence.

There is certainly a lot more work to be done on how we recruit participants into randomised trials – which is good for me as I want to stay in this field of research after my PhD, and hopefully get some of these questions answered over the course of my career!

A Trip to Buckingham Palace (Yes, Really!)

Just before Christmas we had an all Unit photograph at work – we all gathered together, fighting over places because no one wanted to be in the front row. Looking around I felt really lucky, I am so, so, lucky to be doing my PhD in an environment filled with such brilliant colleagues. After the photograph had been taken, I went to walk out of the building and back to the open plan office I work in, that was until Prof Craig Ramsay, HSRU Director pulled me aside and said he had something to talk to me about. Genuinely, my first thought was ‘Oh God, can you get fired from a PhD?’, shortly followed by, ‘Did I ever put anything awful on Twitter?’.

Thankfully, neither of those thoughts lasted long – Craig was explaining to me and my friend and fellow PhD student, Beatriz, that HSRU and HERU (the Health Economics Research Unit) – both based at the University of Aberdeen – had won the Queen’s Anniversary Prize, and the two of us had been selected to represent the HSRU’s postgraduate students.

Fast forward about 6 weeks, and this arrived:

Apparently the whole going to Buckingham Palace thing wasn’t a joke.

Anyway, that led to a few weeks of pondering what to wear, where to get my nails done, and whether my hair needed a new style, and last week the time came for us to head to London. Beatriz and I flew down on Wednesday morning – she had a hair appointment and I had a nail appointment (#priorities).

Thursday morning was quite possibly the most surreal morning of my life. Representatives from HSRU and HERU teams (photograph below) gathered with a sort of nervous energy in the air. We got in a taxi and asked the driver to take us to Buckingham Palace, we even had a car pass that meant he would drop us off right outside the gates.

L-R: Me, Prof Craig Ramsay, Prof Marion Campbell, Ruben Sakowsky, Prof Mandy Ryan, Alastair Irvine, Maria Dimitrova, Beatriz Goulao

Once we were inside the Palace (it’s still weird even typing that), we handed our coats/bags (and phones! – unfortunately no selfies with the Royals this time) in, and were then guided through to The Ballroom, which was where the awards ceremony would take place.

Image taken from the @QAPrizes Twitter account.

We were given name tags (I’ve kept mine because I’m doubtful I’ll ever see my name alongside the Royal cypher ever again), and then shown to our seats, which were ready with booklets detailing the proceedings (left).

We were told by one of the guards what would happen next; when to stand, when to clap, and when to be seated. At this point everyone seemed a bit on edge, but in a really excited way – we were not sure what to expect, but we knew that we were about to experience something really special.

Prof Craig Ramsay and Prof Sir Ian Diamond, Principal of the University of Aberdeen, were up first (image below). The Queen’s Anniversary Prize for Higher and Further Education was presented to them by the Prince of Wales on behalf of the Queen, and the Duchess of Cornwall presented the Prize Certificates.

Prof Craig Ramsay receiving HSRU and HERU’s award.

After the ceremony all of the teams were taken through to another room where there were stands set up for each University, the Prince of Wales and the Duchess of Cornwall then came round to meet with each of the teams. Both HSRU and HERU teams were given the opportunity to discuss the research that we do in our Units with the Prince and Duchess – they were hugely engaged and interested in the work that we do. The Duchess even said that it must be really exciting to work around clinical trials; a refreshing change from the eye rolls I get when I’ve been talking about trials to my friends for too long..

Again, it was one of the most surreal mornings of my life; I flew back to Aberdeen later that evening, and was in my own bed by 11pm wondering if it had all been a very elaborate dream! I felt incredibly privileged to be representing HSRU, and it’s a day I won’t be forgetting for a very long time to come.

Now, I’d better get back to my thesis…