#365papers July Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

For the first time in a few months, I’m finishing July ahead of schedule! I’m currently writing this before I go on holiday (July 28th) and it’s been scheduled and published whilst I’m enjoying myself with friends in Wroclaw or Krakow, depending on when you’re reading this.

This month I’ve really focussed on getting abstracts screened for my literature review. I still have a big pile waiting for me when I get back to the office, but it feels good to have made at least a little dent in the workload, and the task definitely made reading much easier to fit in too.

July’s reading:

  1. Marketing and clinical trials: a case study
  2. Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned
  3. Avoidable waste related to inadequate methods and incomplete reporting of interventions: a systematic review of randomised trials performed in Sub-Saharan Africa
  4. External validity of randomised controlled trials: “To whom do the results of this trial apply?”
  5. Implementing research findings in developing countries
  6. Spending on public health cut as councils look to save money
  7. New law will force hospitals to charge foreign patients for non-urgent care
  8. Participation in a clinical trial: The patients’ point of view
  9. Clinical trial participation: Viewpoints from racial/ethnic groups
  10. Barriers to clinical trial participation as perceived by oncologists and patients
  11. Determinants of patient participation in clinical studies requiring informed consent: why patients enter a clinical trial
  12. Patient income level and cancer clinical trial participation
  13. Why African Americans may not be participating in clinical trials
  14. Why patients don’t take part in cancer clinical trials: an overview of the literature
  15. Resource implications of preparing individual participant data from a clinical trial to share with external researchers
  16. Short-term impact of celebrating the international clinical trial day: experience from Ethiopia
  17. How to design efficient cluster randomised trials
  18. Six pairs of things to celebrate on International Clinical Trials Day
  19. Development in the number of clinical trial applications in Western Europe from 2007 to 2015: retrospective study of data from national competent authorities
  20. When scientists turn to the public: alternative routes in science communication
  21. Blockchain technology for improving clinical research quality
  22. Barriers to clinical trial recruitment and possible solutions: a stakeholder survey
  23. Unsuccessful trial accrual and human subjects’ protections: an empirical analysis of recently closed trials
  24. Routine data from hospital information systems can support patient recruitment for clinical studies
  25. Impact of participant and physician intervention preferences on randomised trials – a systematic review
  26. Motivators of enrolment in HIV vaccine trials: a review of HIV vaccine preparedness studies
  27. Informed consent documents do not encourage good-quality decision making
  28. The effects of an open design on trial participant recruitment, compliance and retention – a randomized controlled trial comparison with a blinded, placebo-controlled design
  29. Provider roles in the recruitment of underrepresented populations to cancer clinical trials
  30. Recruiting subjects for acute stroke trials: a meta-analysis
  31. Minimisation: a new method of assigning patients to treatment and control groups

PhD Life and Depression

This is a much more personal post than any I’ve posted on this blog before, but I’m hoping that what I have to say will put things into perspective, and encourage other PhD students to speak up.

I have depression.

I think I’ve probably struggled with depression since the first year of my undergraduate degree (2010), but I didn’t tackle the issue and get help until January this year. Last year was a really difficult one for me personally, and after Christmas and New Year I decided that I was fed up of being mopey – to be quite honest I was boring myself, and I missed being excited about stuff. I went to see my GP and she was brilliant (yet another case of ‘I love the NHS’) – she gave me medication and arranged a follow-up appointment to check how I was doing in a month’s time. Since then I’ve doubled the dosage but stayed on the same medication, and things finally feel like they’re starting to get easier.

If you have never had depression, it’s difficult to get your head around – looking at it from the outside people can think you’re lazy or workshy when you become the textbook flakey friend/colleague who cancels more than usual. The only way I can describe it, is that it feels like you’ve got a really heavy blanket over you all the time, it’s so heavy that it’s tiring to drag around with you whilst you do normal tasks like go to work or go to the gym. For me, it’s been a constant source of frustration. I want to do loads of things, I’m still really excited about my PhD, but when I sit down and try to focus this big heavy blanket seems to cover everything. Motivation has been in short supply, but I’m just as stubborn as I am miserable (the fact I’ve maintained a sense of humour helps!) – so I’ve kept on going as much as I possibly can. That might mean going into the office on a Sunday purely because my motivation has come back and I want to make the most of it.

I’ve read a lot online about PhD students and the mental health problems that come with the pressure of academia – here, here and here are decent starting points. My depression has in no way been a result of my PhD. If anything, I think that doing the PhD has kept me going – so I wanted to add my two cents to the internet of ‘terrible things PhD students go through’, with a more balanced perspective. To be clear, I know lots of PhD students will have mental health issues that are linked to their studies; I’m not belittling their experience at all, I just want to even things out with my own experiences.

As I said earlier, I think I’ve had depression for about 7 years now, and I have no doubt that my PhD was the thing that made me get help. It wasn’t because I was under intense pressure, or that I didn’t think I’d ever be able to write a thesis – the reason I finally said something to my GP was because I was so bloody annoyed that I couldn’t drag my ass to work each day and I wasn’t able to read papers or write coherently anymore. It was purely frustration – it felt like my PhD was slipping away from me, and I really love the work I do so I wasn’t willing to let that happen.

I don’t feel unsupported at work. Lots of posts I’ve read online say that PhD students are left alone, they suffer from isolation and they get lonely. Again, I don’t doubt that, but it’s not the case for me. The colleagues that surround me are brilliant – some are hilariously funny and mean I’m left smiling all day even after a 5-minute chat in the morning, others express surprise when I’m not myself and ask how I’m doing completely unprompted, some especially brilliant colleagues have been known to leave a little note or treat on my desk, my Supervisors are amazing and always seem to pick up on a down day before I’ve even mentioned it. It’s not that I’m lonely, it’s that I’ve got this heavy blanket weighing me down, and to be honest dragging it around is just too much hassle and it’s easier to stay at home for the day sometimes. Other days I get up and sort myself out as normal, go to work and have a totally normal day – whatever that is.

For now, my PhD work is on target. I’m working weird hours because I’m a bit rubbish in the mornings – I’m very much a night owl and whilst I’m in a bit of a funk it’s just better to roll with what my brain is willing to do. If that means abstract screening at 11pm after snoozing until after 9am that’s fine.

I’m aware that I’m very lucky with my PhD experiences, I genuinely wish I could remain a PhD student for at least another 3 years – I’ve never heard anyone else say that!

The world of academia isn’t all doom and gloom, there are research teams up and down the country that create the most brilliant learning environments for students. So if you’re considering doing a PhD bear that in mind, and make sure you find a team you click with before you start. If you’re already doing a PhD and you’re experiencing these kinds of problems, please do speak up and ask for help. 9 times out of 10 people are not actively isolating you, they’re just too busy to realise you need support – tell them, and then try your best to get rid of the British stiff upper lip and take the help when it’s offered. A PhD is not some sort of horrendous mental health journey, it’s supposed to be part of your career that allows you to learn and build your research experience; it’s meant to be (at least somewhat) fun.

I’m not really sure how to end this post, but I hope it’s showed the other side of the argument when it comes to PhDs and mental health. Mental health issues are so common, and I think it’s important that PhDs and academia are not blamed for those issues entirely – sometimes they’re just what’s needed to make someone realise they need a helping hand every now and again.

If you’re struggling – one of my earlier posts on academic self-care might have some useful tips.

#365papers June Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

This month’s reading has not been great – in order to get the 30 papers for June read to the level I wanted to, I ended up dedicating a few days at the end of the month to get them all complete. This month has been a busy one; I went to Evidence Live for 2 days (blog posts here for day 1 and day 2), and this month seems to have been really heavy with meetings. July is looking a bit quieter so fingers crossed I won’t end up cramming at the end of next month too!

June’s reading:

  1. Can we rely on the best trial? A comparison of individual trials and systematic reviews
  2. Science in the social media age
  3. Communicating data about the benefits and harms of treatment: A randomised trial
  4. Tweeting and rule breaking at conferences
  5. Evolution of poor reporting and inadequate methods over time in 20,920 randomised controlled trials included in Cochrane reviews: research on research study
  6. How scientists engage the public
  7. Influence of social media on the dissemination of a traditional surgical research article
  8. Recruiting adolescent research participants: in-person compared to social media approaches
  9. How are scientists using social media in the workplace?
  10. Through the looking glass: understanding non-inferiority
  11. The need for consensus, consistency, and core outcome sets in perioperative research
  12. Bias due to changes in specified outcomes during the systematic review process
  13. Confidence intervals illuminate absence of evidence
  14. Research funders pledge to make trial results publicly available
  15. US to impose tougher rules on reporting clinical trial data
  16. A methodological approach for assessing the uptake of core outcome sets using clinicaltrials.gov: findings from a review of randomised controlled trials of rheumatoid arthritis
  17. Anonymising and sharing individual patient data
  18. How to translate clinical trial results into gain in healthy life expectancy for individual patients
  19. Sparse data bias: a problem hiding in plain sight
  20. Exploring patients’ treatment journeys following randomisation in mental health trials to improve future trial conduct: a synthesis of multiple qualitative data sets
  21. What do usability evaluators do in practice? An explorative study of think-aloud testing
  22. Getting access to what goes on in people’s heads? Reflection on the think-aloud technique
  23. Think-aloud protocols: a comparison of three think-aloud protocols for use in testing data-dissemination web sites for usability
  24. Evidence based medicine manifesto for better healthcare
  25. Thinking aloud: Reconciling theory and practice
  26. Barriers to participation in randomised controlled trials: a systematic review
  27. Clinical trials: the challenge of recruitment and retention of participants
  28. Increasing recruitment to randomised trials: a review of randomised controlled trials
  29. Principles of recruitment and retention in clinical trials
  30. Engaging veterans with substance abuse disorders into a research trial: success with study branding, networking, and presence

Why PhDs and Perfectionism Doesn’t Mix

This post was originally written by me and published on the Let’s Talk Academia blog. Let’s Talk Academia is an open space on the internet, whereby advice, stories and experiences are shared about postgraduate life and academia. The process of working with Emily, who runs Let’s Talk Academia, was great too – so if you’re looking to get involved in blogging, I’d recommend getting in touch with her via the Let’s Talk Academia Facebook page.

Every PhD project is different, and every PhD student tackles a project in their own unique way. In my experience though, PhD students tend to have one thing in common; they’re high achievers.

When I was younger, I was always that kid that loved school. I was clearing out my old bedroom a few months ago and found diaries that we had to write at school when I was about seven years old. I’d written numerous times, ‘I had fun in Maths today’, ‘I did work at school, I like work’, or the line that makes me cringe the most, ‘I love work, work is easy.’ Please bear in mind I was 7 years old! I’m not that unbearable now at the age of 25, I promise.

I got good GCSE grades, and later on my A-level results got me into the University of Aberdeen to study Pharmacology. I worked hard to convert my Undergraduate BSc degree into an MSci when I took a year away from university for an industrial placement. In the end I graduated with a first class degree and won an academic prize for my final year dissertation; the results of which were then published in the journal Acta Neuropathologica and I was a named author.

I started my PhD in July 2015 and realised quickly that my usual high-achieving track-record wasn’t going to get me through this like it’d got me through exams and assessments before. I’ve always been a perfectionist, whether that’s manifested itself in redrafting and editing essays over and over again, or revising the same topic two or three times before an exam. That attitude simply does not work when you’re doing a PhD; realising that and having to adapt my mentality and working practices was difficult, and I think lots of other PhD students have experienced this too.

Why being a perfectionist simply does not work

A PhD is not an exam or assessment you can write in an evening and then forget about, it’s a really long process that involves literally years of work. If you try and make every single part of that process perfect, you’ll never, ever finish it. You’ll also likely hate the process, and your family and friends will want to strangle you because you’ll be no fun to be around.

Letting go of being a high achiever

After I’d started my PhD I learned pretty quickly that I couldn’t be the best at it. I’d get frustrated when I couldn’t do something, and my Supervisor would regularly remind me, ‘a PhD is a training degree, you’re not expected to know everything – you wouldn’t be here if you did’. That helped, and after repeating that to myself a few hundred times, it started to sink in.

I find it difficult to ask for help, and often I don’t find it easy to try new things; there’s a fear in me that I won’t be good at it so I’d rather not try than deal with the feeling of failure. (Side note – this is the reason why I can’t ride a bike…).

If you’re like me, I have some bad news for you. You are going to have to get used to dealing with perceived failures over the course of a PhD. Failures in PhD-land are common. Losing your memory stick with at least one month’s work on (I’m still not over this and it happened a year ago), software crashing and corrupting documents you’ve been working on for the entire day, missing out on funding, and not having abstracts accepted for conferences; it will all happen. You have to get used to it, learn to get over your defeats quickly and learn from them, otherwise you’ll drive yourself mad.

The intelligence myth

When telling people that I’m doing a PhD, more often than not I get the response ‘OMG you must be SO clever!’. I know this isn’t intentional, but it adds pressure. Every time someone says that, I feel a bit more stupid – know what I mean? Really though, a PhD isn’t about being smart. It’s about consistently learning from your mistakes, dusting yourself off and trying again. It’s a test of tenacity rather than intelligence.

Being able to let my perfectionist side ease off a little has undoubtedly made me a better student. I’m no longer afraid to ask questions, no matter how daft they might have seemed at first, and weirdly, I look forward to getting edits and comments back on my work because I know that’s just helping to improve it. Research is a big collaborative effort, we work in big teams across multiple projects at once, and making everything perfect is impossible. It’s also worth noting, if you’re the guy that wants everything to be ‘just right’, you’re probably a nightmare to work with.

Give yourself a break, and let yourself make mistakes – screwing up during your PhD is a really safe space to do so as well, you’ve got a supervisor who can help to get you out of sticky situations after all!

#365papers May Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

This month’s reading has been pretty rubbish if I’m honest. I’ve been spending my spare time reading books with plots and characters instead of p values and methods, and whilst in PhD mode I’ve been working on writing up the systematic review chapter of my thesis. Last month I was all motivated and excited to write my literature review – that took a total back seat, and I suspect it will remain there for the next few weeks whilst I finish up a first draft of that thesis chapter. I’m super excited to get this chapter written – I think it’ll calm me down a bit when it comes to writing the thesis as a whole; it feels like a head-start, and mentally, I think that’s a good move. Anyway, I managed to get through May’s reading, but that did involve a pretty heft few days of reading towards the end to catch up.

May’s reading:

  1. The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial
  2. Novel participatory methods of involving patients in research: naming and branding a longitudinal cohort study, BRIGHTLIGHT
  3. Developing the SELF study: a focus group with patients and the public
  4. What can we learn from trial decliners about improving recruitment? Qualitative study
  5. Overcoming barrier to recruiting ethnic minorities to mental health research: a typology of recruitment strategies
  6. Systematic techniques for assisting recruitment to trials (START): developing the science of recruitment
  7. Testing the effectiveness of user-tested patient information on recruitment rates across multiple trials: meta-analysis of data from the START programme
  8. Challenges to evaluating complex interventions: a content analysis of published papers
  9. An optimised patient information sheet did not significantly increase recruitment or retention in a falls prevention study: an embedded randomised recruitment trial
  10. Sharing individual level data from observational studies and clinical trials: a perspective from NHLBI
  11. Data sharing: not as simple as it seems
  12. Protecting patient privacy when sharing patient-level data from clinical trials
  13. Predictors of clinical trial data sharing: exploratory analysis of a cross-sectional survey
  14. Opening clinical trial data: are the voluntary data-sharing portals enough?
  15. Subversion of allocation concealment in randomised controlled trial: a historical case study
  16. Making a decision about trial participation: the feasibility of measuring deliberation during the informed consent process for clinical trials
  17. Participants’ preference for type of leaflet used to feed back the results of a randomised trial: a survey
  18. Trialists should tell participants results, but how?
  19. HELP! Problems in executing a pragmatic, randomised, stepped wedge trial on the Hospital Elder Life Program to prevent delirium in older patients
  20. Clinician engagement is critical to public engagement with clinical trials
  21. Patient engagement in research: a systematic review
  22. Health researchers’ attitudes towards public involvement in health research
  23. Open clinical trial data for all? A view from regulators
  24. Patient and public involvement: what next for the NHS?
  25. ‘Ordinary people only’: knowledge, representativeness, and the publics of public participation in healthcare
  26. Reflections on health care consumerism: insights from feminism
  27. Publishing information about ongoing clinical trials for patients
  28. Effectiveness of strategies for information, educating and involving patients
  29. Patient involvement in patient safety: what factors influence patient participation and engagement?
  30. Promoting public awareness of randomised clinical trials using the media: the ‘Get Randomised’ campaign
  31. Communicating the results of clinical research to participants: attitudes, practices, and future directions

How to Make the Most out of Your PhD Supervisors

Choosing a PhD supervisor is difficult. Often you’re meeting them for the first time to discuss the PhD, and there’s not a lot of time to get to know the way they work. I’ve been lucky with my supervisory team and the unit I’m working in. I get on well with my supervisors, we seem to work in a similar way, and they’re super helpful and easy to work with. I realise I’ve been lucky here. Lots of other PhD students are not in the same position that I’m in. Some have difficult relationships to manage, and encounter difficult conversations throughout their project.

This week I thought it would be useful to give some tips on how to choose a supervisor you’ll work well with, and how to make the best out of those you are already working alongside.

Figure out what you want

Every PhD is different, and every student is different. Some students prefer a more involved supervisor. Others prefer to get on with their project on their own before reporting back; in that case a more detached style might be better. Give some thought to how you work, what will begin to grate and how you don’t want your project to pan out.
I liked a more involved way of working at the beginning of my project because it helped me build confidence. Once I had a handle on what I needed to do, I was happy to get on. I check in with my supervisors and know that they’re there if I need them, but it can be weeks between meetings if I don’t need to check in. I feel like they trust me but at the same time they provide support if/when I have a wobble or need their input.

Meet them

When you sign up to do a PhD you’re often committing to working with the same group of people for at least 3 years. That’s ages. If I had to work with some of the bosses I’ve had before for that length of time I’d be miserable by the end.. Anyway, it’s important to meet your potential supervisors before you apply for the project. If you’re miles away or can’t meet face to face, try and arrange a Skype meeting. You’ll be able to get a feel for them as a person rather than just a supervisor. What do they value, what are their hobbies, will they be supportive and understanding if you have some sort of personal disaster during your studies? Figure out if you like your potential supervisors on a human level before you commit to working with them. Some students I know didn’t figure this one out before embarking on the PhD. Now a few years in they’re ready to run as far from the project as possible – and it’s not the project that’s the problem.

Get more out of your PhD than a thesis

Your thesis should be your first priority throughout the course of your studies. That said, you need to build a network to create progression going forward – whether that’s in academia or not. Your supervisor is an amazing resource to help with that. Even if you’re mid-way through your PhD and don’t get on with your supervisor, this is one way for you to improve things. Say ‘yes’ more. Get involved with other projects. Network and meet people that are linked to your research field; use these extra projects as a way to work out what to do once the thesis is complete.
If you’re lucky enough to have a good supervisor that you’d like to continue working with, this is a great way to show that. Help them out and try to give as much as you take. Supervisors are busy people, we are often not their priority – and rightly so! Getting involved with side projects takes some burden from their shoulders and allows you to grow as an independent researcher too.

Self-Care Tips to Keep You Sane: Reading for Pleasure

At the end of January I wrote about the importance of academic self-care for PhD students; I didn’t delve too far into the specifics of what I do in my downtime and a lot of people asked. ‘It’s hard to switch off’ and ‘I find it hard to relax’ were the two phrases I encountered most frequently, so I thought I’d introduce a series of posts that provide more information, and recommendations, on what to do to give yourself a break during the inevitable stressful periods that come with doing a PhD.

This is the second installment in this ‘self-care tips to keep you sane’ series, and this week I’m talking about reading for pleasure. I read a lot, and I think it’s really important to make time to read exciting and imaginative stories that are in no way linked to your work. It gives you a chance to switch off.

A few years ago I joined my local library – it’s free and you get to keep books for a month, perfect for those of us on a budget! I’d really recommend checking out your local library; and make sure to venture further afield than your university library, you’ll end up picking up books related to your studies and that defeats the point.

I feel like I’m really making progress with my PhD, and this month I decided to treat myself. I don’t often re-read books so I don’t often buy books – they end up on shelves forever and I’d much rather borrow or swap books with other people to prevent me from building up a ridiculous collection of books I’ll never read again. I also really like surprises. Enter, Moth Box.

Moth Box is a small business set-up by Youtuber Mercedes Mills. It’s a book postal service with a difference; you don’t know what books you’re getting, and each is from an independent publisher. Each box is £20, and for that you get 2 books fitting that month’s theme – May’s was novels – neatly wrapped in tissue paper, and a bookmark that features a quote from each of the books.

The two books I got in my box are: Ties by Domenico Starnone, and Star-Shot by Mary-Ann Constantine. I hadn’t heard of either, but they both sound like stories I’ll enjoy. Overall I’m really happy with my May Moth Box and can see myself ordering again in the future; great value, brilliant books I wouldn’t otherwise have found, and beautifully packaged too.

Struggling to find time to read? I often do too. Lately I’ve been turning the TV off and closing my laptop an hour and a half before I plan to go to bed; that gives me time to read for an hour or so before sorting my life out for the next day (ironing clothes, making lunch etc etc) and getting ready for bed. It’s been such a lovely way to switch off at the end of a busy day, and I think it’s made my sleep quality improve too.

#365papers April Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

This month’s reading has been good! After a slow March, I was right back into reading regularly and broadly. I chose to read a lot of these papers as I’m starting to write the literature review for my thesis (i.e. my least favourite thing to write, probably ever), so I wanted some relatively general pieces and some more focused work looking at specific aspects of recruitment to trials. I’m also slightly freaked out by the fact that it’s now the end of April and we’re going into summer – where has this year gone?! Time to step it up a gear and get this lit review written!

April’s reading:

  1. Statistics and ethics in medical research: III How large a sample
  2. Factors associated with clinical research recruitment in a pediatric academic medical center – a web-based survey
  3. False hopes and best data: Consent to research and the therapeutic misconception
  4. Influence of clinical communication on patients’ decision making on participation in clinical trials
  5. Sharing interim trial results by the Data Safety Monitoring Board with those responsible for the trial’s conduct and progress: a narrative review
  6. Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey
  7. Why should I do research? Is it a waste of time?
  8. Avoidable waste in the production and reporting of research evidence
  9. An unfinished trip through uncertainties
  10. Patients’ consent preferences for research uses of information in electronic medical records: interview and survey data
  11. Time to publication for results of clinical trials
  12. Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage: observational study
  13. Increasing value and reducing waste in biomedical research regulation and management
  14. The Guinea Pig Syndrome: Improving clinical trial participation among thoracic patients
  15. Accrual to cancer clinical trials: Directions from the research literature
  16. Barriers to participation in clinical trials of cancer: a meta-analysis and systematic review of patient-reported factors
  17. Why patients enroll in clinical trials: Physicians play a key role
  18. Recruitment and retention of participants in randomised controlled trials: a review of trials funded and published by the United Kingdom Health Technology Assessment Programme
  19. Strategies designed to help healthcare professionals to recruit participants to research studies
  20. Effective recruitment strategies in primary care research: a systematic review
  21. Mexican-American perspectives on participation in clinical trials: a qualitative study
  22. Medical research: missing patients
  23. Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review
  24. A nudge toward participation: improving clinical trial enrolment with behavioral economics
  25. The costs of conducting clinical research
  26. Prospective preference assessment: a method to enhance the ethics and efficiency of randomised controlled trials
  27. Clinicians’ views and experiences of offering two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study
  28. Lay perspectives: advantages for health research
  29. Random allocation or allocation at random? Patients’ perspectives of participation in a randomised controlled trial
  30. Lay public’s understanding of equipoise and randomisation in randomised controlled trials

#365papers March Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

Here’s my March update. I found this month reallt difficult to be honest, I was super busy with other things at work and didn’t feel like reading when I had a to do list longer than my arm. I missed a few days in a row and towards the end of the month when I had 10 papers to catch up on, I was making excuses and looking for ways to wriggle out of the challenge. I didn’t though – hoorah! I made time to read and now I’m all caught up.

March’s reading:

  1. Promoting recruitment using information management efficiently (PRIME): study protocol for a stepped-wedge cluster randomised controlled trial within the Restart or Stop Antithrombotics Randomised Trial (RESTART)
  2. A little more conversation please? Qualitative study of researchers’ and patients’ interview account of training for patient and public involvement in clinical trials
  3. Are there fundamental deficiencies in megatrial methodology?
  4. Managing clinical trials
  5. From protocol to published report: a study of consistency in the reporting of academic drug trials
  6. Understanding controlled trials: why are randomised controlled trials so important?
  7. Understanding controlled trials: baseline imbalance in randomised controlled trials
  8. Understanding controlled trials: randomising groups of patients
  9. Using marketing theory to inform strategies for recruitment: a recruitment optimisation model and the txt2stop experience
  10. The natural history of conducting and reporting clinical trials: interviews with trialists
  11. Understanding controlled trials: what is a patient preference trial?
  12. Strategies for increasing recruitment to randomised controlled trials: systematic review
  13. Why clinical trial outcomes fail to translate into benefits for patients
  14. Blog – How marketing is undermining clinical trials
  15. Marketing trials, marketing tricks – how to spot them and how to stop them
  16. The changing face of clinical trials: pragmatic trials
  17. Equipoise across the patient population: optimising recruitment to a randomised controlled trial
  18. Why prudence is needed when interpreting articles reporting clinical trial results in mental health
  19. The possibility of critical realist randomised controlled trials
  20. The association of funding source on effect size in randomised controlled trials: 2013-2016 – a cross-sectional survey and meta-analysis
  21. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review
  22. Registry-based pragmatic trials in heart failure: current experience and future directions
  23. Barriers to recruitment in pediatric obesity trials: comparing opt-in an dopt-out recruitment approaches
  24. Sharing raw data from clinical trials: what progress since we first asked “Whose data set is it anyway?”
  25. Pharmafile Opinion – Are we prepared for the ‘real world’?
  26. Experience with direct-to-patient recruitment for enrollment into a clinical trial in a rare disease: a web-based study
  27. Financial Times article – Small patient groups hinder progress of clinical trials
  28. Fast Company, 3 Minute Read – This compay is helping patients get paid for their influence
  29. Recruitment of minority adolescents and young adults into randomised clinical trials: testing the design of the technology enhanced community health nursing (Tech-N) pelvic inflammatory disease trial
  30. When clinical trials compete: prioritizing study recruitment
  31. The continuing unethical conduct of underpowered clinical trials

If you have any recommended reads that are related to clinical trials/methodology/health services research and that kind of thing, I’d welcome them!

Doing a Systematic Review and Not Being Beaten by Piles of Paper

As with most PhDs based in Health Services Research, my project started with a systematic review. This seems to differ hugely from lab-based PhDs which (from my experience anyway) largely begin with traditional literature reviews. Not sure what the difference is between the two types of review? I’ll point you in the direction of this blog post from Students 4 Best Evidence. In short, systematic reviews can take an absolute age and they require a certain level of patience and persistence that I didn’t realise I had.

Last year HealthPsychTam posted two different posts talking about her experience of doing a systematic review. ‘A Confession…’ which was a brutally honest post about the feeling of wanting to drop out, and ‘Conducting a Systematic Review’ with lots of absolutely brilliant tips on getting through the process. I’d recommend you read both. In this post I want to add to Tamsyn’s experiences and give my own thoughts on the process so far.

What do I aim to achieve with this review?
My primary PhD supervisor has a Cochrane review that looks at methods to improve recruitment to randomised controlled trials, and mine is sort of the mirror of that review. It looks at methods to improve recruitment to randomise controlled trials that are evaluated using only non-randomised evaluations. We know there’s a lot of publications that cover this topic, but as yet there has been no systematic review including only data from non-randomised studies.

What stage am I at now?
Currently I’ve published the protocol for my systematic review (huge gold star to my supervisor for encouraging me to do this – it was a massive motivator), I’ve finished data extraction and we’re now tackling the task of data analysis and synthesis. In very simple terms, I have created a large pile of paper that I now need to shape into something useful.

Things I wish I’d known at the start that I know now

  • Search strategies can never ever weed out all the studies you don’t need
    I worked with an Information Specialist to create my search strategy – put bluntly, I am not an expert in search strategy development and the Information Specialist based in our unit is. She was brilliant to work with, and she made the whole process much easier and quicker than if I was going to figure out how to do this whole thing myself. Still, search strategies can never be perfect and you will always end up with a big pile of studies that won’t make it into your review. I began with over 9,500 abstracts, whittled that down to ~270 full texts to assess, and then ended up with 103 studies in the final review.
  • You will never finish a systematic review of this size in a year
    I still haven’t finished the review and I’m entering month 19th of working on it. That’s a really long slog to go through, most of which was spent reading stuff and meticulously tracking where every abstract, full text and included study was in the biggest spreadsheet I’ve ever made. Be realistic, it’s unlikely you’ll be done within a year unless you’ve got a really small amount of included studies (if this is the case well done you, I am very jealous).
  • A review cannot be done by one person – get people involved as soon as you can
    All of my abstract screening, full text assessments and data extraction were done in duplicate; once by me and once by whichever person I managed to sweet talk that week. It took a lot of time and effort to find people willing to help, and then explain tasks to them via telephone/Skype and a lot of Dropbox files. I couldn’t have done the review without them and I’m so grateful that they offered to help (I had no funds to offer them – they were just being top notch humans). I would thoroughly recommend getting other people involved in your review as early as you can; whether they can help with screening/data extraction or just give you a new perspective on how you’re going to analyse your data, it’s all helpful.

This systematic review has been a really brilliant learning process, but it’s been the longest slog I’ve had over the course of my PhD. Two of my desk drawers are now crammed with papers, some scribbled with ‘include’, others ‘exclude’ – the further down the pile the less clear and politically correct they become, my personal favourite being ‘this is crap, total crap, exclude on the basis it’s utter crap’. I’m on the way with it though! I’ve got the big cloud of screening and extraction out of the way, and I’m on to the fun stuff and seeing what the review itself shows! Hoorah!

If you’re thinking of doing a systematic review, please be realistic with your timescales – and make sure you have snacks along the way. It’s a long process but chocolate definitely helps.