A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study.

BACKGROUND: COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom's response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE: We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). METHODS: A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners' pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers' secure environments, and to support federated cohort discovery queries and meta-analysis. RESULTS: A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. CONCLUSIONS: CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.

"Kickstart to Recovery": An Irish Football Program for Mental Health Service Users.

The "Kickstart to Recovery" program is a collaboration between Irish mental health occupational therapists and the Football Association of Ireland. This pilot study aimed to investigate whether participants experienced changes in quality of life, recovery, social gains, and the meaning of football following participation in the program. A quantitative pre-post study design was employed, with 27 participants completing a questionnaire consisting of outcome measures aimed to measure the above changes. Findings revealed statistically significant improvements in the Short Form 36 Health Survey Questionnaire (SF-36) "Energy/Fatigue" domain for the total sample and the Recovery Assessment Survey-Domains and Scales (RAS-DS) "Mastering My Illness" domain for first-time program participants. Statistically significant results were found for domains of "Social Functioning" and "Emotional Wellbeing" in groups incorporating additional social elements. The Engagement in Meaningful Activities Survey (EMAS) showed no change for the personal meaning participants attributed to football; however, high pre-test scores were noted. The "Kickstart to Recovery" program is attributed as a possible factor contributing to these results.

Awarding global grades in OSCEs: evaluation of a novel eLearning resource for OSCE examiners.

BACKGROUND: A novel online resource has been developed to aid OSCE examiner training comprising a series of videos of OSCE performances that allow inter-examiner comparison of global grade decisions. AIMS: To evaluate this training resource in terms of usefulness and ability to improve examiner confidence in awarding global grades in OSCEs. METHOD: Data collected from the first 200 users included global grades awarded, willingness to change grades following peer comparison and confidence in awarding grades before and after training. RESULTS: Most (86.5%) agreed that the resource was useful in developing global grade scoring ability in OSCEs, with a significant improvement in confidence in awarding grades after using the training package (p<0.001). CONCLUSIONS: This is a useful and effective online training package. As an adjunct to traditional training it offers a practical solution to the problem of availability of examiners.

Nothing about me without me: a scoping review of how illness experiences inform simulated participants' encounters in health profession education.

Background: Person-centred simulation in health professions education requires involvement of the person with illness experience. Objective: To investigated how real illness experiences inform simulated participants' (SP) portrayals in simulation education using a scoping review to map literature. Study selection: Arksey and O'Malley's framework was used to search, select, chart and analyse data with the assistance of personal and public involvement. MEDLINE, Embase, CINAHL, Scopus and Web of Science databases were searched. A final consultation exercise was conducted using results. Findings: 37 articles were within scope. Reporting and training of SPs are inconsistent. SPs were actors, volunteers or the person with the illness experience. Real illness experience was commonly drawn on in communication interactions. People with illness experience could be directly involved in various ways, such as through conversation with an SP, or indirectly, such as a recording of heart sounds. The impact on the learner was rarely considered. Conclusion: Authentic illness experiences help create meaningful person-centred simulation education. Patients and SPs may both require support when sharing or portraying illness experience. Patients' voices profoundly enrich the educational contributions made by SPs.

How to do longitudinal qualitative research.

In health professions education, we are often interested in researching change over time, for example the development of professional identity or the adoption of new practices. Taking a longitudinal qualitative approach to such research can provide valuable insights. In this article, we present some longitudinal qualitative methods to support researchers interested in getting started with this type of research. We discuss what longitudinal qualitative approaches offer, consider the challenges and suggest how to go about it. We also highlight some specific ethical considerations that may arise in longitudinal studies.

How to be reflexive when conducting qualitative research.

Reflexivity can be a complex concept to grasp when entering the world of qualitative research. In this article, we aim to encourage new qualitative researchers to become reflexive as they develop their critical research skills, differentiating between the familiar concept of reflection and reflective practice and that of reflexivity. Although reflection is, to all intents and purposes, a goal-oriented action with the aim of improving practice, reflexivity is a continual process of engaging with and articulating the place of the researcher and the context of the research. It also involves challenging and articulating social and cultural influences and dynamics that affect this context. As a hallmark of high-quality qualitative research, reflexivity is not only an individual process but one that needs to be considered a collective process within a research team, and communicated throughout the research process. In keeping with our previous articles in this series, we have illustrated the theoretical concept of reflexivity using practical examples of published research.

Assessing the readability and patient comprehension of rheumatology medicine information sheets: a cross-sectional Health Literacy Study.

OBJECTIVES: Patients are often provided with medicine information sheets (MIS). However, up to 60% of patients have low health literacy. The recommended readability level for health-related information is ≤grade 8. We sought to assess the readability of MIS given to patients by rheumatologists in Australia, the UK and Canada and to examine Australian patient comprehension of these documents. DESIGN: Cross-sectional study. SETTING: Community-based regional rheumatology practice. PARTICIPANTS: Random sample of patients attending the rheumatology practice. OUTCOME MEASURES: Readability of MIS was assessed using readability formulae (Flesch Reading Ease formula, Simple Measure of Gobbledygook scale, FORCAST (named after the authors FORd, CAylor, STicht) and the Gunning Fog scale). Literal comprehension was assessed by asking patients to read various Australian MIS and immediately answer five simple multiple choice questions about the MIS. RESULTS: The mean (±SD) grade level for the MIS from Australia, the UK and Canada was 11.6±0.1, 11.8±0.1 and 9.7±0.1 respectively. The Flesch Reading Ease score for the Australian (50.8±0.6) and UK (48.5±1.5) MIS classified the documents as 'fairly difficult' to 'difficult'. The Canadian MIS (66.1±1.0) were classified as 'standard'. The five questions assessing comprehension were correctly answered by 9/21 patients for the adalimumab MIS, 7/11 for the methotrexate MIS, 6/28 for the non-steroidal anti-inflammatory MIS, 10/11 for the prednisone MIS and 13/24 for the abatacept MIS. CONCLUSIONS: The readability of MIS used by rheumatologists in Australia, the UK and Canada exceeds grade 8 level. This may explain why patient literal comprehension of these documents may be poor. Simpler, shorter MIS with pictures and infographics may improve patient comprehension. This may lead to improved medication adherence and better health outcomes.

How to get started with theory in education.

This paper, on using theory in health professions education research, is the second in a series that aims to support novice researchers within clinical education, particularly those undertaking their first qualitative study. Diving into the world of education theory can be challenging and uncomfortable for clinician-educators. Nonetheless, theory is an essential ingredient in high-quality research, shaping everything from research questions to study design, analysis and, ultimately, the interpretation of findings. We hope that this paper, introducing different levels of theory and examples of how to use theory, will shed light on how theory can be used in research, and that it will help you in getting to grips with using theory in your own work. It will help you in getting to grips with using theory in your own work.

How to write a good research question.

This paper, on writing research questions, is the first in a series that aims to support novice researchers within clinical education, particularly those undertaking their first qualitative study. Put simply, a research question is a question that a research project sets out to answer. Most research questions will lead to a project that aims to generate new insights, but the target audience and the methodology will vary widely. The term 'evaluation question' is used less commonly, but the same principles apply. The key difference is that evaluation questions are typically more focused on the immediate context: for example, the effectiveness of an educational intervention in a particular setting. Whether your ambition is for research or evaluation, we hope that you will find this paper helpful for designing your own educational projects. A research question is a question that a research project sets out to answer.

How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients.

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ±â€Š12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ±â€Š17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.