Pauline Meskell

Reflections on the added value of using mixed methods in the SCAPE study.

AIM To reflect on the added value that a mixed method design gave in a large national evaluation study of specialist and advanced practice (SCAPE), and to propose a reporting guide that could help make explicit the added value of mixed methods in other studies. BACKGROUND Recently, researchers have focused on how to carry out mixed methods research (MMR) rigorously. The value-added claims for MMR include the capacity to exploit the strengths and compensate for weakness inherent in single designs, generate comprehensive description of phenomena, produce more convincing results for funders or policy-makers and build methodological expertise. DATA SOURCES Data illustrating value added claims were drawn from the SCAPE study. REVIEW METHODS Studies about the purpose of mixed methods were identified from a search of literature. DISCUSSION The authors explain why and how they undertook components of the study, and propose a guideline to facilitate such studies. CONCLUSION If MMR is to become the third methodological paradigm, then articulation of what extra benefit MMR adds to a study is essential. The authors conclude that MMR has added value and found the guideline useful as a way of making value claims explicit. IMPLICATIONS FOR PRACTICE/RESEARCH The clear articulation of the procedural aspects of mixed-methods research, and identification of a guideline to facilitate such research, will enable researchers to learn more effectively from each other.

Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis

This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows: The aim of this qualitative evidence synthesis is to explore the perceptions and experiences of potential and actual participants and trial recruiters to improve understanding of how interventions, strategies and processes of recruitment to RCTs potentially work for specific groups across different settings and contexts. The specific objectives of this review are: to describe recruiters’ perceptions and experiences of recruiting participants to RCTs; to describe potential and actual participants’ perceptions and experiences of recruitment to RCTs; to describe why potential participants accept or decline participation in RCTs; to explore the barriers and facilitators to participation in RCTs; to explore how perceptions and experiences of trial recruitment interventions, strategies and processes influence the decision-making of potential and actual participants; to explore to what extent the barriers and facilitators identified are addressed by interventions and strategies designed to improve recruitment evaluated in a previously published Cochrane review (Treweek 2010).

The effectiveness of physiologically based early warning or track and trigger systems after triage in adult patients presenting to emergency departments: a systematic review

BackgroundChanges to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear. We aimed to systematically review the evidence on the use, development/validation, clinical effectiveness and cost-effectiveness of physiologically based early warning systems and TTS for the detection of deterioration in adult patients presenting to EDs.MethodsWe searched for any study design in scientific databases and grey literature resources up to March 2016. Two reviewers independently screened results and conducted quality assessment. One reviewer extracted data with independent verification of 50% by a second reviewer. Only information available in English was included. Due to the heterogeneity of reporting across studies, results were synthesised narratively and in evidence tables.ResultsWe identified 6397 citations of which 47 studies and 1 clinical trial registration were included. Although early warning systems are increasingly used in EDs, compliance varies. One non-randomised controlled trial found that using an early warning system in the ED may lead to a change in patient management but may not reduce adverse events; however, this is uncertain, considering the very low quality of evidence. Twenty-eight different early warning systems were developed/validated in 36 studies. There is relatively good evidence on the predictive ability of certain early warning systems on mortality and ICU/hospital admission. No health economic data were identified.ConclusionsEarly warning systems seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes. Such studies should include health economics assessments.