ORCID Profile
0000-0003-2369-8088
Current Organisations
University of Oxford
,
WHO Alliance for Health Policy and Systems Research
,
Bartlemas Surgery, East Oxford Health Centre
,
National Institute for Health Research
,
Royal College of General Practitioners
,
NHS England
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Publications
Realist RCTs of complex interventions – An oxymoron
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.SOCSCIMED.2013.06.025
Abstract: Bonell et al. discuss the challenges of carrying out randomised controlled trials (RCTs) to evaluate complex interventions in public health, and consider the role of realist evaluation in enhancing this design (Bonell, Fletcher, Morton, Lorenc, & Moore, 2012). They argue for a "synergistic, rather than oppositional relationship between realist and randomised evaluation" and that "it is possible to benefit from the insights provided by realist evaluation without relinquishing the RCT as the best means of examining intervention causality." We present counter-arguments to their analysis of realist evaluation and their recommendations for realist RCTs. Bonell et al. are right to question whether and how (quasi-)experimental designs can be improved to better evaluate complex public health interventions. However, the paper does not explain how a research design that is fundamentally built upon a positivist ontological and epistemological position can be meaningfully adapted to allow it to be used from within a realist paradigm. The recommendations for "realist RCTs" do not sufficiently take into account important elements of complexity that pose major challenges for the RCT design. They also ignore key tenets of the realist evaluation approach. We propose that the adjective 'realist' should continue to be used only for studies based on a realist philosophy and whose analytic approach follows the established principles of realist analysis. It seems more correct to call the approach proposed by Bonell and colleagues 'theory informed RCT', which indeed can help in enhancing RCTs.
Protocol—the RAMESES II study: developing guidance and reporting standards for realist evaluation: Figure 1
Publisher: BMJ
Date: 08-2015
Realist methods in medical education research: what are they and what can they contribute?
Publisher: Wiley
Date: 13-12-2011
DOI: 10.1111/J.1365-2923.2011.04045.X
Abstract: Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the 'how' and 'why' questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts. One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research). The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.
CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children
Publisher: Public Library of Science (PLoS)
Date: 08-07-2016
Reopening schools without strict COVID-19 mitigation measures risks accelerating the pandemic
Publisher: Center for Open Science
Date: 06-03-2021
Abstract: On 22nd February, the UK government announced schools in England would fully reopen on the 8th March 2021. While returning to school as soon as possible is imperative for the education, social development, and mental and physical welfare of children, not enough has been done to make schools safer for students and staff. Multi-layered mitigations can substantially reduce the risk of transmission within schools and into households. In the Appendix we outline a set of recommendations, in line with CDC guidelines and practiced in many countries, to reduce the risk of transmission in schools and mitigate the impact of COVID-19 on children and families. Making schools safer goes hand in hand with reducing community transmission, and is essential to allow schools to safely reopen and remain open.
RAMESES publication standards: meta‐narrative reviews
Publisher: Wiley
Date: 29-01-2013
DOI: 10.1111/JAN.12092
Abstract: Meta-narrative review is one of an emerging menu of new approaches to qualitative and mixed-method systematic review. A meta-narrative review seeks to illuminate a heterogeneous topic area by highlighting the contrasting and complementary ways researchers have studied the same or a similar topic. No previous publication standards exist for the reporting of meta-narrative reviews. This publication standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for meta-narrative reviews. A mixed method study synthesising data between 2011 to 2012 from a literature review, online Delphi panel and feedback from training, workshops and email list. We: (a) collated and summarized existing literature on the principles of good practice in meta-narrative reviews (b) considered the extent to which these principles had been followed by published reviews, thereby identifying how rigor may be lost and how existing methods could be improved (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, meta-narrative reviews, policy, and/or publishing to produce and iteratively refine a draft set of methodological steps, and publication standards (d) provided real-time support to ongoing meta-narrative reviews and the open-access RAMESES online discussion list so as to capture problems and questions as they arose and (e) synthesized expert input, evidence review, and real-time problem analysis into a definitive set of standards. We identified nine published meta-narrative reviews, provided real-time support to four ongoing reviews, and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 33 members. Within three rounds this panel had reached consensus on 20 key publication standards, with an overall response rate of 90%. This project used multiple sources to draw together evidence and expertise in meta-narrative reviews. For each item we have included an explanation for why it is important and guidance on how it might be reported. Meta-narrative review is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further theoretical and methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of meta-narrative reviews.
Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1—definitions, terminology, taxonomy and imaging outcomes
Publisher: BMJ
Date: 06-12-2022
DOI: 10.1136/BJSPORTS-2022-106085
Abstract: Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures. To collect and aggregate informed opinions, an expert panel—the Young Athlete’s Hip Research Collaborative—rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies. A erse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries 6 stakeholder groups 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership) (2) terminology—use ‘morphology’ and not terms with a negative connotation like ‘lesion’, ‘abnormality’ or ‘deformity’ (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research. This consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history.
RAMESES publication standards: realist syntheses
Publisher: Wiley
Date: 29-01-2013
DOI: 10.1111/JAN.12095
Abstract: There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for ex le, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews. A mixed method study synthesising data between 2011-2012 from a literature review, online Delphi panel and feedback from training, workshops and email list. We: (a) collated and summarized existing literature on the principles of good practice in realist syntheses (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigour may be lost and how existing methods could be improved (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards (d) provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list to capture problems and questions as they arose and (e) synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. We identified 35 published realist syntheses, provided real-time support to 9 ongoing syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within 3 rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. This project used multiple sources to develop and draw together evidence and expertise in realist synthesis. For each item we have included an explanation for why it is important and guidance on how it might be reported. Realist synthesis is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of realist syntheses.
Involving service users in the evaluation and redesign of primary care services for depression: A qualitative study
Publisher: Informa Healthcare
Date: 09-2005
Realist review - a new method of systematic review designed for complex policy interventions
Publisher: SAGE Publications
Date: 07-2005
Abstract: Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems-things like league tables, performance measures, regulation and inspection, or funding reforms. These are not ‘magic bullets‘ which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging ‘realist’ approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories) - the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level.
Use of interactive multimedia decision aids
Publisher: BMJ
Date: 02-02-2002
COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology (Preprint)
Publisher: JMIR Publications Inc.
Date: 07-2020
Abstract: reating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. his study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. e described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. ur use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological s ling, and health outcomes at an in idual practice and at the national level (2) feedback through a dashboard (3) a national observatory (4) regular updates for Public Health England and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). he underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.
Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project
Publisher: BMJ
Date: 19-01-2009
DOI: 10.1136/BMJ.A3152
Chinese herbal medicine (“3 medicines and 3 formulations”) for COVID ‐19: rapid systematic review and meta‐analysis
Publisher: Wiley
Date: 16-09-2021
DOI: 10.1111/JEP.13614
Abstract: To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu, and Xuanfei Baidu), is an effective treatment for COVID‐19. We searched PubMed, MEDLINE and CNKI databases, preprint servers, clinical trial registries and supplementary sources for Chinese‐ or English‐language randomized trials or non‐randomized studies with comparator groups, which tested the constituents of 3M3F in the treatment of COVID‐19 up to September 2020. Primary outcome was change in disease severity. Secondary outcomes included various symptoms. Meta‐analysis (using generic inverse variance random effects model) was performed when there were two or more studies reporting on the same symptom. Of 607 articles identified, 13 primary studies (6 RCTs and 7 retrospective non‐randomized comparative studies) with 1467 participants met our final inclusion criteria. Studies were small and had significant methodological limitations, most notably potential bias in assessment of outcomes. No study convincingly demonstrated a statistically significant impact on change in disease severity. Eight studies reported sufficiently similar secondary outcomes to be included in a meta‐analysis. Some statistically significant impacts on symptoms, chest CT manifestations, laboratory variables and length of stay were demonstrated, but such findings were sparse and many remain unreplicated. These findings neither support nor refute the claim that 3M3F alters the severity of COVID‐19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID‐19.
COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology
Publisher: JMIR Publications Inc.
Date: 17-11-2020
DOI: 10.2196/21434
Abstract: Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological s ling, and health outcomes at an in idual practice and at the national level (2) feedback through a dashboard (3) a national observatory (4) regular updates for Public Health England and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.
RAMESES II reporting standards for realist evaluations
Publisher: Springer Science and Business Media LLC
Date: 24-06-2016
Time to question the NHS diabetes prevention programme
Publisher: BMJ
Date: 07-09-2015
DOI: 10.1136/BMJ.H4717
Infographic. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome—natural history of primary cam morphology to inform clinical practice and research priorities on condi
Publisher: BMJ
Date: 17-01-2023
Protocol - realist and meta-narrative evidence synthesis: Evolving Standards (RAMESES)
Publisher: Springer Science and Business Media LLC
Date: 16-08-2011
Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2—research priorities on conditions affecting the young person’s hip
Publisher: BMJ
Date: 06-12-2022
DOI: 10.1136/BJSPORTS-2022-106092
Abstract: Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-based approach to research on primary cam morphology and its natural history by working towards agreement on a set of research priorities for conditions affecting the young person’s hip. An international expert panel—the Young Athlete’s Hip Research (YAHiR) Collaborative—rated research priority statements through an online two-round Delphi exercise and met online to explore areas of tension and dissent. Panellists ranked the prioritised research statements according to the Essential National Health Research (ENHR) ranking strategy. Reporting of results followed REPRISE (REporting guideline for PRIority SEtting of health). A erse Delphi panel (n=65, Delphi rounds 1 and 2 three ENHR strategy surveys: n=49 n=44 n=42) from 18 countries representing six stakeholder groups, prioritised and ranked 18 of 38 research priority statements. The prioritised statements outlined seven research domains: (1) best practice physiotherapy, (2) rehabilitation progression and return to sport, (3) exercise intervention and load management, (4) primary cam morphology prognosis and aetiology, (5) femoroacetabular impingement syndrome prognosis and aetiology, (6) diagnostic criteria, and (7) screening. The panel recommended areas of tension and dissent for the research community to focus on immediately. While informing more rigorous, inclusive and evidence-based research, this consensus is a roadmap for researchers, policy-makers and funders to implement research dedicated to reducing the cost and burden of hip disease related to primary cam morphology.
An open letter toThe BMJeditors on qualitative research
Publisher: BMJ
Date: 10-02-2016
DOI: 10.1136/BMJ.I563
RAMESES publication standards: realist syntheses
Publisher: Springer Science and Business Media LLC
Date: 29-01-2013
Remote services in general practice: who needs to be trained in what, when and how?
Publisher: Royal College of General Practitioners
Date: 20-10-2023
Publication Guidelines for Improvement Studies in Health Care: Evolution of the SQUIRE Project
Publisher: American College of Physicians
Date: 04-11-2008
DOI: 10.7326/0003-4819-149-9-200811040-00009
Abstract: In 2005, draft guidelines were published for reporting studies of quality improvement as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as Standards for QUality Improvement Reporting Excellence (SQUIRE). This narrative progress report summarizes the special features of improvement that are reflected in SQUIRE and describes major differences between SQUIRE and the initial draft guidelines. It also explains the development process, which included formulation of responses to informal feedback, written commentaries, and input from publication guideline developers ongoing review of the literature on the epistemology of improvement and methods for evaluating complex social programs and a meeting of stakeholders for critical review of the guidelines' content and wording, followed by commentary on sequential versions from an expert consultant group. Finally, the report discusses limitations of and unresolved questions about SQUIRE ancillary supporting documents and alternative versions under development and plans for dissemination, testing, and further development of SQUIRE.
RAMESES publication standards: meta-narrative reviews
Publisher: Springer Science and Business Media LLC
Date: 29-01-2013
The NASSS framework for ex post theorisation of technology-supported change in healthcare: worked example of the TORPEDO programme
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12916-019-1463-X
Abstract: Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study unfolding technology programmes in real time—and in particular to identify and manage their emergent uncertainties and interdependencies. In this paper, we offer a worked ex le of how NASSS can also inform ex post (i.e. retrospective) evaluation. We studied the TORPEDO (Treatment of Cardiovascular Risk in Primary Care using Electronic Decision Support) research programme, a multi-faceted computerised quality improvement intervention for cardiovascular disease prevention in Australian general practice. The technology ( HealthTracker ) had shown promise in a cluster randomised controlled trial (RCT), but its uptake and sustainability in a real-world implementation phase was patchy. To explain this variation, we used NASSS to undertake secondary analysis of the multi-modal TORPEDO dataset (results and process evaluation of the RCT, survey responses, in-depth professional interviews, videotaped consultations) as well as a s le of new, in-depth narrative interviews with TORPEDO researchers. Ex post analysis revealed multiple areas of complexity whose influence and interdependencies helped explain the wide variation in uptake and sustained use of the HealthTracker technology: the nature of cardiovascular risk in different populations, the material properties and functionality of the technology, how value (financial and non-financial) was distributed across stakeholders in the system, clinicians’ experiences and concerns, organisational preconditions and challenges, extra-organisational influences (e.g. policy incentives), and how interactions between all these influences unfolded over time. The NASSS framework can be applied retrospectively to generate a rich, contextualised narrative of technology-supported change efforts and the numerous interacting influences that help explain its successes, failures, and unexpected events. A NASSS-informed ex post analysis can supplement earlier, contemporaneous evaluations to uncover factors that were not apparent or predictable at the time but dynamic and emergent.
A global call for action to include gender in research impact assessment
Publisher: Springer Science and Business Media LLC
Date: 19-07-2016
Related Organisations
University Of Oxford
Location: United Kingdom of Great Britain and Northern Ireland
University Of Cambridge
Location: United Kingdom of Great Britain and Northern Ireland
University College London
Location: United Kingdom of Great Britain and Northern Ireland
UK Research Excellence Framework (HEFC)
Location: United Kingdom of Great Britain and Northern Ireland
WHO Alliance For Health Policy And Systems Research
Location: Switzerland
University Of Oxford University College Oxford
Location: United Kingdom of Great Britain and Northern Ireland
Barts And The London School Of Medicine And Dentistry
Location: United Kingdom of Great Britain and Northern Ireland
Bartlemas Surgery, East Oxford Health Centre
Location: United Kingdom of Great Britain and Northern Ireland
Barnet Health Authority
Location: United Kingdom of Great Britain and Northern Ireland
National Institute For Health Research
Location: United Kingdom of Great Britain and Northern Ireland
National Institute For Health And Clinical Excellence
Location: United Kingdom of Great Britain and Northern Ireland
Dr Patel And Partners
Location: United Kingdom of Great Britain and Northern Ireland
Dr Kelly And Partners
Location: United Kingdom of Great Britain and Northern Ireland
Temple Fortune Medical Group
Location: United Kingdom of Great Britain and Northern Ireland
Royal College Of Physicians
Location: United Kingdom of Great Britain and Northern Ireland
Royal College Of General Practitioners
Location: United Kingdom of Great Britain and Northern Ireland
NHS England
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Trisha Greenhalgh.