Developing NIHR guiding principles for Community Engagement and Involvement - have your say!

Dear HIFA colleagues,

Today we launch a public consultation on our guiding principles for community engagement and involvement in health research (CEI). We are aiming to build consensus by seeking feedback on the principles, their descriptions and how they could be implemented in diverse local contexts.

Here's the link to the survey: https://forms.gle/tLXwpzmAyxLZjsNb7

It should take around 15 - 20 minutes to complete, and it closes on 1 December.

The survey is open to everyone with an interest in CEI, and all HIFA members are welcome to participate. Please do share widely with colleagues, networks, and friends. If you have any questions, email ceiglobalhealth AT nihr.ac.uk.

** Rationale and more detail:

The NIHR expects Community Engagement and Involvement (CEI) to be integrated in the full spectrum of the research it supports. NIHR has both a vision and goals for CEI. However, we wanted to bring together wider work on the foundations of good CEI in research and present these key attributes in an accessible way. These new guiding principles aim to help clarify the expectations of CEI by: - providing stronger guidance for the global health research community in developing CEI plans that are robust, appropriate, and effective for both the local context and for the study design. - being useful to research funding committee members, providing them with a framework and criteria to carry out more robust assessments of research proposals.

The principles are not a set of rules but more conceptual and will be realised in practice in many ways, reflecting the huge contextual variation in global health research.

To date, we have carried out a rapid scoping review of literature, which, along with previous development work, aimed to identify CEI principles related to how researchers and communities interact within the global health research context. Earlier feedback on the emerging principles was sought from a group of CEI Leads across NIHR awards and from an independent group of CEI experts formed to advise on the work.

**

Best regards, Patrick Patrick Wilson Head of Global Health Communications & Stakeholder Engagement National Institute for Health and Care Research (NIHR)  📨 patrick.wilson AT nihr.ac.uk🌐 www.nihr.ac.uk/globalhealth Subscribe to our NIHR Global Health Research monthly newsletter 📝 https://www.nihr.ac.uk/about-us/stay-up-to-date.htm#six

HIFA profile: Patrick Wilson is Head of Global Health Communications & Stakeholder Engagement at the National Institute for Health and Care Research (NIHR), UK . Professional interest: Global health research. @NIHRglobal 

My source: HIFA

Special Issue: Learning Health Systems - Computable Biomedical Knowledge

Learning Health Systems

A unique Special Issue of the Learning Health Systems journal has just been published.  It focuses on Computable Biomedical Knowledge (CBK). 

We invite you to view the table of contents for Volume 7, Issue 4 shown below.

Read the issue at - 
https://onlinelibrary.wiley.com/toc/23796146/2023/7/4

 GUEST EDITOR COMMENTARY

Transforming health and well‐being through publishing computable biomedical knowledge (CBK)

 

Güneş Koru

EXPERIENCE REPORT

Modelling clinical narrative as computable knowledge: The NICE computable implementation guidance project

 

Philip Scott, Michaela Heigl, Charles McCay, Polly Shepperdson, Elia Lima-Walton, Elisavet Andrikopoulou, Klara Brunnhuber, Gary Cornelius, Susan Faulding, Ben McAlister, Shaun Rowark, Matthew South, Mark R. Thomas, Justin Whatling, John Williams, Jeremy C. Wyatt, Felix Greaves

POLICY ANALYSIS

Which computable biomedical knowledge objects will be regulated? Results of a UK workshop discussing the regulation of knowledge libraries and software as a medical device

 

Jeremy C. Wyatt, Philip Scott, Johan Ordish, Matthew South, Mark Thomas, Caroline Jones, Sue Lacey-Bryant, on behalf of workshop participants

RESEARCH REPORT

A novel method for continuous measurements of clinical practice guideline adherence

 

Kees C.W.J. Ebben, Cornelis D. de Kroon, Channa E. Schmeink, Olga L. van der Hel, Thijs van Vegchel, Arturo Moncada-Torres, Ignace H.J.T. de Hingh, Jurrian van der Werf

COMPUTABLE KNOWLEDGE PUBLICATIONS

Striking a match between FHIR‐based patient data and FHIR‐based eligibility criteria

 

Brian S. Alper, Joanne Dehnbostel, Khalid Shahin, Neeraj Ojha, Gopal Khanna, Christopher J. Tignanelli

Evidence Hub: A place to exchange medical knowledge and form communities

 

Kenny Hong, Druvinka Bandaranayake, Guy Tsafnat

Sync for Genes Phase 5: Computable artifacts for sharing dynamically annotated FHIR‐formatted genomic variants

 

Robert Dolin, Bret S. E. Heale, Rohan Gupta, Carla Alvarez, Justin Aronson, Aziz Boxwala, Shaileshbhai R. Gothi, Ammar Husami, James Shalaby, Lawrence Babb, Alex Wagner, Srikar Chamala

A computable biomedical knowledge object for calculating in‐hospital mortality for patients admitted with acute myocardial infarction

 

Rosemarie Sadsad, Gema Ruber, Johnson Zhou, Steven Nicklin, Guy Tsafnat

An application of computable biomedical knowledge to transform patient centered scheduling

 

Namita Azad, Carolyn Armstrong, Corinne Depue, Timothy J. Crimmins, Jonathan C. Touson

LIST OF REVIEWERS

Thanks to our peer reviewers

My source: 
Email from Kathleen Young
Editorial Assistant, Journal of Learning Health Systems

  Also noticed:
Bonten T, Rauwerdink A, Wyatt J, Kasteleyn M, Witkamp L, Riper H, van Gemert-Pijnen L, Cresswell K, Sheikh A, Schijven M, Chavannes N, EHealth Evaluation Research Group Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study. J Med Internet Res 2020;22(8):e17774 URL: https://www.jmir.org/2020/8/e17774 DOI: 10.2196/17774

New animated film Social Care Future - #SocialCareFuture

Individual

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HUMANISTIC --------------------------------------  MECHANISTIC      

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dyad / couple  family  group COMMUNITY population

	Government(s) politics power policy social care funding integration of care

"Watch our story

Without big changes to the way we think about social care, we and the people we care about face losing control of our lives and contact with the people and things that make our lives worthwhile. It doesn’t have to be this way.

Watch our new film, narrated by actress, comedian, broadcaster and international disability rights activist Liz Carr and directed by multi-award winning filmmaker Yoav Segal.

View accessible versions, including BSL, subtitles and comic book."

 

Animating our #SocialCareFuture – the story behind our animated film

My source: 

https://x.com/socfuture/status/1714909895416242221?s=20

National Survey of the Mental Health Nurses aims to understand reasons behind record vacancies

Researchers from the University of Southampton working with the National Institute for Health and Care Research (NIHR) are launching a national survey of the mental health nursing workforce.

Led by Professor Jane Ball (Professor of nursing workforce policy), it is the first to explore the work lives and wellbeing of registered nurses providing mental healthcare in the UK.

More details: 

https://www.arc-wx.nihr.ac.uk/post/national-survey-of-the-mental-health-nurses-aims-to-understand-reasons-behind-record-vacancies

The survey is open to nurses on the NMC register providing mental healthcare to any patient group, in any setting, and for any health and social care provider. It is completely anonymous and will take 15-20mins to complete. https://tinyurl.com/MHNurses

 

Book review i. General Psychotherapy: Principles and Common Theoretical Aspects - Rediscovering Humanity

   General Psychotherapy

Predictably, the title of this book caught my attention.

I did do some homework before requesting a review copy, but it was still a surprise that this book by Prof. Dr. med., Dipl. Psych. Lotte Hartmann-Kottek is not edited. It is a comprehensive tome at 491 pages. As a mental health nurse with experience of cognitive, behavioural and family therapy, I am not an expert, but Prof. Hartmann-Kottek's experience in psychotherapy, the history, theoretical development, clinical application, theoretical underpinnings (including physics) and political machinations are well demonstrated.

A disappointment for me is the lack of an index. This seems a major omission, and yet a comprehensive index here, might itself be difficult to navigate. There are some errors in word-use, repetition but they do not detract from the book and reading experience overall. The book is apparently translated from German. The book is expensive, but students may have access through their institutions and special schemes(?).

The book's subtitle: Principles and Common Theoretical Aspects - Rediscovering Humanity is delivered. The title General Psychotherapy - attracted me for several reasons:

'General' - the (seeming) opposition of generalist-specialist is relevant to the theory and application of Hodges' model.

'Psychotherapy' - I was interested to see how Prof. Hartmann-Kottek dealt with the disparate schools of psychotherapy, given some awareness of the politics and efforts to integrate and reconcile therapeutic approaches, philosophies, and legacies. 

Consequently, the chapters address multiplicity, systems, efficacy, commonalities and interspaces. If a book should benefit its reader, rewarding time/cost then this text has contributed to my continuing professional development. Discussion of systems, individual, whole, humanistic, interdisciplinarity, integration, the therapeutic relationship, transcripts and therapy scenarios provides ongoing stimulus for my efforts with Hodges' model.

"The increasing joint adoption of methods and methodological aspects through the partitioned barriers of the otherwise politic(al)ly competing schools in recent decades has, of course, been met with mixed reception, especially when the adoption was coupled with contemporary political and social repression.

However, it may be precisely this difficult topic of the mutually uncoordinated, intellectual adoption and incorporation of vicinity aspects on a macro scale that may indicate that the time has come for an integrative reconciliation or fusion of the essence of psychotherapeutic approaches. As perhaps needs no mention, this path will require an extensive field of play." p.viii. Preface.

'I' - 'Individual' 'SELF' 'Patient' 'Client'

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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dyad / couple  family  GROUP community population

psychological systems MIND psycho- identity psycho-therapy / therapies subjectivism cognitive  access	physical systems -somatic BODY identity? evidence objectivism physical access
social systems culture history community of practice social access	political systems power professionalism health systems/services funding political access

Many thanks to Prof. Hartmann-Kottek and Springer for the review copy.

More to follow.

Hartmann-Kottek, L. (2022). General Psychotherapy, Principles and Common Theoretical Aspects - Rediscovering Humanity. Springer. https://doi.org/10.1007/978-3-030-87466-7

BCS SGAI: One day event on 'The Rise of AI in the Healthcare Ecosystem'

 BCS SPECIALIST GROUP ON ARTIFICIAL INTELLIGENCE (BCS SGAI)

The Rise of AI in the Healthcare Ecosystem

November 10th 2023 - British Computer Society London Office (near Moorgate Underground) 

Second Invitation to Register

A full-day event with invited talks on the following topics:

 

·       What are the things that AI can help with in the healthcare ecosystem?

·       Semantic Deep Learning for One Health: combining Knowledge Graphs and Large Language Models

·       Biomarkers and Personalised Medicine: how can AI be used for Omics Data Integration, Interpretation, and Its Application?

·       AI in Next Generation Stroke Rehabilitation

·       Machine Readable Healthcare Data Formats using FHIR

·       What SNOMED wants to be, how clinicians actually use it and what lurks in large coded clinical datalakes?

·       Bringing clinical guidelines closer to the bedside with AI techniques

 

Full details are available at http://www.bcs-sgai.org/health2023/

 

The delegate fee is £90 plus VAT for BCS and SGAI members and £110 plus VAT for others. This includes attendance at the event, lunch and refreshments. A special rate of £50 plus VAT is available for students. A Group Discount Rate is available for group bookings of three or more.

 

There is an online registration form at

http://www.bcs-sgai.org/health2023/?section=registration

--------------------------------------------------------

To register for future mailings about SGAI events go to http://www.bcs-sgai.org/register/.

 

Max Bramer
Chair BCS Specialist Group on Artificial Intelligence (bcs-sgai.org)

<>

[ I am looking to attend - travel - trains and industrial action - permitting. ]

Constructivism in Hodges' model: Situated, cognitive, pragmatic

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"From the constructivist perspective, every field has its unique ways of knowing and the overarching goal is to move the learner into thinking within the knowledge domain as an expert of that domain might think. In geography, for example, the goal would not be to teach geography facts or principles but to teach learners to use the domain of geographic information as a cartographer, geographer or navigator might do. Just as the cartographer or geographer must bring new perspectives to bear and construct a particular understanding or interpretation of a situation, so too must the learner. And just as different geographers identify different relevant information and come to different conclusions, we must also leave identification of relevant information and 'correct' solutions open in the teaching situation. The process of constructing a perspective or understanding and developing reflexive awareness of that process are essential to the constructive view of learning." pp.96-97.

Zwozdiak-Myers, Paula. (2012). The Teacher's Reflective Practice Handbook: Becoming an Extended Professional through Capturing Evidence-Informed Practice. Abingdon, Oxon: Routledge. 

https://www.routledge.com/The-Teachers-Reflective-Practice-Handbook-Becoming-an-Extended/Zwozdiak-Myers/p/book/9780415597586

See also: 


Cognitive apprenticeship . . .

Hodges model: What is it? [4] A Periplus for Lifelong Learning

A citation of Hodges' model IN "Excellence in forensic psychiatry services..."

McLaughlin, P., Brady, P., Carabellese, F., Carabellese, F., Parente, L., Uhrskov Sorensen, L., . . . Kennedy, H. (2023). Excellence in forensic psychiatry services: International survey of qualities and correlates. BJPsych Open, 9(6), E193. doi:10.1192/bjo.2023.578

Background

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.

Aims

To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.

Method

A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.

Results

Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.

Conclusions

Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

<>

As the second citation  for Hodges' model from ResearchGate this month, I hope this is a trend. If I can assist any researchers, please let me know. 

While welcome, I'm not interested in being a co-author; if I can help your understanding and application of Hodges' model this is what counts.

Delighted to add McLaughlin et al. to the bibliography.

Many thanks to Harry G. Kennedy and team.

"I'd like to Teach the World to Sing ..."

 

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GROUP

intelligence

ARTIFICIAL

Peoples Communities Societies Peace

"Joseph Votel, a recently retired head of the Pentagon's Central Command, said last year he was struck by how Israeli forces mounting strikes in Gaza in May had been integrating AI into their operations and by "the impact that is having on their targeting cycles". He says Israel is using AI to generate a large range of potential targets for surveillance to whittle down. This lets its forces "disrupt enemy attacks without the need for a lengthy development period or a longer campaign."  America's armed forces, helped by Palantir (an AI company which, like Anduril, takes its name from "The Lord of the Rings") and other contractors, is trying to build such technology into a system which can narrow down a huge range of potential targets and pass information about them freely to where it is most needed. Given the finite capacity of communication systems, not to mention the vulnerability, this requires that an increasing amount of processing be done "on the edge" - that is, on the platform carrying the sensor.  In 2016 a Pentagon project called Maven started trying to address the "lots of surveillance but not much to show for it" problem identified by General Ryan. The idea was to automate the identification of people and objects in the petabytes of video footage sent back by surveillance drones. It ended up producing software efficient enough to run on the drones themselves. In Scarlet Dragon, a recent-AI focused American exercise in which a wide range of systems were used to comb a large area for a small target, things were greatly speeded up by allowing satellites to provide estimates of where a target might be in a compact format readable by another sensor or a targeting system, rather than transmitting high-definition pictures of the sort humans look at.  In a world where bandwidth is often the biggest constraint such parsimony is a boon. It speeds up kill chains while reducing vulnerability to jamming. At the same time, it puts a greater burden on the automated parts of the system to provide reliable synopses of what they see, which is a worry for people keen to ensure that fully informed and responsible human beings stay on top of all decisions about where and when to blow things up." p.9.

 Signals from Noise. Heads in the clouds. The Economist Technology Quarterly, Defence technology, Hide and seek. January 29th 2022. 442: 9281. pp. 9-10.

https://www.youtube.com/watch?v=mR_7Swtv0XM

Hodges' model: How the I-G axis is idealised

As a conceptual model, Hodges' model is idealised.

As an example, take the concept individual in the vertical axis. Whether a patient, client, carer, student or teacher, the individual is where the self also resides.

'I' - INDIVIDUAL 'Self'

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spiritual - emotional self (my mind) Identity?	material / physical self (my body) identity?
social self (realised, or not; loneliness, excluded, isolated, ostracized, or loner by choice/character. Socio-Politically we arrive at 'civil society', if indeed it is civil.)	political self (whether or not politically motivated / engaged. Self as a citizen arises here, with the law in whether in States voting is mandatory.)

 James, W. (1892). The conscious self. In W. James The principles of psychology (Volume 1), Chapter 10. Harvard university Press: MA.

"From the very beginning of the chapter, James established that he was going to take a fresh approach to his subject. "In its widest possible sense," he wrote,

'a man's Self is the sum total of all that he CAN call his, not only his body and his psychic powers, but his clothes and his house, his wife and children, his ancestors and friends, his reputation and works, his lands and horses, and yacht and bank-account.' (p. 279) 

The explication James offered for this claim is telling: All these various things and persons are part of an individual's self insofar as they give that individual the same emotions (pp. 279-280). In pointing thus toward the emotional foundations of the self, James indicated right at the start that he was going to follow Bain (1859, chap. 7) and others in reaching beyond the old rationalist approach to "the soul" in order to ground his treatment of the human self on the experience and makeup of the whole person, emotional as well as intellectual." (p.107)

 
Leary, David E. "William James on the Self and Personality: Clearing the Ground for Subsequent Theorists, Researchers, and Practitioners."Reflections on The Principles of Psychology: William James after a Century. Ed. William James, Michael G. Johnson, and Tracy B. Henley. Hillsdale, NJ: L. Erlbaum Associates, 1990. 101-37. Print.

Nursing observations: the need for Political inoculation in "Intro 101"

"Hockey's (1989b) typology of nursing activities as consisting of autonomous, derived and delegated elements suggests we should focus on the interventions which are initiated as well as undertaken by nurses. This is the core of nurses' work. It is what nurses do which is not done by other people. Nursing has always found it difficult to describe this core. Goddard's (Nuffield Provincial Hospitals Trust 1954) choice of the term 'basic' to describe this element of nursing work has had a disastrous influence not only on nurses' perceptions of the value of their work but also on the way in which nursing is regarded by other professional groups. It has been suggested that the term was used as a shorthand for 'fundamental' or 'essential' and that is has been systematically misinterpreted over the last three decades* by those who wish to use it to justify the horizontal division of nursing labour. Goddard demonstrated that basic nursing was undertaken by the least qualified and the lowest skilled. This observation might have sparked off a revolution in the delivery of nursing care but instead it has been and is used to justify the continued employment of unskilled labour in direct patient care." p.128.

*My emphasis: "... over the last three decades .." hence, since the early 1960s.

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"The struggle between the twin poles of professionalism and bureaucracy is mirrored in that between the holistic, therapeutic approach in nursing, and that which is reductionist and functional (e.g. the task-centred approach to care). To work successfully in such a climate demands considerable skills of nurses, for they must seek to change the nature of the organisation, or at least to neutralise its effects so that they can concentrate on therapeutic practice. Amongst these skills must be those of change agency." p.107.

"Much of health care and particularly nursing is still organised along hierarchical and bureaucratic lines. To work professionally in such a system may in some way be seen as a contradiction in terms. The nurse may seek to exercise professional autonomy and make decisions about patient care (and indeed the organisation may seem to be encouraging him or her, at least superficially, to do so). Yet at the same time the nurse receives conflicting signals as others endeavour to exercise control over nursing practice such as doctors, senior nurses, finance directors, supplies officers and so on." p.107.

In this book's final chapter: Paterson and Zderad's five Phases of Phenomenological Nursology.^

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1. Preparation for the nurse knower coming to know. (Hodges' model as a template - 'clean slate' also facilitating unconditional positive regard - openness to a new encounter - whether the first or subsequent.) 2. Nurse knowing the other intuitively. (Intuition still has a role. A message: speak to a colleague - seek supervision!)

3. Nurse knowing the other scientifically. (Reductionism is needed yet balanced with the humanistic esp. as the march (float ...) of the robots/AI follows apace.)

4. Nurse complementarily synthesising known others. 

(This is a purpose for Hodges' model, supporting the user to identify salient concepts and the relationships between them and their quality; then to reflect, think critically and move towards formulation.)

5. Succession within the nurse from the many to the paradoxical one. 

Nursing as Therapy

  (Tied to #4 above, but can emphasize health education, health literacy, co-production and co-creation with the patient - client. A collapse - in the synthesis with simultaneity of the individual and collective. Arriving at a conclusion and for the future of Hodges' model in theory and practice: an abstraction.)

Paterson J.G., Zderad L.T. (1976). Humanistic nursing. New York: John Wiley. 

The conceptual scope of Hodges' model is demonstrated in how it can encompass other (all?) models of care and frameworks, including humanistic nursing.

McMahon, R. and Pearson, A. (1991) Nursing as Therapy. London: Chapman & Hall.
^Chapter 8 - Breaking the mould: a humanistic approach to nursing practice. pp.170-191.

Bought secondhand, 'Nursing as Therapy' caught my attention as I have read and wondered about 'assessment as therapy' across disciplines.

'System 1 and 2 Modes of Thinking' in Hodges' model

 System 1 - 

"operates automatically and quickly,
with little or no effort and no sense of voluntary control. 

 System 2 - 

allocates attention to the effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration." pp. 20-21.

"When we think of ourselves, we identify with System 2, the conscious, reasoning self that has beliefs, makes choices, and decides what to think about and what to do. Although System 2 believes itself to be where the action is, the automatic System 1 is the hero of the book. I describe System 1 as effortlessly originating impressions and feelings that are the main sources of the explicit beliefs and deliberate choices of System 2. The automatic operations of System 1 generate surprisingly complex patterns of ideas, but only the slower System 2 can construct thoughts in an orderly series of steps. I also describe circumstances in which System 2 takes over, overruling the freewheeling impulses and associations of System 1. You will be invited to think of the two systems as agents with their individual abilities, limitations and functions." p.21.

 

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System 2: Brace for the starter gun in a race. Focus attention on the clowns in the circus. Focus on the voice of a particular person in a crowded and noisy room. Look for a woman with white hair. Search memory to identify a surprising sound. Maintain a faster walking speed than is natural for you. Monitor the appropriateness of your behavior in a social situation. Count the occurrences of the letter a in a page of text. Tell someone your phone number. Park in a narrow space (for most people except garage attendants). Compare two washing machines for overall value. Fill out a tax form. Check the validity of a complex logical argument. p.22.

System 1: Detect that one object is more distant than another. Orientate to the source of a sudden sound. Complete the phrase "bread and . . .". Make a "disgust face" when shown a horrible picture. Detect hostility in a voice. Answer to 2 + 2 = ? Read words on large billboards. Drive a car on an empty road. Find a strong move in chess (if you are a chess master). Understand simple sentences. Recognize that a "meek and tidy soul with a passion for detail" resembles an occupational stereotype. p.21.

Kahneman, D. (2011). Thinking, fast and slow. London: Penguin Books.

See also:

https://thedecisionlab.com/reference-guide/philosophy/system-1-and-system-2-thinking