Healthcare Research Project Research Articles

A shortage of funding or not enough healthcare projects?

The author, having worked in pharmaceuticals for several decades, has advised, in confidence, both investors and small to medium-sized enterprises on transitioning healthcare research projects into commercial development, mainly in Europe. He is now semi-retired. This note is written in the hope that his experience will improve the success of small and medium-sized enter-prises in their attempts to get non-academic investment funding and make life easier for investors. Whilst focused on drugs, the broader advice is relevant to other healthcare areas, such as diagnostics and devices.

Asking those who know their needs best: A framework for active engagement and involvement of childhood cancer survivors and parents in the process of psychosocial research-A workshop report.

Patient and public involvement and engagement (PPIE) in healthcare research is crucial for effectively addressing patients' needs and setting appropriate research priorities. However, there is a lack of awareness and adequate methods for practicing PPIE, especially for vulnerable groups like childhood cancer survivors. This project aimed to develop and evaluate engagement methods to actively involve pediatric oncological patients, survivors, and their caregivers in developing relevant research questions and practical study designs. An interdisciplinary working group recruited n = 16 childhood cancer survivors and their caregivers to work through the entire process of developing a research question and a practicable study design. A systematic literature review was conducted to gather adequate PPIE methods which were then applied and evaluated in a series of three workshop modules, each lasting 1.5 days. The applied methods were continuously evaluated, while a monitoring group oversaw the project and continuously developed and adapted additional methods. The participants rated the different methods with varying scores. Over the workshop series, the participants successfully developed a research question, devised an intervention, and designed a study to evaluate their project. They also reported increased expertise in PPIE and research knowledge compared to the baseline. The project resulted in a practical toolbox for future research, encompassing the final workshop structure, evaluated methods and materials, guiding principles, and general recommendations. These findings demonstrate that with a diverse set of effective methods and flexible support, actively involving patients, survivors, and caregivers can uncover patients' unmet disease-related needs and generate practical solutions apt for scientific evaluation. The resulting toolbox, filled with evaluated and adaptable methods (workbook, Supplement 1 and 2), equips future scientists with the necessary resources to successfully perform PPIE in the development of health care research projects that effectively integrate patients' perspectives and address actual cancer-related needs. This integration of PPIE practices has the potential to enhance the quality and relevance of health research and care, as well as to increase patient empowerment leading to sustainable improvements in patients' quality of life.

Who is sensitising whom? A participatory interview guide development as an awareness tool within a health care research project

Who is sensitising whom? A participatory interview guide development as an awareness tool within a health care research project

Obstacles to health care research projects at the University of Jordan: a cross-sectional survey

Objective: To assess the obstacles faced by biomedical researchers in Jordan and the reasons behind the stagnation of health care research. Background: Health care research is essential for the advancement of medical care but faces obstacles that delay the completion of research projects, and the literature is still deficient, especially in developing countries. Methods: A cross-sectional survey was conducted of all academic staff of health care faculties at the University of Jordan who had been employed for five years or more and had at least one stagnant research project. Questionnaires were completed by the academic staff online using Google Forms after a face-to-face interview to explain the study process to them. Results: A total of 82 researchers with a mean age of 42.68 (±9.16) years were included most of whom (84.1%) had only one stagnant project. Of the 106 stagnant projects, 28.3% were in the basic sciences and 71.7% were in clinical research. Almost a third (29.5%) of the projects remained stagnant after reaching the publication stage. Most researchers (81.3%) identified lack of time and high workload as the most common personal barriers and 44.4% identified lack of funds and research incentives as the most common institutional barriers. Conclusions: Medical research is affected by different barriers including lack of time, high workload, lack of funds, and insufficient incentives for research. An institutional strategic plan is required to overcome those barriers and to improve medical research.

Neuropilin-1 and Neovascularization Are Associated With the Vulnerability of Carotid Plaques: New Insights Into Atherosclerosis Plaques Development

Background and Objective: Intraplaque neovascularization was considered as an important indicator of plaque vulnerability, neuropilin-1 (NRP1) acted as a coreceptor for vascular endothelial growth factor with an essential role in angiogenesis, the mechanism of NRP1 in plaque vulnerability remained unknown. This article aimed to investigate the relationship between NRP1 and neovascularization with carotid atherosclerotic plaque vulnerability. Besides, new insights into the NRP1 was attained by regulating the development of atherosclerosis plaques. Methods: In this study, 3 plaques of carotid endarterectomy (CEA) and 3 normal external carotid arteries which were obtained from trimmed external carotid artery of high flow intracranial - external artery bypass grafting was first compared by RNA sequencing, functional analysis was used to screen out the genes significantly different related to neovascularization in plaques. A total of 65 plaques from CEA were registered and divided into stable group and vulnerable group by histology. NRP1 and its associated protein expression were analyzed by western blot and co-immunoprecipitation assay. CCK-8 and tube formation assays were used to analyze cell viability and angiogenesis. Transwell migration and Wound healing assays were utilized to assess the motility of HMEC-1 cells. Immunohistochemistry of CD31 and CD68 were used to assess neovascularization and inflammation respectively. Findings: 7110 differentially expressed genes were identified in RNA sequencing. NRP1 was up-regulated compared to normal external carotid artery and related to angiogenesis. The protein levels of NRP1 was elevated in vulnerable plaques. Knockdown of NRP1 inhibited HMEC-1 cells proliferation, angiogenesis and migration in vitro. The protein levels of phospho-FAK and the molecules of integrin α3, α6, αV and β1 were also up-regulated in vulnerable plaques (all P < 0.05). In immunohistochemical results, the expression of CD31 and CD68 were elevated in vulnerable plaques and associated with the plaque vulnerability (P = 0.038, P = 0.015). Interpretation: The current study demonstrated that NRP1 played an important role in vulnerable plaques with angiogenesis. Meanwhile, NRP1 may interact with integrin to activate the FAK signaling pathway to increase neovascularization of plaques. Besides, neovascularization was also associated with plaques instability and inflammatory infiltrate. Funding Statement: This work was supported by cadre health care research project of Jiangsu Province (No. BJ17010), people’s livelihood science and technology demonstration project of Suzhou (No. SS202061, No. SS201859), thirteen major projects of the ministry of science and technology of China (No. 2017YFC0114302). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the local ethics committee (NO: 2019124) and all enrolled subjects had signed written informed consent.

What are the resourcing requirements for an Aboriginal and Torres Strait Islander primary health care research project?

To explore the role of resourcing during an Aboriginal and Torres Strait Islander primary health care research project. Process evaluation using grounded theory approaches of a national Aboriginal and Torres Strait Islander research project (N = 500) named Getting it Right: the validation study. Qualitative semistructured interviews with 36 primary health care staff and 4 community members from 9 of 10 primary health care services involved in the research project. Interviews included questions about the resources needed to conduct the research project, including flexible reimbursement to participating services (allocated within services), human resources and reimbursement to research participants (vouchers). Qualitative data were triangulated with participant feedback, study administrative data and field notes kept by the interviewer. Three themes were identified: 1) the influence of reimbursement on participating services and the research project; 2) the influence of human resources on the research project at participating services; and 3) the consequences of offering vouchers to reimburse research participants. Reimbursement was allocated to research expenses (human resources and logistics) or non-research expenses (service operations, equipment and conference attendance costs). Most services opted to offer vouchers to compensate participants for their time, which staff considered was appropriate recognition of participants' contributions and facilitated recruitment. Some staff described some potential unintended negative consequences from offering vouchers, including creating a welfare mentality or creating problematic expectations. Primary health care research should have sufficient resourcing available, including human resource capacity, to achieve research targets. Research planning should include consideration of the existing commitments, priorities and human capacity needs of services and patients.

Intrauterine Growth Restriction: Transsectoral, Interdisciplinary and Multiprofessional Care for Pregnant Women and Newborns in a Feto-neonatal Pathway: A Project of the Innovationsfonds

Intrauterine growth restriction (IUGR) is present in fetuses that do not achieve their full in-utero growth potential. IUGR needs to be discriminated from small for gestational age (SGA) because IUGR newborns in particular experience long-term side effects from their small growth. IUGR fetuses have a significantly increased risk of prematurity and a distinct risk profile compared to adequate-for-gestational-age preterm newborns. Complications of prematurity are more frequent, including bronchopulmonary dysplasia, intraventricular hemorrhage, and meconium ileus. IUGR newborns are at risk of long-term health issues like cerebral palsy, impaired lung function, and delayed speech development. Interdisciplinary and interprofessional care of IUGR pregnancies in the context of a standardized health care research project is feasible: Pregnant women at risk are identified, early therapy with acetylsalicylic acid is started as indicated, risk-adapted care at level III centers is organized including psychosocial interventions and neonatal consultations. Postnatally, integrated neonatal care focusing on parent-child interaction and optimized nutrition is a hallmark. Afterwards, in-depth pediatric follow-up visits with local pediatricians help to identify growth and neurodevelopment problems early. The effects, acceptance. and cost efficiency of this approach are evaluated prospectively as part of an Innovationsfonds project.

Tight Ties in Collaborative Health Research Puts Research Ethics on Trial? A Discussion on Autonomy, Confidentiality, and Integrity in Qualitative Research.

Collaborative research involving different stakeholders is increasingly becoming a preferred way of doing qualitative research to improve health care services. However, ethical research dilemmas arise when collaborative ties are tight. Based on lessons learned from two qualitative collaborative health care research projects in two different municipalities in Norway and Denmark, respectively, this article illuminates ethical research dilemmas around ethical principles and guidelines of autonomy (informed consent), confidentiality (anonymity), and integrity of research. Accordingly, there is a need to revisit and resume international ethical research guidelines formulated in the Declaration of Helsinki, when it comes to research guidelines of informed consent, anonymity, and integrity of research. Moreover, we suggest that collaborators contemplate and negotiate these ethical research issues to avoid unnecessary misunderstandings, conflicts, and pressures when doing research with stakeholders when collaboration ties are tight.

Getting On With Field Research Using Participant Deconstruction

This article adds to the repertoire of field research methods through developing the technique of “participant deconstruction.” This technique involves research participants challenging and reinterpreting organizational texts through the application of orienting, disorienting, and reorienting deconstructive questions. We show how participant deconstruction complements existing strategies for “getting on” with field research—cultivating relationships, developing outsider knowledge, and mobilizing insider knowledge—by facilitating research participants’ questioning and challenging of organizational texts and thus opening up alternative latent understandings, illuminating concealed meanings, supporting reflexivity for participants and researchers, and suggesting fruitful lines of inquiry. We illustrate the application of the technique with examples drawn from health care research projects. Through gathering further practitioner feedback from a variety of alternative contexts, we go on to demonstrate the potential application of participant deconstruction in a range of field contexts, by different types of practitioners undertaking deconstructive readings of a wide variety of organizational texts. We also offer suggestions for further research to extend the technique.

Telematics services and telemedicine under ophthalmological legal aspects

Telemedical solutions are increasing with respect to diversity, frequency and scope. It should be part of medical practice to remind again and again that telemedicine does not represent aspecial medical field or even asubspecialty. The concept of telemedicine is more used as asuperior term for different medical care concepts, provided across distance and time barriers. Telematic solutions implemented as anew field of service in ophthalmological practice or in hospitals must fulfill the following obligatory requirements in conformity with the law: patients must be informed about the range of telemedical solutions, operators must ensure medical specialist qualifications and all care responsibilities combined with the telemedical services must be guaranteed. The legal assessment standard is always the direct comparison between telemedical measures and the individual patient result of medical treatment in a face to face situation in an ophthalmologists practice as the gold standard. The court makes a targeted examination on whether the individual damage to health of a patient under telemedical care would also have normally occurred under medical treatment within the framework of regular care by a medical specialist in apractice or clinic. If the court has a well-founded doubt, the operator must be able to justify either constraints in individual cases or abetter prognosis and success rate (reversal of burden of proof). Especially due to the latter aspect it is important for the operator that the standards for telemedical services of the specific medical fields are predefined by the specialist societies or that corresponding results from healthcare research projects are available.

Complex Networks: Theory Building for Integrated Healthcare Research in Rural of China

Introduction: The three tiered healthcare networks（county, township and village) in rural area of China undertakes health service needs of 0.8 billion rural residents. Multiple researches in this area indicates the healthcare system in rural area is suffering from lacking integrated networkss not only among healthcare institutions, but also among all the participants from different interest related parties, this current situation causes numerous issues in rural healthcare system including huge waste of healthcare resources, overuse and misuse of medication between different tiered institutions and gaps of medical information transferring and sharing during the referral processes, etc. However, the traditional models and methods for healthcare system analysis usually not enough to elaborate the specific networkss among all of participants in this system and to monitor the changing of the overall networkss. We introduced the Complex networks theory into this area and try to build a new analysis aspect for future study of integrated healthcare researches. Method: This study simulated and analyzed the characteristics of Complex networks system in rural area of China by introducing the Small world and Community structure theories from System Science. We designed a hypothetic complex networks environment of rural healthcare system with participants (Nodes=200), connectivity (K=15, means the average number of edges connected to a node), and s=0.15 which indicates the possibility of connection of each participant. Result: In simulated environment of healthcare system in rural area, the Clustering coefficient (which measures the density of triangles in a networks) is high and the Scale-free Property (which refers to any functional form f(x) that remains unchanged to within a multiplicative factor under a rescaling of the independent variable x) is quite obvious (Graph 1.). Furthermore, the result also indicates that the networkss of rural healthcare system shows the “Community structure” which means the groups of vertices that have a high density of edges within them, with a lower density of edges between groups. (Graph.2.) Graph.1. The small world effect and Scale-free Property Graph.2. The Community structure Conclusions: We presume thatthe small world Effect, Scale-free Property and the Community structure does exist in interpersonal networkss in rural healthcare system, it indicates that in an actual environment of rural healthcare system, the providers and users consisted millions of nodes, and most of these nodes only contact with their neighbors or acquaintances. At the same time, most of rural areas in China has no initial diagnosis or “Gate keeper”-General practice system at present, so service users could freely reach to any providers who has high professional position or good reputation in that area. Discussion: This study was inspired by the innovative works in complex theory studies in recent years. We could use the theories from complex networkss such as Small world and Community structure to simulate and to analyze the healthcare networkss in rural China in order to find more specific characteristics among the integrated networkss in rural area. For example, by analyzing the actual networkss based on Small world theory, we could locate the high density “community” (it could be an institution or a physician) in networkss and precisely change the healthcare resource structure to make the system more integrated. Lessons learned: The Complex Networks theory is rarely used in the area of Integrated Healthcare studies, we learned that when building the model of Small world by Matlab, it should be very carefully to avoid the characteristic difference between the healthcare networks and other networkss. Limitation: Because of data limitation, we could not use the actual interpersonal networks data for modeling, just simulated the modeling process to report the practical significance for using this theory to analyze the integrated healthcare system in rural area. Suggestion for future research: This study is trying to introduce an essential theory into integrated healthcare networks study. However, the stage for now is just in the process of simulating a hypothetical environment. Actually, at present, our research team launched a big data healthcare research project in Yichang, Hubei province, China. We are trying to analyzing the networks of Yichang region which contains millions of resident information by using Complex networks theory which mentioned in this paper.

Health Science Research with Primary Care Routine Data From Electronic Patient Records: the BeoNet Registry

Reliable current information is needed for daily patient care and the health system, but comprehensive data, especially from primary care, are scarce and/or hard to access. The BeoNet Register-Database (BNR) aims to depict quality of medical care in Germany using routine data and with no additional documentation or costs for GPs. Registry design, data structure and database use will be demonstrated using chronic obstructive lung disease (COPD) as an example. The BNR is moving through pilot- and roll-out phases. Participating practices provide standardized information about (1) master data (2) practice profile (3) infrastructure and documentation systems. The routinely documented data will be pseudonymized before transmission via standardized secure interfaces to the registry database. Practices can participate in studies in cooperation with BNR if informed consent is obtained from the patients. The registry data will be linked with questionnaires on health care utilization, quality of life and disease-specific parameters. Researchers and physicians can access quasi anonymized data in specific datasets extracted from the registry. Regular automatic data quality checks and feedback from GPs, patients and researchers enhance the quality of the registry. Performance and data analysis are continuously optimized. The data security concept has been approved and ethical approval is on hand. GPs, pediatricians and pneumologists from Hanover, Munich and Heidelberg participated in the pilot phase. The registry database currently holds 98497 patient IDs and related information. BNR contains more than the standard billing data collected by health insurers. The data are applicable to a wide range of health practices, health care and economics and disease development questions. Questionnaires have been generated, tested and are being distributed. First descriptive analyses of prevalence, age and gender have been performed. Quality and validity checks have been implemented. 2016 marks the roll-out phase of the BNR. Further recruitment of practices throughout Germany, data linkage with additional questionnaires, recruitment of patients for health care research projects, quality checks and data analysis of disease-specific costs and health-related quality of life in COPD are progressing with the overall aim of improving pulmonary healthcare strategies. The floor is now open for retro- and prospective cross-sectional and longitudinal studies.

Pathways to research impact in primary healthcare: What do Australian primary healthcare researchers believe works best to facilitate the use of their research findings?

BackgroundPrimary healthcare researchers are under increasing pressure to demonstrate measurable and lasting improvement in clinical practice and healthcare policy as a result of their work. It is therefore important to understand the effectiveness of the research dissemination strategies used. The aim of this paper is to describe the pathways for research impact that have been achieved across several government-funded primary healthcare projects, and the effectiveness of these methods as perceived by their Chief Investigators.MethodsThe project used an online survey to collect information about government-funded primary healthcare research projects. Chief Investigators were asked how they disseminated their findings and how this achieved impact in policy and practice. They were also asked to express their beliefs regarding the most effective means of achieving research impact and describe how this occurred.ResultsChief Investigators of 17 projects indicated that a number of dissemination strategies were used but that professional networks were the most effective means of promoting uptake of their research findings. Utilisation of research findings for clinical practice was most likely to occur in organisations or among individual practitioners who were most closely associated with the research team, or when research findings were included in educational programmes involving clinical practice. Uptake of both policy- and practice-related research was deemed most successful if intermediary organisations such as formal professional networks were engaged in the research. Successful primary healthcare researchers had developed critical relationships with intermediary organisations within primary healthcare before the initiation of the research and had also involved them in the design. The scale of research impact was influenced by the current policy environment, the type and significance of the results, and the endorsement (or lack thereof) of professional bodies.ConclusionsChief Investigators believed that networks were the most effective means of research dissemination. Researchers who were embedded in professional, clinical or policy-focussed intermediary organisations, or had developed partnerships with clinical services, which had a vested interest in the research findings, were more able to describe a direct impact of their research. This suggests that development of these relationships and engagement of these stakeholders by primary healthcare researchers is a vital step for optimal research utilisation in the primary healthcare setting.

Development tendency of American nursing related mobile health care studies and its enlightenment to China from the perspective of NIH fund programs

The United States of America is one of the countries who conducted the mobile health care related studies earlier, and its mobile health care concept has had a relatively mature application and development in the nursing research field. Through analyzing and discussing nursing related mobile health care research projects supported by the American National Institutes of Health funds in recent years, the research hotspots of the current mobile health care and its development tendency are grasped, which is significant to promote nursing related researches in China actively. Key words: Nursing; United States; NIH fund program; Mobile health care; Development tendency; Enlightenment

Earmarking tobacco taxes for health purposes via median entities.

Fiscal policies are an especially promising lever for reducing the burden of non-communicable diseases and injuries (1). On World No Tobacco Day 2014, World Health Organization (WHO) repeated with greater intensity its well-known proposal (2) on raising tobacco taxes to encourage users to stop or reduce consumption, and to prevent potential users from taking up smoking. Evidence as to why this is an effective strategy abounds (3). Despite concerns over manufacturers’ political influence, technical problems such as tax manipulation, and increased smuggling considerations, it is hoped that governments shall be scaling their efforts toward this direction in the next few years, by enforcing increases in specific excise taxes. A 2011 review of more than 100 econometric studies estimates that doubling inflation-adjusted prices should reduce consumption by about one third (4). In terms of revenue, WHO estimates that raising specific excise taxes on tobacco to double prices would raise about 100 billion US dollars per year worldwide, in addition to the approximately 300 billion US dollars that governments already collect on tobacco (5). Each country enforcing such taxes must decide how to allocate their share of this prospective additional revenue in advance. Careful consideration is particularly important; this is a chance for tobacco to atone, partly at least, for the damage it has inflicted throughout the years of its uncontrollable use. The process of earmarking (or dedicating) revenues from tobacco taxes for health purposes constitutes a fairly recent policy, adopted in various forms globally. Experience demonstrates that public support for higher tobacco taxes is greater when some of the increased revenues are used to support health-focused programmes (6). Rather than paying without knowing where the money is used, earmarked taxes assure taxpayers that these revenues are targeted to specific desirable purposes, regardless of the fiscal authority’s mandate to allocate budgets as they see appropriate. However, economists argue that policy-makers have the opportunity to use these funds in an indirect way, in the sense that fiscal authorities can decrease general-fund spending on targeted expenditures (7). This is especially tempting in conditions of fiscal austerity, particularly for middle- and low-income countries with small budgets and pressing needs. A better, more secure way to benefit health from tobacco taxes has to be found. The solution might lie in median autonomous or semi-autonomous entities, as is the case in several countries. For instance, Thailand’s Thai Health Promotion Foundation receives 2% of the total national tax revenue on alcohol and tobacco products, and supports groups and organizations that are already working on public health issues. Such a foundation could also accept applications to fund healthcare research projects, thus enhancing a country’s scientific capabilities. Its public autonomous status would allow partnerships in both public and private sectors. The foundation would have to report directly to a higher authority, but in essence it would be independent from ministries of finance. Thus its resources would be protected, and smokers would know that their increased taxes are allocated directly to health-focused programmes. Countries differ in their needs, abilities, and priorities. There is no universal approach to the most efficient use of tobacco tax money, but earmarking it to health-focused programmes via an autonomous foundation offers important advantages. Policy-makers who will respond to WHO’s call need to research this and other options thoroughly in order to benefit as much as possible from raising taxes on tobacco.

Creating the Foundation of a Healthcare Research Project

Creating the Foundation of a Healthcare Research Project

What research impacts do Australian primary health care researchers expect and achieve?

BackgroundFunding for research is under pressure to be accountable in terms of benefits and translation of research findings into practice and policy. Primary health care research has considerable potential to improve health care in a wide range of settings, but little is known about the extent to which these impacts actually occur. This study examines the impact of individual primary health care research projects on policy and practice from the perspective of Chief Investigators (CIs).MethodsThe project used an online survey adapted from the Buxton and Hanney Payback Framework to collect information about the impacts that CIs expected and achieved from primary health care research projects funded by Australian national competitive grants.Results and DiscussionChief Investigators (CIs) provided information about seventeen completed projects. While no CI expected their project to have an impact in every domain of the framework used in the survey, 76% achieved at least half the impacts they expected. Sixteen projects had published and/or presented their work, 10 projects included 11 doctorate awards in their research capacity domain. All CIs expected their research to lead to further research opportunities with 11 achieving this. Ten CIs achieved their expectation of providing information for policy making but only four reported their research had influenced policy making. However 11 CIs achieved their expectation of providing information for organizational decision making and eight reported their research had influenced organizational decision making.ConclusionCIs reported that nationally funded primary health care research projects made an impact on knowledge production, staff development and further research, areas within the realm of influence of the research team and within the scope of awareness of the CIs. Some also made an impact on policy and organizational decision-making, and on localized clinical practice and service delivery. CIs reported few broader economic benefits from their research. Routine use of an instrument of this type would facilitate primary health care research funders' determination of the payback for funding of research in this sector.

The feasibility of determining the impact of primary health care research projects using the Payback Framework

BackgroundPrimary health care research is under pressure to be accountable to funders in terms of benefits for practice and policy. However, methods to assess the impact of primary health care research must be appropriate to use with the diverse topics, settings and approaches of this sector. This project explored the feasibility of using the Buxton and Hanney Payback Framework to determine the impact of a stratified random sample (n = 4) of competitively funded, primary health care research projects.MethodsThe project conducted telephone interviews based on the Payback Framework with leaders of the research teams and nominated users of their research, used bibliometric methods for assessing impact through publication outputs and obtained documentary evidence of impact where possible. The purpose was to determine the effectiveness of the data collection methods and the applicability of the Payback Framework, and any other issues which arose around the assessment of impact of primary health care research.Results and discussionThe thirteen interviews were resource intensive to organise conduct and analyse but provided better information about impact than bibliometric analysis or documentary analysis. Bibliometric analysis of the papers published from the four projects was hampered by the inclusion of only one of the journals in major citation indexes. Document analysis provided more evidence of dissemination than of impact.The payback framework and logic model were a sound basis for assessing impact. Chief investigators and nominated users of research provided substantial information relevant to the impact categories closest to their spheres of influence and awareness, but less about the impact their research had on the wider health sector, population health or economic benefits. An additional category of impact emerged from the interviews, that of strengthening research networks which could enhance the impact of later work. The framework provided rich information about the pathways to impact, better understanding of which may enhance impact.ConclusionIt is feasible to use the Buxton and Hanney Payback framework and logic model to determine the proximal impacts of primary health care research. Though resource intensive, telephone interviews of chief investigators and nominated users provided rich information.

Six methodological steps to build medical data warehouses for research

Purpose We propose a simple methodology for heterogeneous data collection and central repository-style database design in healthcare. Our method can be used with or without other software development frameworks, and we argue that its application can save a relevant amount of implementation effort. Also, we believe that the method can be used in other fields of research, especially those that have a strong interdisciplinary nature. Background The idea emerged during a healthcare research project, which consisted among others in grouping information from heterogeneous and distributed information sources. We developed this methodology by the lessons learned when we had to build a data repository, containing information about elderly patients flows in the UK's long-term care system (LTC). Design We explain thoroughly those aspects that influenced the methodology building. The methodology is defined by six steps, which can be aligned with various iterative development frameworks. We describe here the alignment of our methodology with the RUP (rational unified process) framework. The methodology emphasizes current trends, as early identification of critical requirements, data modelling, close and timely interaction with users and stakeholders, ontology building, quality management, and exception handling. Results Of a special interest is the ontological engineering aspect, which had the effects with the highest impact after the project. That is, it helped stakeholders to perform better collaborative negotiations that brought better solutions for the overall system investigated. An insight into the problems faced by others helps to lead the negotiators to win-win situations. We consider that this should be the social result of any project that collects data for better decision making that leads finally to enhanced global outcomes.