welcome to the: rcslt research champion workshop€¦ · professor amanda burls, professor of...

Welcome to the:

RCSLT Research

Champion Workshop 24th March 2015

#RCSLTresearch

Outline 09.30 – 10.00 Registration and refreshments

10.00 – 11.00

Welcome

Professor Victoria Joffe, Trustee for Research and Development, RCSLT Board of Trustees; and Emma Pagnamenta, Research Manager, RCSLT

11.00 – 11.25 Using technology and social media to collaborate

Dominique Lowenthal, Head of Professional Development, RCSLT

11.25 – 11.40 Refreshments

11.40 – 12.40 Critical appraisal workshop: Introduction

Professor Amanda Burls, Professor of Public Health, City University London

12.40 – 13.30 Lunch

13.30 – 14.30

Critical appraisal workshop:

Small discussion group work (with refreshments)

14.30 – 14.35 Break

14.35 – 15.30

Critical appraisal workshop:

Plenary

15.30 – 15.50 Summary of day Professor Victoria Joffe, Trustee for Research and Development, RCSLT Board of Trustees; and Emma Pagnamenta, Research Manager, RCSLT

15.50 – 15.55 Thanks and close

Today we hope you will….

Hear about Research and Development at the RCSLT

Explore and discuss the role of RCSLT Research Champions

Make contacts and connections

Share good practice

Develop skills in critical appraisal and application of research evidence

Vicky Joffe, Emma Pagnamenta & Vanessa Rogers

Building research capacity for the

profession: past present and future

Strategy

Vision

Evaluation

Strategy

Vision

Evaluation

Strategy

RCSLT Research Strategy 2010 supporting members to access and carry out research and EBP

that will be relevant at each stage of their careers

members work together to create and promote research opportunities and support the development of research awareness, capacity and capability

collaborative working of all members and the synthesis of their knowledge and skills is essential to the development of an evidence base which is focused on the needs of service users

culture of EBP will run through work based activity,

formal education, management of services and

research

Strategy

RCSLT Strategic Plan

2012-15

The development, synthesis and dissemination of the SLT evidence base supported and developed by the RCSLT

Members feel that RCSLT membership is essential for their professional development

Communities between members are recognisable and self-sustaining

The RCSLT has enabled the profession by supporting local managers and other members- in influencing local commissioners, decision-makers and budget holders

QUESTIONS GAPS

DISSEMINATION IMPACT

OUTCOMES FOR SERVICE USERS

RCSLT RESEARCH

CHAMPIONS HUBS

CLINICAL ACADEMIC

WORKFORCE

Strategy

Vision

Evaluation

The Vision

SLT services

Research Champions

Reaching out Supporting

services Capacity

building

Council for AHP Research

RCSLT Hubs

Research Champions

Aphasia

Speech

Language impairment

Acquired Speech

Difficulties

Bilingualism

Cleft Dysfluency

Dyslexia

Learning disabilities

Mental Health

Physical disabilities

Progressive neuro

Research Champions

R & D Reference

Clinical

Research

Reference

Groups

infrastructure

for research

Council for AHP Research

RCSLT Hubs

Research Champions

113 Research Champions 70% RCSLT Hub members 23% Council for AHP Research Hub members

Strategy

Vision Evaluation

R&D so far…

RCSLT R & D Team Networks Bulletin Website Elearning/resources Journal access Support RCSLT Studentships CAHPR

R&D, the future…

RCSLT R & D Team Networks Bulletin Website Elearning/resources Journal access Support CAHPR

Research priority setting Research champions Clinical research reference

groups Mentorship IJLCD/new journal Dissemination of evidence Qualitative research Hubs

What you told us

• Improving support

• Journal access

• Leadership and guidance

• Resources

• Website

• Bulletin

• Hubs

• 86% said RCSLT work is valuable or very valuable

Accessing Evidence

Evidence-based

practice

Comments Research Activity

RCSLT R & D Resources: usage

RCSLT R & D Resources

1 2 15 9 11 8 5 4 7 3 17 14 16 13 12 10 6

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

RCSLT R & D Resources

In the Journals

Journals Collection

Evidence-based decision making tool

How have they helped?

EBP under pressure

Reflection

Networking

Signposting Research skills

Journal access

Strategy

Vision

Evaluation Role

Where did we start from?

Passionate about evidence-based practice and research

Enabler of others

Link person

Connected to networks

Keen to work with RCSLT

Experience/developing skills in evaluation/research

Flexible requirements from RCSLT

What do you think?

Generating

evidence

Linking

practice and

research

Signposting/

sharing

information

Supporting

colleagues

Capacity

building

Promoting/

awareness

raising

Personal

development

Role models

EBP/research activities so far

Doing audit/evaluation/research

Network activity

Providing CPD for others

Links with HEIs

Supporting colleagues

Writing for Bulletin

Social media

Applying skills to practice

Expert involvement/review

What have you not managed to

achieve? Small-scale research projects Practice-based evidence Hub activity Attending events Contributing to RCSLT publications Clinical academic training/funding Building research awareness Outcomes tool Journal club Teaching SLTs Influencing

Barriers No. of

comments Time 36 Limited Knowledge and Skills 9 Lack of support from Managaement 8 Clinical pressures 6 Funding 5 Confidence 3 Resources 3 Research pressures 2 Travel 2 Access issues 1 Challenges of data collection in the context of busy clinical work 1 Early stage of career 1 Expectation for EBP to happen at home/outside of work hours 1 Formal processes 1 IRAS confusing 1

Support you would like

Better

networking

Guidance

managers

Clearer roles

responsibilities

Funding

advice

Ideas for enthusing

colleagues about

Your ideas for the future

Networking

Linking

practice and

research

Collaborations

Advice and

support on

research

Sharing

research Recruitment of

champions

Define role of

a research

champion

Influencing

Projects

Publication of research

Doctorate/PhD/Masters

Training others in research

skills

Journal/EBP clubs

Hub involvement

Bulletin writing

Systematic reviews

Developing a Trust research

strategy

Your exciting plans!

Your upcoming projects

Word finding

Elklan

Transdisciplinary model

Babble and cochlear

implant

Counselling and stroke

Feeding at risk

Service outcomes

Big CACTUS study

Choking and medication in

MH and LD

LSVT with Cerebral Palsy

Group discussion: the role of a RCSLT Research Champion

Group discussion: the role of a Research Champion

We want to know what you think

Let’s make this fun…

Which do you like most?

A. Dogs

B. Cats

C. Not sure/Neither

DogsCat

Not sure

Do you attend a journal club?

A. Yes

Yes No

51%49%

How often do you read research

articles?

A. 1 or more a week

B. 2-3 per month

C. 1 per month

D. Less than 1 per

1 or m

er month

1 per m

er month

How confident do you feel in

critically appraising research?

A. Very confident

B. Confident

C. Quite confident

D. Not confident

Very c

onfident

Confiden

Quite co

nfident

Not confid

undertaking research?

A. Very confident

B. Confident

C. Quite confident

D. Not confident

Very c

onfident

Confiden

Quite co

nfident

Not confid

35%33%

How confident do you feel in undertaking

research?

Very confident

Confident

Quite confident

Not confident

First Slide Second Slide

Is your manager aware that you

are a Research Champion?

A. Yes

C. Not sure

Yes No

Not sure

15%13%

How supportive is your

manager?

A. Very supportive

B. Supportive

C. Quite supportive

D. Not supportive

Very s

upportive

Support

Quite su

pportiv

Not supporti

How supportive is your manager?

Very supportive

Supportive

Quite supportive

Not supportive

Yes No Not sure

Supportiveness of line manager as a function of awareness

How important is the research

champion role to you and your

professional identity?

A. Very important

B. Important

C. Quite important

D. Not important

Very i

Import

Quite im

portan

Not im

portant

Do you attend a journal club?

Very important Important Quite important Not important

Effect of perceived importance on journal club attendance

Group discussion • Looking to the future, how do you see your role

as a Research Champion growing and developing?

• How do you see the research champion network growing and developing?

• What do research champions offer the profession?

• What other events would you find useful?

RCSLT Research

Champion Workshop

24th March 2015

#RCSLTresearch

Using technology and

social media to

collaborate

Dominique Lowenthal Head of professional Development

How do you

feel about

technology?

Younger generations…

Will never understand

the battles we faced…

What this sound is…

Or what the

relationship between

these two objects

might be…

Who is in charge here?

“If I had asked people

what they wanted, they

would have said faster

horses.”

― Henry Ford

Technology driving what we do What we need to do driving technology?

A bit of both?

Where are you on the technology curve?

It’s called what!?

Hopefully, it’s

just a faze…

What is my

password!?

Hang on… no

one else knows

how to use this

either!

It’s going

alright…

Bottom line tech should make

something better for you…

1.Will it help me do more ‘stuff’ that I wanted to do

anyway?

2.Will I be able to do better quality ‘stuff’?

3.Will I be able to do ‘stuff’ quicker?

4.Will it be more fun than the way I’m doing it now?

So what is the ‘stuff’ of

collaboration?

Discuss

Problem solving

Supportive

Sharing and open

Easy to stay in the ‘loop’

Quick to use

Easy to pass on information

Platforms that help you to

work and connect with

your colleagues

Platforms that help to keep

you informed with the wider

1. Whatsapp

2. Basecamp

3. Teleconference

4. Videoconference

5. Skype

6. Twitter

7. Webinar

Technology platforms

Example collaborative sites

for research

r • Communities @wespeechies #slpeeps

• Following researchers e.g. ‘PamelaSnow2, @NicolaBotting, @SusanEbbels, @deevybee

• Funders e.g. @ESRC, @OfficialNIHR, @HealthFdn

• Others?

bsites

• www.researchgate.net

• rcsltalk.forums.net

• RCSLT Basecamp groups

• Others?

cebook

• RCSLT Facebook

• speechBITE.com

• NIHR Clinical Research Network

• Others?

• Send messages and queries

• Write to do lists

• Collaborate on writeboard documents

• See events on your calendar

• Join in a chat

• Share files

Basecamp

“My idea of good company is the company of

clever, well-informed people who have a great

deal of conversation; that is what I call good

company.”

Jane Austen

Twitter

@RCSLT

#RCSLT

#slpeeps

#wespeechies Thank you to Caroline Bowen

for the quote in relation to

Twitter

And now?

Those same opportunities to engage, connect

and share professionally, within and across

disciplines and international borders, endure.

But the possibilities Twitter offers for SLT

collaboration, education, intervention and

dissemination of information are only now

beginning to unfold.

Caroline Bowen

Check out your Techipe’s

Dom’s top 5 tips 1. Get adept at adapting

2. Learn a few of the keystone technologies

(e.g. skype, basecamp, twitter)

3. Accept it all changes (hopefully for the better!)

4. Be lazy (there must be an app for that!)

5. Share what works with your colleagues / learn

from others learning journey…

That’s about it!

Give it a try!

If you get stuck email:

info@rcslt.org

References

Dr. Caroline Bowen. @speech_woman

@WeSpeechies #RCSLT2014 Keynote, Workshop and Social Media Links

and Resources

http://speech-language-therapy.com

RCSLT Research

Champion Workshop

24th March 2015

#RCSLTresearch

What makes good evidence about

the effectiveness of treatments?

Amanda Burls

RCSLT Research Champions Workshop

March 24th 2015

Objectives of this session

• Appreciate the importance of making decisions informed by evidence

• Understand what makes studies testing treatments trustworthy

• Critically appraise a trial

• To have fun

In a road traffic accident there are two different

ways of organising the ambulance service

ATLS: A team trained and equipped

for advanced trauma life support to

stabilise you in the field?

BLS: A team trained and equipped

only for basic life support to take you

as quickly as possible to the nearest

emergency department?

“Stay and Play”

“Scoop and Run”

You have been injured in a road traffic

accident – which do you want?

A. ATLS: Team trained and

equipped for advanced

trauma life support?

B. BLS: Team trained and

equipped only for basic life

support to take you as quickly

as possible to the nearest

emergency department?

ATLS: T

ned and e

BLS: T

ned an

d equi..

Liberman et al J Trauma 2000 49(4):584-599

“Mind you only one out of every ten

doctors recommends it!”

“Drinking alcohol in moderation is

good for your health”

A. Agree

B. Disagree

C. Don’t know

Disagr

Don’t kn

How should babies be laid down to

sleep?

A. On their backs

B. On their fronts

C. On their sides

D. It doesn’t matter

E. I don’t know

On thei

It does

n’t m

I don’t

International Journal of Epidemiology

Conclusion

“Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10,000 infant deaths in the UK and at least 50,000 in Europe, the USA, and Australasia.”

Should left-handed children be

encourage to write with their right

hands?

A. Yes

C. Don’t know

Yes No

Don’t kn

2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End

Investigating effects and effectiveness

Intervention

Population (Patients)

Outcomes (Benefits

and harms)

‘The art of medicine consists in

amusing the patient while

nature cures the disease.’

Voltaire

How could you design a study to

minimise the chance of being fooled into

thinking an intervention is effective (or

harmful), when the changes observed

would simply have happened any way?

2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End

Answer

• Compare what happens to people given the

intervention to what happens to people that

didn’t have the intervention

• This is known as a

Control Group

Is the “effect” due to pre-existing

differences between the groups? • Differences?

– Severity of illness

– Where they live

– Genetics

– Social class

– Volunteers

– Sex

– Age

– Past treatments

How can we get comparable groups?

1. Sex

2. Severity of illness

3. Age

4. Social class

5. Past treatments

6. Genetics

• 2 groups

• Mild, average, severe (6)

• <18, 18-40, 40-70, >70 (24)

• 5 social classes (>100)

• Smoker? (>300)

• (?Unknown)

How can we get comparable groups?

Randomised controlled trial

Group 1

Group 2

Outcome

Intervention

Control

(No intervention; placebo; usual care)

Population

Allocation concealment

• The researcher or health care provider entering

a participant into a trial cannot tell which

treatment they will get

• Sequentially numbered opaque sealed envelopes

• Centralised randomisation

Check the baseline characteristics of the

groups – imbalances can occur by chance

Unconscious measurement bias

The view from the inside

“Performance bias”

Additional

interventions

are provided

preferentially

to one group

How can we make groups remain

comparable?

• Blinding (patient, researcher, health

professionals)

• Reduce losses to follow up

• Assess differential drop out (attrition bias)

• Are those who drop out similar to other

participants?

How can we make groups remain

comparable?

• Blinding (patient, researcher, health

professionals)

• Reduce losses to follow up

• Assess differential drop out (attrition bias)

• Are those who drop out similar to other

participants?

When things go wrong…

“There could be no worse experimental animals on

earth than human beings: they go on vacations, they

take things they are not supposed to take, they live

incredibly complicated lives and, sometimes, they do

not take their medicine.”

Efron B F: Limburg Compliance Symposium.

Statistics in medicine 1988; 17:249-250

When things go wrong

• What if patients don’t take the treatment they

were randomised to receive or get the wrong

treatment?

• Let’s look at a hypothetical example…

Balloon blowing for children with cystic

fibrosis

Children with CF eligible for trial

Balloon blowers Usual care

Balloons blowers Usual care

Strategies to deal with this?

2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End

Strategies to deal with this 1. Reject trial as spoilt

2. Exclude patients who did not get right treatment (comparing the outcomes only for those people who got the treatment they were supposed to)

3. Switch patients to the other group (Analyse results according to the treatment people actually got)

4. Ignore the problem (Treat people as if they got the treatment they were supposed to and analyse results comparing randomised groups regardless of treatment actually received)

5. Adjust for any imbalances in the analysis

Which strategy is best?

A. Reject trial as spoilt

B. Exclude patients who did not get right treatment

C. Analyse according to the treatment people got

D. Analyse as randomised

E. Adjust for imbalances in the analysis

Reject

l as s

de patie

ho did

Analyse a

s random

Adjust

s in th

Strategy 2 - Exclusion

Strategy 3 – Care received

Strategy 4 - Intention-to-treat

Critical appraisal:

questions to apply to trials

A. Is the trial trustworthy? Validity

Screening questions

Detailed questions

B. What does the trial tell you? Results

C. Will it help? Relevance

Small group work

Did the trial address a clearly focused issue?

A. Yes

B. Can’t Tell

Can’t

Was the assignment of patients to treatments

randomised?

A. Yes

B. Can’t Tell

Can’t

Were patients, health workers and

study personnel blinded?

A. Yes

B. Can’t Tell

Can’t

Were the groups similar at the start

of the trial?

A. Yes

B. Can’t Tell

Can’t

Aside from the experimental intervention,

were the groups treated equally?

A. Yes

B. Can’t Tell

Can’t

Were all of the patients who entered the trial

properly accounted for at its conclusion?

A. Yes

B. Can’t Tell

Can’t

Validity – only one question!

• Were the groups compared similar in all respects other than the intervention of interest?

(Including the way they were assessed)

How large was the treatment effect?

How precise was the estimate of the

treatment effect?

Can the results be applied in your context?

A. Yes

B. Can’t Tell

Can’t

Were all clinically important outcomes

considered?

A. Yes

B. Can’t Tell

Can’t

Are the benefits worth the harms and costs?

A. Yes

B. Can’t Tell

Can’t

15%23%

critically appraising research

A. Very confident

B. Confident

C. Quite confident

D. Not confident

Very c

onfident

Confiden

Quite co

nfident

Not confid

How confident do you feel in critically appraising

research

Very confident

Confident

Quite confident

Not confident

First Slide Second Slide

Closing remarks: what next?

Reflections and Themes of day

• Enthusiasm and buzz throughout

• Connect and support one another

• Learn, learn learn…

• TIME

• Work context differs, and so do challenges

• Twitter is great (@becciknill)

• Don’t guess, or rely on intuition, USE evidence

You said….

You would like clear roles and responsibilities

We are….

Drafting a mission statement

Developing roles and responsibilities

You said….

You would like to have a directory for the network

We are….

Collating a directory of:

Research Champions

Current research

Signposting you to opportunities

You said….

You would like RCSLT to influence managers about the role and requirements of being a research champion

We will….

Write a letter to Managers

Support the work undertaken by the Council for AHP Research

You said….

You would like advice on making research happen and opportunities to share your research

You are all invited to….

We are creating and identifying opportunities

E.g. “Pathways into clinical research for speech and language therapists”, Safer Care Conference, Birmingham, June 25

– Free to attend

– Opportunities to share your research and/or career pathways

You said….

You would like to develop collaborations across the network

We will….

Continue to support an interactive network

Watch this space…

So, you call yourselves

A champion is someone

who gets up when he can’t.

Jack Dempsey

A true champion can

adapt to anything.

Floyd Mayweather, Jr

If you’re a champion,

you have to have it in

your heart.

Chris Evert

Champions are willing

to do what they hate

in order to get what

they love.

To be champion requires more

than simply being a strong

player, one has to be a strong

human being as well.

Anatoly Karpov

I’ve failed over and

over and over again in

my life….That is why I

succeed.

Michael Jordan

If it doesn’t challenge

you, it doesn’t change

Together we can make a difference

Leaders…wake people out of inertia. They… get

people excited about something they’ve never

seen before, something that does not yet exist.

Rosa Beth Moss Kanter (Leadership for Change: Enduring Skills for Change Masters)

Thank you for listening Keep in touch...

v.joffe@city.ac.uk emma.pagnamenta@rcslt.org

vanessa.rogers@rcslt.org

welcome to the: rcslt research champion workshop€¦ · professor amanda burls, professor of...

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