Meetings minutes with 1st Supervisor

17 Feb 2017

core issues:
  • practitioner usage: is a safety issue

how can we help e-prescribing systems to become safer? Safer on the grounds of safe practice, for example decide which drug to give and giving it correctly.

  • help patients to comply with prescriptions

how can we use PHR (personal health record) to help people to reasonably comply with medication?

what is the evidence around it?


the title of the project is the aim.


produce 2 questions based on the title; they will assist with the structured literature review.

28 Mar 2017

Main research question and key focus points:

What are the essential design features of PHR to help adults with type 1 diabetes comply with their medication?

  • Is there a connection between personality types and PHRs and adherence/compliance? Will a different personality person react differently or comply more or less to their prescriptions and why?
  • After focusing on adults with diabetes type 1, we can investigate older patients with multiple conditions that take multiple medication.
    • Their reaction towards applications and wearable technology.
    • Assuming that millennials will be keen on using a screen – any screen for their management, what is happening with older people?
  • What can PHRs learn from the hospital systems? PHRs can help hospital prescribing systems and vice versa.


The official methodology of the literature review is called PRISMA.


Create the protocol based on the guidelines of BioMed Central

I will try my luck at the Research Spotlight competition too.



This meeting was with both 1st and 2nd supervisor at the same time.

The hospital prescribing system is functioning as background and source of knowledge for my research.

In pharmacies, a common problem is that some times ignoring a field in the software, becomes an organization pattern, and ends up ignored all the time.

Older patients tend to get nomad, blister packs more than younger patients with same problems.

Is there any obvious differentiation between age groups in medication compliance? To answer this, I have to do a case study.

Medication discharge review: It might give us a starting point, but non-anonymous patient data handled by someone random, will be a problem in confidentiality.

Renal patients they usually include more diseases.

Renal patient views: what data patients record on the software for themselves?

An idea is to find a patient group that the patients might be able to do something with the data they collect/input.  -> Support decision making

Comorbidity is more common word than polypharmacy.


find systematic reviews about PHR



discussed about the background section of the literature review protocol.

I will not use eMC database for literature search but I will write about it.

Why do I exclude grey literature? I need to justify of any exclusions, apart from government policy documents.

Include in the literature review as much as possible.

Evidence of pyramid of Cochran collaboration. Have a look at this evidence pyramid too: Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016 Aug21(4):125-7.

Exclude literature: commercial, abstract without references, party political statements. The rest of the literature will be evaluated with the help of the pyramids and will be given a grade.

My literature search keywords:

( phr  OR p.h.r. OR  “personal health record” )   AND   ( polypharmacy  OR  comorbidity )  AND   adult*   AND  ( “chronic disease”  OR  “chronic illness”  OR  “chronic condition”  OR  “long term disease”  OR  “long term illness”  OR  “long term condition” )

CASP tools and checklist for appraising the evidence in the quality section.

In the discussion section a limitation will be that we exclude any other languages apart from English and Greek.



The majority of the discussion was about my participation at the  13th London Hopper Colloquium at BCS HQ Londonon on 25/5/2017. There was a 3 minute presentation competition that I had my abstract accepted. We discussed about the slides that I will use to present my part.

We also went through the poster for my participation on the 2017 Faculty of Technology Research and Innovation Conference.


The literature review protocol is finalized.

My systematic literature review is submitted at PROSPERO ( and is currently assessed.

We want to publish my protocol at BioMed Central. However, it is open access therefore, I need to find out if the school will fund me. Nick Savage told me that I need to answer the following questions and if the answers are sufficient there should not be a problem:

  1. why is BioMed Central a good place to publish?
  2. cost?
  3. impact factor?

Check with Helena (2nd supervisor) regarding the following assumption:

  • most people with chronic conditions take a lot of drugs?

remove polypharmacy from the keyword, exclusion/inclusion criteria, since there is too few literature available if we include polypharmacy in inclusion/exclusion criteria.

Finished the screening of the papers for the literature review.




exclude abstracts without full papers

search for PHR definition:

  • IMIA and AMIA working groups -> “consumer health informatics”
  • which if any EFMI groups have worked on PHRs
  • where does PHR fits in the working groups?
  • IMIA yearbook -2012 no.7: Write to authors and M. Rigby and ask about a definition of PHR. Mention that I have read the IMIA yearbook and extend to PHR


Write protocol to comply with BMJ open publication guidelines.


find papers:

  1. Basic concepts in medical informatics by Wyatt and Liu
  2. T. Greenhalgh: Synthesis of qualitative studies



find the impact factors of the chosen journals



I should add a PHR definition to the protocol.
Use the systematic literature review grade, to classify the narrative literature reviews.
Swap CASP for Joanna Briggs in protocol.
Email Helena Herrera and ask her: should we assume a relationship between medication adherence and control of chronic conditions such as asthma and diabetes? Could we call it a proxy?
Email Jim Briggs regarding moving of desks.
Draft the email to Nick Savage regarding open access publishing.
Had a look at the impact factors.


Sent the email to Nick Savage asking for money for Open access publication.

Secondary objectives: Change 2nd and 3rd objectives order.

Rephrase 3rd objective as: Explore how implementation factors affect the outcomes.



Realist approach

Discuss about methodology of my research

I justify the methodology that I will select by demonstrating the logic from my background

  1. overall paradigm
  2. ontology, epistemology in paradigm
  3. to end up to realist approach and mixed methods

Also PS approved my poster, and my data analysis method for my systematic literature review.



Discuss the echo opportunity.

draft an email for the echo CEO.

the subtitle data synthesis and analysis of the protocol to change, based on the analysis I need to finish in 2 days.

Complete initial write-up of literature review as soon as possible, we need to start discussing methodology and ethics.



Find the exact number of developed countries from WHO

Appropriate polypharmacy is….

Inappropriate polypharmacy is ….

All 3 authors (I, Philip, Helena) were collaborating on synthesis

We should invite Helena (2nd supervisor) to be a co-author and document her contribution.



The entire meeting was about the new project with Echo company.

PPI: patient and public involvement

if we only do qual then we can go small 30 to max 40 participants.

phase 1 qual study

Have a think about the interview questions (MS Word)

semi-structured interviews

The question is, if the qual results are enough to come up with a good qual study.

phase 2 quan study (see briston online services)


Time plan:

  • November 2017: costing + contract + PPI
  • Dec 2017: ethics submission before xmas
  • Jan 2018: start recruitment
  • Feb 2018: continue recruitment and do interviews
  • March 2018: finish interviews and do transcription
  • April 2018: Analysis

Don’t forget: I need something to record the interviews



pilot phase (individual interviews + focus group discussion)

measurement study (validate a mixed methods instrument)

what sample size ? I need PPI.


draft docs – > PPI review -> piloting -> ethics appraisal -> measurement study -> ethics again -> interview + survey?

Can I get enough data from interview to answer the RQs?



There is a lot of crap about worldview but from a pragmatism perspective.

People start from different places and give a neutral view

qual —— pragmatist ——– quan

axiology is covered by ethics?  + is it relevant i.e. feminism/ religius

constructivism + constructionism are considered the same here because. ….

objectivism is both ontology and epistemology whereas subjectivism is more limited to epistemology


Assume that the transcription will be supplied

backup plan for transcription video on youtube.

ethics approval (REC, HRA, R&D)



Final meeting for major review document.

mention P2020 it is a national policy it is important.

change to 30 mins interviews

I need quan contribution:

in data collection section, have a section for instruments. i.e. 1)semi-structured interviews and 2) quan survey which will be MMAS-4 plus my scale

use substantial variation instead of re-submit


technology is maturing to a point that affects policy: that’s why we elaborating on P2020.


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