, J. M. (2010). What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychology & Health, 25(10), pp. 1229-1245. doi: 10.1080 This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent 2What is an adequate sample size? Operationalising data saturation for theory-based interview studies AbstractIn interview studies, sample size is often justified by interviewing participants until reaching "data saturation". However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on Theory of Planned Behaviour, designed to identify three belief categories (Behavioural, Normative, Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or study-wise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Study-wise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies.

BackgroundDespite the availability of evidence-based guidance, many patients with type 2 diabetes do not achieve treatment goals. AimTo guide quality improvement strategies for type 2 diabetes by synthesising qualitative evidence on primary care physicians' and nurses' perceived influences on care. Design and settingSystematic review of qualitative studies with findings organised using the Theoretical Domains Framework. MethodDatabases searched were MEDLINE, Embase, CINAHL, PsycInfo, and ASSIA from 1980 until March 2014. Studies included were Englishlanguage qualitative studies in primary care of physicians' or nurses' perceived influences on treatment goals for type 2 diabetes.

PURPOSE Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) is an online eHealth system for patients to self-report symptoms during cancer treatment. It provides automated severity-dependent patient advice guiding self-management or medical contact and displays the reports in electronic patient records. This trial evaluated the impact of eRAPID on symptom control, healthcare use, patient self-efficacy, and quality of life (QOL) in a patient population treated predominantly with curative intent. METHODS Patients with colorectal, breast, or gynecological cancers commencing chemotherapy were randomly assigned to usual care (UC) or the addition of eRAPID (weekly online symptom reporting for 18 weeks). Primary outcome was symptom control (Functional Assessment of Cancer Therapy-General, Physical Well-Being subscale [FACT-PWB]) assessed at 6, 12, and 18 weeks. Secondary outcomes were processes of care (admissions or chemotherapy delivery), patient self-efficacy, and global quality of life (Functional Assessment of Cancer Therapy–General, EQ5D-VAS, and EORTC QLQ-C30 summary score). Multivariable mixed-effects repeated-measures models were used for analyses. Trial registration: ISRCTN88520246. RESULTS Participants were 508 consenting patients (73.6% of 690 eligible) and 55 health professionals. eRAPID compared to UC showed improved physical well-being at 6 ( P = .028) and 12 ( P = .039) weeks and no difference at 18 weeks (primary end point) ( P = .69). Fewer eRAPID patients (47%) had clinically meaningful physical well-being deterioration than UC (56%) at 12 weeks. Subgroup analysis found benefit in the nonmetastatic group at 6 weeks ( P = .0426), but not in metastatic disease. There were no differences for admissions or chemotherapy delivery. At 18 weeks, patients using eRAPID reported better self-efficacy ( P = .007) and better health on EQ5D-VAS ( P = .009). Average patient compliance with weekly symptom reporting was 64.7%. Patient adherence was associated with clinician's data use and improved FACT-PWB at 12 weeks. CONCLUSION Real-time monitoring with electronic patient-reported outcomes improved physical well-being (6 and 12 weeks) and self-efficacy (18 weeks) in a patient population predominantly treated with curative intent, without increasing hospital workload.

Background The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. Objectives To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. Search methods We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Selection criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. Data collection and analysis A minimum of two reviewers independently extracted data and assessed study quality. Main results Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second ‘in-house’ opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. Authors’ conclusions There are a limited number of rigorous eva...

Analysis 1.30. Comparison 1 Rehabilitation versus control, Outcome 30 TUG Test (by gender).. .. .. .. Analysis 1.31. Comparison 1 Rehabilitation versus control, Outcome 31 Walking speed (by risk of bias).. .. . Analysis 1.32. Comparison 1 Rehabilitation versus control, Outcome 32 Walking speed (by duration of intervention). Analysis 1.33. Comparison 1 Rehabilitation versus control, Outcome 33 Walking speed (by mode of delivery).. . Analysis 1.34. Comparison 1 Rehabilitation versus control, Outcome 34 Walking speed (by baseline walking speed). Analysis 1.35. Comparison 1 Rehabilitation versus control, Outcome 35 Walking speed (by age).. .. .. .. Analysis 1.36. Comparison 1 Rehabilitation versus control, Outcome 36 Walking speed (by gender).. .. .. . Analysis 1.37. Comparison 1 Rehabilitation versus control, Outcome 37 Walking speed (by distance walked).. .. Analysis 1.38. Comparison 1 Rehabilitation versus control, Outcome 38 Death (by risk of bias).. .. .. .. Analysis 1.39. Comparison 1 Rehabilitation versus control, Outcome 39 Death (by duration of intervention).. .. Analysis 1.40. Comparison 1 Rehabilitation versus control, Outcome 40 Death (by mode of delivery).. .. .. Analysis 1.41. Comparison 1 Rehabilitation versus control, Outcome 41 Death (by age