.......99,949 - so happy to see this number!! If nothing else this week I have managed to reduce my word count by 7000 words so now under the magic 100,000 words. Chapter 4 reworked and discussion around theoretical framework possibilities simplified and reproduced as a table - I think looks and reads better - saved some words there. Now to return to the discussion chapter (again) - needs further reworking/rewriting - still too much repetition, need to improve linkage and critiquing of other literature to my study findings. I have also had a suggestion that I need to look at the literature on GP-patient relationship in concordance. Hope to save a good few words with rewrite of this chapter too. Well this week gone was my final study leave so now have 2 weeks max to get thesis finished, proof read, printed, bound and off to UCL.

Nothing back yet from PhD supervisors with feedback on draft of thesis so getting on with proof reading and reorganising the literature reviews. I am still approx 3000 words over the limit so trying to reduce any waffle and move tables to the Appendices - surprising how long this takes. This afternoon I am going to rework the methodology chapter again - still not happy with it and need to make sure I include evidence of presentations and posters where I have received feedback at the various stages of this journey. Hope I hear soon re my draft - time is running out fast now.........

What a weekend - IT - aaghhhh!! It all started at the end of last week when the table of all non-pharmacological treatments for depression was completed and looking good.......I then tried to embed this into my thesis but would it go in properly - no!! I think because of my fancy merging of cells to make the table look good. Once merged there is not an 'unmerge' option in Word.......you have to split cells. Anyway, long story short - did it work - no! So I still have a table I need to get into the thesis - it has to be embedded as it is heavily referenced so I need Reference Manager to pull all the references out. Option - to do the table again but this time in the thesis - not ideal to say the least. Next problem was Saturday afternoon when my large 250 + page thesis crashed - autorecover would not bring up the recent work and would only bring up a corrupted file - wanted to weep!!! Anyway.........with the help of husband, daughter and her other half managed to find where Word saves autorecover files. Found an uncorrupted version which was about 3 hours old so none of the work I had done that afternoon was in it......but it was a starting point and with reasonable speed managed to repeat that piece of work. I now have multiple copies of this file being saved - autorecover (which was already on) plus I now have Word back-up on as well as manually saving a back-up version myself. The third major problem of the past few days was yesterday when I finally had a draft thesis to send to my PhD Supervisors - the 277 page document has now made itself enormous - 269MB enormous! I have no idea how or why........ Even a zipped version was still 51MB big - I tried sending from Norfolk with our very slow broadband - it blocked my outbox for 3 hours and never went anywhere. So I now had a thesis I could not send anywhere easily. Eventually got it into Dropbox - but took 3+ hours to save it to that. One of the PhD Supervisors was able to access the thesis via the email link I sent, the other couldn't and got a corrupted file. he asked for me to re-upload - the thought of another 3 hours for this to happen........ Anyway, first supervisor then responded with the thesis attached as a PDF file - all of 2MB!!! Why did I not think of doing that.......would have saved a load of time and considerable amount of effort I must say. Today - having trawled Microsoft help and support I found a link to what to do about very large documents - open a new document, format it as you want it and then copy and paste original into the new - hallelujah!! I now have a document that is only 8MB - much more reasonable to work with and send anywhere. My poor laptop will now be able to work seamlessly with this rather than keep crashing as it tried to save the previous version. I think the problem arose from styles formatting - who knows!!

Draft done and gone for review.......... Now reworking discussion chapter whilst I await feedback (nervously!). I have one week study leave next week and that will be it - will need to get the thesis completed, proof read and corrected and bound and sent off by end Jan/first week February at the very latest. Mock viva - 31st January.

Logged onto NVivo as part of my rewrite of the Findings Chapter for it to fail to start.........I got a message about SQL not being found. Panic of the major order ensued! This is not the first time NVivo has been problematic. I have previously had to reload NVivo, reboot my system from an earlier save point and even had to give the NVivo team based in Australia remote access to my laptop to solve the quirky but catastrophic problems that Windows upgrades occasionally seem to cause. I really, really do not want anything like this happening now......time is precious and it is so time consuming trying to resolve IT issues, easily half a day or more sometimes. All my data and analyses are embedded in NVivo so I would be completely lost without it. The good news - a reboot of the laptop plus a few prayers and thank God NVivo worked. Too close for comfort, but NVivo survives another day.

Discussion chapter is nearly there. Positive feedback from Supervisors this week, still a bit more editing to be done and need to make it an easier read. I am now working on the rewrite of the findings chapter and then plan to do rewrite of literature review chapters (2 of them), so will do next revision of the discussion chapter after this as some of discussion chapter may duplicate parts of the lit review or if not may be able to move some sections into the lit review. Full draft of thesis to Supervisors by end of year.......

"If a cluttered desk signs a cluttered mind, of what, then, is an empty desk a sign?" Albert Einstein. Just love his quotes. So looking at my desk, what do I see? Piles of papers and books on it, under it and to the sides of my chair. Makes for a cosy sort of feeling I think. Can get irritating though when I don't even have a space for my cuppa tea, or wheel back on my chair over some eminent person's academic paper. Trouble is, when you clear everything away into some sort of neat order you then have to spend hours finding the paper you now so desperately need - and you knew which pile it was in previously........moral of that story, maintain the clutter! There is logic and organisation to chaos - well the chaos of my cluttered desk at least! Comfort in the knowledge I am surrounded by knowledge - perhaps it will all leap off the pages onto my thesis pages. There's a thought - perhaps the new iOS 'Siri' could write my chapter for me - simply give her the command and leave her to my knowledgeable (cluttered) desk, the information is all there. Empty desk? Empty mind? Happily no - not in my flat today. But I do need to do some writing.

10 years ago.......September 2001 is where this academic journey all began. It was our first week on the MSc Primary Care, a web-based distance learning degree at UCL; the inspiration and product of Prof Trish Greenhalgh. The first week was London based, many of us spent the week in student accommodation at Aston House - somewhere near Euston as I recall. Rooms were small and bleak with shared shower and toilet facilities down the corridor - as near as a prison cell as I can imagine (not ever having been in a prison cell I hasten to add!) The week was amazing - Sunday night no-one knew each other and by Friday it felt we had known each other for a lifetime. That MSc took up the next 3 years of my life and led me onto the PhD which is nearly finished....... So 9/11 - it was just after 2pm and we were all in the basement of the UCL Archway building on the computers being taught how to use WebCT. One of my colleagues got a call/text from her partner from a newspaper newsroom to say something major was happening in NY. Anyway, long story short - we picked up on events that afternoon and then when we went back to Aston House and found the TV room for the first time we were able to absorb the enormity of what had hapeened - shocking newsreel as everyone knows. We had all planned to meet up for a meal and drink at a local hostelry that evenign and needless to say TVs were on and we continued following the news coverage there. The following days in the rest of that first week of our MSc were in part very surreal - the airspace over London was completely cleared and suddenly the skies above Archway were empty. You don't notice the planes when they are there but you certainly miss them when they are gone! For me the week of 9/11 coincided with the beginning of a 10 year journey into the world of academia - I am still a clinician but trying to be just a little bit of an academic and still with the aim to make sure clinical research is what it says on the tin. It is the clinicians who know where the problems are and what needs to be researched in order to improve patient care and make it evidenced based; it is the clinicians who need to be doing research too. All sorted for GP academics but still nothing established for nurses in the same way. So memories of that fateful week back in September 2001 - happy ones but sad ones too. A week that certainly changed my life.

All social engagements cancelled forthwith! Have I got time to go back to work next week - no not really but is that an option -no. I am currently trying to think of innovative ways to get more time out of the full time job back at Health E1 - I will discuss these next week with my Practice Manager - no guarantee they are realistic though - we shall see......... So what is left bearing in mind that I do need to sleep even though that has eluded me somewhat this week - in bed by half past midnight and yet wide (that's debatable!) awake at 6.30am with discussion chapter thoughts already in my head (did they ever leave I ask) alongside a sense of rising panic that I will ever get through this PhD. Back to what is left to do - I can cancel all life other than work and sleep - seems only option and thereby reasonable. I have already sent apologies and flowers to an anniversary celebration I should be attending tomorrow, I will be taking a rain check on a weekend away in November to friends - hopefully reschedule for Feb 2012 in that brief gap between thesis submission and viva. The only other social events are a visit 'p North' to visit daughter and partner next weekend - can't cancel that but can work on train journey there and back and whilst visiting - they will hopefully understand; and finally a long weekend in Belgium - booked and paid for so cancelling not an option there either. Still I am sure Eurostar will be an inspirational place to work as will the hotel room in Namur.....at least the other half can wander off and keep himself amused and I will of course join him some of the time and certainly for R&R in the evenings - I wonder what the food and wine is like in Belgium, mind you will I really care!!!

Drat or words to that effect.......more work to do! My personal referencing preference is to use BMJ style referencing so this is what I have used all through the thesis to date. However, on looking through awarded PhD theses the other day I noted that they all use Harvard referencing style. I can see this must be much easier for the reader/examiner as there is no need to keep turning to the references at the back of the tome to see what reference '1' or '233' actually is. So I asked my supervisors what is best to use - 'what will please the examiners most?' - I want happy examiners at the viva! Their answers - both? Harvard, so Harvard it is! I do use Reference Manager so simply need to change the settings in the RefMan programme - that's easy to do.......but the thesis is slightly more work as the referencing works differently - so will need to go back and review all referencing and how it is inserted into the text....... Another thing to do on the To Do list........

Too much temptation to twitter, tweet, take tea, trips to loo etc etc What is it about the time one knows one should be reading, writing, thinking etc but all those distractions come along to take you away from the task in hand? The temptation to check FaceBook - again! To log-on to Twitter and see what's trending, add a little tweet of my own here and there! Tea - awash with it but every cup tastes good......so of course, then multiple trips off to the toilet - what goes in must come out! Time off work this week - the discussion chapter needs to be finished and sent off to supervisors by next Monday - no time to delay, prevaricate, twiddle and tweet about. Time to get on - back to work!

Loving it! Writing up the discussion chapter is really enjoyable. Reading around my 4 core themes is fascinating. Feels like all the disparate bits of info in my head, previous discussions with my Supervisors, and research findings are all coming together at long last. The chapter is still very much a combination of reading notes and a stream of consciousness but definitely something of substance there to work with and pull together into a meaningful whole. After all, this needs to be the 'new knowledge' that the PhD has to demonstrate it has found. Pondering as to whether to call the discussion chapter 'Discussion Chapter' or whether to use the phrase 'Synthesis of Findings'.........I am currently calling my 4 themes: - Name Giving - Illness Cause......or possibly Illness Attributions - Illness Narrative.......or Illness Coherence - Treatment and Control of the Illness I think it will all become clearer once I have a finished chapter.

Well, that's it then. Examiners confirmed and date for the Viva is confirmed for afternoon of Thursday 15th March 2012. So near.......have double checked the UCL thesis guidelines........ Thesis must be 100,000 words max; page formatting as per guidelines spec and two soft bound copies submitted at least 4 weeks before the viva date. Realistically this means I have until the end of January 2012 to get the thesis complete......mock viva scheduled for Tuesday 31 January.

Well at least one person reads this blog! Have been reminded that no post since March. So, message to self - must do better! If I think of this as a distraction from the PhD I might well do better at remembering to update the blog and record my thoughts and progress. Facebook and newly rediscovered Twitter are distractions enough.......I personally call them my R&R time but need to get the balance right!! Now late at night with meetings galore scheduled for tomorrow, plus a walk-in clinic squeezed in between, but will definitely update the blog with PhD progress in the next couple of days....... Thank you to my loyal reader :-)

What is health - a quality rather than a fact. One persons construct of health will not be the same as another's. What does the term health encompass - physical, mental, emotional etc. Not just the absence of disease. Someone with a long term disease which is well-controlled may consider themselves healthy - health is relative. Lots of theoretical definitions and the 1948 WHO definition still stands although academics critique its continued validity as it consists of general concepts that are in themselves impossible to define. WHO def: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Western definitions of health are not necessarily the same as other cultures..........hmmmmm.... ..............so back to writing that chapter...............

Edmonton is the venue for the ICCHNR Conference in 2011. My abstract was not accepted as it does not coincide with the conference theme. No worries, I am still attending and plan to make it a 3 week trip to W and NW Canada - too good an opportunity to miss. It will also provide the opportunity to network with colleagues - all helps to fuel the motivation and enthusiasm.

So what have I achieved over the past 18 months - really cannot believe it is that long since I last posted......... The Australia 2009 ICCHNR conference went well. My presentation was on the Wednesday and I felt really jet-lagged that day - not the best feeling when having to stand up and present in the main hall! The presentation findings were new ones and I must say I felt less confident than on previous presenting occasions. Having said that, it was well received and individuals engaged in a short Q&A session at the end. In 2010, I attended the SAPC Annual Conference in Norfolk. This was the first time I had been to this conference for a couple of years so really good to meet up with colleagues and acquaintances and make new contacts. Salsa dancing with a female colleague as my 'man' was a good laugh, I really do have 2 left feet and the ability to remember dance steps is not my forte!! I had a poster presentation at this conference which was well received. That sums up the past 18 months worth of dissemination.

2011 New Year resolution - the one and only - is to complete this PhD this year! The past year has been very hectic with work and home - so much so that the 6 months from July 2010 until January 2011 saw no progress with the PhD. Something had to give and sadly the PhD had to take a backseat for a while. Work is no less hectic but home sagas are hopefully under control and/or resolved - this gives me 'head space' to think, work and write. Supervision a couple of weeks ago has helped set a clearly defined timetable - a chapter a month from now on with 1st, 2nd and 3rd drafts completed by year end. Feels good to be working on this again - I have missed it. The break was obviously necessary but it feels good to be back doing this because I want to, as well as because I have to. Not completing is not an option!

At last - tickets booked!  Flights confirmed and off to Adelaide for the ICCHNR Conference.  My presentation is scheduled for the Wednesday and I now need to get it prepared.....most of the work is done.

Should be a great trip - 6 days in Adelaide, then off to Melbourne for the weekend and then off to Sydney for 10 days.  Flight home is via Singapore with a stopover there for 3 days.........

Can't wait!!

UCL lunchtime seminar last Monday - it went well I think.  There was a reasonable number of people attending and they all appeared interested in the work. The post presentation discussion raised some interesting points for further thought and consideration:

- Actor network theory (Callon and Latour, 1986)
- Self - if people can cope in public, then why not continue to cope when in private?
- Restoration or Cure?  What is the difference?  The difference in this study appears to be antidepressants, no cure if still needing antidepressants.~
- What are the messages to clinicians from this work? An understanding of the problems some people have in stopping antidepressants after long-term use.
- Methodological questions: clarification around the inclusion and exclusion criteria; those groups not included in the interviews may have had a view to discuss; cultural issues.

Thanks to all for attending and for your feedback.

Two articles published as advanced practice pieces in May editions of Practice Nurse.  Good to see work undertaken in my literature review transformed into publications.  Will be able to add them to my thesis appendix too.

Doubting my abilities and capacity to take this forward....can I really dig deep into the data and come up with meaningful conclusions?  Finding it difficult to find the time to think and focus and then when I do to get my head into gear and think and concentrate........  Hmmm.........

Seminar booked for Monday 6 July at the RFMS.  Need to get my title and abstract submitted and then put together a presentation for the session.  The key aims of the seminar will be to test my theory of what the data is saying and get feedback from my audience.  Hopefully I will be asked pertinent questions and have any omissions highlighted.  Best to get asked the difficult questions now and have any errors and omissions pointed out now rather than at the viva!

Good supervision session today.  Really beginning to feel that I am putting a thesis together now.  Plan now is to revisit the Yellow Chapter and interrogate the data further and to summarise the chapter in my own words.  Supervisors suggestion is that I do that before pressing on further with the Turquoise Chapter.  The intention then is for me to compare and contrast my conclusions from the Yellow Chapter with Kleinman's 5 Parts of the Illness Experience which is the Turquoise Chapter.

Whilst reading Kleinman's book 'Pateints and Healers in the Context of Culture' in preparation for writing my Turquoise Chapeter, I came upon a series of concepts that I found both interesting and relevant to the PhD.  I have recorded them here as a way of being able to re-access them in the future:

~ Healthcare activities need to be studied holistically in the context that they are socially organised responses to disease
~ Medicine is a cultural system - a system of symbolic meanings anchored in particular arrangements of soical institutions and patterns of interpersonal interactions
~ In every culture, the responses to illness by the individuals experiencing it, those treating it and the social institutions relating to it are all systematically interconnected
~ The totality of the relationships is the healthcare system

Two key writers I need to visit/revisit are Zola (1972) and Illich (1975) who both write about the medicalisation of society.

Giddens (1976) also has something to say: the cultural analysis of any concrete aspect of the social world should attend to the effects produced by the interplay of 3 types of forces:

~ Meaning
~ Norms
~ Power

The power differential between the sick role and the therapeutic role is an ideal example of this.

Yellow Chapter first draft finished and now half way through Turquoise Chapter.......the colours really are meaningful at this stage of the write-up - needless to say they will not be the final chapter names......  The colours for chapters came about from an earlier mind map which identified what I needed to develop in the thesis and which bit linked to what etc.  Colours to follow are the Blue and the Red Chapters....

Have now registered for the ICCHNR conference in Adelaide and booked hotel for the week.  Just need to plan the rest of the trip following on from the conference - will go to Melbourne for first weekend and then onto Sydney for 7-10 days.  Once planned I can then book flights.......will be an interesting trip, especially as I have never been to Australia before.

Yay!!!  PhD supervision today - ramblings re. first 2 questions in draft 'yellow chapter' described by one supervisor as 'intriguing' - feels great, thankfully not told they were rubbish.......  Really enjoyed the writing - well more a stream of consciousness at this stage but feels good to be putting a thesis together at long last.  Now need to get down to writing up questions 3-8, have until beginning of March to get this done but hope to be finished with this first chapter draft well before then.

Really exciting to be getting ideas out for discussion - exploring what might be new and what simply reinforces known knowledge - debates with supervisors good too - all of a sudden beginning to feel as if on same level and can hold my own..........

......abstract accepted.........Health Foundation monies secure - am off to Adelaide in August 2009!!

The time has come to start to put a story together.  The previous months and years since 2005 when I started this PhD have been spent getting the data and then breaking it down, finally the time has come to tentatively put words together to create a story that does justice to people's  narratives about the depression in their lives.  Small steps initially, so will be starting with the first two of Kleinman's 8 questions - feedback from my PhD Supervisors will give me an indication as to whether I am on the right track.

Christmas is the deadline for this first piece of writing........

At last........my final monies from the LPTR Award are secure and can be accessed for ongoing dissemination.  The Health Foundation have been brilliant and have come to an agreement within their organisation to let me access the final monies via them rather than via the original contracted arrangement.  Great news and thanks to them - means that my dissemination plans for 2009 and beyond should hopefully materialise.

Health matters and Healthmatters is an excellent quarterly publication that publishes pertinent articles relative to the current health agenda.  I was asked to submit an article I wrote about the Kirsch paper in PLoS regarding antidepressants and their benefit in depression.

"Antidepressant Medication Data: Why has something that was already known become a media circus years later?

The recent article published in PLoS by Kirsch et al (1) which reported the results of a meta-analysis of the evidence submitted to the Food and Drug Administration (FDA) re efficacy of the SSRIs is not new news.  This is the third article published by Kirsch which has focused on meta-analyses of antidepressant medication, the first article was published in 1998 and the second article published in 2002.  So why did the recent publication in PLoS create such media interest with coverage on national radio, TV and the press?"

If you want to know the answer to that question you can either find yourself a copy of the Spring edition of Healthmatters or patiently wait for me to attach a copy of the article to this blog.......I am still waiting for the pdf...........it's here now.....see attachment.

 

 

Why NVivo 8?

NVivo 8 - computer aided qualitative data analysis software (CAQDAS) - has been bought as an upgrade to N6 which I already have and had used for the analysis of my questionnaire data many moons ago.  Having completed the charting I was somewhat daunted by the numerous charts and data embedded within them - how on earth was I going to be able to get my head round all this data particularly considering the fractured way in which I have to work i.e. the norm of a part-time PhD, and then to do the data justice as well as the interviewees who had given of their time as well as their illness/depression stories.  So....after thought and consideration and discussion with my PhD supervisors I decided that using NVivo would enable me to more easily work with my data in a structured and consistent way and it would help me work within the constraints I currently have.

Benefits of NVivo 8

- Provides a recognised and consistent method to underpin my data analysis
- It is a logical process that I can track back to understand how and why I have got to where I have in the analysis
- It facilitates a rigorous analysis process

As a tool, NVivo is a complexity aid to assist with the process of the data analysis; it will allow me to maintain the momentum of the data analysis as I will be able to revisit and regroup my thought processes and assumptions over time.  The ability to complete a journal within NVivo will also allow me to document my thoughts and actions as they develop throughout the process; I will be able to identify personal goals and hopefully recognise assumptions and experiential knowledge and thus allow me to develop a critical subjectivity towards the data and its analysis.  It is important to remember that prior assumptions do exist so by recognising them and recording them I can become more aware of their influence on the way I am thinking and subsequently then assess their impact on the analysis.

 

Framework was developed by Ritchie and Spencer in 1994 (see below for full reference); it is a systematic approach to data analysis which is transparent and reproducible - the data is sifted and charted according to key issues and themes to facilitate the determination of meaning, salience and connections from the data. Framework is useful when the questions of a study are clearly known and it is an approach to data analysis that has been validated in studies of this kind.  Framework has certainly provided me with a structured tool with which to undertake my data analysis.  Having already previously worked with Framework it has been useful to understand how it works  form the outset.  Listed below is a summary of the stages of Framework; I have also attached the Framework flowchart which shows how all the parts link together.

Familiarisation

- Read proposal
- Read transcripts
- Review topic guide

Identify Recurring & Important Themes

- Develop a working framework of key themes and sub-topics

Indexing

- Apply a numerical series to working framework
- Label or code transcripts numerically
- Adapt framework in light of gaps or overlap

Pilot Charting

- Chart a few transcripts using working framework
- Adapt framework in light of gaps or overlap

Charting

- Summarise / synthesise verbatim data within finalised thematic framework

Abstraction

- Analyse and theorise using NVivo 8

Investigation & Interpretation

Having got to the abstraction stage I realised that I was going to struggle to continue working with my data now that it was in the form of the charts - either electronically as spreadsheets or in A3 paper format  - too much information to try and work with in an intermittent way..........I knew I needed help and decided to look into putting my spreadsheets into NVivo 8.  NVivo 8 is QSRs latest software that is able to embed all Word format documents and also pdfs - sadly though not Excel.  However, I worked out a way to save my spreadsheets as Word docs and these can then be imported into NVivo - NVivo seems to be the answer.........

 

Framework Reference:

Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In Bryman A, Burgess RG, eds. Analysing Qualitative Data, pp 173-94. London: Routledge, 1994

 

A bit of a slow month - relative to the PhD anyway...... Life events have taken over to a considerable extent with the 'oldies' having an accident and weekends thus spent visiting etc.  Fortunately they are recovering well and should be back to some sort of normality over the next few weeks.  However, the events of end of May do highlight how little flexibility I have with my time, certainly no spare capacity - so PhD time has been taken over with needs of family.

I have been thinking through about how best to manage and cope with all my data I now need to analyse - part-time working means I have a disjointed approach to analysing my data and I need to somehow keep on top of my analysis and my thinking as to where the data is taking me.  This is not going to be easy to manage and is certainly a major concern I have.......

The NVivo workshop I attended last week (courtesy of NELCRAD) was excellent; NVivo 8 could well be the way forward and help to allay some of my concerns.