Amazingly my 2 years of the LPTR Award will be up mid November 2007.  I really cannot believe that the practical work for this PhD started 2 years ago, the time has gone so quickly.  In some respects this year has been slow in terms of getting on with the data analysis; undertaking my Independent/Supplementary Nurse Prescribing course from Jan-July 2007 was challenging but necessary to keep my clinical skills and career up to date and on track.

The recommendations are that one should not change jobs mid PhD.........nevertheless if a job comes by with all the right opportunities and challenges one cannot let it pass!  Consequently I am on the move and am off to a new Nurse-led medical practice as their new Lead Nurse Practitioner.  As from December 3rd I will be working at Health E1 Homeless Medical Practice on Brick Lane, in Tower Hamlets.  This new post will provide me with new clinical challenges as I have no prior experience of working with the homeless or with people with substance misuse problems; hopefully my managerial and leadership skills will be adequate; but importantly I hope I can link my own clinical and and research interests into the interests of the practice and develop close working relationships between the practice and primary care academic units in London.  Changing jobs and having to sort out accommodation in London for a Mon-Fri commute has also been a distraction to data analysis and added to a slowing of the overall progress.  However, hopefully when I am ensconced in my studio flat Mon-Fri I will have plenty of time to work on the PhD...no more excuses then!

The Health Foundation have been very supportive and extended my Award by 6 months to allow completion of the data analysis and production of a final report for them.  The Health Foundation are a great organisation to be involved with, the twice yearly days for Award holders are also excellent, it is a shame that I will be unable to attend the December day as it is the day after I start at Health E1.

The ICCHNR Symposium in Granada was the first international academic event I have attended.  The simultaneous translations (Spanish-English, English-Spanish) were fascinating - I have great admiration for the translators as it must be a very challenging job.  Despite the distractions of the act of translation, the debates were very good and provided much food for thought.

The many posters on display were also all of a high quality, it was good to get positive feedback on my poster.  It certainly seems that there is an interest in the aspect of the patient experience of stopping antidepressant medication, reassuring to say the least.

It was also a great opportunity to meet up with London colleagues, old and new, to be able to share PhD progress updates and forthcoming plans.

The next ICCHNR conference is in 2009, in Adelaide.......

My supervision session to review progress with my 7 Framework pilot charts went well.  We reviewed the index framework and charts, no changes were made and it was agreed I should continue charting using index framework as per pilot charts.

We identified that there was a need to map the methodology; to map Kleinman’s 8 questions to the recurrent/important themes, the 5 parts of an illness, and the semantic illness network.  This should show any gaps in Kleinman’s questions which do not cover the breadth of the illness experience of people with depression.

We also identified some themes to explore:

- Do the narratives of the patients fit with an acceptance of depression; are their narratives contradictory or complementary, both within narratives and across narratives?

- What models to the patients have to explain their depression?

- Kleinman’s research was carried out in China, is there a cultural explanation for his 8 questions not explaining the whole of the patient depression experience?