On Taking a ‘Mental Health’ Day

The idea of a ‘mental-health’ day was first introduced to me at the age of about 16 when the film Nick and Norah’s Infinite Playlist came out. The film starts with Michael Cera’s character, Nick, taking a ‘mental health’ day from school, which finds him burning mix CDs in honor of his lost love. Predictably, 16 year old me thought this film was amazing. At the age of 25 I haven’t watched it since, and I suspect I might not have the same feelings about it – so don’t take this as a recommendation.

Anyway.. at that point I didn’t reallyget  mental health days – I thought they were designed as a way to get out of school/stuff you didn’t want to do, and that you spent the day overdosing on carbs and feeling sorry for yourself. Turns out, that’s not (always) the case.
Confession time: I took a mental health day last week. My relationship isn’t crumbling, my family are mostly fine, and my friends are all just as sassy and hilarious as usual – so what prompted this? Honestly, I just felt really overwhelmed.

My PhD is on track, I’m still really enjoying the work, and I feel like I’m making progress at the right pace – whatever that is. One day last week I just wasn’t feeling it though. My alarm went off and I did the usual email-checking whilst still in bed, I got up, got ready and had breakfast as normal, and then I didn’t go into work. Instead I got some house jobs done (anyone else’s boyfriend not know that bedding should be changed regularly?!), I watched some really terrible TV, and I slowly got on with some of the less-brain tasking things on my to-do list. On paper, it wasn’t the most productive day.

The next day I went back into the office with a new sense of determination, I felt motivated again and I was excited to go to work. I don’t take these mental health days very often, but sometimes it’s really important to. If I hadn’t I can guarantee I’d had been horrendously unproductive, and grouchy and annoyed at myself as a result. So I guess the point of this post is to highlight the fact that everyone needs space every now and again, even if they do love their work. If you genuinely need a day away from whatever you’re doing then take time to step back; I was really glad that I did, and shockingly, the world didn’t stop when it realised I wasn’t sitting at my desk for one day.

Freelancing Whilst Doing a PhD: The Good Bits

Outside of PhD life, I work as a freelance copywriter – yep, full-time PhD plus some-of-the-time writer. This week has probably been my most difficult yet, freelance-wise that is. I had to put my big-girl pants on and tell a client I wasn’t working with them anymore because they were messing me around with deadlines and not replying to emails. I really didn’t like doing it; I still feel like I’m about 12 years old and I’m reluctant to look like a kid stomping her feet because she didn’t get her own way. ANYWAY. Usually I love freelancing, so I thought I’d give a run down of the good bits of freelance life, what you get from it and why it’s a valuable thing to do even whilst trying to get a PhD – both to give some information to anyone looking at starting to freelance, and to remind me why I love what I do again. Of course, the bad bits of freelancing deserve their very own blog post, so stay tuned for that in a few weeks!

£££. Let’s just get this one out of the way early one – additional money is always helpful when you’re on a PhD stipend. I’ve mentioned previously that I love to travel, and any extra pennies come in handy for that. Linked to that is the process of putting a price on your work; at first it’s really weird, and it can feel awkward. It’s important to remember that your time is valuable, you’re spending time and effort on whatever project you’re working on, and you should be rewarded for that fairly.

Building skills. I was freelancing for a year whilst finishing my undergraduate degree and I thought my organisational skills were pretty good; I was also juggling a structured part-time job too. Turns out it’s not a patch on juggling everything that comes with a full-time PhD and freelancing! That said, it’s a good sort of hectic. I find I get more done if I have more to do – I work best to a deadline, so everything goes on one to-do list and it all gets done eventually. As well as being Queen of Organisation I’ve also had to develop the skill of invoicing, chasing invoices when they’re not paid on time (more often than not), and crafting the perfect ‘I’m pissed off because you haven’t done something you said you were going to so can you please do it now’ email. All good skills – the perfectly crafted stroppy but polite email has served me well when trying to get PhD related stuff moving too, though I should note I’ve only needed that when contacting people for approvals etc, no one that’s in my research group! Freelancing also forces you to write when you don’t feel like writing. Throughout the course of a PhD it’s important to keep writing, writing is the way that we as scientists communicate information, so waiting to write until you ‘feel’ like writing isn’t always possible. Getting used to  consistent stream of writing-related deadlines (sometimes 3 or 4 a week) means PhD-related writing suddenly comes more naturally.

Learning. Before PhD life I was based in a wet-science lab – doing what people think of as ‘proper’ science, in a laboratory and everything. My project now is office-based (I have a guest post coming up on Soph Talks Science about that later this month so head on over there to see how office-life differs), but that doesn’t mean I’m not interested in what’s going on inside the labs around me, or even across industries that are loosely linked to my PhD work. For example – a few of my clients are based in recruitment (staffing type recruitment, not participant recruitment which is what my research focusses on), and their techniques may be useful for participant recruitment in some way. Another client I work with are involved with routinely collected data – an area that could have direct implications on the way we recruit participants to trials. So it’s all useful, it’s extra knowledge that I wouldn’t have if I wasn’t doing it – and I think that will definitely strengthen my own research.

Have you thought about freelancing whilst doing your own research? If you have any questions please let me know and I’ll be happy to answer them (if I can!).

5 TED Talks Every PhD Student Should Watch

In lots of posts on this blog I’ve told you about my experiences, my advice and things I’ve learned during the process of my PhD. I thought it was about time I shared part of where I get my advice from; TED talks. They’re usually pretty short, and they give really good information in the form of research snippets, life lessons and ideas worth spreading. These are the 5 talks I’ve watched multiple times throughout my PhD, I suggest you watch them too.

Shonda Rhimes: My year of saying yes to everything

“The nation I’m building, the marathon I’m running, the troops, the canvas, the high note, the hum, the hum, the hum. I like that hum. I love that hum. I need that hum. I am that hum. Am I nothing but that hum? And then the hum stopped. Overworked, overused, overdone, burned out. The hum stopped.
When to watch: When you’ve lost your hum, when the PhD gets too much and when you don’t think you’re capable anymore.

Celeste Headlee: 10 ways to have a better conversation

“I came to realize that conversational competence might be the single most overlooked skill we fail to teach. Kids spend hours each day engaging with ideas and each other through screens, but rarely do they have an opportunity to hone their interpersonal communications skills. It might sound like a funny question, but we have to ask ourselves: Is there any 21st-century skill more important than being able to sustain coherent, confident conversation?”
When to watch: When you’re feeling nervous about going to a conference/networking event, when you’re freaking out about looking like you know what you’re talking about.

Alan Smith: Why you should love statistics

“Very often, we talk about statistics as being the science of uncertainty. My parting thought for today is: actually, statistics is the science of us. And that’s why we should be fascinated by numbers.”
When to watch: When you’re at a point in your PhD that requires statistics, and you really hate statistics.

“I could not believe I had pledged allegiance to research, where our job — you know, the definition of research is to control and predict, to study phenomena for the explicit reason to control and predict. And now my mission to control and predict had turned up the answer that the way to live is with vulnerability and to stop controlling and predicting.
When to watch: When you feel nervous, anxious or not good enough in some way. When you feel vulnerable and you just want to ‘solve’ that feeling and move on.

Diana Laufenberg: How to learn? From mistakes

“They were a little uncomfortable with it, because we’d never done this before, and they didn’t know exactly how to do it. They can talk — they’re very smooth, and they can write very, very well, but asking them to communicate ideas in a different way was a little uncomfortable for them. But I gave them the room to just do the thing. Go create. Go figure it out. Let’s see what we can do.”
When to watch: The quote above refers to American school kids – but it could just as easily be about PhD students. Watch this when you’ve got bad feedback, when no one’s replying to your emails, when your ethics approvals have taken twice as long to come back that you thought they would.

#365papers March Update

In my first post on this blog, I set myself 3 PhD-related goals for 2017. One of those goals was to read more widely, and more frequently, and I decided that doing the #365papers challenge would be a good way to do that.

Here’s my March update. I found this month reallt difficult to be honest, I was super busy with other things at work and didn’t feel like reading when I had a to do list longer than my arm. I missed a few days in a row and towards the end of the month when I had 10 papers to catch up on, I was making excuses and looking for ways to wriggle out of the challenge. I didn’t though – hoorah! I made time to read and now I’m all caught up.

March’s reading:

  1. Promoting recruitment using information management efficiently (PRIME): study protocol for a stepped-wedge cluster randomised controlled trial within the Restart or Stop Antithrombotics Randomised Trial (RESTART)
  2. A little more conversation please? Qualitative study of researchers’ and patients’ interview account of training for patient and public involvement in clinical trials
  3. Are there fundamental deficiencies in megatrial methodology?
  4. Managing clinical trials
  5. From protocol to published report: a study of consistency in the reporting of academic drug trials
  6. Understanding controlled trials: why are randomised controlled trials so important?
  7. Understanding controlled trials: baseline imbalance in randomised controlled trials
  8. Understanding controlled trials: randomising groups of patients
  9. Using marketing theory to inform strategies for recruitment: a recruitment optimisation model and the txt2stop experience
  10. The natural history of conducting and reporting clinical trials: interviews with trialists
  11. Understanding controlled trials: what is a patient preference trial?
  12. Strategies for increasing recruitment to randomised controlled trials: systematic review
  13. Why clinical trial outcomes fail to translate into benefits for patients
  14. Blog – How marketing is undermining clinical trials
  15. Marketing trials, marketing tricks – how to spot them and how to stop them
  16. The changing face of clinical trials: pragmatic trials
  17. Equipoise across the patient population: optimising recruitment to a randomised controlled trial
  18. Why prudence is needed when interpreting articles reporting clinical trial results in mental health
  19. The possibility of critical realist randomised controlled trials
  20. The association of funding source on effect size in randomised controlled trials: 2013-2016 – a cross-sectional survey and meta-analysis
  21. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review
  22. Registry-based pragmatic trials in heart failure: current experience and future directions
  23. Barriers to recruitment in pediatric obesity trials: comparing opt-in an dopt-out recruitment approaches
  24. Sharing raw data from clinical trials: what progress since we first asked “Whose data set is it anyway?”
  25. Pharmafile Opinion – Are we prepared for the ‘real world’?
  26. Experience with direct-to-patient recruitment for enrollment into a clinical trial in a rare disease: a web-based study
  27. Financial Times article – Small patient groups hinder progress of clinical trials
  28. Fast Company, 3 Minute Read – This compay is helping patients get paid for their influence
  29. Recruitment of minority adolescents and young adults into randomised clinical trials: testing the design of the technology enhanced community health nursing (Tech-N) pelvic inflammatory disease trial
  30. When clinical trials compete: prioritizing study recruitment
  31. The continuing unethical conduct of underpowered clinical trials

If you have any recommended reads that are related to clinical trials/methodology/health services research and that kind of thing, I’d welcome them!

Doing a Systematic Review and Not Being Beaten by Piles of Paper

As with most PhDs based in Health Services Research, my project started with a systematic review. This seems to differ hugely from lab-based PhDs which (from my experience anyway) largely begin with traditional literature reviews. Not sure what the difference is between the two types of review? I’ll point you in the direction of this blog post from Students 4 Best Evidence. In short, systematic reviews can take an absolute age and they require a certain level of patience and persistence that I didn’t realise I had.

Last year HealthPsychTam posted two different posts talking about her experience of doing a systematic review. ‘A Confession…’ which was a brutally honest post about the feeling of wanting to drop out, and ‘Conducting a Systematic Review’ with lots of absolutely brilliant tips on getting through the process. I’d recommend you read both. In this post I want to add to Tamsyn’s experiences and give my own thoughts on the process so far.

What do I aim to achieve with this review?
My primary PhD supervisor has a Cochrane review that looks at methods to improve recruitment to randomised controlled trials, and mine is sort of the mirror of that review. It looks at methods to improve recruitment to randomise controlled trials that are evaluated using only non-randomised evaluations. We know there’s a lot of publications that cover this topic, but as yet there has been no systematic review including only data from non-randomised studies.

What stage am I at now?
Currently I’ve published the protocol for my systematic review (huge gold star to my supervisor for encouraging me to do this – it was a massive motivator), I’ve finished data extraction and we’re now tackling the task of data analysis and synthesis. In very simple terms, I have created a large pile of paper that I now need to shape into something useful.

Things I wish I’d known at the start that I know now

  • Search strategies can never ever weed out all the studies you don’t need
    I worked with an Information Specialist to create my search strategy – put bluntly, I am not an expert in search strategy development and the Information Specialist based in our unit is. She was brilliant to work with, and she made the whole process much easier and quicker than if I was going to figure out how to do this whole thing myself. Still, search strategies can never be perfect and you will always end up with a big pile of studies that won’t make it into your review. I began with over 9,500 abstracts, whittled that down to ~270 full texts to assess, and then ended up with 103 studies in the final review.
  • You will never finish a systematic review of this size in a year
    I still haven’t finished the review and I’m entering month 19th of working on it. That’s a really long slog to go through, most of which was spent reading stuff and meticulously tracking where every abstract, full text and included study was in the biggest spreadsheet I’ve ever made. Be realistic, it’s unlikely you’ll be done within a year unless you’ve got a really small amount of included studies (if this is the case well done you, I am very jealous).
  • A review cannot be done by one person – get people involved as soon as you can
    All of my abstract screening, full text assessments and data extraction were done in duplicate; once by me and once by whichever person I managed to sweet talk that week. It took a lot of time and effort to find people willing to help, and then explain tasks to them via telephone/Skype and a lot of Dropbox files. I couldn’t have done the review without them and I’m so grateful that they offered to help (I had no funds to offer them – they were just being top notch humans). I would thoroughly recommend getting other people involved in your review as early as you can; whether they can help with screening/data extraction or just give you a new perspective on how you’re going to analyse your data, it’s all helpful.

This systematic review has been a really brilliant learning process, but it’s been the longest slog I’ve had over the course of my PhD. Two of my desk drawers are now crammed with papers, some scribbled with ‘include’, others ‘exclude’ – the further down the pile the less clear and politically correct they become, my personal favourite being ‘this is crap, total crap, exclude on the basis it’s utter crap’. I’m on the way with it though! I’ve got the big cloud of screening and extraction out of the way, and I’m on to the fun stuff and seeing what the review itself shows! Hoorah!

If you’re thinking of doing a systematic review, please be realistic with your timescales – and make sure you have snacks along the way. It’s a long process but chocolate definitely helps.

Studies Within A Trial (SWAT) Workshop – Aberdeen, 23rd March 2017

I realised earlier in the week that I haven’t talked a huge amount about the other projects I’m involved with aside from my PhD work, so this week’s post is about a project linked, but not central to, my own research project.

Studies Within A Trial (SWATs) are smaller studies embedded within a host trial, largely they have the aim of investigating some methodological aspect of the way we conduct the trial. There are currently 46 SWATs listed on the SWAT repository, which mainly look at recruitment and retention of participants; the two most difficult parts of the trial process.

These types of study are notoriously difficult to get funding for, they’re often poorly understood by approvals and ethics bodies, and they tend to be the first thing to fall off the list of priorities for trial teams as they’re an ‘add-on’ – a bonus that’s not central to the aims of the overarching trial. On Thursday last week I attended a SWAT workshop led by my PhD Supervisor in Aberdeen. Other attendees included representatives from pharma, the National Institute for Health Research (NIHR), the Health Research Authority (HRA), researchers, clinicians, trial managers, patients and directors of UK Clinical Trials Units.

Our discussion was lively, wide-ranging and incredibly useful. We tackled the tricky aspects of how to gain approvals, how to get funding, and how to galvanise the trials community to embed the use SWATs in routine practice.

One thing that I found really valuable was the discussion with patient representatives; we had 2 ladies join us to give their opinions. They drew our attention to topics I hadn’t necessarily thought of before, and helped us work through how we might (or might not) explain this additional study to trial participants both at the beginning and end of the study.

Throughout the day I took lots of notes – scribbling away whilst different people were talking to ensure I didn’t miss key points. We ended up discussing how to make SWATs easier to do for around 6 hours so my pile of notes was pretty huge! Once I’d got home I read over my notes whilst the discussion was fresh in my head, and consolidated them into one side of A5.

I find this a really useful thing to do after a day at a conference or workshop – it helps me to summarise topics in my head and ensures I don’t just push my pile of notes to the back of my desk drawer to be forgotten about.
Does anyone else do this or is it just an excuse I’m making to get the best use out of my unhealthily large stationery collection…?

Getting involved with additional projects outside of the PhD has been so valuable for me – it’s helped to improve my time management skills, expanded my knowledge of health services research more generally, but most importantly it’s helped me build confidence. I really enjoyed the day, and found it useful to speak to people outside of my own little research group; we tend to agree on a lot of things so it’s refreshing to get a new perspective and be challenged on points I’d previously taken at face value.

Self-Care Tips to Keep You Sane: Podcasts

At the end of January I wrote about the importance of academic self-care for PhD students; I didn’t delve too far into the specifics of what I do in my downtime and a lot of people asked. ‘It’s hard to switch off’ and ‘I find it hard to relax’ were the two phrases I encountered most frequently, so I thought I’d introduce a series of posts that provide more information, and recommendations, on what to do to give yourself a break during the inevitable stressful periods that come with doing a PhD.

This week I’m starting with podcasts. I listen to podcasts daily; they help force my brain to focus on something that isn’t work, and they can be a really good way to spend the time you can easily lose when experiments are running or when you’re walking to/from the office. When looking for a new podcast to listen to I’m always a bit overwhelmed by the amount of choice available, so I’ve narrowed my favourites down to 4, and also given you a list of the 3 that are next on my ‘to listen to’ list.

What? Serial – Season 1
Who? Sarah Koenig, the people from This American Life, and a huge variety of guests linked to the case
What’s it about? Serial started the rise in podcast creation, it’s still the bench-mark for new pods to aim for, and it won a Peabody Award in 2015 for its innovative telling of a long-form non-fiction story. The first season investigated the 1999 murder of Hae Min Lee, an 18-year-old student at Woodlawn High School in Baltimore, Maryland. Her corpse was discovered on February 9th and identified two days later. The case was immediately treated as a homicide. Lee’s ex-boyfriend, Adnan Syed, was arrested on February 28th, and charged with first-degree murder. Syed’s first trial ended in a mistrial, but after a six-week second trial, Syed was found guilty of Lee’s murder on February 25th 2000, and given a life sentence.
A word of caution – don’t get sucked into Serial Season 2; it’s no where near as good as Season 1. Season 3 is coming later this year – fingers crossed it matches up to Season 1.
When? Season 1 aired in 2014 but all episodes are still on iTunes ready for you to binge!
Where can I listen? Listen on iTunes here, or on the podcast website here.

The creators of Serial have just announced a new podcast called S-Town, starting March 28th, which sounds amazing.

What Undisclosed – All seasons are brilliant, but season 1 is my favourite
Who? Season 1 – Rabia Chaudry, Susan Simpson, Colin Miller
What’s it about? Rabia Chaudry was the person who initially alerted Sarah Koenig to Adnan’s case, leading to Serial. After Serial Rabia didn’t feel as though Sarah had done enough digging, she knew there was more, so she got together with Susan Simpson and Colin Miller to take a closer look at the case through Undisclosed. Season 1 is a brilliant podcast for those who’ve just finished Serial Season 1, but Season 2 (Joey Watkins) and Season 3 (Freddie Gray) stand alone. It’s one of the most in-depth podcasts I’ve ever listened to, and I find myself thinking about it for days afterwards.
When? Seasons 1 and 2 are already on iTunes, Season 3 started on March 6th, updating Mondays and Thursdays
Where can I listen? Listen on iTunes here, or on the podcast website here.

What? Don’t Salt My Game
Who? Laura Thomas PhD, plus guests
What’s it about? Laura Thomas is a Registered Nutritionist and Wellness Advocate, she talks to people in wellness, foodies, bloggers, entrepreneurs from cool brands, nutritionists, doctors, and anyone else who is shaking up the wellness world, to find out how they stay on top of their game – and to help you do you, but better. It’s not all headstands and courgette though; she and her guests aren’t afraid to dig deep into the darker side of wellness and will call BS on weird and faddy trend that don’t have any legitimacy or scientific merit.
This is a refreshingly honest pod that focusses on evidence, avoids the usual airy-fairy Insta-nutrition we see from unqualified influencers, and straight up calls out weird stuff like putting coconut oil in everything. I love this podcast, it feels like you’re having a chat with Laura and her guests – you’ll learn a tonne and never feel patronised.
When? New episodes every Friday
Where can I listen? Listen on iTunes here, or on Laura’s website here.

What? Missing Richard Simmons
Who? Dan Taberski and whoever he can rope in to speak to him
What’s it about? On February 15, 2014, fitness guru Richard Simmons disappeared. He stopped teaching his regular exercise class at Slimmons, cut off his closest friends, and removed himself from the public eye after decades as one of the most accessible celebrities in the world. Nobody has heard from him – and no one knows why he left. Filmmaker Dan Taberski was a Slimmons regular and a friend of Richard’s. Missing Richard Simmons is Dan’s search for Richard – and the deeper he digs, the stranger it gets.
The thing I really love about this podcast is that everyone has a different theory of what’s happened/is happening. Amanda Hess reported in The New York Times that this is a ‘morally suspect podcast’ – others think Taberski is genuinely worried about his friend and is doing everything he can to find him. I’m not sure where I sit, I just really hope that at some point we get an updated episode with an appearance from Richard Simmons himself.
When? New episodes every Wednesday
Where can I listen? Listen on iTunes here, or on the podcast website here.

Podcasts on my ‘to listen to’ list:

  • My Dad Wrote a Porno – I’ve heard a lot about this podcast, everyone I’ve spoken to about it says it’s absolutely hilarious, but then they blush a little and the topic moves on..
  • The 45th – hosted by Rabia Chaudry (Undisclosed), and featuring Susan Simpson and Sarah Basha, this is a recently developed podcast that examines developments from the White House that are worth a second look.
  • The Minimalists – After watching the Minimalism film – a ‘documentary about the important things’ I’m really intrigued by this, it’s next on my list once Missing Richard Simmons finishes next week.

Are you an avid podcast listener, are there pods I’ve skipped entirely? Leave a comment or Tweet me your recommendations!