The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation.

BACKGROUND: EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes. METHODS: This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club. DISCUSSION: The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs. TRIAL REGISTRATION: ISRCTN81935608 . Registered on 16 June 2015.

Incident reporting schemes and the need for a good story.

Incident reporting is a central strategy for improving safety in the NHS (UK National Health Service). In this paper we discuss incident reporting in anaesthesia. We discuss four schemes for reporting: longstanding, departmental based schemes; newer, hospital wide schemes; a national scheme; and an inter-departmental scheme (developed by the authors). We also discuss an example report. We argue that this example report gives an expert 'story' of an incident, describing the incident in a way that is useful for the practical activities of maintaining and improving safety. We argue that stories are told and retold in reporting schemes. The reporting schemes are not just there to collect data but to afford the stories of what went wrong. In turn these schemes must be afforded stories by the anaesthetists, safety managers and the organisation at large. We consider how schemes can be designed to afford a 'good' story, one that is useful for the maintaining and improvement of safety.

Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia.

In this qualitative study using observation and interviews, 10 anaesthetists from five Departments of Anaesthesia in the North-West region of England were enlisted to participate in the design of an online system to allow the sharing of critical incidents. Respondents perceived that existing schemes had differing and sometimes conflicting aims. Reporting was used for reasons other than simply logging incidents in the interests of promoting patient safety. No existing scheme allowed the lessons learned from incidents to be shared between members of the professional group from which they arose. Using participants' suggestions, we designed a simple, secure, anonymous system favouring free-text description, intended to enable the on-line sharing and discussion of selected incidents. Seven incidents were posted during the 6-month pilot period. The practitioners in our study valued the opportunity to share and discuss educational incidents 'horizontally' within their community of practice. We suggest that large-scale reporting systems either incorporate such a function or allow other systems that permit such sharing to co-exist.

Patient reports as stories of clinical work: narrative and work in neuroradiology.

OBJECTIVE: This paper describes the connections between the radiology report and clinical work and considers the implications for computerisation. METHOD: A story representation is described that allows consideration of the radiology report as an active unit of narrative rather than a passive collection of data. This paper draws upon the results of a qualitative study of a neuroradiology department. RESULTS AND CONCLUSION: Radiology reports recount a patient condition but also represent and influence clinical work.

Clinical narrative and clinical organisation: properties of radiology reports.

Radiology reports, as a form of clinical narrative, are more than a repository of patient information but are active in patient care. They are not unique and individual to each patient but have structured content suitable for supporting the activities of care. We consider these activities of care and how they manifest in the report. This recognition of the infusion of clinical organisation in clinical narrative leads to the recognition of seven properties of radiology reports: labels, concepts, genre, structure, author, subject, reader. These properties exist across two relationships: the intertextual relationship between radiology reports and the interpersonal relationship between a radiology report and people.

The communicative function of clinical narrative in radiology reporting.

Clinical narrative is often taken as a direct representation of real objects and events such as patients, diseases and treatments. We refer to this conceptualisation as the 'referential function' of clinical narrative. We introduce a complimentary perspective, taking clinical narrative as a construction relative to the situated intentions and routines of communication between author and reader. This perspective, that we call the 'communicative function', highlights the value of some underused features of clinical narrative. In this paper we bring together models of narrative structure and of communication to present a theory of the communicative function of clinical narrative. We pay particular attention to clinical narrative in radiology reporting.