In the September issue of HOC we cover the sometimes daunting matter of writing a grant application... and the universal issue of how to get the most out of your working day. Kevin Frick, PhD, associate professor at Johns Hopkins University’s Bloomberg School of Public Health, has some novel thoughts on making QALYs understandable using creative visual images, while Mary Gabb offers some insights on how to master interview techniques. Ruth Murray identifies the top ten most common mistakes in statistical analysis of clinical trials, and we continue our list of upcoming conferences.

Make sure your grant application
doesn't go in the bin

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You want money? Improve your chances of writing a winning grant proposal

by David Woods, HOC editor

At some time in their careers most health economists will be faced with writing a grant proposal. Doing it properly will greatly increase your chances of separating potential granters from their money. Here are some pointers:

• Understand who you’re writing to and what their needs are
• Underscore your project’s suitability for funding
• Make clear why you’re the right person to undertake the project for which you’re seeking funds
• Know your resources of grant makers, using such online sources as the Sponsored Programs Information Network (SPIN)
• Find out what fiscal resources your potential grantor has
• Prepare a realistic budget
• Don’t hedge: write your proposal in strong, simple language
• Develop an arresting opening statement
• Get colleagues to review your proposal
• Remember that the acceptance rate for grant proposals by such organisations as the National Institutes of Health in the US are in the 15–20 percent range.

Keep in mind that a grant proposal, unlike an article submitted to a journal, won’t have the benefit of an editor. In other words, if your submission is unclear, unfocused, disorganised, unspecific, or just poorly written, it will be thrown aside. The same fate will await you if you miss the granting organisation’s required deadline. It’s also true, though, that even if it’s written in impeccable prose, a grant proposal that’s inherently flawed or unworkable won’t get support.

In Preparation of the Research Grant Application: Opportunities and Pitfalls, George Eaves advises prospective grantees to state their study objectives and specific aims clearly; to state the significance of the problem to healthcare; to use the literature review to justify the need for a proposed project; to organise paragraphs to permit intelligent skimming; to prepare and justify your budget carefully, including personnel, equipment, supplies, and travel; and, above all, he says, don't inflate proposed budgets. And follow all instructions to the letter.

For those of you in the pharmaceutical industry, the same principles can be applied to the internal budget planning rounds that are underway in most companies at present. Artificially inflating budgets might seem more irresistible in this situation where budget cuts are frequently encountered. In these circumstances, we suggest you present your proposals with ‘levels’ of resource, so that, in the case of a project undergoing a budget cut after it starts, you can move from the ‘deluxe’ model to an ‘economy’ model but not lose the ability to complete the project.

How to use visual images when explaining QALYs

by Kevin D. Frick

Before lecturing on quality adjusted life years (QALYs) you should carefully consider the most appropriate way to educate an audience. The most obvious visual image related to QALYs is the graph of health utility over time. However, health economists called upon to give one-shot lectures to clinical audiences should not limit the visual images they employ to these standard graphs. The use of visual images relevant to clinicians’ day-to-day professional lives can facilitate communication.

Imagine discussing a series of syringes, flasks, and vats to illustrate the aggregation health-related quality of life over time and among individuals.

To begin illustrating the concept of measuring health related quality of life, you could ask members of a clinical audience to imagine filling a 10mL syringe in proportion to their personal feeling about health-related quality of life on the day of the lecture. When comparing different individuals, syringes filled with more liquid represent a higher quality of life for that individual.

To characterise health-related quality of life over a year, you might ask members of your audience to imagine filling a syringe each day. At the end of the year, the contents of all 365 syringes are emptied into a single flask that measures 3.65L of liquid when full. The number of QALYs experienced by the individual in a year would be the fraction of the flask that is full. Many different sequences of syringe levels (i.e. daily quality of life) can yield the same total amount of liquid after a year. The calculation of QALYs cannot distinguish among these sequences. The fact that the sequence of health-related quality of life experiences during a year does not affect the QALYs that are calculated is the key insight regarding aggregation over time for an individual.

Then, imagine a population of 100 individuals, each of whom has filled some fraction of a 3.65L flask. The QALYs experienced by the population (an important component of a cost-effectiveness analysis) can be measured by emptying all 3.65L flasks into a 365L vat. The fraction of the vat that is full measures the average QALYs experienced. The key insight for aggregation at this stage is that the distribution of QALYs among members of the population is not considered.

An economist who wants to facilitate understanding of cost-effectiveness and QALYs should take advantage of the opportunity to be creative, or even light-hearted, when choosing visual images to use in a lecture. The images must meet two primary criteria: being appreciated by the audience and being easily explained by the economist.

Clinical trials – Top ten mistakes in statistical analysis of clinical trials

By Ruth Murray

The growth of evidence-based medicine has triggered an increased focus on the quality of clinical trials. However, careful scrutiny of the literature has revealed high rates of statistical errors in large numbers of scientific articles, even in the best journals. Errors in statistical analysis of clinical trials are widespread, have occurred for some time and, perhaps surprisingly, concern basic and easily avoidable statistical concepts. The ten most common mistakes are:

1. Concluding equivalence on the basis of a non-significant p-value
2. Relying solely on p-values
3. Using Pearson X² test on ordinal data
4. Using Logrank test on ‘survival’ data displaying only a delay
5. Removing non-compliant patients from the analysis
6. Using paired t-tests back to baseline in treatment groups separately (rather than two sample t-tests on changes, to ‘compare’ the groups)
7. Using anything other than the point of randomisation as the origin for a time to event measure when comparing treatments
8. Using non-parametric methods unnecessarily
9. Counting and comparing serious adverse events (rather than the number of patients suffering a serious adverse event)
10. Using covariates which depend on changes during treatment.

Avoid these errors by asking your statisticians to review your manuscript before submission.

Tools of the trade: mastering the interview

by Mary Gabb

Most health economists, at some point in their careers, will be on one side or other of an interview. For interviewers, it helps to remember the sage words of Louis Pasteur: fortune favours the prepared mind. In fact, the keys to a successful interview are preparation and relaxation: doing your homework ahead of time to prepare the questions, but being ready to let the interview offer the information in its own way.

• Be prepared. Draw up a list of questions, but be prepared to deviate from it if you get an interesting but unexpected line of responses. Also, long pauses can make many of us feel uncomfortable, but this is often when the truth (or at least something unintended) is revealed! Fight the urge to fill the ‘pregnant pause’; instead, encourage the interviewee with a simple ‘Oh’ or ‘Really’, or even by just raising an eyebrow, or looking anticipatory.
• Be kind. Put the subject at ease. Most people need a chance to warm up and relax, and asking the interviewee about him or herself is often a good way to do this. While you may be anxious to get straight to the heart of your subject, most people will become defensive if the interview starts with embarrassing or tough questions.
• Listen. A good interviewer is a good listener. While it may be necessary to ask an interviewee about a published criticism of their work, try to avoid a debate and offer them a chance to explain their thoughts, eg, ‘I’ve read some criticisms of your study. How do you respond to these comments?’
• Don’t be intimidated. While we each have made great strides in our fields as health economists, everyone has their own speciality. It’s all right to admit that a certain subject is outside your expertise. This gives interviewees an opportunity to explain and educate, making them feel more at ease because they are ensuring that the subject is explained in their own terms.
• To edit or not to edit. This may depend on the editing style used by your publication. The spoken word is often quite different from the written word for many people. It is best to use direct quotes when these capture picturesque speech or a colourful or powerful statement. However, be kind to your interviewee: too much colloquialism or idioms (or even sub-standard English) can be embarrassing to the interviewee.
• Don’t end it too early. While interviewees may insist they have another appointment, try to keep the interview going without causing distress. Offer reassurance that it will end (for example, ‘One last question…’), as you are approaching the end of your question list. Then, end the interview with an open-ended question, such as, ‘Is there something I should have asked, but didn’t?’ or ‘What one thing…?’ This type of questioning flatters the interviewee as an expert (or at least more of an expert than you) and offers the opportunity for some unexpected revelations.

Note: This article is based on the scientific writing and communications course offered at Thomas Jefferson University’s College of Graduate Studies (Philadelphia, PA, USA) taught by HOC editor David Woods, PhD, and from Jorgensen LB. Real-World Newsletters To Meet Your Unreal Demands. Alexandria, VA: EEI Press; 1999.

‘To me, every interview, even if you love the artist, needs to be somewhat adversarial.
Which doesn't mean you need to attack the person, but you do need to look at it like you're trying to get information
that has not been written about before’.
Chuck Klosterman, American pop-culture journalist, critic, and essayist

Abstract submission deadlines

Over the next few months HOC will bring you dates for meeting abstract submissions, (please note that dates were correct at time of sending this email; HOC cannot be responsible for any amendments).

By Clare Gurton

Are you hopelessly busy all day yet frustrated by how little you have achieved at the end of the day? You could improve productivity by using a few simple time management tricks and tools. Planning your time efficiently allows you to spread your work evenly over the day, avoid ‘traffic jams’ or bunching of jobs, and to cope with stress. Here are some time-tested ideas:

Log your current activities to see obvious areas for improvement
A good place to start is to look at how you spend your time now. Keep a log for a week and note everything you do during the working day and how long it takes you. You will immediately see areas that could be improved. At the same time try to record how you are feeling during the day such as times of tiredness, discomfort, or high energy. This should help you realise your natural rhythms and when you need a break for food, or simply a change of pace. Use this log to help plan future working days.

Write a ‘must do’ list and prioritise your work
A prioritised ‘must do’ list will help you organise yourself and reduce stress. Try to break down each job and only give yourself a short list to work on at any one time.

Use time slots wisely
Each day there may be long and short time slots; slots that are less than one hour may be more useful for reviewing and previewing tasks; slots of between one and three hours can allow concentrated effort on more detailed assignments such as report writing. Try to use time slots alongside your ‘must do’ list so that you use your different time slots for suitable activities; a well used 15 minutes is more effective than a wasted two hours.

Break difficult or boring work into sections
Don’t try to write a long report, manuscript, or plan in one session – write it section by section.

Go easy on yourself
If you are struggling with one particular task put it down and go to the next thing. If you are losing direction, take a break and allow yourself some quiet thinking time.

‘Time is the scarcest resource and unless it is managed nothing else can be managed.’
Peter Drucker, (1909–2005)
American (Austrian-born) management writer

Look forward to Essentials of editing and proof-reading, Preparing the perfect CV, and the start of a new series of book reviews.