157
Welcome to the: RCSLT Research Champion Workshop 24 th March 2015 #RCSLTresearch
Welcome to the:
RCSLT Research
Champion Workshop 24th March 2015
#RCSLTresearch
Outline 09.30 – 10.00 Registration and refreshments
10.00 – 11.00
Welcome
Professor Victoria Joffe, Trustee for Research and Development, RCSLT Board of Trustees; and Emma Pagnamenta, Research Manager, RCSLT
11.00 – 11.25 Using technology and social media to collaborate
Dominique Lowenthal, Head of Professional Development, RCSLT
11.25 – 11.40 Refreshments
11.40 – 12.40 Critical appraisal workshop: Introduction
Professor Amanda Burls, Professor of Public Health, City University London
12.40 – 13.30 Lunch
13.30 – 14.30
Critical appraisal workshop:
Small discussion group work (with refreshments)
Professor Amanda Burls, Professor of Public Health, City University London
14.30 – 14.35 Break
14.35 – 15.30
Critical appraisal workshop:
Plenary
Professor Amanda Burls, Professor of Public Health, City University London
15.30 – 15.50 Summary of day Professor Victoria Joffe, Trustee for Research and Development, RCSLT Board of Trustees; and Emma Pagnamenta, Research Manager, RCSLT
15.50 – 15.55 Thanks and close
Today we hope you will….
Hear about Research and Development at the RCSLT
Explore and discuss the role of RCSLT Research Champions
Make contacts and connections
Share good practice
Develop skills in critical appraisal and application of research evidence
Vicky Joffe, Emma Pagnamenta & Vanessa Rogers
Building research capacity for the
profession: past present and future
Strategy
Vision
Evaluation
Role
Strategy
Vision
Evaluation
Role
Strategy
RCSLT Research Strategy 2010 supporting members to access and carry out research and EBP
that will be relevant at each stage of their careers
members work together to create and promote research opportunities and support the development of research awareness, capacity and capability
collaborative working of all members and the synthesis of their knowledge and skills is essential to the development of an evidence base which is focused on the needs of service users
culture of EBP will run through work based activity,
formal education, management of services and
research
Strategy
RCSLT Strategic Plan
2012-15
The development, synthesis and dissemination of the SLT evidence base supported and developed by the RCSLT
Members feel that RCSLT membership is essential for their professional development
Communities between members are recognisable and self-sustaining
The RCSLT has enabled the profession by supporting local managers and other members- in influencing local commissioners, decision-makers and budget holders
CL
INIC
AL
RE
SE
AR
CH
EBP
CLI
NIC
AL
PR
AC
TIC
E
RES
EAR
CH
QUESTIONS GAPS
DISSEMINATION IMPACT
OUTCOMES FOR SERVICE USERS
CLI
NIC
AL
PR
AC
TIC
E
RES
EAR
CH
C
RCSLT RESEARCH
CHAMPIONS HUBS
CLINICAL ACADEMIC
WORKFORCE
Strategy
Vision
Evaluation
Role
The Vision
SLT services
Research Champions
RCSLT
Reaching out Supporting
services Capacity
building
Council for AHP Research
RCSLT Hubs
Research Champions
Aphasia
H & N
Speech
Language impairment
Acquired Speech
Difficulties
AAC
ASD
Bilingualism
Cleft Dysfluency
Dyslexia
HI
Learning disabilities
Mental Health
Physical disabilities
Progressive neuro
Research Champions
R & D Reference
Group
RCSLT
Clinical
Research
Reference
Groups
An
infrastructure
for research
Council for AHP Research
RCSLT Hubs
Research Champions
113 Research Champions 70% RCSLT Hub members 23% Council for AHP Research Hub members
Strategy
Vision Evaluation
Role
R&D so far…
RCSLT R & D Team Networks Bulletin Website Elearning/resources Journal access Support RCSLT Studentships CAHPR
R&D, the future…
RCSLT R & D Team Networks Bulletin Website Elearning/resources Journal access Support CAHPR
Research priority setting Research champions Clinical research reference
groups Mentorship IJLCD/new journal Dissemination of evidence Qualitative research Hubs
What you told us
• Improving support
• Journal access
• Leadership and guidance
• Resources
• Website
• Bulletin
• Hubs
• 86% said RCSLT work is valuable or very valuable
• 93% said RCSLT work is valuable or very valuable
• 95% said RCSLT work is valuable or very valuable
Accessing Evidence
Evidence-based
practice
Comments Research Activity
RCSLT R & D Resources: usage
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
RCSLT R & D Resources
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 15 9 11 8 5 4 7 3 17 14 16 13 12 10 6
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Usage
Ben
efit
RCSLT R & D Resources
In the Journals
Journals Collection
IJLCD
Evidence-based decision making tool
How have they helped?
EBP under pressure
Reflection
Networking
Signposting Research skills
Journal access
Strategy
Vision
Evaluation Role
Where did we start from?
Passionate about evidence-based practice and research
Enabler of others
Link person
Connected to networks
Keen to work with RCSLT
Experience/developing skills in evaluation/research
Flexible requirements from RCSLT
What do you think?
Generating
new
evidence
Linking
practice and
research
Signposting/
sharing
information
Supporting
colleagues
Capacity
building
Promoting/
awareness
raising
Personal
development
Role models
EBP/research activities so far
Doing audit/evaluation/research
Network activity
Providing CPD for others
Links with HEIs
Supporting colleagues
Writing for Bulletin
Social media
Applying skills to practice
Expert involvement/review
What have you not managed to
achieve? Small-scale research projects Practice-based evidence Hub activity Attending events Contributing to RCSLT publications Clinical academic training/funding Building research awareness Outcomes tool Journal club Teaching SLTs Influencing
Barriers No. of
comments Time 36 Limited Knowledge and Skills 9 Lack of support from Managaement 8 Clinical pressures 6 Funding 5 Confidence 3 Resources 3 Research pressures 2 Travel 2 Access issues 1 Challenges of data collection in the context of busy clinical work 1 Early stage of career 1 Expectation for EBP to happen at home/outside of work hours 1 Formal processes 1 IRAS confusing 1
Support you would like
Better
networking
Guidance
for
managers
Clearer roles
and
responsibilities
Funding
advice
Ideas for enthusing
colleagues about
EBP
Your ideas for the future
Networking
Linking
practice and
research
Collaborations
Advice and
support on
research
Sharing
research Recruitment of
champions
Define role of
a research
champion
Influencing
Projects
Publication of research
Doctorate/PhD/Masters
Training others in research
skills
Journal/EBP clubs
Hub involvement
Bulletin writing
Systematic reviews
Developing a Trust research
strategy
Your exciting plans!
Your upcoming projects
Slang
Word finding
Elklan
Transdisciplinary model
Babble and cochlear
implant
Counselling and stroke
Feeding at risk
Service outcomes
Big CACTUS study
Choking and medication in
MH and LD
LSVT with Cerebral Palsy
Group discussion: the role of a RCSLT Research Champion
Group discussion: the role of a Research Champion
We want to know what you think
Let’s make this fun…
Which do you like most?
A. Dogs
B. Cats
C. Not sure/Neither
DogsCat
s
Not sure
/Nei
ther
61%
5%
34%
Do you attend a journal club?
A. Yes
B. No
Yes No
51%49%
How often do you read research
articles?
A. 1 or more a week
B. 2-3 per month
C. 1 per month
D. Less than 1 per
month
1 or m
ore a
week
2-3 p
er month
1 per m
onth
Less
than
1 p
er month
36%
7%
23%
34%
How confident do you feel in
critically appraising research?
A. Very confident
B. Confident
C. Quite confident
D. Not confident
Very c
onfident
Confiden
t
Quite co
nfident
Not confid
ent
9% 9%
53%
28%
How confident do you feel in
undertaking research?
A. Very confident
B. Confident
C. Quite confident
D. Not confident
Very c
onfident
Confiden
t
Quite co
nfident
Not confid
ent
7%
26%
35%33%
How confident do you feel in undertaking
research?
9%
28%
53%
9%
7%
33%
35%
26%
Very confident
Confident
Quite confident
Not confident
First Slide Second Slide
Is your manager aware that you
are a Research Champion?
A. Yes
B. No
C. Not sure
Yes No
Not sure
72%
15%13%
How supportive is your
manager?
A. Very supportive
B. Supportive
C. Quite supportive
D. Not supportive
Very s
upportive
Support
ive
Quite su
pportiv
e
Not supporti
ve
32%
14%
24%
30%
How supportive is your manager?
33%
30%
26%
11%
33%
33%
0%
33%
17%
33%
33%
17%
Very supportive
Supportive
Quite supportive
Not supportive
Yes No Not sure
Supportiveness of line manager as a function of awareness
How important is the research
champion role to you and your
professional identity?
A. Very important
B. Important
C. Quite important
D. Not important
Very i
mport
ant
Import
ant
Quite im
portan
t
Not im
portant
32%
5%
24%
39%
Do you attend a journal club?
45%
55%
53%
47%
22%
78%
100%
0%
Yes
No
Very important Important Quite important Not important
Effect of perceived importance on journal club attendance
Group discussion • Looking to the future, how do you see your role
as a Research Champion growing and developing?
• How do you see the research champion network growing and developing?
• What do research champions offer the profession?
• What other events would you find useful?
RCSLT Research
Champion Workshop
24th March 2015
#RCSLTresearch
Using technology and
social media to
collaborate
Dominique Lowenthal Head of professional Development
RCSLT
How do you
feel about
technology?
Younger generations…
Will never understand
the battles we faced…
What this sound is…
Or what the
relationship between
these two objects
might be…
Who is in charge here?
“If I had asked people
what they wanted, they
would have said faster
horses.”
― Henry Ford
Technology driving what we do What we need to do driving technology?
A bit of both?
Where are you on the technology curve?
It’s called what!?
Hopefully, it’s
just a faze…
What is my
password!?
Hang on… no
one else knows
how to use this
either!
It’s going
to be
alright…
Bottom line tech should make
something better for you…
1.Will it help me do more ‘stuff’ that I wanted to do
anyway?
2.Will I be able to do better quality ‘stuff’?
3.Will I be able to do ‘stuff’ quicker?
4.Will it be more fun than the way I’m doing it now?
So what is the ‘stuff’ of
collaboration?
Discuss
Problem solving
Supportive
Sharing and open
Easy to stay in the ‘loop’
Quick to use
Easy to pass on information
Platforms that help you to
work and connect with
your colleagues
Platforms that help to keep
you informed with the wider
world
1. Whatsapp
2. Basecamp
3. Teleconference
4. Videoconference
5. Skype
6. Twitter
7. Webinar
Technology platforms
Example collaborative sites
for research
Tw
itte
r • Communities @wespeechies #slpeeps
• Following researchers e.g. ‘PamelaSnow2, @NicolaBotting, @SusanEbbels, @deevybee
• Funders e.g. @ESRC, @OfficialNIHR, @HealthFdn
• Others?
We
bsites
• www.researchgate.net
• rcsltalk.forums.net
• RCSLT Basecamp groups
• Others?
Fa
cebook
• RCSLT Facebook
• speechBITE.com
• NIHR Clinical Research Network
• Others?
• Send messages and queries
• Write to do lists
• Collaborate on writeboard documents
• See events on your calendar
• Join in a chat
• Share files
Basecamp
“My idea of good company is the company of
clever, well-informed people who have a great
deal of conversation; that is what I call good
company.”
Jane Austen
@RCSLT
#RCSLT
#slpeeps
#wespeechies Thank you to Caroline Bowen
for the quote in relation to
And now?
Those same opportunities to engage, connect
and share professionally, within and across
disciplines and international borders, endure.
But the possibilities Twitter offers for SLT
collaboration, education, intervention and
dissemination of information are only now
beginning to unfold.
Copyright © 2014
Caroline Bowen
Check out your Techipe’s
Dom’s top 5 tips 1. Get adept at adapting
2. Learn a few of the keystone technologies
(e.g. skype, basecamp, twitter)
3. Accept it all changes (hopefully for the better!)
4. Be lazy (there must be an app for that!)
5. Share what works with your colleagues / learn
from others learning journey…
References
Dr. Caroline Bowen. @speech_woman
@WeSpeechies #RCSLT2014 Keynote, Workshop and Social Media Links
and Resources
http://speech-language-therapy.com
RCSLT Research
Champion Workshop
24th March 2015
#RCSLTresearch
What makes good evidence about
the effectiveness of treatments?
Amanda Burls
RCSLT Research Champions Workshop
March 24th 2015
Objectives of this session
• Appreciate the importance of making decisions informed by evidence
• Understand what makes studies testing treatments trustworthy
• Critically appraise a trial
• To have fun
In a road traffic accident there are two different
ways of organising the ambulance service
ATLS: A team trained and equipped
for advanced trauma life support to
stabilise you in the field?
BLS: A team trained and equipped
only for basic life support to take you
as quickly as possible to the nearest
emergency department?
“Stay and Play”
“Scoop and Run”
You have been injured in a road traffic
accident – which do you want?
A. ATLS: Team trained and
equipped for advanced
trauma life support?
B. BLS: Team trained and
equipped only for basic life
support to take you as quickly
as possible to the nearest
emergency department?
ATLS: T
eam
trai
ned and e
q...
BLS: T
eam
trai
ned an
d equi..
.
18%
82%
Liberman et al J Trauma 2000 49(4):584-599
9
“Mind you only one out of every ten
doctors recommends it!”
“Drinking alcohol in moderation is
good for your health”
A. Agree
B. Disagree
C. Don’t know
Agree
Disagr
ee
Don’t kn
ow
51%
31%
18%
How should babies be laid down to
sleep?
A. On their backs
B. On their fronts
C. On their sides
D. It doesn’t matter
E. I don’t know
On thei
r bac
ks
On thei
r fro
nts
On thei
r sid
es
It does
n’t m
atte
r
I don’t
know
46%
7%
34%
10%
2%
International Journal of Epidemiology
2005
Conclusion
“Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10,000 infant deaths in the UK and at least 50,000 in Europe, the USA, and Australasia.”
Should left-handed children be
encourage to write with their right
hands?
A. Yes
B. No
C. Don’t know
Yes No
Don’t kn
ow
0%7%
93%
2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End
Investigating effects and effectiveness
Intervention
Population (Patients)
Outcomes (Benefits
and harms)
‘The art of medicine consists in
amusing the patient while
nature cures the disease.’
Voltaire
How could you design a study to
minimise the chance of being fooled into
thinking an intervention is effective (or
harmful), when the changes observed
would simply have happened any way?
2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End
Answer
• Compare what happens to people given the
intervention to what happens to people that
didn’t have the intervention
• This is known as a
Control Group
Is the “effect” due to pre-existing
differences between the groups? • Differences?
– Severity of illness
– Where they live
– Genetics
– Social class
– Volunteers
– Sex
– Age
– Past treatments
How can we get comparable groups?
1. Sex
2. Severity of illness
3. Age
4. Social class
5. Past treatments
6. Genetics
• 2 groups
• Mild, average, severe (6)
• <18, 18-40, 40-70, >70 (24)
• 5 social classes (>100)
• Smoker? (>300)
• (?Unknown)
How can we get comparable groups?
Randomised controlled trial
Group 1
Group 2
Outcome
Outcome
Intervention
Control
(No intervention; placebo; usual care)
Population
Allocation concealment
• The researcher or health care provider entering
a participant into a trial cannot tell which
treatment they will get
• Sequentially numbered opaque sealed envelopes
• Centralised randomisation
Check the baseline characteristics of the
groups – imbalances can occur by chance
Unconscious measurement bias
Unconscious measurement bias
The view from the inside
“Performance bias”
Additional
interventions
are provided
preferentially
to one group
How can we make groups remain
comparable?
• Blinding (patient, researcher, health
professionals)
• Reduce losses to follow up
• Assess differential drop out (attrition bias)
• Are those who drop out similar to other
participants?
How can we make groups remain
comparable?
• Blinding (patient, researcher, health
professionals)
• Reduce losses to follow up
• Assess differential drop out (attrition bias)
• Are those who drop out similar to other
participants?
When things go wrong…
“There could be no worse experimental animals on
earth than human beings: they go on vacations, they
take things they are not supposed to take, they live
incredibly complicated lives and, sometimes, they do
not take their medicine.”
Efron B F: Limburg Compliance Symposium.
Statistics in medicine 1988; 17:249-250
When things go wrong
• What if patients don’t take the treatment they
were randomised to receive or get the wrong
treatment?
• Let’s look at a hypothetical example…
Balloon blowing for children with cystic
fibrosis
Children with CF eligible for trial
Balloon blowers Usual care
Balloons blowers Usual care
Strategies to deal with this?
2:00 1:59 1:58 1:57 1:56 1:55 1:54 1:53 1:52 1:51 1:50 1:49 1:48 1:47 1:46 1:45 1:44 1:43 1:42 1:41 1:40 1:39 1:38 1:37 1:36 1:35 1:34 1:33 1:32 1:31 1:30 1:29 1:28 1:27 1:26 1:25 1:24 1:23 1:22 1:21 1:20 1:19 1:18 1:17 1:16 1:15 1:14 1:13 1:12 1:11 1:10 1:09 1:08 1:07 1:06 1:05 1:04 1:03 1:02 1:01 1:00 0:59 0:58 0:57 0:56 0:55 0:54 0:53 0:52 0:51 0:50 0:49 0:48 0:47 0:46 0:45 0:44 0:43 0:42 0:41 0:40 0:39 0:38 0:37 0:36 0:35 0:34 0:33 0:32 0:31 0:30 0:29 0:28 0:27 0:26 0:25 0:24 0:23 0:22 0:21 0:20 0:19 0:18 0:17 0:16 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 End
Strategies to deal with this 1. Reject trial as spoilt
2. Exclude patients who did not get right treatment (comparing the outcomes only for those people who got the treatment they were supposed to)
3. Switch patients to the other group (Analyse results according to the treatment people actually got)
4. Ignore the problem (Treat people as if they got the treatment they were supposed to and analyse results comparing randomised groups regardless of treatment actually received)
5. Adjust for any imbalances in the analysis
Which strategy is best?
A. Reject trial as spoilt
B. Exclude patients who did not get right treatment
C. Analyse according to the treatment people got
D. Analyse as randomised
E. Adjust for imbalances in the analysis
Reject
tria
l as s
poilt
Exclu
de patie
nts w
ho did
no...
Analyse a
ccord
ing
to th
e tr.
..
Analyse a
s random
ised
Adjust
for i
mbal
ance
s in th
e...
0%
18%
44%
15%
23%
Balloons blowers Usual care
Strategy 2 - Exclusion
Balloons blowers Usual care
Strategy 3 – Care received
Strategy 4 - Intention-to-treat
=
Balloons blowers Usual care
Critical appraisal:
questions to apply to trials
A. Is the trial trustworthy? Validity
Screening questions
Detailed questions
B. What does the trial tell you? Results
C. Will it help? Relevance
Small group work
Did the trial address a clearly focused issue?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
100%
0%0%
Was the assignment of patients to treatments
randomised?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
75%
8%17%
Were patients, health workers and
study personnel blinded?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
85%
4%11%
Were the groups similar at the start
of the trial?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
100%
0%0%
Aside from the experimental intervention,
were the groups treated equally?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
4%
22%
74%
Were all of the patients who entered the trial
properly accounted for at its conclusion?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
82%
0%
18%
Validity – only one question!
• Were the groups compared similar in all respects other than the intervention of interest?
(Including the way they were assessed)
How large was the treatment effect?
How precise was the estimate of the
treatment effect?
Can the results be applied in your context?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
40%
25%
35%
Were all clinically important outcomes
considered?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
0%
67%
33%
Are the benefits worth the harms and costs?
A. Yes
B. Can’t Tell
C. No
Yes
Can’t
Tell
No
15%23%
62%
How confident do you feel in
critically appraising research
A. Very confident
B. Confident
C. Quite confident
D. Not confident
Very c
onfident
Confiden
t
Quite co
nfident
Not confid
ent
16%
8%
35%
41%
How confident do you feel in critically appraising
research
9%
28%
53%
9%
16%
41%
35%
8%
Very confident
Confident
Quite confident
Not confident
First Slide Second Slide
Closing remarks: what next?
Reflections and Themes of day
• Enthusiasm and buzz throughout
• Connect and support one another
• Learn, learn learn…
• TIME
• Work context differs, and so do challenges
• Twitter is great (@becciknill)
• Don’t guess, or rely on intuition, USE evidence
You said….
You would like clear roles and responsibilities
We are….
Drafting a mission statement
Developing roles and responsibilities
You said….
You would like to have a directory for the network
We are….
Collating a directory of:
Research Champions
Current research
Signposting you to opportunities
You said….
You would like RCSLT to influence managers about the role and requirements of being a research champion
We will….
Write a letter to Managers
Support the work undertaken by the Council for AHP Research
You said….
You would like advice on making research happen and opportunities to share your research
You are all invited to….
We are creating and identifying opportunities
E.g. “Pathways into clinical research for speech and language therapists”, Safer Care Conference, Birmingham, June 25
– Free to attend
– Opportunities to share your research and/or career pathways
You said….
You would like to develop collaborations across the network
We will….
Continue to support an interactive network
Watch this space…
So, you call yourselves
A champion is someone
who gets up when he can’t.
Jack Dempsey
A true champion can
adapt to anything.
Floyd Mayweather, Jr
If you’re a champion,
you have to have it in
your heart.
Chris Evert
Champions are willing
to do what they hate
in order to get what
they love.
To be champion requires more
than simply being a strong
player, one has to be a strong
human being as well.
Anatoly Karpov
I’ve failed over and
over and over again in
my life….That is why I
succeed.
Michael Jordan
If it doesn’t challenge
you, it doesn’t change
you.
Together we can make a difference
Leaders…wake people out of inertia. They… get
people excited about something they’ve never
seen before, something that does not yet exist.
Rosa Beth Moss Kanter (Leadership for Change: Enduring Skills for Change Masters)
