The SOFA score-development, utility and challenges of accurate assessment in clinical trials

The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients' SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.

Nursing students' attitudes toward research: An integrative review

OBJECTIVE

This paper describes the state of the science related to undergraduate nursing students' attitudes toward research.

DESIGN

The updated integrative review method was used to systematically examine the published nursing literature about students' attitudes toward nursing research.

DATA SOURCES

Data sources for this review included: the Cumulative Index of Nursing and Allied Health Literature, PubMed, and Education Resources Information Center databases.

REVIEW METHODS

Database searches identified 207 articles. Abstracts were screened for relevance, and, if appropriate, the full article was obtained and reviewed. Ancestral searches of reference lists yielded an additional 29 articles, thus a total of 236 articles were screened for this review.

RESULTS

This comprehensive screening process yielded a total of 11 quantitative, 2 qualitative, and 2 mixed method studies about undergraduate nursing students' attitudes toward research.

CONCLUSIONS

Nursing students have generally positive attitudes toward research and see the value of research to professional nursing practice. Engaging in a research course or other active research-related activity improves attitudes toward nursing research. More rigorous study is warranted to determine best teaching/learning strategies to enhance students' perceptions of research. Future research is also needed to gain a better understanding of the demographic, academic, and program factors that affect nursing students' attitudes toward nursing research.

The scientific term paper at the Charité: a project report on concept, implementation, and students' evaluation and learning

Aim: Better training in scientific skills, such as the ability to conduct research independently, has been one of the main drivers of reform in medical education. The aim of this article is to report on the scientific term paper module in the modular curriculum of medicine (MCM) at the Charité. This module is an established example of undergraduate medical students conducting their own scientific investigations. Project outline: A faculty-wide, outcome-oriented process resulted in a four-week module for writing a scientific term paper in the 6^th semester of the MCM as part of a longitudinal science curriculum. Acquired competencies were assessed through a written term paper and an oral presentation. Two student cohorts (winter terms 2013 and 2014) were surveyed on how they rated the module concept, organizational aspects and the quality of support. We further analysed the chosen topics of the papers as well as student assessment results. Results: The student evaluation (return rates of 193 and 197, 71% and 77%) showed high overall satisfaction with the module. This result was evident in the high rating of the module concept and organizational aspects, a positive attitude towards scientific research, and strong motivation to pursue further scientific research. There was a wide spectrum of term paper topics with a focus on literature reviews. Most of the student work was assessed as good or very good. Conclusion: The scientific term paper module has proven itself as a curricular concept for students to perform own scientific research in the MCM, with strong acceptance and good performance by students. This project report can serve as basis and guidance for development and further improvements to promote scientific competencies in undergraduate medical education in other faculties.

The state of social science research on antimicrobial resistance

This paper investigates the genealogy of social science research into antimicrobial resistance (AMR) by piecing together the bibliometric characteristics of this branch of research. Drawing on the Web of Science as the primary database, the analysis shows that while academic interest in AMR has increased substantially over the last few years, social science research continues to constitute a negligible share of total academic contributions. More in-depth network analysis of citations and bibliometric couplings suggests how the impact of social science research on the scientific discourse on AMR is both peripheral and spread thin. We conclude that this limited social science engagement is puzzling considering the clear academic and practical demand and the many existing interdisciplinary outlets.

Musings from an Unlikely Clinician-Scientist: 2018 American Society of Anesthesiologists Excellence in Research Award

This article, which stems from the 2018 American Society of Anesthesiologists Excellence in Research Award Lecture, aims to encourage young investigators, offer advice, and share several early life experiences that have influenced the author's career as an anesthesiologist and clinician-scientist. The article also describes key discoveries that have increased understanding of the role of γ-aminobutyric acid type A (GABAA) receptors in health and disease. The author's research team identified the unique pharmacologic properties of extrasynaptic GABAA receptors and their role in the anesthetic state. The author's team also showed that extrasynaptic GABAA receptors expressed in neuronal and nonneuronal cells contribute to a variety of disorders and are novel drug targets. The author's overarching message is that young investigators must create their own unique narratives, train hard, be relentless in their studies and-most important-enjoy the journey of discovering new truths that will ultimately benefit patients.

Advancing research integrity: a programme to embed good practice in Africa

In Africa, training programmes as well as institutional policies on research integrity are lacking. Institutions have a responsibility to oversee research integrity through various efforts, including policies and training. We developed, implemented and evaluated an institutional approach to promote research integrity at African institutions, comprising a workshop for researchers ("bottom-up") and discussions with senior faculty on institutional policies ("top-down"). During the first day, we facilitated a workshop to introduce research integrity and promote best practices with regards to authorship, plagiarism, redundant publication and conflicts of interest. We used a variety of interactive teaching approaches to facilitate learning, including individual and group activities, small group discussions and case-based learning. We met with senior faculty on the following day to provide feedback and insights from the workshop, review current institutional policies and provide examples of what other research groups are doing. We evaluated the process. Participants actively engaged in discussions, recognised the importance of the topic and acknowledged that poor practices occurred at their institution. Discussions with senior researchers resulted in the establishment of a working group tasked with developing a publication policy for the institution. Our approach kick-started conversations on research integrity at institutions. There is a need for continued discussions, integrated training programmes and implementation of institutional policies and guidelines to promote good practices.

On the relationship between road safety research and the practice of road design and operation

How do the findings of road safety research affect the practice by which the road infrastructure is built and operated? The question is seldom asked. I discuss the complexities of the research-practice symbiosis in the light of two historical anecdotes. These allow me to point out several issues of concern. My general conclusion is that the relationship, as it evolved over time, is unpremeditated and occasionally dysfunctional. Issues of concern are the lightness with which decisions affecting road-user safety can be based on opinion that is unsupported by evidence, that such opinions can trump inconvenient evidence, that research findings can be willfully distorted or disregarded, that questionable results can be given a ring of consensual truth, and that the questions which research asks and what findings get published are at times influenced by external interest. In sum, the concern is that practice is not sufficiently evidence-based. Road users have a right to expect that decisions substantially affecting their safety take into account fact-based expectation of safety consequences. It is therefore time to endow the research-practice relationship with a premeditated and purposeful structure.

Congress of the United States, Ramazzini Institute and its affiliates, IARC: questions on scientific transparency

No abstract available.

The "Top 10" research and development priorities for battlefield surgical care: Results from the Committee on Surgical Combat Casualty Care research gap analysis

BACKGROUND

The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.

METHODS

A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.

RESULTS

13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented.

CONCLUSIONS

This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers.

LEVEL OF EVIDENCE

Study design, level IV.

Informant discrepancies in assessments of psychosocial functioning in school-based services and research: Review and directions for future research

Psychosocial functioning plays a key role in students' wellbeing and performance inside and outside of school. As such, techniques designed to measure and improve psychosocial functioning factor prominently in school-based service delivery and research. Given that the different contexts (e.g., school, home, community) in which students exist vary in the degree to which they influence psychosocial functioning, educators and researchers often rely on multiple informants to characterize intervention targets, monitor intervention progress, and inform the selection of evidence-based services. These informants include teachers, students, and parents. Across research teams, domains, and measurement methodologies, researchers commonly observe discrepancies among informants' reports. We review theory and research-occurring largely outside of school-based service delivery and research-that demonstrates how patterns of informant discrepancies represent meaningful differences that can inform our understanding of psychosocial functioning. In turn, we advance a research agenda to improve use and interpretation of informant discrepancies in school-based services and research.

A rapid research needs appraisal methodology to identify evidence gaps to inform clinical research priorities in response to outbreaks-results from the Lassa fever pilot

BACKGROUND

Infectious disease epidemics are a constant threat, and while we can strengthen preparedness in advance, inevitably, we will sometimes be caught unaware by novel outbreaks. To address the challenge of rapidly identifying clinical research priorities in those circumstances, we developed and piloted a protocol for carrying out a systematic, rapid research needs appraisal (RRNA) of existing evidence within 5 days in response to outbreaks globally, with the aim to inform clinical research prioritization.

METHODS

The protocol was derived from rapid review methodologies and optimized through effective use of pre-defined templates and global time zones. It was piloted using a Lassa fever (LF) outbreak scenario. Databases were searched from 1969 to July 2017. Systematic reviewers based in Canada, the UK, and the Philippines screened and extracted data using a systematic review software. The pilot was evaluated through internal analysis and by comparing the research priorities identified from the data, with those identified by an external LF expert panel.

RESULTS

The RRNA pilot was completed within 5 days. To accommodate the high number of articles identified, data extraction was prioritized by study design and year, and the clinical research prioritization done post-day 5. Of 118 potentially eligible articles, 52 met the data extraction criteria, of which 46 were extracted within the 5-day time frame. The RRNA team identified 19 clinical research priorities; the expert panel independently identified 21, of which 11 priorities overlapped. Each method identified a unique set of priorities, showing that combining both methods for clinical research prioritization is more robust than using either method alone.

CONCLUSIONS

This pilot study shows that it is feasible to carry out a systematic RRNA within 5 days in response to a (re-) emerging outbreak to identify gaps in existing evidence, as long as sufficient resources are identified, and reviewers are experienced and trained in advance. Use of an online systematic review software and global time zones effectively optimized resources. Another 3 to 5 days are recommended for review of the extracted data and to formulate clinical research priorities. The RRNA can be used for a "Disease X" scenario and should optimally be combined with an expert panel to ensure breadth and depth of coverage of clinical research priorities.

The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies

Prenatal alcohol exposure is a leading cause of disability, and a major public health concern in Canada. There are well-documented barriers for women and for service providers related to asking about alcohol use in pregnancy. Confidential research is important for learning about alcohol use before, during and after pregnancy, in order to inform fetal alcohol spectrum disorder (FASD) prevention strategies. The Research Advancement through Cohort Cataloguing and Harmonization (ReACH) initiative provides a unique opportunity to leverage the integration of the Canadian pregnancy and birth cohort information regarding women's drinking during pregnancy. In this paper, we identify: The data that can be collected using formal validated alcohol screening tools; the data currently collected through Canadian provincial/territorial perinatal surveillance efforts; and the data currently collected in the research context from 12 pregnancy cohorts in the ReACH Catalogue. We use these findings to make recommendations for data collection about women's alcohol use by future pregnancy cohorts, related to the frequency and quantity of alcohol consumed, the number of drinks consumed on an occasion, any alcohol consumption before pregnancy, changes in use since pregnancy recognition, and the quit date. Leveraging the development of a Canadian standard to measure alcohol consumption is essential to facilitate harmonization and co-analysis of data across cohorts, to obtain more accurate data on women's alcohol use and also to inform FASD prevention strategies.

Science, Technology and Innovation as Social Goods for Development: Rethinking Research Capacity Building from Sen's Capabilities Approach

Science and technology are key to economic and social development, yet the capacity for scientific innovation remains globally unequally distributed. Although a priority for development cooperation, building or developing research capacity is often reduced in practice to promoting knowledge transfers, for example through North-South partnerships. Research capacity building/development tends to focus on developing scientists' technical competencies through training, without parallel investments to develop and sustain the socioeconomic and political structures that facilitate knowledge creation. This, the paper argues, significantly contributes to the scientific divide between developed and developing countries more than any skills shortage. Using Charles Taylor's concept of irreducibly social goods, the paper extends Sen's Capabilities Approach beyond its traditional focus on individual entitlements to present a view of scientific knowledge as a social good and the capability to produce it as a social capability. Expanding this capability requires going beyond current fragmented approaches to research capacity building to holistically strengthen the different social, political and economic structures that make up a nation's innovation system. This has implications for the interpretation of human rights instruments beyond their current focus on access to knowledge and for focusing science policy and global research partnerships to design approaches to capacity building/development beyond individual training/skills building.

Intervention of artemisinin in macular edema associated with retinal vein occlusion: A protocol for a systematic review and meta-analysis

BACKGROUND

Artemisinin was discovered to be highly effective antimalarial drugs shortly after the isolation of the parent artemisinin in 1971 in China. It is derived from extracts of sweet wormwood (Artemisia annua) and are well established for the treatment of malaria. Recently, artemisinin has been shown that it might have therapeutic value for several other diseases. The purpose of this review is to assess the efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion.

METHODS AND ANALYSIS

A systematic literature search will be performed in all available databases to quantitatively review eligible studies and identify all relevant data. We will include randomized controlled trials assessing efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

ETHICS AND DISSEMINATION

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

PROSPERO REGISTRATION NUMBER

The protocol for this systematic review has been registered on PROSPERO under the number CRD42019131408.

Pharmacy student perceptions regarding understanding of and confidence in literature evaluation following a student-led journal club

BACKGROUND

Journal clubs are commonly used by healthcare professionals, including pharmacists, as a means of analyzing and applying research to clinical practice. The purpose of this research is to determine if participation in student-led journal clubs impacts students' understanding of and confidence in literature evaluation.

METHODS

First- through third-year pharmacy students attended co-curricular journal club sessions. Students attending these sessions completed a questionnaire (Journal Club Comprehension and Confidence Instrument [JCCCI]) immediately prior to [pre-survey] and following [post-survey] the journal club session (journal club group). The JCCCI was also delivered to student pharmacists not attending the co-curricular journal club sessions (control group). Wilcoxon Signed-Rank tests were used to compare the responses to the JCCCI questionnaire. Analysis was conducted using SPSS. This research was approved by the University's Institutional Review Board.

RESULTS

A total of 182 student pharmacists completed the survey (journal club group, n = 52; control group, n = 130). There were significant differences in the pre- and post-survey of the journal club group in eight of the 10 competencies; "process", "background", "methods", "intervention/treatment", "statistical analysis", "results", "clinical significance" and "strengths/limitations". There were significant differences discovered between the journal club group (post-survey) and control group in three of the 10 competencies; "process", "importance", and "intervention/treatment".

CONCLUSIONS

This study demonstrates that participation in a journal club yielded significant improvements in how students self-rated their confidence in and understanding of literature evaluation. Based on students' self-assessed understanding of and confidence in literature evaluation, student-led journal club sessions conducted outside of the traditional pharmacy curriculum offer a perceived benefit to students.

Researchers' experiences and lessons learned from doing mixed-methods research with a population with intellectual disabilities: Insights from the SOPHIE study

Researchers are challenged to provide opportunities for people with intellectual disabilities (IDs) and their families to become participants in research. This article explores the processes and procedures involved in conducting a mixed-methods study. The preparation for the study is described and explained. Recruitment is examined by describing the process and analysing phone calls made to potential participants. Reflections of research team members help to develop the analysis and contribute to a discussion of the fieldwork. Lessons learned show that research projects involving people with IDs and their families need careful planning and have additional costs. The research team requires a mix of expertise. Traditional recruitment methods may not be suitable, and researchers need to build good relationships with gatekeepers so that participants can be contacted directly. Good quality research with people with IDs and their families is possible once suitable strategies are employed throughout the research process.

PGY1 resident research projects: Publication rates, project completion policies, perceived values, and barriers

PURPOSE

To assess the publication rates of PGY1 pharmacy residents and to determine the beliefs of pharmacy residency program directors (RPDs) regarding PGY1 residency research projects, the residency-specific policies on publishing, and the perceived barriers to publishing for PGY1 residents.

METHODS

The 2013 American Society of Health-System Pharmacists Midyear Clinical Meeting resident poster presentation roster was used to compile the list of PGY1 residents who submitted an abstract. The Web of Science database was searched using the PGY1 residents' name and research title to determine if a publication resulted from the abstract by December 2016. Publication rates were calculated using several demographic subcategories. The PGY1 RPDs identified from the ASHP website (n = 1220) were surveyed to determine how they value the research project, policies regarding publishing at their institution, and potential barriers to publication.

RESULTS

Out of 1419 abstracts from PGY1 residents, 26 (1.8%) resulted in a publication by 2016. Of the 369 RPDs who responded, the majority complimented their programs as favorable environments for completing research, 55% stating that their institutions offered formal research training, 65% stating that they have preceptors specifically assigned for research, and 83% stating that they provide dedicated time to residents to complete their research. The common barriers to publication were difficulty in completing the project in one year and lack of continuity after residency completion.

CONCLUSION

Despite pharmacy residency programs requiring residents to complete a research project, most residents end the residency without a publication. Further research is needed to identify the residents' barriers to publications and resources needed to publish the research projects.

Issues and current standards of controls in microbiome research

Good scientific practice is important in all areas of science. In recent years this has gained more and more attention, especially considering the 'scientific reproducibility crisis'. While most researchers are aware of the issues with good scientific practice, not all of these issues are necessarily clear, and the details can be very complicated. For many years it has been accepted to perform and publish sequencing based microbiome studies without including proper controls. Although in recent years more scientists realize the necessity of implementing controls, this poses a problem due to the complexity of the field. Another concern is the inability to properly interpret the information gained from controls in microbiome studies. Here, we will discuss these issues and provide a comprehensive overview of problematic points regarding controls in microbiome research, and of the current standards in this area.

"Turning a Blind Eye to Ratoon Stunting Disease of Sugarcane in Australia" May Be Putting It Too Strongly Without A Lot More Evidence

A recent Feature article, "Turning a Blind Eye to Ratoon Stunting Disease of Sugarcane in Australia" by Dr. Anthony J. Young, claims "The potential RSD plays a significant, industry-wide role in reduced yields and crop deterioration in Australia has been widely overlooked." As a result, "the industry has exhibited what amounts to an ideological attitude, repeatedly claiming the disease is economically managed." These statements are the basis for the provocative title of the article. Dr. Young presents very elaborately constructed arguments that conclude RSD is likely to be more widespread than realized, is causing significant yield losses and loss of varieties, and is the unrecognized cause of multiple yield decline problems. His overall contention is that the RSD situation has been mismanaged to the detriment of the industry. Allegations such as these should be supported by well documented, direct evidence. Are they supported by solid evidence?

Developing and establishing research guidelines in a private higher education institution of Saudi Arabia. An experience

OBJECTIVES

To develop and establish research guidelines of international standards that matches appropriate cross-cultural and religious considerations of the region.

METHODS

We followed the guidelines given by the American College of Cardiology Foundation and American Heart Association, Inc., Washington DC, USA task force on practice to develop research guidelines of international standards for our institution. In October 2015 the task team (of a private higher education institution in Jeddah, Saudi Arabia) qualitatively analyzed the national codes and guidelines using 19 ethical protections stated in the other universally accepted international guidelines.

RESULTS

The electronic search yielded 11 different guidelines and documents, of which 4 documents were from Saudi Arabia. When the Saudi Arabian documents were compared using 19 universally accepted ethical protections, we found one of the document contained 15 of the 19 ethical protections, another document contained 9 protections and the least being 5 of the 19 protections.

CONCLUSION

Research guidelines of international standards were developed with respect to the cultural, traditional, and religious considerations of the Kingdom, providing a valuable framework to guide our institutional researchers to conduct ethically sound inquiry.