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Lucas AR, Focht BC, Cohn DE, Klatt MD, Buckworth J. Recruiting Endometrial Cancer Survivors to Studies Examining Lifestyle Behaviors and Quality of Life: Challenges Faced and Lessons Learned. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:857-864. [PMID: 28188570 PMCID: PMC5552444 DOI: 10.1007/s13187-017-1187-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There are a growing number of cancer survivors in the USA. Despite lifestyle behaviors being strongly associated with morbidity and mortality following primary treatment, recruitment to clinical research studies that aim to improve such behaviors remains a significant challenge. Furthermore, pilot and feasibility studies are critical for the refinement of research methods and form an important training opportunity for early career scientists. This report details the challenges faced and lessons learned in the process of recruiting a population of overweight/obese endometrial cancer survivors (ECS) to two separate studies focused on lifestyle behaviors: a survey study and a randomized behavioral intervention study that aimed to improve diet, physical activity, and quality of life. We used in-clinic and mail-based approaches to reach eligible patients identified from clinic records. Surveys were offered via paper or online. To evaluate the recruitment process, we compared clinic records and enrollment data over time and location. Chi-squared tests were also used to compare recruitment strategies. We address specific challenges at the patient level, the clinic/provider level, and the organizational level. Overall response rate was 13.9% to the survey and 4% to the intervention. Responses to in-clinic offers were greater than to mail-based approaches for the survey with no difference for the intervention. Identifying the unique characteristics of each survivorship population, adequate planning, resource allocation, and involvement of key staff are essential to supporting recruitment efforts to research studies. Having the support of physicians and nurses is especially critical to the success of recruitment.
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Affiliation(s)
- Alexander R Lucas
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Brian C Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH, 43201, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, M-210 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43201, USA
| | - Maryanna D Klatt
- Clinical Family Medicine, The Ohio State University College of Medicine, Suite 250 Northwood-High Building # 261, 2231 North High Street, Columbus, OH, 43201, USA
| | - Janet Buckworth
- Department of Kinesiology, University of Georgia, 115K Ramsey Center 330 River Road, Athens, GA, USA
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152
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Young AS, Seidenfeld AM, Healy KZ, Arnold LE, Fristad MA. Predicting enrollment in two randomized controlled trials of nonpharmacologic interventions for youth with primary mood disorders. J Affect Disord 2018; 235:368-373. [PMID: 29674252 PMCID: PMC5951766 DOI: 10.1016/j.jad.2018.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND As recruitment and retention are often challenging in randomized controlled trials (RCTs), this study sought to identify predictors of participation (i.e., trial enrollment). METHOD These analyses identified predictors of enrollment among 119 youth, ages 7-14, with a primary mood disorder, who screened eligible for the Omega-3 and Therapy pilot studies; 95 (79.8%) actually participated in the treatment. RESULTS Youth who received some form of travel assistance (16.0%) almost uniformly enrolled in the treatment portion of the RCT. Youth who lived further away from the study site (p = .047) or whose primary caregiver never married (p = .01) were less likely to enroll. Of note, socioeconomic status (SES) variables (parent education and child insurance status) did not significantly predict enrollment, suggesting that study incentives or accommodations may have adequately addressed barriers commonly associated with SES. LIMITATIONS Due to the fairly high trial enrollment rate (approximately 80%), there likely was limited power to detect some differences between groups. Generalizability may be limited to youth with a primary mood disorder diagnosis. CONCLUSIONS Despite retaining a large proportion of the youth who screened eligible, participant self-selection is a limitation of any RCT. A silent inclusion criterion of any RCT is willingness to be randomized.
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Affiliation(s)
- Andrea S. Young
- Correspondence concerning this article should be addressed to Andrea S. Young, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, 5300 Alpha Commons Dr., 4 Floor, Baltimore, MD 21224. Ph: 410-550-7015; Fax: 410-550-0564;
| | | | - K. Zachary Healy
- Department of Psychiatry and Behavioral Health, The Ohio State University
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University
| | - Mary A. Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University, Departments of Psychology and Nutrition, The Ohio State University
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153
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Khatamian Far P. Challenges of Recruitment and Retention of University Students as Research Participants: Lessons Learned from a Pilot Study. JOURNAL OF THE AUSTRALIAN LIBRARY AND INFORMATION ASSOCIATION 2018. [DOI: 10.1080/24750158.2018.1500436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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154
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Henshall C, Narendran P, Andrews RC, Daley A, Stokes KA, Kennedy A, Greenfield S. Qualitative study of barriers to clinical trial retention in adults with recently diagnosed type 1 diabetes. BMJ Open 2018; 8:e022353. [PMID: 30018100 PMCID: PMC6059261 DOI: 10.1136/bmjopen-2018-022353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Regular physical exercise may preserve β cell function in newly diagnosed adults with type 1 diabetes (T1D). However, clinical trials to test this theory require the recruitment and retention of adults with new-onset T1D, which can be challenging. We sought to determine the overall experiences of newly diagnosed adults with T1D in an exercise study, to understand issues that influence the retention of trial participants in such studies. DESIGN Qualitative methodology using individual face-to-face (n=6) and telephone interviews (n=14). Interview transcripts were thematically analysed using the framework method. SETTING The study took place at five participating UK hospitals. PARTICIPANTS Twenty participants, aged 19-55 years, in the Exercise for Type 1 Diabetes study were interviewed to explore their study experiences and identify motivators and deterrents towards the study. Participants in control and intervention arms were interviewed, as were people with T1D who had completed (n=16) and withdrawn (n=4). RESULTS Participants revealed barriers and facilitators to retention; the majority were generalisable to clinical trials of people with newly diagnosed T1D. Coming to terms with a diagnosis of T1D, lack of time, work pressures, level of health professional support, volume, clarity and consistency of information and feedback and a desire for knowledge about their condition were all cited as influencing factors to trial retention. CONCLUSIONS To our knowledge, this is the first qualitative study to examine the experience of being involved in an exercise trial by people with T1D. Findings suggest appointments could be shorter, available outside of working hours and planned longer in advance; study information should be clear, consistent and in electronic and paper formats; questionnaires need minimising; healthcare support and feedback needs providing regularly; thought is required around how to support non-exercising arm participants. These considerations may improve participant retention rates in new-onset T1D studies.
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Affiliation(s)
| | - Parth Narendran
- Institute or Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Amy Kennedy
- Department of Diabetes & Endocrinology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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155
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Rios-Romenets S, Acosta-Baena N, Lopez L, Madrigal-Zapata L, Street H, Jakimovich L, Langbaum JB, Cho W, Reiman EM, Tariot PN, Lopera F. Adherence/Retention Alzheimer's Prevention Initiative Colombia Plan. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:283-287. [PMID: 30090848 PMCID: PMC6077834 DOI: 10.1016/j.trci.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction The Alzheimer's Prevention Initiative Colombia Trial is a collaborative project involving the Neurosciences Group of Antioquia, Genentech/Roche, and the Banner Alzheimer's Institute, studying whether crenezumab can delay or prevent the clinical onset of Alzheimer's disease in cognitively unimpaired individuals who carry the PSEN1 E280A mutation. In an effort to optimize participant compliance and adherence and maintain interest in the trial for its duration, the Neurosciences Group of Antioquia developed an “Adherence/Retention Plan.” This plan identifies potential barriers to trial adherence related to characteristics of the participants and study partners, protocol design, sponsors, investigators, environmental factors, and characteristics of this population in general and identifies potential solutions to these barriers. Methods Neurosciences Group of Antioquia designed and implemented a number of strategies including a) a prescreening process that emphasized detailed and staged informed consent involving the participant and family and/or friends, b) a schedule of visits and assessments designed to minimize burden while achieving the trial's aims, c) appointment reminders, d) reimbursement for transportation and missed work, e) meals during study visits, f) birthday cards, g) quarterly newsletters, h) annual in-person feedback meetings, i) a supplemental health plan to participants, and j) a social plan to support family members. All the methods used in this plan were approved by local ethics committees. Results By the end of the fourth year of the trial, participant retention was 94.0%, with most participants reporting that they felt “very satisfied” with their participation in the trial. Discussion The Adherence/Retention Plan plays a crucial role in maintaining adherence and compliance needed to achieve the ambitious goals of the Alzheimer's Prevention Initiative-Colombia Autosomal Dominant Alzheimer's Disease Trial and may offer guideposts for other prevention trials.
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Affiliation(s)
| | | | - Liliana Lopez
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | | | | | | | | | - William Cho
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | | | | | - Francisco Lopera
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
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Zabaleta-del-Olmo E, Pombo H, Pons-Vigués M, Casajuana-Closas M, Pujol-Ribera E, López-Jiménez T, Cabezas-Peña C, Martín-Borràs C, Serrano-Blanco A, Rubio-Valera M, Llobera J, Leiva A, Vidal C, Campiñez M, Martín-Álvarez R, Maderuelo JÁ, Recio JI, García-Ortiz L, Motrico E, Bellón JÁ, Moreno-Peral P, Martín-Cantera C, Clavería A, Aldecoa-Landesa S, Magallón-Botaya R, Bolíbar B. Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial. BMC Public Health 2018; 18:874. [PMID: 30005705 PMCID: PMC6045838 DOI: 10.1186/s12889-018-5805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. METHODS This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the "5A's". It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the "Consolidated Framework for Implementation Research", a set of discrete implementation strategies and an evaluation framework. DISCUSSION EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. TRIAL REGISTRATION ClinicalTrials.gov , NCT03136211 .Retrospectively registered on May 2, 2017.
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Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power Kalea 18, 48014 Bilbao, Spain
| | - Mariona Pons-Vigués
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Marc Casajuana-Closas
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Tomás López-Jiménez
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Carmen Cabezas-Peña
- Deputy Directorate of Health Promotion, Public Health Agency, Department of Health, Goverment of Catalonia, Roc Boronat, 81-95 (Edifici Salvany), 08005 Barcelona, Spain
| | - Carme Martín-Borràs
- Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, C/Císter 34, 08022 Barcelona, Spain
- Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull Univesity, C/Padilla 326-332, 08025 Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Llobera
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Alfonso Leiva
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Clara Vidal
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Manuel Campiñez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023 Barcelona, Spain
| | - Remedios Martín-Álvarez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023 Barcelona, Spain
| | - José-Ángel Maderuelo
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
| | - José-Ignacio Recio
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, c/Energía Solar 1, Sevilla, Spain
| | - Juan-Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla 23, Málaga, Spain
- Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla 23, Málaga, Spain
- El Palo Health Center, Andalusian Health Service (SAS), Av. Salvador Allende 159, 29018 Málaga, Spain
- Department of Public Health and Psychiatry, University of Malaga, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla 23, Málaga, Spain
- Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla 23, Málaga, Spain
| | - Carlos Martín-Cantera
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Ana Clavería
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201 Vigo, Spain
| | - Susana Aldecoa-Landesa
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201 Vigo, Spain
- Primary Health Centre Beiramar, Xerencia de Xestión Integrada Vigo, Servizo Galego de Saúde (SERGAS), Avda Rosalía Castro 21, 36201 Vigo, Spain
| | - Rosa Magallón-Botaya
- Instituto de Investigación Sanitaria Aragón, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Bonaventura Bolíbar
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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157
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Carpenter R, Theeke LA. Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence. Int J Nurs Sci 2018; 5:230-237. [PMID: 31406830 PMCID: PMC6626207 DOI: 10.1016/j.ijnss.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. OBJECTIVES The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. DESIGN The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. PROCEDURES The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. RESULTS Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. CONCLUSIONS These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
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158
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Sickinger K, Walker WC, Agyemang AA, Cifu DX, Lewis TL, Carne W. Recruiting for a multicentre DoD and VA longitudinal study: lessons learned. Brain Inj 2018; 32:1218-1225. [PMID: 29985677 DOI: 10.1080/02699052.2018.1492740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PRIMARY OBJECTIVE The primary objective of the study is to identify and delineate effective recruitment practises in a large, multi-site, longitudinal, observational study employing both military service members and Veterans. SETTING Four Chronic Effects of Neurotrauma Consortium sites. DESIGN A descriptive study. RESULTS Overall and cohort-specific recruitment increased with the addition of focused recruitment strategies and a military/Veteran-centric recruitment director. CONCLUSION Use of site-specific strategies aligned with local Institutional Review Board procedures and emphasizing awareness of service member organizational allegiances was the key to effective recruiting. Adding a recruitment director with background similar to study participants coincided with significantly improved overall participant numbers and specific subpopulations of research subjects, thus adding to the value of the study.
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Affiliation(s)
- Kevin Sickinger
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond, VA , USA
| | - William C Walker
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond, VA , USA.,b Hunter Holmes McGuire VA Medical Center Richmond , VA , USA
| | - Amma A Agyemang
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond, VA , USA
| | - David X Cifu
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond, VA , USA
| | - Tiffany L Lewis
- c Defense and Veterans Brain Injury Center Program , Silver Spring , MD
| | - William Carne
- a Department of Physical Medicine & Rehabilitation , Virginia Commonwealth University , Richmond, VA , USA.,b Hunter Holmes McGuire VA Medical Center Richmond , VA , USA
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159
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Mudaranthakam DP, Thompson J, Hu J, Pei D, Chintala SR, Park M, Fridley BL, Gajewski B, Koestler DC, Mayo MS. A Curated Cancer Clinical Outcomes Database (C3OD) for accelerating patient recruitment in cancer clinical trials. JAMIA Open 2018; 1:166-171. [PMID: 30474074 PMCID: PMC6241508 DOI: 10.1093/jamiaopen/ooy023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/29/2018] [Accepted: 05/29/2018] [Indexed: 11/13/2022] Open
Abstract
Data used to determine patient eligibility for cancer clinical trials often come from disparate sources that are typically maintained by different groups within an institution, use differing technologies, and are stored in different formats. Collecting data and resolving inconsistencies across sources increase the time it takes to screen eligible patients, potentially delaying study completion. To address these challenges, the Biostatistics and Informatics Shared Resource at The University of Kansas Cancer Center developed the Curated Cancer Clinical Outcomes Database (C3OD). C3OD merges data from the electronic medical record, tumor registry, bio-specimen and data registry, and allows querying through a single unified platform. By centralizing access and maintaining appropriate controls, C3OD allows researchers to more rapidly obtain detailed information about each patient in order to accelerate eligibility screening. This case report describes the design of this informatics platform as well as initial assessments of its reliability and usability.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jeffrey Thompson
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jinxiang Hu
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Dong Pei
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Michele Park
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Devin C Koestler
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Matthew S Mayo
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Cancer Center, Kansas City, Kansas, USA
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Purcell A, Buckley T, King J, Moyle W, Marshall AP. Eutectic mixture of local anaesthetics (EMLA®) as a primary dressing on painful chronic leg ulcers: a pilot randomised controlled trial. Pilot Feasibility Stud 2018; 4:123. [PMID: 30002870 PMCID: PMC6035424 DOI: 10.1186/s40814-018-0312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 06/22/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The physical, occupational, social and psychological impact of chronic leg ulcers (CLUs) on an individual is considerable. Wound-related pain (WRP), the most common symptom, is frequently reported as moderate to severe and mostly occurs at dressing change. WRP pain may not be alleviated by oral analgesics alone. Persistent poorly controlled leg ulcer pain can negatively impact wound healing and health-related quality of life (HRQoL). METHODS A pilot, parallel group, non-blinded, randomised controlled trial was conducted in six procedure clinics located in a public community nursing service in New South Wales, Australia to evaluate eutectic mixture of local anaesthetics (EMLA®) on painful CLUs when used as a primary dressing. The primary objective was to assess feasibility by using pre-determined criteria: at least 80% recruitment rate, 80% retention rate and 80% adherence to the study protocol. Key eligibility criteria were that participants had a painful CLU no larger than 100 cm2, a numerical rating scale (NRS) wound-related pain intensity score equal to or greater than 4, low to moderate exudate, no contraindications to EMLA® and capacity to consent. One hundred and seven patients with painful CLUs were screened for eligibility; 56% (n = 60) were eligible and consented to participate in the study. Participants were randomly assigned to the intervention (n = 30) or control (n = 30) groups. The intervention group received a measured dose of the topical anaesthetic EMLA® 5% cream daily as a primary dressing for 4 weeks followed by usual wound management for a further 8 weeks. The control group received usual wound management. Participants and investigators were not blinded to the treatment. WRP was measured at every dressing change. Wound healing and HRQoL were measured at baseline, 4 and 12 weeks. RESULTS Recruitment rate was lower than expected which likely meant patients were missed. Study retention rate was 90% (n = 54). Intervention fidelity was impacted by availability of resources and patient factors such as increased WRP. CONCLUSION This study identified that a larger randomised controlled trial investigating EMLA® applied as a primary dressing on painful chronic leg ulcers is feasible with modifications to the study protocol. TRIAL REGISTRATION Australian New Zealand Clinical Trials Register: Registered 16 December, 2009.
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Affiliation(s)
- Anne Purcell
- Menzies Health Institute, Griffith University, Nathan Campus, Building N48, Room 2.10, 170 Kessels Road, Nathan, Queensland 4111 Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus. Building N48, Room 2.06, 170 Kessels Road, Nathan, Queensland 4111 Australia
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, New South Wales 2250 Australia
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, New South Wales 2050 Australia
| | - Jennie King
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, New South Wales 2250 Australia
- Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, New South Wales 2050 Australia
| | - Wendy Moyle
- Menzies Health Institute, Griffith University, Nathan Campus, Building N48, Room 2.10, 170 Kessels Road, Nathan, Queensland 4111 Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus. Building N48, Room 2.06, 170 Kessels Road, Nathan, Queensland 4111 Australia
| | - Andrea P. Marshall
- Menzies Health Institute, Griffith University, Nathan Campus, Building N48, Room 2.10, 170 Kessels Road, Nathan, Queensland 4111 Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus. Building N48, Room 2.06, 170 Kessels Road, Nathan, Queensland 4111 Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Services, E. 2 015, 1 Hospital Blvd, Southport, Queensland 4215 Australia
- National Centre of Research Excellence in Nursing, Room 2.08, G01, Griffith University, Southport, Queensland 4222 Australia
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Cleo G, Hersch J, Thomas R. Participant experiences of two successful habit-based weight-loss interventions in Australia: a qualitative study. BMJ Open 2018; 8:e020146. [PMID: 29858412 PMCID: PMC5988089 DOI: 10.1136/bmjopen-2017-020146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Habit-based weight-loss interventions have shown clinically important weight loss and weight-loss maintenance. Understanding why habit-based interventions work is therefore of great value, but there is little qualitative evidence about the experiences of participants in such programmes. We explored the perspectives of individuals who completed two habit-based weight-management programmes, Ten Top Tips and Do Something Different. DESIGN One-on-one, face-to-face, semistructured interviews were conducted and analysed thematically. SETTING Participants from the community were interviewed at Bond University, Australia. PARTICIPANTS Using a maximum variation design, we recruited 15 participants (eight men, seven women) aged 39-69 years (mean 53.3 years, SD 10.3) with a range of education levels (no high school to university degree) and percentage weight change on the programmes (+4.0% to -10.4%). MAIN OUTCOME MEASURES (1) The general experience of participants who completed the Ten Top Tips or Do Something Different intervention, (2) whether and how the interventions affected the participants' lifestyle postintervention, and (3) participants' views regarding the acceptability and practical application of Ten Top Tips and Do Something Different. RESULTS Participants reported positive experiences of the two programmes, both during and after the interventions. Participants particularly enjoyed the novelty of the interventions as they shifted focus from diet and exercise, to practical everyday habit changes. They also reported indirect health benefits such as increased energy levels, increased confidence and improved self-awareness. Accountability throughout the programmes and convenience of the interventions were identified as key themes and facilitators for weight-loss success. CONCLUSIONS This study offers insight into how and why habit-based interventions might work. Overall, Ten Top Tips and Do Something Different are practical and convenient to implement, and are viewed favourably by participants when compared with conventional lifestyle programmes for weight control. TRIAL REGISTRATION NUMBER ACTRN12615000114549.
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Affiliation(s)
- Gina Cleo
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Queensland, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Queensland, Australia
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Knight JM, Kerswill SA, Hari P, Cole SW, Logan BR, D’Souza A, Shah NN, Horowitz MM, Stolley MR, Sloan EK, Giles KE, Costanzo ES, Hamadani M, Chhabra S, Dhakal B, Rizzo JD. Repurposing existing medications as cancer therapy: design and feasibility of a randomized pilot investigating propranolol administration in patients receiving hematopoietic cell transplantation. BMC Cancer 2018; 18:593. [PMID: 29793446 PMCID: PMC5968588 DOI: 10.1186/s12885-018-4509-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Repurposing existing medications for antineoplastic purposes can provide a safe, cost-effective, and efficacious means to further augment available cancer care. Clinical and preclinical studies suggest a role for the ß-adrenergic antagonist (ß-blocker) propranolol in reducing rates of tumor progression in both solid and hematologic malignancies. In patients undergoing hematopoietic cell transplantation (HCT), the peri-transplant period is a time of increased activity of the ß-adrenergically-mediated stress response. METHODS We conducted a proof-of-concept randomized controlled pilot study assessing the feasibility of propranolol administration to patients between ages 18-75 who received an autologous HCT for multiple myeloma. Feasibility was assessed by enrollment rate, tolerability, adherence, and retention. RESULTS One hundred fifty-four patients underwent screening; 31 (20%) enrolled in other oncology trials that precluded dual trial enrollment and 9 (6%) declined to enroll in the current trial. Eighty-nine (58%) did not meet eligibility requirements and 25 (16%) were eligible; of the remaining eligible patients, all were successfully enrolled and randomized. The most common reasons for ineligibility were current ß-blocker use, age, logistics, and medical contraindications. 92% of treatment arm patients tolerated and remained on propranolol for the study duration; 1 patient discontinued due to hypotension. Adherence rate in assessable patients (n = 10) was 94%. Study retention was 100%. CONCLUSIONS Findings show that it is feasible to recruit and treat multiple myeloma patients with propranolol during HCT, with the greatest obstacle being other competing oncology trials. These data support further studies examining propranolol and other potentially repurposed drugs in oncology populations. TRIAL REGISTRATION This randomized controlled trial was registered at clinicaltrials.gov with the identifier NCT02420223 on April 17, 2015.
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Affiliation(s)
- Jennifer M. Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | | | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Steve W. Cole
- Department of Medicine, Division of Hematology-Oncology, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Brent R. Logan
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
- Division of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, USA
| | - Anita D’Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | - Nirav N. Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Mary M. Horowitz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | | | - Erica K. Sloan
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, VIC Australia
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and UCLA AIDS Institute, UCLA, Los Angeles, CA USA
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC Australia
| | | | - Erin S. Costanzo
- Carbone Cancer Center and Department of Psychiatry, University of Wisconsin-Madison, Madison, WI USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - J. Douglas Rizzo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
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Tsai JH, Janssen E, Bridges JFP. Research as an event: a novel approach to promote patient-focused drug development. Patient Prefer Adherence 2018; 12:673-679. [PMID: 29765204 PMCID: PMC5939881 DOI: 10.2147/ppa.s153875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patient groups are increasingly engaging in research to understand patients' preferences and incorporate their perspectives into drug development and regulation. Several models of patient engagement have emerged, but there is little guidance on how to partner with patient groups to engage the disease community. Our group has been using an approach to engage patient groups that we call research as an event. Research as an event is a method for researchers to use a community-centered event to engage patients in their own environment at modest incremental cost. It is a pragmatic solution to address the challenges of engaging patients in research to minimize patients' frustration, decrease the time burden, and limit the overall cost. The community, the event, and the research are the three components that constitute the research as an event framework. The community represents a disease-specific community. The event is a meeting of common interest for patients and other stakeholders, such as a patient advocacy conference. The research describes activities in engaging the community for the purpose of research. Research as an event follows a six-step approach. A case study is used to demonstrate the six steps followed by recommendations for future implementation.
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Affiliation(s)
- Jui-Hua Tsai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John FP Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Raymond C, Profetto-McGrath J, Myrick F, Strean WB. Process Matters: Successes and Challenges of Recruiting and Retaining Participants for Nursing Education Research. Nurse Educ 2018; 43:92-96. [PMID: 28715347 PMCID: PMC5839709 DOI: 10.1097/nne.0000000000000423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/25/2022]
Abstract
Researchers who study nursing education encounter difficulty when trying to recruit and retain nurse educator participants. Researchers would benefit from knowing more about effective and ineffective sampling strategies and methods to increase the efficiency of the research process. This article outlines the struggles and successes encountered with a mixed methods study that examined nurse educators' critical thinking. Specific examples are interwoven with current literature to uncover some important insights and future recommendations for researchers in nursing education.
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Affiliation(s)
- Christy Raymond
- Author Affiliations: Acting Associate Dean, Assistant Professor, Faculty of Nursing, MacEwan University (Dr Raymond), Edmonton, Alberta; and Assistant Adjunct Professor (Dr Raymond), Vice Dean and Professor (Dr Profetto-McGrath), and Faculty Emerita (Dr Myrick), Faculty of Nursing, and Professor (Dr Strean), Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
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165
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Strömmer S, Lawrence W, Rose T, Vogel C, Watson D, Bottell JN, Parmenter J, Harvey NC, Cooper C, Inskip H, Baird J, Barker M. Improving recruitment to clinical trials during pregnancy: A mixed methods investigation. Soc Sci Med 2018; 200:73-82. [PMID: 29421474 PMCID: PMC6033317 DOI: 10.1016/j.socscimed.2018.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/31/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify reasons underlying women's refusal to participate in a pregnancy trial and to identify ways of increasing recruitment. DESIGN Mixed methods study using a questionnaire and qualitative interviews. SAMPLE A questionnaire asking them to indicate reasons for their decision was completed by 296 pregnant women who declined to participate in one of two trials of nutritional supplementation in a large teaching hospital in southern England. Qualitative interview data were collected from two samples of pregnant women: 1) 30 women who declined to participate in a trial but completed the questionnaire; and 2) 44 women who participated in a trial. RESULTS Questionnaire data from pregnant women who declined to participate suggested the major barriers to participation were study requirements, including taking study medication, having a bone scan or blood tests, or being too busy. Thematic analysis of interview data identified differences in self-efficacy and levels of trust in medical research between participants and decliners. Participants believed that the research would cause no harm, while decliners felt they or their unborn child would be at risk. When faced with potential obstacles, participants found ways around them while decliners felt they were insurmountable. CONCLUSIONS Recruitment methods for pregnancy trials should focus on building women's trust in the trial, and on enhancing women's self-efficacy so they feel able to meet trial requirements. Suggestions for building trust include investing time in open, honest discussion of the risks and benefits of participation, improving visibility of the research team, testimonials from previous participants and advertising study safety and ethical conduct. Self-efficacy can be enhanced by training research staff in empowering styles of communication enabling women to feel heard and supported to problem-solve. These strategies could be implemented relatively easily into pregnancy trial protocols, and their effectiveness tested through their impact on recruitment rates.
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK.
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Daniella Watson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Joanne N Bottell
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Janice Parmenter
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Oxford Musculoskeletal Biomedical Research Unit, University of Oxford, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
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166
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Johnson MR, Kenworthy-Heinige T, Beck DJ, Asghar A, Broussard EB, Bratcher K, Tommessilli LM, Antonelli M, Planeta BM. Research site mentoring: A novel approach to improving study recruitment. Contemp Clin Trials Commun 2018; 9:172-177. [PMID: 29696240 PMCID: PMC5898529 DOI: 10.1016/j.conctc.2018.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 11/06/2022] Open
Abstract
Background/Aims The VA Cooperative Studies Program's (CSP) Network of Dedicated Enrollment Sites (NODES) is a consortium of nine VA medical centers (VAMCs) with teams (nodes) dedicated to enhance performance, compliance, and management of CSP multi-site clinical trials. The West Haven CSP Coordinating Center (WH-CSPCC), study coordinating center for CSP #577, Colonoscopy Versus Fecal Immunochemical Test (FIT) in Reducing Mortality from Colorectal Cancer (CONFIRM) trial, and NODES piloted a “site mentoring” (hub-and-spoke) model. In this model, a node site would work one-on-one with a low enrolling CONFIRM site to identify and overcome barriers to recruitment. The aim was to determine the impact of a research site mentoring model on study recruitment and examine site-level characteristics that facilitate or impede it. Results Sites in the mentorship pilot had an average improvement of 5 ± 4 participants randomized per month (min −2.6; max 11.6; SD 4.3). Four of ten sites (40%) demonstrated continuous improvement in the average number of randomized participants per month after the pilot intervention and at three-month follow-up (post-intervention), as compared to the five-month period preceding the intervention. An additional two sites (20%) demonstrated improvement in the average number of randomized participants per month after the pilot intervention, and sustained that level of improvement at three-month follow-up (post-intervention). Additionally, six of ten sites (60%) demonstrated an increased number of participants screened for eligibility immediately following the intervention and at three-month follow-up (post-intervention). Only one site showed a decreased monthly average of randomized participants shortly after the intervention and through the three-month follow-up period. Conclusions The site mentoring model was successful in improving recruitment at low enrolling CONFIRM sites. An additional feasibility assessment is needed to determine if this mentoring model will be effective with other CSP trials.
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Affiliation(s)
- Marcus R Johnson
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, 508 Fulton Street (152), Durham, NC 27705, USA
| | | | - Danielle J Beck
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Aliya Asghar
- Tibor Rubin VA Medical Center, 5901 E. 7th Street (09/151-C2), Long Beach, CA 90822, USA
| | - Emily B Broussard
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, MHCL 116 Room 6B-310, Houston, TX 77030, USA
| | - Karen Bratcher
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Building 4, Third Floor B-325, Palo Alto, CA 94304, USA
| | - Lynn M Tommessilli
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
| | - Margaret Antonelli
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
| | - Beata M Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
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167
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Leighton PA, Brealey SD, Dias JJ. Interventions to improve retention in a surgical, clinical trial: A pragmatic, stakeholder-driven approach. J Evid Based Med 2018; 11:12-19. [PMID: 29356437 DOI: 10.1111/jebm.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/23/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore stakeholder perspectives upon participant retention in clinical trials, and to generate strategies to support retention in a surgical, clinical trial. STUDY DESIGN AND SETTING The SWIFFT trial is a multicenter study comparing treatments for the fracture of the waist of the scaphoid bone in adults. Here we report upon a multistage, iterative consultative process with SWIFFT stakeholders, these include workshops with members of the public, with nurses involved in data collection, and with consultant clinicians. Structured discussions were digitally recorded and transcribed, data were handled and analyzed following a framework approach to qualitative data analysis. RESULTS Removing practical barriers were identified as important factors in supporting retention. Stakeholders also identified that (i) how well a study is understood and (ii) how much it is valued are important factors in an individual's willingness to maintain their involvement. A number of strategies resulted from this consultation, these include: in-clinic data collection, co-ordinated clinical and research appointments, a SWIFFT website, and newsletter. CONCLUSION A participatory approach to trial retention might engage all relevant stakeholders in the delivery of a clinical trial, it might also support the generation of specific and contextually relevant solutions to the challenge of participant retention.
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Affiliation(s)
- Paul A Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joseph J Dias
- Clinical Division of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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168
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Wong ATY, Mannix C, Grantham JJ, Allman-Farinelli M, Badve SV, Boudville N, Byth K, Chan J, Coulshed S, Edwards ME, Erickson BJ, Fernando M, Foster S, Haloob I, Harris DCH, Hawley CM, Hill J, Howard K, Howell M, Jiang SH, Johnson DW, Kline TL, Kumar K, Lee VW, Lonergan M, Mai J, McCloud P, Peduto A, Rangan A, Roger SD, Sud K, Torres V, Vilayur E, Rangan GK. Randomised controlled trial to determine the efficacy and safety of prescribed water intake to prevent kidney failure due to autosomal dominant polycystic kidney disease (PREVENT-ADPKD). BMJ Open 2018; 8:e018794. [PMID: 29358433 PMCID: PMC5780847 DOI: 10.1136/bmjopen-2017-018794] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Maintaining fluid intake sufficient to reduce arginine vasopressin (AVP) secretion has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). However, evidence to support this as a clinical practice recommendation is of poor quality. The aim of the present study is to determine the long-term efficacy and safety of prescribed water intake to prevent the progression of height-adjusted total kidney volume (ht-TKV) in patients with chronic kidney disease (stages 1-3) due to ADPKD. METHODS AND ANALYSIS A multicentre, prospective, parallel-group, open-label, randomised controlled trial will be conducted. Patients with ADPKD (n=180; age ≤65 years, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2) will be randomised (1:1) to either the control (standard treatment+usual fluid intake) or intervention (standard treatment+prescribed fluid intake) group. Participants in the intervention arm will be prescribed an individualised daily fluid intake to reduce urine osmolality to ≤270 mOsmol/kg, and supported with structured clinic and telephonic dietetic review, self-monitoring of urine-specific gravity, short message service text reminders and internet-based tools. All participants will have 6-monthly follow-up visits, and ht-TKV will be measured by MRI at 0, 18 and 36 months. The primary end point is the annual rate of change in ht-TKV as determined by serial renal MRI in control vs intervention groups, from baseline to 3 years. The secondary end points are differences between the two groups in systemic AVP activity, renal disease (eGFR, blood pressure, renal pain), patient adherence, acceptability and safety. ETHICS AND DISSEMINATION The trial was approved by the Human Research Ethics Committee, Western Sydney Local Health District. The results will inform clinicians, patients and policy-makers regarding the long-term safety, efficacy and feasibility of prescribed fluid intake as an approach to reduce kidney cyst growth in patients with ADPKD. TRIAL REGISTRATION NUMBER ANZCTR12614001216606.
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Affiliation(s)
- Annette T Y Wong
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carly Mannix
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Jared J Grantham
- The Kidney Institute, Division of Nephrology and Hypertension, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Sunil V Badve
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands and the Harry Perkins Institute of Medical Research, University of Western Australia, Sydney, Australia
| | - Karen Byth
- Research and Education Network, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | | | | | - Marie E Edwards
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Erickson
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Eastern Sydney Health District and the University of New South Wales, Randwick, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Imad Haloob
- Department of Renal Medicine, Bathurst Base Hospital, Bathurst, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Julie Hill
- McCloud Consulting Group, Gordon, Australia
| | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, Australia
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Simon H Jiang
- Department of Renal Medicine, Canberra Hospital, Garran, Australia
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Timothy L Kline
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vincent W Lee
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Norwest Private Hospital, Sydney, Australia
| | - Maureen Lonergan
- Department of Renal Medicine, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Jun Mai
- Department of Renal Medicine, Liverpool Hospital, Southwestern Sydney Local Health District, Liverpool, Australia
| | | | - Anthony Peduto
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Anna Rangan
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | | | - Kamal Sud
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, Australia
- Nepean Clinical School, The University of Sydney Medical School, Sydney, Australia
| | - Vincent Torres
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, Newcastle, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
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Hershey DS, Hession SL. Recruitment and retention of a challenging population: Lessons learned and design implications. Appl Nurs Res 2017; 38:111-117. [PMID: 29241502 DOI: 10.1016/j.apnr.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/23/2017] [Accepted: 09/04/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of this article is share the lessons learned from recruiting and retaining adults with type 2 diabetes and solid tumor cancer into a longitudinal study exploring the relationship among chemotherapy, glycemic control, and symptoms. DESIGN/METHODS Twelve-week longitudinal study, recruited thirty-four adults 21years or older with pre-existing type 2 diabetes and a solid tumor cancer, from three community based cancer centers who were eligible to receive outpatient chemotherapy. METHODS Fisher's Exact Test (categorical variables) and Logistic Regression (continuous variables) were used to evaluate factors associated with participant withdrawal. A dichotomous attrition variable was created to identify those who dropped out of the study before the final week and those who completed. RESULTS Thirteen of the 34 participants completed the study. Symptom severity, baseline HbA1c and metastases were all identified as being factors that potentially influenced attrition. Recruitment was improved once recruiters were hired at each of the cancer centers and adjustments made to the inclusion criteria. CONCLUSIONS/IMPLICATIONS FOR RESEARCH Several design elements need to be considered to address attrition in future including the use of recruiters, inclusion and exclusion criteria, consent timing, data collection schedules, participant characteristics, participant burden, and support person identification.
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Affiliation(s)
- Denise Soltow Hershey
- College of Nursing, Michigan State University, Bott Building for Nursing Research and Education, 1355 Bogue St, C341, East Lansing, MI 48824, United States.
| | - Sarah L Hession
- Center for Statistical Training & Consulting, Michigan State University, Giltner Hall 293 Farm Ln Room 178, East Lansing, MI 48824, United States.
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170
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Roberge EM, Benedek DM, Marx CE, Rasmusson AM, Lang AJ. Analysis of Recruitment Strategies: Enrolling Veterans With PTSD Into a Clinical Trial. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Erika M. Roberge
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, and Veterans Affairs Medical Center, Washington, D.C
| | - David M. Benedek
- Department of Psychiatry, Uniformed Services University of the Health Sciences
| | - Christine E. Marx
- Duke University Medical Center, Durham, North Carolina, and Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina
| | - Ann M. Rasmusson
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego, and Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health, San Diego, California
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171
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Flood-Grady E, Clark VC, Bauer A, Morelli L, Horne P, Krieger JL, Nelson DR. Evaluating the Efficacy of a Registry linked to a Consent to Re-Contact Program and Communication Strategies for Recruiting and Enrolling Participants into Clinical Trials. Contemp Clin Trials Commun 2017; 8:62-66. [PMID: 29503877 PMCID: PMC5831259 DOI: 10.1016/j.conctc.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Although registries can rapidly identify clinical study participants, it is unknown which follow up methods for recruiting are most effective. Our goal is to examine the efficacy of three communication strategies for recruiting and enrolling patients who were identified via a contact registry (i.e., registry linked to a consent to re-contact program). METHODS Patients who met the study criteria were identified via the contact registry and targeted for recruitment. In condition 1, patients established in the university hepatology specialty clinics were contacted one time via phone call by the study coordinator and asked to participate (C1). In condition 2, non-established specialty clinic patients were mailed an IRB-approved letter with study information and instructions for calling the study coordinator to participate (C2). Condition 2A included patients who called within two weeks of receiving the letter (C2A); condition 2B included patients who did not call after receiving the letter but were subsequently contacted via phone call. RESULTS A registry identified 1,060 patients, of which 661were eligible and targeted for recruiting. All 37 patients were reached in C1 and 17 (45.9%) were recruited. Nineteen of the 624 patients in C2A were reached and 10 were recruited whereas 120 of the 605 patients in C2B were reached and 53 (8.7%) were recruited. Seventy patients enrolled with C2B being the most effective (total, cost) recruitment strategy (n = 50) (p < .001). CONCLUSION The efficacy of enrolling patients identified via a contact registry into clinical trials varies based on the communication strategies used for recruiting.
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Affiliation(s)
- Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
| | - Virginia C. Clark
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Angie Bauer
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Lauren Morelli
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Patrick Horne
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, United States
| | - David R. Nelson
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
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Tucker T, Bouvette M, Daly S, Grassau P. Finding the sweet spot: Developing, implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees. EVALUATION AND PROGRAM PLANNING 2017; 65:106-112. [PMID: 28763733 DOI: 10.1016/j.evalprogplan.2017.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/03/2017] [Accepted: 07/16/2017] [Indexed: 05/24/2023]
Abstract
Medical trainees are at high risk for developing burnout. Introducing trainees to the risks of burnout and supporting identification and proactive responses to their 'warning' signs of compassion fatigue (CF) is critical in building resiliency. The authors developed and evaluated a burnout and CF program for third year trainees at a Canadian Medical School. Of 165 medical trainees who participated in the burnout and CF program, 59 (36%) provided evaluation and feedback of the program and its impact throughout their year. Participation included self-utilization of a validated CF and burnout tool (ProQOL) across three time-points, workshop feedback, and focus group participation. Results highlighted the importance of 1) Recognizing Individual Signs & Symptoms of Stress, CF and Burnout; 2) Normalizing Stress, CF and Burnout for Students and Physicians; 3) Learning to Manage One's Own Stress. A decrease in compassion satisfaction and increase in burnout between beginning and end of third year were found. Further outcomes highlighted the importance of learning, living and surviving CF and burnout in clerkship. Emergent theory reveals the important responsibility educators have to integrate CF and burnout programs into 'the sweet spot' that third year offers, as trainees shift from theoretical to experiential practice as future clinicians.
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Affiliation(s)
- Tara Tucker
- Community Palliative Care Physician, 316-1500 Bank St. Ottawa, ON K1H 1B8, Canada.
| | - Maryse Bouvette
- Bruyère Continuing Care, Regional Palliative Care Consultation Service, 43 Bruyere St., Ottawa, ON K1N 5C8, Canada.
| | - Shauna Daly
- Bruyère Research Institute, Palliative Care Education and Research, 43 Bruyere St., Ottawa, ON K1N 5C8, Canada; Hospice Care Ottawa, 114 Cameron Avenue Ottawa, ON K1S 0X1, Canada.
| | - Pamela Grassau
- Bruyère Research Institute, Palliative Care Education and Research, 43 Bruyere St., Ottawa, ON K1N 5C8, Canada; Carleton University, School of Social Work, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada.
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173
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Luxembourg A, Moeller E. 9-Valent human papillomavirus vaccine: a review of the clinical development program. Expert Rev Vaccines 2017; 16:1119-1139. [PMID: 28956458 DOI: 10.1080/14760584.2017.1383158] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The 9-valent human papillomavirus (9vHPV) vaccine covers the same HPV types (6/11/16/18) as the quadrivalent HPV (qHPV) vaccine and 5 additional cancer-causing types (31/33/45/52/58). Epidemiological studies indicate that the 9vHPV vaccine could prevent approximately 90% of cervical cancers, 70-85% of high-grade cervical dysplasia (precancers), 85-95% of HPV-related vulvar, vaginal, and anal cancers, and 90% of genital warts. Areas covered: Study design features and key findings from the 9vHPV vaccine clinical development program are reviewed. In particular, 9vHPV vaccine efficacy was established in a Phase III study in young women age 16-26 years. Efficacy results in young women were extrapolated to pre- and young adolescent girls and boys and young men by immunological bridging (i.e., demonstration of non-inferior immunogenicity in these groups versus young women). Expert commentary: The development of the 9vHPV vaccine is the outcome of 20 years of continuous clinical research. Broad vaccination programs could help substantially decrease the incidence of HPV-related disease.
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Farley JE, Starbird LE, Anderson J, Perrin NA, Lowensen K, Ross T, Carroll KC. Methodologic considerations of household-level methicillin-resistant Staphylococcus aureus decolonization among persons living with HIV. Am J Infect Control 2017; 45:1074-1080. [PMID: 28684128 PMCID: PMC5791522 DOI: 10.1016/j.ajic.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND People living with HIV (PLWH) have a higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and likelihood of recurrent infection than the general population. Simultaneously treating MRSA-colonized household members may improve success with MRSA decolonization strategies. This article describes a pilot trial testing household-level MRSA decolonization and documents methodologic and pragmatic challenges of this approach. METHODS We conducted a randomized controlled trial of individual versus individual-plus-household MRSA decolonization to reduce recurrent MRSA. PLWH with a history of MRSA who are patients of an urban HIV clinic received a standard MRSA decolonization regimen. MRSA colonization at 6 months was the primary outcome. RESULTS One hundred sixty-six patients were referred for MRSA screening; 77 (46%) enrolled. Of those, 28 (36%) were colonized with MRSA and identified risk factors consistent with the published literature. Eighteen were randomized and 13 households completed the study. CONCLUSIONS This is the first study to report on a household-level MRSA decolonization among PLWH. Challenges included provider referral, HIV stigma, confidentiality concerns over enrolling households, and dynamic living situations. Although simultaneous household MRSA decolonization may reduce recolonization, recruitment and retention challenges specific to PLWH limit the ability to conduct household-level research. Efforts to minimize these barriers are needed to inform evidence-based practice.
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Affiliation(s)
- Jason E Farley
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD.
| | - Laura E Starbird
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Jill Anderson
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Nancy A Perrin
- Johns Hopkins Center for Global Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Kelly Lowensen
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Tracy Ross
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Kearney A, Daykin A, Shaw ARG, Lane AJ, Blazeby JM, Clarke M, Williamson P, Gamble C. Identifying research priorities for effective retention strategies in clinical trials. Trials 2017; 18:406. [PMID: 28859674 PMCID: PMC5580283 DOI: 10.1186/s13063-017-2132-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. METHODS Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. RESULTS Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance. CONCLUSION The surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research.
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Affiliation(s)
- Anna Kearney
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Institute of Child Health, Alder Hey NHS Trust, Liverpool, L12 2AP UK
| | - Anne Daykin
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Alison R. G. Shaw
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Athene J. Lane
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jane M. Blazeby
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University of Belfast, University Road, Belfast, BT7 1NN UK
| | - Paula Williamson
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Carrol Gamble
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Institute of Child Health, Alder Hey NHS Trust, Liverpool, L12 2AP UK
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176
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Szymczynska P, Walsh S, Greenberg L, Priebe S. Attrition in trials evaluating complex interventions for schizophrenia: Systematic review and meta-analysis. J Psychiatr Res 2017; 90:67-77. [PMID: 28231496 DOI: 10.1016/j.jpsychires.2017.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Abstract
Essential criteria for the methodological quality and validity of randomized controlled trials are the drop-out rates from both the experimental intervention and the study as a whole. This systematic review and meta-analysis assessed these drop-out rates in non-pharmacological schizophrenia trials. A systematic literature search was used to identify relevant trials with ≥100 sample size and to extract the drop-out data. The rates of drop-out from the experimental intervention and study were calculated with meta-analysis of proportions. Meta-regression was applied to explore the association between the study and sample characteristics and the drop-out rates. 43 RCTs were found, with drop-out from intervention ranging from 0% to 63% and study drop-out ranging from 4% to 71%. Meta-analyses of proportions showed an overall drop-out rate of 14% (95% CI: 13-15%) at the experimental intervention level and 20% (95% CI: 17-24%) at the study level. Meta-regression showed that the active intervention drop-out rates were predicted by the number of intervention sessions. In non-pharmacological schizophrenia trials, drop-out rates of less than 20% can be achieved for both the study and the experimental intervention. A high heterogeneity of drop-out rates across studies shows that even lower rates are achievable.
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Affiliation(s)
- P Szymczynska
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK.
| | - S Walsh
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
| | - L Greenberg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - S Priebe
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
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Wu V, Abo-Sido N, Espinola JA, Tierney CN, Tedesco KT, Sullivan AF, Camargo CA. Predictors of successful telephone follow-up in a multicenter study of infants with severe bronchiolitis. Ann Epidemiol 2017; 27:454-458.e1. [PMID: 28645568 PMCID: PMC5550350 DOI: 10.1016/j.annepidem.2017.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/12/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify the characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis. METHODS We analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child's age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts. RESULTS 798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income $60,000 or more, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with 3 or more children. In multivariable analyses, follow-up was more likely among parents of females, and, compared with the South, in the Northeast and Midwest (all P < .05). Compared with non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with 3 or more children (all P < .05). CONCLUSION Sociodemographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.
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Affiliation(s)
| | | | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Courtney N Tierney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
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A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents. Nutrients 2017; 9:nu9050474. [PMID: 28489030 PMCID: PMC5452204 DOI: 10.3390/nu9050474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The influence of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation on health outcomes has been studied extensively with randomized controlled trials (RCT). In many research fields, difficulties with recruitment, adherence and high drop-out rates have been reported. However, what is unknown is how common these problems are in n-3 LCPUFA supplementation studies in children and adolescents. Therefore, this paper will review n-3 LCPUFA supplementation studies in children and adolescents with regard to recruitment, adherence and drop-out rates. METHODS The Web of Science, PubMed and Ovid databases were searched for papers reporting on RCT supplementing children and adolescents (2-18 years) with a form of n-3 LCPUFA (or placebo) for at least four weeks. As a proxy for abiding to CONSORT guidelines, we noted whether manuscripts provided a flow-chart and provided dates defining the period of recruitment and follow-up. RESULTS Ninety manuscripts (reporting on 75 studies) met the inclusion criteria. The majority of the studies did not abide by the CONSORT guidelines: 55% did not provide a flow-chart, while 70% did not provide dates. The majority of studies provided minimal details about the recruitment process. Only 25 of the 75 studies reported an adherence rate which was on average 85%. Sixty-five of the 75 studies included drop-out rates which were on average 17%. CONCLUSION Less than half of the included studies abided by the CONSORT guidelines (45% included a flow chart, while 30% reported dates). Problems with recruitment and drop-out seem to be common in n-3 LCPUFA supplementation trials in children and adolescents. However, reporting about recruitment, adherence and dropout rates was very heterogeneous and minimal in the included studies. Some techniques to improve recruitment, adherence and dropout rates were identified from the literature, however these techniques may need to be tailored to n-3 LCPUFA supplementation studies in children and adolescents.
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179
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Marshall EA, Oates JC, Shoaibi A, Obeid JS, Habrat ML, Warren RW, Brady KT, Lenert LA. A population-based approach for implementing change from opt-out to opt-in research permissions. PLoS One 2017; 12:e0168223. [PMID: 28441388 PMCID: PMC5404843 DOI: 10.1371/journal.pone.0168223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 11/28/2016] [Indexed: 01/23/2023] Open
Abstract
Due to recently proposed changes in the Common Rule regarding the collection of research preferences, there is an increased need for efficient methods to document opt-in research preferences at a population level. Previously, our institution developed an opt-out paper-based workflow that could not be utilized for research in a scalable fashion. This project was designed to demonstrate the feasibility of implementing an electronic health record (EHR)-based active opt-in research preferences program. The first phase of implementation required creating and disseminating a patient questionnaire through the EHR portal to populate discreet fields within the EHR indicating patients' preferences for future research study contact (contact) and their willingness to allow anonymised use of excess tissue and fluid specimens (biobank). In the second phase, the questionnaire was presented within a clinic nurse intake workflow in an obstetrical clinic. These permissions were tabulated in registries for use by investigators for feasibility studies and recruitment. The registry was also used for research patient contact management using a new EHR encounter type to differentiate research from clinical encounters. The research permissions questionnaire was sent to 59,670 patients via the EHR portal. Within four months, 21,814 responses (75% willing to participate in biobanking, and 72% willing to be contacted for future research) were received. Each response was recorded within a patient portal encounter to enable longitudinal analysis of responses. We obtained a significantly lower positive response from the 264 females who completed the questionnaire in the obstetrical clinic (55% volunteers for biobank and 52% for contact). We demonstrate that it is possible to establish a research permissions registry using the EHR portal and clinic-based workflows. This patient-centric, population-based, opt-in approach documents preferences in the EHR, allowing linkage of these preferences to health record information.
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Affiliation(s)
- Elizabeth A. Marshall
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jim C. Oates
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Medical Service, Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America
| | - Azza Shoaibi
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jihad S. Obeid
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Melissa L. Habrat
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Robert W. Warren
- Department of Pediatrics, Division of Pediatric Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Leslie A. Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Medicine, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
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180
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The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit. Nat Biotechnol 2017; 35:354-362. [PMID: 28288104 DOI: 10.1038/nbt.3826] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 02/13/2017] [Indexed: 01/17/2023]
Abstract
The feasibility of using mobile health applications to conduct observational clinical studies requires rigorous validation. Here, we report initial findings from the Asthma Mobile Health Study, a research study, including recruitment, consent, and enrollment, conducted entirely remotely by smartphone. We achieved secure bidirectional data flow between investigators and 7,593 participants from across the United States, including many with severe asthma. Our platform enabled prospective collection of longitudinal, multidimensional data (e.g., surveys, devices, geolocation, and air quality) in a subset of users over the 6-month study period. Consistent trending and correlation of interrelated variables support the quality of data obtained via this method. We detected increased reporting of asthma symptoms in regions affected by heat, pollen, and wildfires. Potential challenges with this technology include selection bias, low retention rates, reporting bias, and data security. These issues require attention to realize the full potential of mobile platforms in research and patient care.
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181
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Zamani P, Akers S, Soto-Calderon H, Beraun M, Koppula MR, Varakantam S, Rawat D, Shiva-Kumar P, Haines PG, Chittams J, Townsend RR, Witschey WR, Segers P, Chirinos JA. Isosorbide Dinitrate, With or Without Hydralazine, Does Not Reduce Wave Reflections, Left Ventricular Hypertrophy, or Myocardial Fibrosis in Patients With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.116.004262. [PMID: 28219917 PMCID: PMC5523746 DOI: 10.1161/jaha.116.004262] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Wave reflections, which are increased in patients with heart failure with preserved ejection fraction, impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine coadministration is unknown. Methods and Results We randomized 44 patients with heart failure with preserved ejection fraction in a double‐blinded fashion to isosorbide dinitrate (ISDN; n=13), ISDN+hydralazine (ISDN+hydral; n=15), or placebo (n=16) for 6 months. The primary end point was the change in reflection magnitude (RM; assessed with arterial tonometry and Doppler echocardiography). Secondary end points included change in left ventricular mass and fibrosis, measured with cardiac magnetic resonance imaging, and the 6‐minute walk distance. ISDN reduced aortic characteristic impedance (mean baseline=0.15 [95% CI, 0.14–0.17], 3 months=0.11 [95% CI, 0.10–0.13], 6 months=0.10 [95% CI, 0.08–0.12] mm Hg/mL per second; P=0.003) and forward wave amplitude (Pf, mean baseline=54.8 [95% CI, 47.6–62.0], 3 months=42.2 [95% CI, 33.2–51.3]; 6 months=37.0 [95% CI, 27.2–46.8] mm Hg, P=0.04), but had no effect on RM (P=0.64), left ventricular mass (P=0.33), or fibrosis (P=0.63). ISDN+hydral increased RM (mean baseline=0.39 [95% CI, 0.35–0.43]; 3 months=0.31 [95% CI, 0.25–0.36]; 6 months=0.44 [95% CI, 0.37–0.51], P=0.03), reduced 6‐minute walk distance (mean baseline=343.3 [95% CI, 319.2–367.4]; 6 months=277.0 [95% CI, 242.7–311.4] meters, P=0.022), and increased native myocardial T1 (mean baseline=1016.2 [95% CI, 1002.7–1029.7]; 6 months=1054.5 [95% CI, 1036.5–1072.3], P=0.021). A high proportion of patients experienced adverse events with active therapy (ISDN=61.5%, ISDN+hydral=60.0%; placebo=12.5%; P=0.007). Conclusions ISDN, with or without hydralazine, does not exert beneficial effects on RM, left ventricular remodeling, or submaximal exercise and is poorly tolerated. ISDN+hydral appears to have deleterious effects on RM, myocardial remodeling, and submaximal exercise. Our findings do not support the routine use of these vasodilators in patients with heart failure with preserved ejection fraction. Clinical Trial Registration URL: www.clinicaltrials.gov. Unique identifier: NCT01516346.
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Affiliation(s)
- Payman Zamani
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Scott Akers
- Department of Radiology, Philadelphia Veterans' Affairs Medical Center, Philadelphia, PA
| | - Haideliza Soto-Calderon
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Melissa Beraun
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Maheswara R Koppula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Swapna Varakantam
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Deepa Rawat
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Prithvi Shiva-Kumar
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Philip G Haines
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.,Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jesse Chittams
- Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Raymond R Townsend
- Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Walter R Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patrick Segers
- Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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182
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Duprez V, Vandecasteele T, Verhaeghe S, Beeckman D, Van Hecke A. The effectiveness of interventions to enhance self-management support competencies in the nursing profession: a systematic review. J Adv Nurs 2017; 73:1807-1824. [DOI: 10.1111/jan.13249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Veerle Duprez
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
| | - Tina Vandecasteele
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Department Health Care; VIVES University College; Roeselare Belgium
| | - Sofie Verhaeghe
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Department Health Care; VIVES University College; Roeselare Belgium
| | - Dimitri Beeckman
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- School of Health Sciences; Nursing and Midwifery; University of Surrey; United Kingdom
| | - Ann Van Hecke
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Ghent; University Hospital; Belgium
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183
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Bergmann S, Keitel-Korndörfer A, Herfurth-Majstorovic K, Wendt V, Klein AM, von Klitzing K, Grube M. Recruitment strategies in a prospective longitudinal family study on parents with obesity and their toddlers. BMC Public Health 2017; 17:145. [PMID: 28143475 PMCID: PMC5286690 DOI: 10.1186/s12889-017-4038-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Recruitment of participants with obesity is a real challenge. To reduce time and costs in similar projects, we investigated various recruiting strategies used in a longitudinal family study with respect to their enrolment yield and cost effectiveness. Results may help other research groups to optimize their recruitment strategies. Methods We applied different recruitment strategies to acquire families with children aged 6 to 47 months and at least one parent with obesity (risk group) or two parents of normal weight (control group) for a longitudinal non-interventional study. Based on four main strategies-via media, kindergartens, health professionals and focusing on the community-we examined 15 different subcategories of strategies. Based on enrolment yield and relative costs (e.g., material expenses, staff time) we analyzed the effectiveness of each recruitment strategy. Results Following different recruitment approaches, 685 families contacted us; 26% (n = 178) of these met the inclusion criteria. Of the four main strategies, the community-focused strategy was the most successful one (accounting for 36.5% of the sample) followed by contacts with kindergartens (accounting for 28.1% of the sample). Of the subcategories, two strategies were outstanding: Posters (community-focused strategies), and recruitment via kindergartens using phone contacts rather than emailing. Only a small number of participants were recruited via announcements in newspapers (lower cost strategy), advertisements on public transport or face-to-face recruitment at various places (higher cost strategies). Conclusions Results revealed that only a combination of different active and passive methods and approaches led to a sufficient sample size. In this study, recruitment via posters and contacting kindergartens on the phone produced the highest numbers of participants (high enrolment yield) at moderate costs.
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Affiliation(s)
- Sarah Bergmann
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anja Keitel-Korndörfer
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Katharina Herfurth-Majstorovic
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Verena Wendt
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Annette M Klein
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Matthias Grube
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany. .,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany.
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184
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Resnik L, Klinger S. Attrition and retention in upper limb prosthetics research: experience of the VA home study of the DEKA arm. Disabil Rehabil Assist Technol 2017; 12:816-821. [DOI: 10.1080/17483107.2016.1269212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Linda Resnik
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Shana Klinger
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
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185
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Nelson LA, Mulvaney SA, Johnson KB, Osborn CY. mHealth Intervention Elements and User Characteristics Determine Utility: A Mixed-Methods Analysis. Diabetes Technol Ther 2017; 19:9-17. [PMID: 28099052 PMCID: PMC5248539 DOI: 10.1089/dia.2016.0294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mobile health (mHealth) interventions are improving the medication adherence of adults with type 2 diabetes mellitus (T2DM), but few studies examine how users experience these interventions. Therefore, we used a mixed-methods approach to understand how T2DM users experience a text messaging and interactive voice response (IVR)-delivered medication adherence intervention called MEssaging for Diabetes (MED). METHODS Adults with T2DM used MED as part of a 3-month pilot study. MED sends daily tailored text messages addressing adherence barriers, daily assessment text messages asking about adherence, and weekly tailored IVR calls providing adherence feedback, encouragement, and questions to facilitate problem solving. Sixty participants completed feedback interviews. We used a mixed-methods approach to understand their experience, examining associations between participants' characteristics and their feedback. RESULTS Participants who completed feedback interviews were on average 50.0 ± 10.1 years old; 65% female, 62% non-white; 15% had less than a high school education, 70% had annual incomes less than $20K; and average hemoglobin A1c was 8.0% ± 1.9%. Participants rated each intervention element favorably; common reasons for MED's helpfulness included receiving novel information about diabetes medications, emotional support, and reminders to take medication. People who were younger and more recently diagnosed with T2DM had more favorable experiences using MED. In general, users valued text messages more than IVR calls. CONCLUSIONS Consideration of the user experience is critical for developing engaging mHealth interventions. User feedback reveals what mHealth elements have the most value and why, which users to target, and how to optimize an intervention's utility and appeal.
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Affiliation(s)
- Lyndsay A. Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shelagh A. Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin B. Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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186
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Pfammatter AF, Mitsos A, Wang S, Hood SH, Spring B. Evaluating and improving recruitment and retention in an mHealth clinical trial: an example of iterating methods during a trial. Mhealth 2017; 3:49. [PMID: 29184901 PMCID: PMC5682361 DOI: 10.21037/mhealth.2017.09.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/28/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recruitment and retention strategy investigations in mHealth clinical trials are rare. Technology presents an opportunity to intensely and remotely evaluate recruitment, use of mobile apps, and retention, leading to new insights for continuous improvement of mHealth trials. The objective of this paper is to present a case study in which a trial evaluated and changed strategies during a clinical trial to improve recruitment, adherence to study protocols, and retention in the mHealth trial. METHODS In Fall 2015, the NUYou trial enrolled 150 college freshmen in an mHealth protocol. Three months after study initiation, NUYou struggled to meet recruitment goals and maintain anticipated usage levels of the study smartphone application. Two sets of data were collected to improve recruitment and retention: a survey about recruitment was sent to the target population and surveys regarding usability of the app was sent to the study sample. Survey results informed improvements in recruitment strategies, the study retention protocol, and the smartphone application. RESULTS Survey results revealed several insights including misunderstanding components of the trial by potential participants, low perceived usefulness of the app, and little recall or impact of the incentive structure. After implementation of user-centered improvements, the second cohort of NUYou recruitment in the fall of 2016 produced an equal sample size in 4 weeks less time. Winter quarter of 2016 compared to 2017 demonstrated an improvement in retention via app use and completion of weekly in-app surveys. CONCLUSIONS Recruitment and retention in clinical trials continues to be a critical challenge and mHealth trials may present both unique challenges and opportunities. To our knowledge, this is the first study to describe a systematic evaluation followed by changes and further evaluation to recruitment, use of the mHealth application, adherence to study protocol, and retention during an mHealth clinical trial. Future work should adopt and explicitly study these processes to optimize both enrollment and retention in these types of trials to preserve validity and reliability of research results.
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Affiliation(s)
- Angela Fidler Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexa Mitsos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shirlene Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan Hammett Hood
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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187
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Polese JC, Faria-Fortini ID, Basílio ML, Faria GSE, Teixeira-Salmela LF. Recruitment rate and retention of stroke subjects in cross-sectional studies. CIENCIA & SAUDE COLETIVA 2017; 22:255-260. [DOI: 10.1590/1413-81232017221.14262015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/10/2015] [Indexed: 11/21/2022] Open
Abstract
Abstract This article aimed to determine the recruitment rate of chronic stroke survivors to cross-sectional studies and to determine their retention at the two days of assessments. Participants after six months of a unilateral stroke were screened for eligibility and invited to participate in two cross-sectional studies, by telephone. The number of people who were screened, eligible, and successfully recruited was recorded. Retention at the two days of assessments was also recorded. From a list of 654 individuals, 87 were ineligible. Of the 567 left, 216 had wrong contact numbers, 144 refused to participate, and 12 had died. A total of 165 subjects participated in both studies. Out of the 56 who agreed to attend to the second day of assessment, eight did not return. The results showed that individuals with chronic stroke had low rates of recruitment and retention.
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188
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Kaur G, Smyth RL, Powell CVE, Williamson P. A survey of facilitators and barriers to recruitment to the MAGNETIC trial. Trials 2016; 17:607. [PMID: 28010731 PMCID: PMC5180395 DOI: 10.1186/s13063-016-1724-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022] Open
Abstract
Background Recruitment to randomised controlled trials with children is challenging. It is imperative to understand the factors that boost or hinder recruitment of children to clinical trials. We conducted a survey of facilitators and barriers to recruitment to the MAGNETIC trial, using a previously developed web-based tool. Methods MAGNETIC is a multicentre randomised trial of nebulised magnesium in acute severe asthma, recruiting 508 children from 30 UK sites. Recruiters were asked to grade a list of factors from –3 to +3 depending on whether the factor was perceived as a strong, intermediate or weak barrier (–3 to –1) or facilitator (+1 to + 3), and using (0) if it was thought to be not applicable. Free text responses were invited on strategies applied to counter the identified barriers. Results The commonly identified facilitators were motivation and experience of study teams, effective communication and coordination between teams at site and between sites and the Clinical Trials Unit, the presence of designated research nurses, good trial management, clinical trial publicity, simple inclusion criteria, effective communication with parents and presentation of trial information in a simple and clear manner. The commonly identified barriers were heavy clinical workload, shift patterns of work, Good Clinical Practice (GCP) training, inadequate number of trained staff, time and setting of consent seeking, non-availability of research staff out of hours and parents' concerns about their child taking an experimental medicine. Having a designated research nurse, arranging GCP training and trial-related training sessions for staff were the most commonly reported interventions. Conclusions This study highlights important generic and trial-specific facilitators and barriers to recruitment to a paediatric trial in the acute setting and provides information on the recruitment strategies or interventions that were applied to overcome these barriers. This information can be very useful in informing the design and conduct of future clinical trials with children, particularly in the acute or emergency setting. Trial registration ISRCTN, ISRCTN81456894. Registered on 15 November 2007. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1724-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geetinder Kaur
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Rosalind L Smyth
- University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Colin V E Powell
- Division of Population Medicine, Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff, CF144XN, UK
| | - Paula Williamson
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
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189
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Hug K, Johansson M. The ethics of withdrawal: the case of follow-up from first-in-human clinical trials. Regen Med 2016; 12:25-36. [PMID: 27976967 DOI: 10.2217/rme-2016-0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This paper aims to analyze whether patients should be allowed to veto research-related use of medical data collected during routine follow-ups after their withdrawal from first-in-human clinical trials. Forms of withdrawal are identified and it is argued that the right to withdraw might be limited to some of these. The paper concludes that if veto right is denied, then: the research participant should be informed about the potential use of his/her follow-up data in case of his/her withdrawal and consent to it; follow-up should not be initiated for research purposes; compulsory use of follow-up data should imply the use of data anyway collected, requiring no additional effort from the patient; and before deciding about the veto right, investigation of concerned patients' value preferences is needed.
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Affiliation(s)
- Kristina Hug
- Medical Ethics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BMC I12, 22184 Lund, Sweden
| | - Mats Johansson
- Medical Ethics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BMC I12, 22184 Lund, Sweden
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190
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Howarth E, Moore THM, Welton NJ, Lewis N, Stanley N, MacMillan H, Shaw A, Hester M, Bryden P, Feder G. IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04100] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Emma Howarth
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England (NIHR CLAHRC EoE), Cambridge, UK
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa HM Moore
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalia Lewis
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicky Stanley
- Connect Centre, School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Harriet MacMillan
- Psychiatry and Behavioural Neurosciences, and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Alison Shaw
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Marianne Hester
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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191
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Kanstrup M, Wicksell RK, Kemani M, Wiwe Lipsker C, Lekander M, Holmström L. A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning. CHILDREN-BASEL 2016; 3:children3040030. [PMID: 27854323 PMCID: PMC5184805 DOI: 10.3390/children3040030] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022]
Abstract
Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
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Affiliation(s)
- Marie Kanstrup
- Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
| | - Rikard K Wicksell
- Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
| | - Mike Kemani
- Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
| | - Camilla Wiwe Lipsker
- Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
- Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden.
| | - Linda Holmström
- Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden.
- Department of Women's and Children's health, Karolinska Institutet, H2:00, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden.
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192
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Topolovec-Vranic J, Natarajan K. The Use of Social Media in Recruitment for Medical Research Studies: A Scoping Review. J Med Internet Res 2016; 18:e286. [PMID: 27821383 PMCID: PMC5118584 DOI: 10.2196/jmir.5698] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Recruiting an adequate number of participants into medical research studies is challenging for many researchers. Over the past 10 years, the use of social media websites has increased in the general population. Consequently, social media websites are a new, powerful method for recruiting participants into such studies. Objective The objective was to answer the following questions: (1) Is the use of social media more effective at research participant recruitment than traditional methods? (2) Does social media recruit a sample of research participants comparable to that recruited via other methods? (3) Is social media more cost-effective at research participant recruitment than traditional methods? Methods Using the MEDLINE, PsycINFO, and EMBASE databases, all medical research studies that used social media and at least one other method for recruitment were identified. These studies were then categorized as either interventional studies or observational studies. For each study, the effectiveness of recruitment, demographic characteristics of the participants, and cost-effectiveness of recruitment using social media were evaluated and compared with that of the other methods used. The social media sites used in recruitment were identified, and if a study stated that the target population was “difficult to reach” as identified by the authors of the study, this was noted. Results Out of 30 studies, 12 found social media to be the most effective recruitment method, 15 did not, and 3 found social media to be equally effective as another recruitment method. Of the 12 studies that found social media to be the best recruitment method, 8 were observational studies while 4 were interventional studies. Of the 15 studies that did not find social media to be the best recruitment method, 7 were interventional studies while 8 were observational studies. In total, 8 studies stated that the target population was “hard-to-reach,” and 6 of these studies found social media to be the most effective recruitment method. Out of 14 studies that reported demographic data for participants, 2 studies found that social media recruited a sample comparable to that recruited via traditional methods and 12 did not. Out of 13 studies that reported cost-effectiveness, 5 studies found social media to be the most cost-effective recruitment method, 7 did not, and 1 study found social media equally cost-effective as compared with other methods. Conclusions Only 12 studies out of 30 found social media to be the most effective recruitment method. There is evidence that social media can be the best recruitment method for hard-to-reach populations and observational studies. With only 30 studies having compared recruitment through social media with other methods, more studies need to be done that report the effectiveness of recruitment for each strategy, demographics of participants recruited, and cost-effectiveness of each method.
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Affiliation(s)
- Jane Topolovec-Vranic
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Karthik Natarajan
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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193
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Hedman R, Hellström I, Ternestedt BM, Hansebo G, Norberg A. Sense of Self in Alzheimer’s Research Participants. Clin Nurs Res 2016; 27:191-212. [DOI: 10.1177/1054773816672671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The sense of self is vulnerable in people with Alzheimer’s disease (AD), and might be positively and negatively influenced by research participation. The purpose of this study was to describe how people with AD express their experience of being a research participant with respect to their sense of self. Interviews and support group conversations involving 13 people with mild and moderate AD were analyzed using qualitative content analysis. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks. Participants described contributing to research as being in line with their lifelong values and lifestyles. They expressed contentment and pride about being research participants, emphasized their positive relationships with the researchers, and described participation as a meaningful activity. When research procedures threatened their sense of self, they were able to reason about risks and decline participation.
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Affiliation(s)
- Ragnhild Hedman
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Ingrid Hellström
- Ersta Sköndal University College, Stockholm, Sweden
- Linköping University, Sweden
| | - Britt-Marie Ternestedt
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Görel Hansebo
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Astrid Norberg
- Ersta Sköndal University College, Stockholm, Sweden
- Umeå University, Sweden
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194
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Hudon C, Chouinard MC, Lambert M, Dufour I, Krieg C. Effectiveness of case management interventions for frequent users of healthcare services: a scoping review. BMJ Open 2016; 6:e012353. [PMID: 27687900 PMCID: PMC5051491 DOI: 10.1136/bmjopen-2016-012353] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Frequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost. This study aimed to examine the evidence of the effectiveness of CM interventions for frequent users of healthcare services. DESIGN Scoping review. DATA SOURCES An electronic literature search was conducted using the MEDLINE, Scopus and CINAHL databases covering January 2004 to December 2015. A specific search strategy was developed for each database using keywords 'case management' and 'frequent use'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES To be included in the review, studies had to report effects of a CM intervention on healthcare use and cost or patient outcomes. Eligible designs included randomised and non-randomised controlled trials and controlled and non-controlled before-after studies. Studies limited to specific groups of patients or targeting a single disease were excluded. Three reviewers screened abstracts, screened each full-text article and extracted data, and discrepancies were resolved by consensus. RESULTS The final review included 11 articles evaluating the effectiveness of CM interventions among frequent users of healthcare services. Two non-randomised controlled studies and 4 before-after studies reported positives outcomes on healthcare use or cost. Two randomised controlled trials, 2 before-after studies and 1 non-randomised controlled study presented mitigated results. Patient outcomes such as drug and alcohol use, health locus of control, patient satisfaction and psychological functioning were evaluated in 3 studies, but no change was reported. CONCLUSIONS Many studies suggest that CM could reduce emergency department visits and hospitalisations as well as cost. However, pragmatic randomised controlled trials of adequate power that recruit the most frequent users of healthcare services are still needed to clearly confirm its effectiveness.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada
| | - Isabelle Dufour
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Cynthia Krieg
- Département de pharmacologie-physiologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
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195
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Lamb KA, Backhouse MR, Adderley UJ. A qualitative study of factors impacting upon the recruitment of participants to research studies in wound care – The community nurses' perspective. J Tissue Viability 2016; 25:185-8. [DOI: 10.1016/j.jtv.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/25/2016] [Accepted: 03/17/2016] [Indexed: 11/15/2022]
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196
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Ventura F, Sawatzky R, Öhlén J, Karlsson P, Koinberg I. Challenges of evaluating a computer-based educational programme for women diagnosed with early-stage breast cancer: a randomised controlled trial. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27339805 DOI: 10.1111/ecc.12534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
In a two-group, multi-centre, randomised controlled 9 months trial, we (1) evaluated the impact of a computer-based educational programme compared to standard care and (2) examined whether different patterns of programme usage could be explained by demographic, medical and psychosocial factors. We involved 226 Swedish-speaking women diagnosed with early-stage breast cancer and scheduled for surgery. Primary outcomes were health self-efficacy and health care participation measured by the Comprehensive Health Enhancement Supportive System instrument. Secondary outcomes were anxiety and depression levels measured by the Hospital Anxiety and Depression scale. The Functional Assessment of Cancer Therapy-Breast and Sense of Coherence scales measured psychosocial factors for the study's secondary aim. Multi-level modelling revealed no statistically significant impact of the computer-based educational programme over time on the outcomes. Subsequent exploratory regression analysis revealed that older women with axillary dissection and increased physical well-being were more likely to use the programme. Furthermore, receiving post-operative chemotherapy and increased meaningfulness decreased the likelihood of use. Providing reliable and evidence-based medical and rehabilitation information via a computer-based programme might not be enough to influence multi-dimensional outcomes in women diagnosed with breast cancer. The use of these programmes should be further explored to promote adherence to e-Health supportive interventions.
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Affiliation(s)
- F Ventura
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Sawatzky
- Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - J Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Palliative Research Centre, Ersta Sköndal, University College, Stockholm, Sweden
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Koinberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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197
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Robinson L, Adair P, Coffey M, Harris R, Burnside G. Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children: a systematic review. Trials 2016; 17:294. [PMID: 27334018 PMCID: PMC4918126 DOI: 10.1186/s13063-016-1415-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/28/2016] [Indexed: 02/01/2023] Open
Abstract
Background Randomised controlled trials (RCTs) are recommended as the ‘gold standard’ in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children. Aim To identify predictors of recruitment and retention in RCTs involving children. Methods A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0–12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists. Results Twenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research. Conclusion Parent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1415-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Robinson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK. .,R&D Department, Salford Royal NHS Foundation Trust, Summerfield House, Stott Lane, Salford, M6 8HD, UK.
| | - Pauline Adair
- Health Psychology and Behavioural Medicine Research Group, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow, G1 1QE, UK
| | - Margaret Coffey
- School of Health Sciences, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Rebecca Harris
- Department of Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Waterhouse Building, Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Girvan Burnside
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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198
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Maximizing Patient Recruitment and Retention in a Secondary Stroke Prevention Clinical Trial: Lessons Learned from the STAND FIRM Study. J Stroke Cerebrovasc Dis 2016; 25:1371-80. [PMID: 27009610 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recruitment and retention of patients in a clinical trial is important for generalizability and robustness of findings. We aimed to investigate features of a study design that were associated with recruitment and retention in a Phase II and Phase III trial of a secondary prevention program for stroke. METHODS Following informed consent in hospital, Phase II participants were randomized to intervention or usual care. Baseline clinical assessments were conducted at home approximately 3 months after discharge. In Phase III study, informed consent was obtained at home. We compared the characteristics of participants recruited and retained to 12 months for both phases. Interviews with study nurses were undertaken in order to ascertain their opinions of features of study design. Triangulation was used to identify the features of study design that nurses thought had improved recruitment and retention. RESULTS All 24 eligible participants were recruited to the Phase II pilot study (100% recruitment), with 67% retention at 12 months. In Phase III study, 570 participants were recruited, and 93% of these participants had reached their 12-month assessment (n = 532) and were still participating. Consistent with the greater patient retention in Phase III study, nurses reported that patients' willingness to participate was greater when consent was obtained at home. CONCLUSION Following a change in the consent process from hospital to home, more participants continued participation to 12 months. Pilot studies can provide important data to improve study design and better understand potential barriers to recruitment and retention.
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199
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Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, Obeid J. Teleconsent: A Novel Approach to Obtain Informed Consent for Research. Contemp Clin Trials Commun 2016; 3:74-79. [PMID: 27822565 PMCID: PMC5096381 DOI: 10.1016/j.conctc.2016.03.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Lack of recruitment of qualified research participants continues to be a significant bottleneck in clinical trials, often resulting in costly time extensions, underpowered results, and in some cases early termination. Some of the reasons for suboptimal recruitment include laborious consent processes and access to participants at remote locations. While new electronic consents technologies (eConsent) help overcome challenges related to readability and consent management, they do not adequately address challenges related to remote access. To address this, we have developed an innovative solution called “teleconsent”, which embeds the informed consent process into a telemedicine session. Teleconsent allows a researcher to remotely video conference with a prospective research participant, display and interactively guide participants in real-time through a consent form. When finished, the researcher and participant can electronically sign the consent form and print or download the signed document for archiving. This process can eliminate challenges related to travel and management of personnel at remote sites. Teleconsent has been successfully implemented in several clinical trials. Teleconsent can improve research recruitment by reducing the barriers related to informed consent, while preserving human interaction.
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Affiliation(s)
- Brandon M Welch
- Biomedical Informatics Center, Medical University of South Carolina, 135 Cannon St, Suite 405, Charleston, SC 29425
| | - Elizabeth Marshall
- Biomedical Informatics Center, Medical University of South Carolina, 135 Cannon St, Suite 405, Charleston, SC 29425
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425
| | - Ayesha Aziz
- Biomedical Informatics Center, Medical University of South Carolina, 135 Cannon St, Suite 405, Charleston, SC 29425
| | - Marilyn Laken
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, 135 Cannon St, Suite 405, Charleston, SC 29425
| | - Jihad Obeid
- Biomedical Informatics Center, Medical University of South Carolina, 135 Cannon St, Suite 405, Charleston, SC 29425
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200
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Trends in Heart Failure Clinical Trials From 2001–2012. J Card Fail 2016; 22:171-9. [DOI: 10.1016/j.cardfail.2015.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/12/2015] [Accepted: 06/15/2015] [Indexed: 11/24/2022]
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