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Permana DA, Susanah S, Adrizain R, Rahayuningsih SE, Dhamayanti M, Rakhmilla LE. Factors Related to the Quality of Life in Children with Transfusion-Dependent Thalassemia. Pediatr Hematol Oncol 2024; 41:179-197. [PMID: 38424668 DOI: 10.1080/08880018.2023.2286962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/07/2023] [Indexed: 03/02/2024]
Abstract
Objective: Increased survival rate of patients with Transfusion-dependent Thalassemia (TDT) should be in line with their good quality of life (QoL). The study aimed to analyze the relationship between sociodemographic factors and clinical characteristics with the QoL of children with TDT. Methods: A cross-sectional study was conducted at Hasan Sadikin General Hospital from December 2022 to February 2023. A total of 158 eligible subjects aged 5-18 years with TDT were included in the analysis. QoL assessment was performed using child self-report and parent-proxy report questionnaires, along with physical examination findings. Bivariate and multivariate analyses were conducted to analyze the data. Results: A total of 158 subjects who met the research criteria were included in the analysis. Of 58.9% of children with TDT had a low adherence rate to iron chelating therapy (ICT). School function had the lowest score in QoL based on child-self report and parent proxy. Gender (p<0,05) and adherence to ICT (p<0,05) were significantly associated with lower quality of life. Conclusion: Female and adherence to ICT were predictors of children with TDT's QoL.
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Affiliation(s)
- Dea Aprilianti Permana
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Susi Susanah
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Riyadi Adrizain
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Lulu Eva Rakhmilla
- Department of Epidemiology and Biostatistic, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Makumbi S, Bajunirwe F, Ford D, Turkova A, South A, Lugemwa A, Musiime V, Gibb D, Tamwesigire IK. Voluntariness of consent in paediatric HIV clinical trials: a mixed-methods, cross-sectional study of participants in the CHAPAS-4 and ODYSSEY trials in Uganda. BMJ Open 2024; 14:e077546. [PMID: 38431301 PMCID: PMC10910635 DOI: 10.1136/bmjopen-2023-077546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To examine the voluntariness of consent in paediatric HIV clinical trials and the associated factors. DESIGN Mixed-methods, cross-sectional study combining a quantitative survey conducted concurrently with indepth interviews. SETTING AND PARTICIPANTS From January 2021 to April 2021, we interviewed parents of children on first-line or second-line Anti-retroviral therapy (ART) in two ongoing paediatric HIV clinical trials [CHAPAS-4 (ISRCTN22964075) and ODYSSEY (ISRCTN91737921)] at the Joint Clinical Research Centre Mbarara, Uganda. OUTCOME MEASURES The outcome measures were the proportion of parents with voluntary consent, factors affecting voluntariness and the sources of external influence. Parents rated the voluntariness of their consent on a voluntariness ladder. Indepth interviews described participants' lived experiences and were aimed at adding context. RESULTS All 151 parents randomly sampled for the survey participated (84% female, median age 40 years). Most (67%) gave a fully voluntary decision, with a score of 10 on the voluntariness ladder, whereas 8% scored 9, 9% scored 8, 6% scored 7, 8% scored 6 and 2.7% scored 4. Trust in medical researchers (adjusted OR 9.90, 95% CI 1.01 to 97.20, p=0.049) and male sex of the parent (adjusted OR 3.66, 95% CI 1.00 to 13.38, p=0.05) were positively associated with voluntariness of consent. Prior research experience (adjusted OR 0.31, 95% CI 0.12 to 0.78, p=0.014) and consulting (adjusted OR 0.25. 95% CI 0.10 to 0.60, p=0.002) were negatively associated with voluntariness. Consultation and advice came from referring health workers (36%), spouses (29%), other family members (27%), friends (15%) and researchers (7%). The indepth interviews (n=14) identified the health condition of the child, advice from referring health workers and the opportunity to access better care as factors affecting the voluntariness of consent. CONCLUSIONS This study demonstrated a high voluntariness of consent, which was enhanced among male parents and by parents' trust in medical researchers. Prior research experience of the child and advice from health workers and spouses were negatively associated with the voluntariness of parents' consent. Female parents and parents of children with prior research experience may benefit from additional interventions to support voluntary participation.
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Affiliation(s)
- Shafic Makumbi
- Joint Clinical Research Centre, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Annabelle South
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Victor Musiime
- Joint Clinical Research Centre, Mbarara, Uganda
- Makerere University, Kampala, Uganda
| | - Diana Gibb
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Imelda K Tamwesigire
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Baba A, Smith M, Potter BK, Chan AW, Moher D, Offringa M. Guidelines for reporting pediatric and child health clinical trial protocols and reports: study protocol for SPIRIT-Children and CONSORT-Children. Trials 2024; 25:96. [PMID: 38287439 PMCID: PMC10826142 DOI: 10.1186/s13063-024-07948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Despite the critical importance of clinical trials to provide evidence about the effects of intervention for children and youth, a paucity of published high-quality pediatric clinical trials persists. Sub-optimal reporting of key trial elements necessary to critically appraise and synthesize findings is prevalent. To harmonize and provide guidance for reporting in pediatric controlled clinical trial protocols and reports, reporting guideline extensions to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines specific to pediatrics are being developed: SPIRIT-Children (SPIRIT-C) and CONSORT-Children (CONSORT-C). METHODS The development of SPIRIT-C/CONSORT-C will be informed by the Enhancing the Quality and Transparency of Health Research Quality (EQUATOR) method for reporting guideline development in the following stages: (1) generation of a preliminary list of candidate items, informed by (a) items developed during initial development efforts and child relevant items from recent published SPIRIT and CONSORT extensions; (b) two systematic reviews and environmental scan of the literature; (c) workshops with young people; (2) an international Delphi study, where a wide range of panelists will vote on the inclusion or exclusion of candidate items on a nine-point Likert scale; (3) a consensus meeting to discuss items that have not reached consensus in the Delphi study and to "lock" the checklist items; (4) pilot testing of items and definitions to ensure that they are understandable, useful, and applicable; and (5) a final project meeting to discuss each item in the context of pilot test results. Key partners, including young people (ages 12-24 years) and family caregivers (e.g., parents) with lived experiences with pediatric clinical trials, and individuals with expertise and involvement in pediatric trials will be involved throughout the project. SPIRIT-C/CONSORT-C will be disseminated through publications, academic conferences, and endorsement by pediatric journals and relevant research networks and organizations. DISCUSSION SPIRIT/CONSORT-C may serve as resources to facilitate comprehensive reporting needed to understand pediatric clinical trial protocols and reports, which may improve transparency within pediatric clinical trials and reduce research waste. TRIAL REGISTRATION The development of these reporting guidelines is registered with the EQUATOR Network: SPIRIT-Children ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials-protocols/#35 ) and CONSORT-Children ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/#CHILD ).
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Affiliation(s)
- Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Ottawa, ON, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Jawa NA, Boyd JG, Maslove DM, Scott SH, Silver SA. Informed consent practices in clinical research: present and future. Postgrad Med J 2023; 99:1033-1042. [PMID: 37265442 DOI: 10.1093/postmj/qgad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/06/2023] [Indexed: 06/03/2023]
Abstract
Clinical research must balance the need for ambitious recruitment with protecting participants' autonomy; a requirement of which is informed consent. Despite efforts to improve the informed consent process, participants are seldom provided sufficient information regarding research, hindering their ability to make informed decisions. These issues are particularly pervasive among patients experiencing acute illness or neurological impairment, both of which may impede their capacity to provide consent. There is a critical need to understand the components, requirements, and methods of obtaining true informed consent to achieve the vast numbers required for meaningful research. This paper provides a comprehensive review of the tenets underlying informed consent in research, including the assessment of capacity to consent, considerations for patients unable to consent, when to seek consent from substitute decision-makers, and consent under special circumstances. Various methods for obtaining informed consent are addressed, along with strategies for balancing recruitment and consent.
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Affiliation(s)
- Natasha A Jawa
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3L4, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - David M Maslove
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Samuel A Silver
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
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Koonrungsesomboon N, Charoenkwan P, Natesirinilkul R, Fanhchaksai K, Sakuludomkan W, Morakote N. What information and the extent of information to be provided in an informed assent/consent form of pediatric drug trials. BMC Med Ethics 2022; 23:113. [DOI: 10.1186/s12910-022-00856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
This study aimed to determine the elements and the extent of information that child participants and their parents would like to read in an informed assent form (IAF)/informed consent form (ICF) of a pediatric drug trial.
Methods
A descriptive survey was conducted to determine the perceived importance of each element of the ICF content from child participants and their parents who underwent informed assent/consent of a multi-center pediatric drug trial. The respondents were asked to indicate the level of importance of each item in a questionnaire, by giving a rating scale from 1 (not important) to 5 (very important).
Results
A total of 22 families, 17 child participants with the diagnosis of hematology or oncology diseases and 27 parents, were enrolled. Among 30 items, risk–benefit aspects (i.e., direct health benefit [mean: 4.71 for child respondents, 4.89 for parent respondents], indirect/societal benefit [mean: 4.65, 4.85], major foreseeable risk [mean: 4.47, 4.78], post-trial benefit/provision [mean: 4.59, 4.74], and all adverse effects of the drug including uncommon adverse effects [mean: 4.53, 4.74]) were perceived to be of most concerning items from both child participants’ and parents’ viewpoint. None of the items were considered ‘slightly important’ or lower by more than 20% of the respondents.
Conclusions
For pediatric drug trials, risk–benefit information (including direct health benefit, indirect/societal benefit, and post-trial benefit/provision, as well as major foreseeable risk and adverse effects of the drug) should be made a salient feature of an IAF/ICF. This empirical data could help related stakeholders arrange essential information in order of importance and tailor an IAF/ICF to better suit child participants’ and parents’ needs, particularly for pediatric drug trials involving children with the diagnosis of hematology or oncology diseases.
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Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Hidalgo-García C, Tricás-Moreno JM. Active Cervical Range of Motion in Babies with Positional Plagiocephaly: Analytical Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121146. [PMID: 34943342 PMCID: PMC8700430 DOI: 10.3390/children8121146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Positional plagiocephaly (PP) is a general term describing cranial distortion from pre- or postnatal forces on the infant head. Abnormal intrauterine forces, multiple births, primiparous mothers, obstetric interventions, prematurity, male sex, excessive time lying in the supine position, and mobility restrictions of the cervical spine have been considered as the main predisposing factors. The objective was to investigate the association between the severity of PP and the active cervical rotation and to analyze the influence of predisposing factors in babies with PP. An analytical cross-sectional study was performed on 74 babies with moderate PP. Clinical and demographic data, cranial vault asymmetry, and active cervical rotation range of motion (ROM) were measured. Associations were analyzed with generalized linear models. The mean age was 16.8 ± 5.0 weeks, and 56.8% were male. A restriction in the ROM of active cervical rotation, especially to the left side, was observed. Our models showed that cranial asymmetry was related with left active cervical rotation ROM (p = 0.034) and with being transported in a pushchair (p < 0.001). Conclusions: An increased severity of PP was related with being transported in a baby pushchair and with a reduced active cervical rotation ROM toward the most restricted side.
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Affiliation(s)
- Iñaki Pastor-Pons
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
| | - Marta Barrau-Lalmolda
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | | | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
| | - José Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
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Smith H, Scalchunes C, Cowan MJ, Puck J, Heimall J. Expectations and experience: Parent and patient perspectives regarding treatment for Severe Combined Immunodeficiency (SCID). Clin Immunol 2021; 229:108778. [PMID: 34144198 PMCID: PMC8559521 DOI: 10.1016/j.clim.2021.108778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Infants with SCID are treated with hematopoietic cell transplantation (HCT) or gene therapy (GT). Caregiver perceptions of pre-treatment counseling and understanding of durability of HCT/GT are poorly understood. METHODS A survey was designed and distributed to families of patients with SCID. Topics in the questionnaire included SCID genotype and treatment, family recollections of pre-treatment counseling and present clinical status. RESULTS 151 surveys were analyzed. 132 were treated with HCT, 19 with GT. From counseling received, 37% expected HCT/GT would lead to "cure"; 43% expected HCT/GT would last a lifetime. Of 136 living patients, 59% reported overall good health but 65% reported some persistent health challenges. CONCLUSIONS For some, interpretation of the word "cure" varied, leading to misunderstanding regarding need for continued medical evaluations and additional therapies. Clear communication regarding the importance of lifelong follow-up, no matter the treatment outcome, will help to optimize good health and quality of life.
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Affiliation(s)
| | | | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation; Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Puck
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation; Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, USA.
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Cotrim H, Granja C, Carvalho AS, Cotrim C, Martins R. Children's Understanding of Informed Assents in Research Studies. Healthcare (Basel) 2021; 9:871. [PMID: 34356249 PMCID: PMC8307200 DOI: 10.3390/healthcare9070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
The assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. AIMS To evaluate the minors' ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child's assent. METHODS The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. RESULTS The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (<14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child's acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. CONCLUSION Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child's acceptance of health care.
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Affiliation(s)
- Hortense Cotrim
- Nursing Department, Universidade Atlântica, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
| | - Cristina Granja
- Anaesthesiology Department, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
| | - Ana Sofia Carvalho
- Associated Teacher with Aggregation, Institute of Bioethics, University of Portugal, 1649-023 Lisboa, Portugal;
| | - Carlos Cotrim
- Cardiology Department, Hospital da Cruz Vermelha, 1549-008 Lisboa, Portugal;
| | - Rui Martins
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, 1549-008 Lisboa, Portugal;
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Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Hidalgo-García C, Tricás-Moreno JM. Efficacy of pediatric integrative manual therapy in positional plagiocephaly: a randomized controlled trial. Ital J Pediatr 2021; 47:132. [PMID: 34090515 PMCID: PMC8180102 DOI: 10.1186/s13052-021-01079-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. METHODS Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (- 10 cm to + 10 cm). RESULTS CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). CONCLUSION Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. TRIAL REGISTRATION Trial registration number: NCT03659032 ; registration date: September 1, 2018. Retrospectively registered.
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Affiliation(s)
- Iñaki Pastor-Pons
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
- Instituto de Terapias Integrativas, Constitución 29 Dplo, 50001 Zaragoza, Spain
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
| | | | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, Constitución 29 Dplo, 50001 Zaragoza, Spain
| | - Ángel Luis Rodríguez-Fernández
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo CEU, Urbanización Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
| | - Jose Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
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Pastor-Pons I, Hidalgo-García C, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Tricás-Moreno JM. Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial. Ital J Pediatr 2021; 47:41. [PMID: 33632268 PMCID: PMC7908758 DOI: 10.1186/s13052-021-00995-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. METHODS Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d. RESULTS All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. CONCLUSION The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032 . Registration date: September 1, 2018.
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Affiliation(s)
- Iñaki Pastor-Pons
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
- Instituto de Terapias Integrativas, San Miguel, 16, 50001, Zaragoza, Spain
| | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain.
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
| | | | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, San Miguel, 16, 50001, Zaragoza, Spain
| | - Ángel Luis Rodríguez-Fernández
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo CEU, Urbanización Montepríncipe, 28925, Alcorcón, Madrid, Spain
| | - José Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
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Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Hidalgo-García C, Tricás-Moreno JM. Interrater and Intrarater Reliability of Cranial Anthropometric Measurements in Infants with Positional Plagiocephaly. CHILDREN-BASEL 2020; 7:children7120306. [PMID: 33348822 PMCID: PMC7766735 DOI: 10.3390/children7120306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (<28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) > 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC > 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: −0.03 cm; inter: −0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.
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Affiliation(s)
- Iñaki Pastor-Pons
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
- Correspondence: ; Tel.: +34-626-480-131
| | - Marta Barrau-Lalmolda
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | | | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
| | - Jose Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
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Kim JP, Rostami M, Roberts LW. Attitudes of Mothers Regarding Willingness to Enroll Their Children in Research. J Empir Res Hum Res Ethics 2020; 15:452-464. [PMID: 32552481 DOI: 10.1177/1556264620927583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed mothers' perspectives regarding research involvement by their children, factors that might affect perceptions of research risks, and attitudes regarding willingness to enroll children in research. Participants completed a survey on Amazon Mechanical Turk. Mothers were less inclined to enroll children in research involving procedures posing higher risk (regression coefficient = -0.51). Mothers without mental health issues with children without health issues were more sensitive to risk than mothers without mental health issues with children with health issues (estimated difference = 0.49). Mothers with mental health issues were more willing than mothers without mental health issues to enroll children in research (regression coefficient = -0.90). Among mothers with mental health issues, having a child with a health issue was associated with increased willingness to enroll in research, compared with having children without health issues (estimated difference = 0.65).
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Affiliation(s)
- Jane Paik Kim
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maryam Rostami
- Stanford University School of Medicine, Palo Alto, CA, USA
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Almomani BA, Al‐Azzam SI, Al‐Shatnawi SF. Knowledge and views of parents regarding ethical aspects of medical research among their children in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Basima A. Almomani
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology Irbid Jordan
| | - Sayer I. Al‐Azzam
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology Irbid Jordan
| | - Samah F. Al‐Shatnawi
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology Irbid Jordan
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Koonrungsesomboon N, Traivaree C, Tiyapsane C, Karbwang J. Improved parental understanding by an enhanced informed consent form: a randomized controlled study nested in a paediatric drug trial. BMJ Open 2019; 9:e029530. [PMID: 31772085 PMCID: PMC6887000 DOI: 10.1136/bmjopen-2019-029530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate the applicability and effectiveness of the enhanced informed consent form (ICF) methodology, proposed by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), in paediatric research requiring parental consent. The objective of this study was to compare the parental understanding of information between the parents who read the SIDCER ICF and those who read the conventional ICF. DESIGN A prospective, randomized, controlled design. SETTING Paediatric Outpatients Department, Phramongkutklao Hospital, Thailand. PARTICIPANTS 210 parents of children with thalassemia (age=35.6 ± 13.1 years). INTERVENTIONS The parents were randomly assigned to read either the SIDCER ICF (n=105) or the conventional ICF (n=105) of a paediatric drug trial. PRIMARY AND SECONDARY OUTCOME MEASURES Parental understanding of trial information was determined using 24 scenario-based questions. The primary endpoint was the proportion of parents who obtained the understanding score of more than 80%, and the secondary endpoint was the total score. RESULTS Forty-five parents (42.9%) in the SIDCER ICF group and 29 parents (27.6%) in the conventional ICF group achieved the primary endpoint (relative risk=1.552, 95% CI 1.061 to 2.270, p=0.021). The total score of the parents in the SIDCER ICF group was significantly higher than the conventional ICF group (18.07±3.71 vs 15.98±4.56, p=0.001). CONCLUSIONS The SIDCER ICF was found to be superior to the conventional ICF in improving parental understanding of trial information.
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Affiliation(s)
- Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanchai Traivaree
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Charnunnut Tiyapsane
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Juntra Karbwang
- Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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15
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Best Practices for Obtaining Genomic Consent in Pediatric Traumatic Brain Injury Research. Nurs Res 2019; 68:E11-E20. [PMID: 30829926 DOI: 10.1097/nnr.0000000000000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Precision health relies on large sample sizes to ensure adequate power, generalizability, and replicability; however, a critical first step to any study is the successful recruitment of participants. OBJECTIVES This study seeks to explore how the enrollment strategies used in a parent study contributed to the high consent rates, establish current best practices that can be used in future studies, and identify additional factors that contribute to consent into pediatric traumatic brain injury biobanks. METHODS Retrospective secondary analysis of data from a parent study with high consent rates was examined to explore factors affecting consent into biobanking studies. RESULTS Of the 76 subjects who were approached, met the eligibility criteria, and reviewed the consent form, only 16 (21.1%) declined to participate. The consented group (n = 60) represents 64.5% of those who met the eligibility criteria upon initial screening (n = 93) and 78.9% of those with confirmed eligibility (n = 76). Analysis of screening data suggested there were no major barriers to consenting individuals into this pediatric traumatic brain injury biobank. DISCUSSION There were no demographic or research-related characteristics that significantly explained enrollment. Ethically, to obtain true informed consent, parents need to understand only their child's diagnosis, prognosis, and medical care, as well as the purpose of the proposed research and its risks and benefits. Researchers need to implement best practices, including a comprehensive review of census data to identify eligible participants to approach, a prescreening protocol, and effective consenting process to obtain informed consent so that precision care initiatives can be pursued.
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Hejoaka F, Varloteaux M, Desclaux-Sall C, Ndiaye SM, Diop K, Diack A, Niasse F, Cames C. Improving the informed consent process among HIV-infected undisclosed minors participating in a biomedical research: insights from the multicentre nutritional SNACS study in Senegal. Trop Med Int Health 2019; 24:294-303. [PMID: 30624827 DOI: 10.1111/tmi.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Providing research information in a manner accessible to minors participating in biomedical research is a major challenge. Guidance is dramatically lacking regarding best practices for seeking informed consent among undisclosed minors enrolled in HIV-related research. We implemented an improved informed consent process (IICP) and identified factors associated with understanding of the information presented to HIV-infected minors prior to their enrolment in a study. METHODS We enrolled study participants attending 12 paediatric HIV clinics in Senegal. Children ≥7 years were provided with standardised research information using the IICP, which involves viewing a video and taking part in extended group discussions. Understanding was assessed by seven basic questions scored 1 or 2 points, with a maximum score of 11 points. A score of 9 or more points was defined as satisfactory understanding. Factors associated with understanding were identified using a stepwise logistic regression model. RESULTS Overall, 112 children, with a median age of 12.9 years (IQR: 10.2-15.0), participated in the IICP, of whom 37% were HIV disclosed. 71% achieved a satisfactory understanding score and all gave consent to participate in the research. HIV-disclosed children were more likely to demonstrate satisfactory understanding than undisclosed children (aOR = 3.2, 95% CI: 1.1-9.6). Age, study setting and education level were not associated with satisfactory understanding. CONCLUSION These findings provide practical guidance for the development of improved and friendly informed consent processes in research involving minors. The implementation of the paediatric HIV research agenda will require a standardised and operational definition of informed consent, integrating the issue of HIV disclosure.
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Affiliation(s)
- Fabienne Hejoaka
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Marie Varloteaux
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Caroline Desclaux-Sall
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Sidy Mokhtar Ndiaye
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal
| | - Karim Diop
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal.,Division de lutte contre le sida et les IST/Ministère de la santé et de l'action sociale, Dakar, Sénégal
| | - Aminata Diack
- Centre hospitalier national d'enfants Albert Royer, Dakar, Sénégal
| | - Fatou Niasse
- Conseil national de lutte contre le sida, Dakar, Sénégal
| | - Cécile Cames
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
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17
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Rethinking informed consent in pediatric research: a time for regulatory policy change? Pediatr Res 2018; 84:477-478. [PMID: 30143778 DOI: 10.1038/s41390-018-0151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 11/08/2022]
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18
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Jacquot C, Delaney M. Pathogen-inactivated blood products for pediatric patients: blood safety, patient safety, or both? Transfusion 2018; 58:2095-2101. [DOI: 10.1111/trf.14811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Cyril Jacquot
- Divisions of Pathology & Laboratory Medicine; Children's National Health System; Washington DC
- Departments of Pathology & Pediatrics, School of Medicine and Health Sciences; The George Washington University; Washington DC
| | - Meghan Delaney
- Divisions of Pathology & Laboratory Medicine; Children's National Health System; Washington DC
- Departments of Pathology & Pediatrics, School of Medicine and Health Sciences; The George Washington University; Washington DC
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Massetti T, Crocetta TB, Guarnieri R, da Silva TD, Leal AF, Voos MC, de Mello Monteiro CB. A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent. Clinics (Sao Paulo) 2018; 73:e207. [PMID: 30156595 PMCID: PMC6104506 DOI: 10.6061/clinics/2018/e207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE When children participate in research protocols, consent (by a parent or legal guardian) and assent (by the children) must be given. Understanding research protocols can be challenging for an adult and even more difficult for a child. The aim of this study was to describe the development of a comic book created to facilitate children's understanding of informed assent with clear and simple language. METHODS Five researchers with scores above seven according to the Fehring criteria developed the comic book, avoiding the use of technical terminology. Twenty children between 7 and 12 years old, and enrolled in a larger study, responded using a Likert scale and questions about the clarity of texts and illustrations. The final version met National Health System Resolutions (Resoluções do Conselho Nacional da Saúde - CNS n° 196/1996 and 466/2012). RESULTS The comic book assent presents a short story containing information about a real study: the invitation to participate, objectives, methods, instruments, procedures, risks, benefits, and the researchers' contact information. Most of the participants answered that they perceived the content of the text to be "Excellent" (40%) and "Very good" (40%), and the illustrations were perceived as "Excellent" (45%) and "Very good" (55%). CONCLUSION The construction of a simple and clear model of informed assent is possible, and this model should be used in experiments with children.
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Affiliation(s)
- Thaís Massetti
- Programa de Graduacao em Ciencias da Reabilitacao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Tânia Brusque Crocetta
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Faculdade de Medicina do ABC, Santo Andre, SP, BR
| | - Regiani Guarnieri
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Faculdade de Medicina do ABC, Santo Andre, SP, BR
| | - Talita Dias da Silva
- EACH - Escola de Artes, Ciencias e Humanidades, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andrea Fernanda Leal
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Faculdade de Medicina do ABC, Santo Andre, SP, BR
| | - Mariana Callil Voos
- Programa de Graduacao em Ciencias da Reabilitacao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Bandeira de Mello Monteiro
- Programa de Graduacao em Ciencias da Reabilitacao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Delineamento de Estudos e Escrita Cientifica, Faculdade de Medicina do ABC, Santo Andre, SP, BR
- EACH - Escola de Artes, Ciencias e Humanidades, Universidade de Sao Paulo, Sao Paulo, SP, BR
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20
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Ethical issues in research: Human and animal experimentation. J Pediatr Urol 2018; 14:287-288. [PMID: 29477694 DOI: 10.1016/j.jpurol.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022]
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21
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Gates A, Caldwell P, Curtis S, Dans L, Fernandes RM, Hartling L, Kelly LE, Williams K, Woolfall K, Dyson MP. Consent and recruitment: the reporting of paediatric trials published in 2012. BMJ Paediatr Open 2018; 2:e000369. [PMID: 30555937 PMCID: PMC6267313 DOI: 10.1136/bmjpo-2018-000369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES We evaluated 300 paediatric trials to determine: the consent and recruitment strategies used, who trial information was targeted to, how incentives were used and if they achieved their recruitment targets. METHODS For this cross-sectional evaluation, we searched the Cochrane Central Register of Controlled Trials for paediatric trials published in 2012 and randomly selected 300 that reported on outcomes for participants aged ≤21 years. We collected data on consent and recruitment procedures for each trial and undertook descriptive analyses in SPSS statistics V.23. RESULTS All but one trial (99.7%) used a standard recruitment strategy. Most (92%) trials reported that consent was obtained but only 13% reported who obtained consent. Two-thirds (65%) of trials included school-aged participants, and of these 68% reported obtaining assent. Half (50%) of the trials reported who the trial information was targeted to. Most trials (75%) of school-aged participants targeted information towards children or children and their parents. Fourteen per cent of trials reported using incentives, half (50%) of which were in the form of compensation. Only 48% of trials reported sufficient data to determine if their recruitment targets were achieved. Of these, 70% achieved their targets. CONCLUSIONS Notable reporting shortcomings included: how families were recruited into the trial, who obtained consent and/or assent and how, who trial information was directed to, whether incentives were used and sufficient data to determine if the recruitment target was achieved. Forthcoming paediatric-specific reporting standards may improve reporting in this priority area. Our data provide a baseline for ongoing monitoring of the state of the research.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patrina Caldwell
- Discipline of Child and Adolescent Health and Centre for Kidney Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Curtis
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Leonila Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - Ricardo M Fernandes
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Clinical Trials Platform, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Katrina Williams
- Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kerry Woolfall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Michele P Dyson
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Khabour OF, Alomari MA, Al-Sheyab NA. Parental Perceptions About Informed Consent/Assent in Pediatric Research in Jordan. J Empir Res Hum Res Ethics 2017; 12:261-268. [PMID: 28697643 DOI: 10.1177/1556264617718937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The informed consent/assent process during enrollment in pediatric research is integral to protecting children from possible harm. Here we explored parents' perceptions about the informed consent/assent process in Jordan. Therefore, focus group interviews were conducted that focused on the importance of consent/assent, the quality of the information provided during consent process, and the parents' perceptions toward written/verbal informed consent. Content thematic analysis approach was adopted in the transcription and translation processes of the interviews. The majority of parents have an ethically acceptable understanding of many of the aspects related to consent/assent; however, some views were not consistent with the proper conduct of research. For example, some parents believed that informed consent is not required for questionnaire studies. Discrepancies were also noted regarding the appropriate age of a child's assent. Some parents would force their child to participate. Thus, the development of Jordanian, culturally sensitive pediatric research guidelines is required.
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Affiliation(s)
- Omar F Khabour
- 1 Jordan University of Science and Technology, Irbid, Jordan
| | | | - Nihaya A Al-Sheyab
- 1 Jordan University of Science and Technology, Irbid, Jordan
- 2 The University of Sydney, Australia
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Weijenberg A, Callenbach PMC, Brouwer OF. Investigator-initiated randomized controlled trials in children with epilepsy: Mission impossible? Epilepsia Open 2016; 2:32-38. [PMID: 29750211 PMCID: PMC5939385 DOI: 10.1002/epi4.12024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/25/2022] Open
Abstract
Objective In children many antiepileptic drugs (AEDs) are prescribed off‐label due to a lack of well‐designed randomized controlled trials (RCTs). We conducted a multicenter RCT in the Netherlands to compare levetiracetam and valproic acid as monotherapy in children with newly diagnosed epilepsy. After 2 years, we had to stop this investigator‐initiated trial prematurely because the inclusion rate was too low. We analyzed the reasons for this failure, assessed the various issues involved in performing RCTs in children, and now give recommendations for future studies. Methods A questionnaire was completed by all investigators involved in the study. It included questions about the motivation to participate and the perceived reasons for recruitment failure. We also studied literature about financial, logistic, legal, and ethical aspects of RCTs in children. Results Main reasons for recruitment failure were overestimation of the number of eligible AED‐naive children referred by general pediatricians; personal preferences of investigators for specific antiepileptic drugs; and the extensive administrative load due to extra regulations and guidelines for children. Fundraising for investigator‐initiated trials is difficult and the majority of RCTs concerning AEDs are sponsored by pharmaceutical companies. Involving children requires balancing between protection and participation; the randomization procedure and obtaining informed consent are complex for both children and parents. Significance Performing RCTs with AEDs in children is important but complicated by logistic, regulatory, legal, and ethical restrictions. Based on our recent experience, our advice to colleagues who are planning a similar trial would be to perform a feasibility pilot study; to set up intensive collaboration with referring pediatricians; to arrange support of a clinical trials unit and a local research nurse during the complete trial period; and to incorporate the possibility of extending the recruitment period. Major investments, both financially from governmental organizations and in time, are imperative for independent RCTs in children.
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Affiliation(s)
- Amerins Weijenberg
- Department of Neurology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Petra M C Callenbach
- Department of Neurology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Oebele F Brouwer
- Department of Neurology University Medical Centre Groningen University of Groningen Groningen the Netherlands
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Abstract
Although the right to health care is not written into the U.S. Constitution, moral and ethical tenets govern the delivery of optimal medical care universally and across the life continuum. Pertaining to children, in accordance with the Geneva Declaration of the Rights of the Child of 1924 and the United Nations Human Rights General Assembly adoption of the Rights of the Child in 1959, parents or guardians are responsible for the health and well-being of a child until age 18 years. Much consideration is needed regarding the anatomic, physiologic, emotional, and cognitive development of children when making decisions regarding their health care and, particularly, when enrolling them into research studies.
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