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Gabel M, Bollinger RM, Coble DW, Grill JD, Edwards DF, Lingler JH, Chin E, Stark SL. Retaining Participants in Longitudinal Studies of Alzheimer's Disease. J Alzheimers Dis 2022; 87:945-955. [PMID: 35404282 PMCID: PMC9673904 DOI: 10.3233/jad-215710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Retention of study participants is essential to advancing Alzheimer's disease (AD) research and developing therapeutic interventions. However, recent multi-year AD studies have lost 10% to 54% of participants. OBJECTIVE We surveyed a random sample of 443 participants (Clinical Dementia Rating [CDR]≤1) at four Alzheimer Disease Research Centers to elucidate perceived facilitators and barriers to continued participation in longitudinal AD research. METHODS Reasons for participation were characterized with factor analysis. Effects of perceived fulfillment of one's own goals and complaints on attendance and likelihood of dropout were estimated with logistic regression models. Open-ended responses suggesting study improvements were analyzed with a Latent Dirichlet Allocation topic model. RESULTS Factor analyses revealed two categories, personal benefit and altruism, as drivers of continued participation. Participants with cognitive impairment (CDR > 0) emphasized personal benefits more than societal benefits. Participants with higher trust in medical researchers were more likely to emphasize broader social benefits. A minority endorsed any complaints. Higher perceived fulfillment of one's own goals and fewer complaints were related to higher attendance and lower likelihood of dropout. Facilitators included access to medical center support and/or future treatment, learning about AD and memory concerns, and enjoying time with staff. Participants' suggestions emphasized more feedback about individual test results and AD research. CONCLUSION The results confirmed previously identified facilitators and barriers. Two new areas, improved communication about individual test results and greater feedback about AD research, emerged as the primary factors to improve participation.
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Affiliation(s)
- Matthew Gabel
- Department of Political Science, Washington University in St. Louis, St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Dean W. Coble
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological Disorders, Departments of Psychiatry & Human Behavior and Neurobiology & Behavior, University of California Irvine, Irvine, CA, USA
| | - Dorothy F. Edwards
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jennifer H. Lingler
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
- Alzheimer’s Disease Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Chin
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Susan L. Stark
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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2
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Pedersen SH, Bergman H, Berlin J, Hartvigsson T. Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research. Front Psychiatry 2021; 12:647450. [PMID: 34220570 PMCID: PMC8247569 DOI: 10.3389/fpsyt.2021.647450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/18/2021] [Indexed: 01/07/2023] Open
Abstract
Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.
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Affiliation(s)
- Sven H. Pedersen
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Bergman
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Berlin
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Research and Development, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Thomas Hartvigsson
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- School of Philosophy and Art History, Faculty of Humanities, University of Essex, Colchester, United Kingdom
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3
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Mundy J, Stansfeld J, Orrell M, Cartwright M, Wenborn J. Reasons for nonparticipation in the Valuing Active Life in Dementia randomised controlled trial of a dyadic occupational therapy intervention: An interview study. SAGE Open Med 2020; 8:2050312120958926. [PMID: 33133601 PMCID: PMC7576897 DOI: 10.1177/2050312120958926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives: There is currently little known about why people decline to participate in dyadic, psychosocial dementia research. This interview study aims to explore the reasons why people declined to participate in the Valuing Active Life in Dementia research trial. Methods: Ten family carers of people with dementia, who were part of a dyad that had declined to take part in the randomised controlled trial, participated in qualitative telephone interviews to explore their reasons for declining. Inductive thematic analysis was used to identify themes. Findings: Two themes with related sub-themes were identified: (1) Protectiveness – protecting the person with dementia, themselves as carers and their current lifestyle; (2) ‘It’s not for us’ – the time commitment, and the possible unsuitability of the intervention, was seen to outweigh the perceived benefit of taking part. People with dementia were not always involved in the decision-making process, with carers stating the decision not to participate was made in the usual way as all their decisions. No apparent differences between the spousal and the child carers were apparent in the small sample. Conclusion: Recruitment to randomised controlled trials can be considered difficult or unfair because some participants will miss out on the desired intervention. However, this study shows that concern about the time and inconvenience of being involved in the trial can put people off research participation. Identifying possible reasons for declining research participation contributes to the design of future trials and recruitment strategies, so that the potential benefit is considered relative to the time and effort involved. Offering research opportunities to people with dementia and their families at the right stage of the dementia trajectory for their needs, facilitating personalised recruitment strategies with finely tailored researcher communication skills should help maximise recruitment, reduce attrition and deliver a more successful trial.
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Affiliation(s)
- Jacqueline Mundy
- Essex Stroke Hub Team, North East London NHS Foundation Trust (NELFT), London, UK.,School of Health Sciences, City University of London, London, UK
| | - Jacki Stansfeld
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, UK
| | - Martin Orrell
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | | | - Jennifer Wenborn
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, UK.,Division of Psychiatry, University College London, London UK
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4
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Memon AA, Coleman JJ, Amara AW. Effects of exercise on sleep in neurodegenerative disease. Neurobiol Dis 2020; 140:104859. [PMID: 32243913 PMCID: PMC7497904 DOI: 10.1016/j.nbd.2020.104859] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/22/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
As the population ages, the incidence and prevalence of neurodegenerative disorders will continue to increase. Persons with neurodegenerative disease frequently experience sleep disorders, which not only affect quality of life, but potentially accelerate progression of the disease. Unfortunately, pharmacological interventions are often futile or have adverse effects. Therefore, investigation of non-pharmacological interventions has the potential to expand the treatment landscape for these disorders. The last decade has observed increasing recognition of the beneficial role of exercise in brain diseases, and neurodegenerative disorders in particular. In this review, we will focus on the therapeutic role of exercise for sleep dysfunction in four neurodegenerative diseases, namely Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Available data suggest that exercise may have the potential to improve sleep disorders and attenuate neurodegeneration, particularly in Alzheimer's disease and Parkinson's disease. However, additional research is required in order to understand the most effective exercise therapy for these indications; the best way to monitor the response to interventions; the influence of exercise on sleep dysfunction in Huntington's disease and amyotrophic lateral sclerosis; and the mechanisms underlying exercise-induced sleep modifications.
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Affiliation(s)
- Adeel A Memon
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Juliana J Coleman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America; UAB Center for Exercise Medicine, Birmingham, AL 35205, United States of America; UAB Sleep and Circadian Research Core, United States of America.
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5
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Gallagher S, O'Sullivan L, Hughes Z, O'Connell BH. Building Resources in Caregivers: Feasibility of a Brief Writing Intervention to Increase Benefit Finding in Caregivers. Appl Psychol Health Well Being 2020; 12:513-531. [PMID: 32026574 PMCID: PMC7384052 DOI: 10.1111/aphw.12195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Building Resources in Caregivers (BRiC) is a pilot feasibility trial that compared the effects of a 2-week benefit finding writing expressive intervention to a control intervention, who wrote about the weather. Caregivers completed primary (benefit finding) and secondary (quality of life, depression and anxiety) outcome measures at pre (t1), immediately post-test (t2) and 1 month later (t3). They also completed measures relating to trial feasibility, difficulty, and acceptance. Using complete case analysis only, analysis revealed no effect of the intervention for primary or secondary outcomes. Despite this, there were no differences between the intervention and control groups on key feasibility measures. Caregivers in the control condition were less likely to recommend this to other caregivers. Moreover, qualitative commentary provided by caregivers suggested that not everyone enjoyed the writing, some found it stressful, offering up some explanation for our findings. Our pilot trial suggests that any future benefit-finding writing intervention would require several procedure modifications including tailoring to a specific cohort of caregivers, in particular those who like writing, before it has some utility as a psychosocial intervention.
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Affiliation(s)
- Stephen Gallagher
- University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Zoe Hughes
- Care Alliance Ireland, Dublin, Ireland.,University College Cork, Cork, Ireland
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Abstract
There are many potential pitfalls in the identification and enlistment of suitable candidates for psychiatric research. The challenges of recruitment are highlighted, detailing impact of study design, characteristics of participants, including demographics and personal preferences, investigator characteristics and collaboration with clinicians. Techniques used in recruitment are discussed, including financial incentives, assertive tracking and communication methods. Ethical issues, methods of data collection, and control participants are also considered. Key issues are: early consideration of the impact of study design on the recruitment process; the participant's perspective; close collaboration with colleagues; the investigator's good interpersonal, communication and organisational skills; and feedback to collaborators, associated clinicians and participants.
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7
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The Effectiveness of Small-group Community-based Information Sessions on Clinical Trial Recruitment for Secondary Prevention of Alzheimer's Disease. Alzheimer Dis Assoc Disord 2017; 31:141-145. [PMID: 27213625 DOI: 10.1097/wad.0000000000000151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Effective and practical recruitment strategies are needed to ensure successful recruitment into the Alzheimer disease clinical trials. To facilitate successful recruitment for the NIH-sponsored A4 (Anti-Amyloid treatment in Asymptomatic Alzheimer's disease, NCT02008357) trial for the secondary prevention of Alzheimer disease, we developed a small-group community information session to attract and recruit potential research participants. After a successful media campaign, 213 participants were screened through telephone for eligibility, identifying 127 potential participants. Participants were given the option of a traditional one-on-one recruitment session or a small-group session. One-on-one recruitment was performed for 15 participants requesting this procedure, and yielded an overall recruitment rate of 67% (n=10). Substantially more individuals (n=112, 88%) requested small-group sessions to learn about the study. After attending the small-group informational sessions, 98% of potential participants self-reported a greater understanding of the study; and the recruitment rate from these sessions was 90%. Small-group sessions not only improved recruitment success rates, but also contributed to significantly shorter median time for consent processes (20 vs. 60 min) and reduced staff time spent on persons not recruited. Small-group education programs are an effective strategy for enhancing recruitment success and facilitating practical recruitment into clinical trials with high recruitment demands.
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8
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A Systematic Review of the Evidence for Hyporesponsivity in ASD. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0084-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Chiatti C, Rimland JM, Bonfranceschi F, Masera F, Bustacchini S, Cassetta L. The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: preliminary findings on recruitment and caregiving burden in the baseline population. Aging Ment Health 2015; 19:517-25. [PMID: 25188811 DOI: 10.1080/13607863.2014.954526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The paper describes recruitment results and characteristics of the UP-TECH clinical trial sample, including level of care services use, informal caregiver burden and its determinants. METHODS UP-TECH is designed to test innovative care solutions for community-dwelling patients with moderate stage Alzheimer's disease and their caregivers in Italy. Four hundred and fifty patient-caregiver dyads were randomized into three arms receiving different combinations of services, composed of case management interventions, nurse visits, assistive technology and educational brochures. The research nurses administered a questionnaire comprising an in-depth socio-demographic assessment and several clinical scales, such as Novak's Caregiver Burden Inventory. Analyses of baseline data were conducted using uni- and bi-variate statistics. Linear regressions were computed to identify de-confounded correlates of caregiver burden. RESULTS Four hundred and thirty-eight patient-caregiver dyads were recruited and randomized. In our sample, patients are predominantly women (71.5%), with an average age of 81.5 years and a mean Mini-Mental State Examination score of 16.2. Caregivers are mostly women (66.2%) and offspring (55.7%), with a mean caregiver burden score of 27.6. They provide more than 50 hours of care per week, while receiving an almost negligible support from public services. Factors associated with caregiver burden are female gender, kinship and the patient's behavioral disturbances. The most important factor associated with lower burden is the employment of a live-in care worker. CONCLUSION The paper provides a comprehensive description of moderate stage Alzheimer's disease patients and their caregivers, suggesting useful markers of caregiver burden. The well-balanced randomization assures the reliability of the study data-set for prospective evaluation of care strategies.
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Affiliation(s)
- Carlos Chiatti
- a Scientific Directorate , Italian National Research Center on Aging (INRCA) , Ancona , Italy
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10
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Brand C, O'Connell BH, Gallagher S. A randomised controlled trial of benefit finding in caregivers: The Building Resources in Caregivers Study Protocol. Health Psychol Open 2015; 2:2055102915595019. [PMID: 28070362 PMCID: PMC5193262 DOI: 10.1177/2055102915595019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caregivers may engage in benefit finding, that is, an increase in perceived positive growth, as a cognitive strategy for coping with stress. The Building Resources in Caregivers study will compare effects of a brief benefit finding writing intervention with a control intervention. Caregivers of people with mental and physical disabilities will be randomised into either a benefit-writing group or a neutral writing group. Caregivers will complete measures relating to themselves and care-recipients (e.g. sociodemographics and illness type) and psychometric measures of benefit finding, distress and quality of life at three time points. Additionally, qualitative commentary on participation experiences will be gathered.
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Affiliation(s)
- Charles Brand
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Brenda H O'Connell
- Department of Psychology, University of Limerick, Limerick, Ireland; Centre for Social Issues Research, Study of Anxiety, Stress and Health Lab, University of Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, University of Limerick, Limerick, Ireland; Centre for Social Issues Research, Study of Anxiety, Stress and Health Lab, University of Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
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11
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Rodríguez-Gonzalo A, García-Martí C, Ocaña-Colorado A, Baquera-De Micheo MJ, Morel-Fernández S. Efficiency of an intensive educational program for informal caregivers of hospitalized, dependent patients: cluster randomized trial. BMC Nurs 2015; 14:5. [PMID: 25648152 PMCID: PMC4314749 DOI: 10.1186/s12912-015-0055-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Educational initiatives for informal caregivers have proved efficient at reducing some of their symptoms, consequence of their involvement in care giving. However, more progress must be made in terms of the design of more successful interventions. AIMS Randomized clinical trial to test the efficiency of an Education Program for Primary Informal Caregivers of Hospitalized Dependent Patients in relation to their burden, mental and physical health, and care related knowledge. METHODS DESIGN Cluster Randomized Trial. SAMPLE 151 participants, primary caregivers of hospitalized, dependent patients, carried out from February 2009 to March 2010. They were assigned at random to two groups: one received an intensive educational program (n = 78), and the other just a generic speech (n = 73). The degree of burden of caregivers was recorded (Zarit Test), as well as their physical and mental health (SF12) and their knowledge of caregiving, before, immediately, after and one and a half months after the intervention. These analyses were carried out according to the Generalized Estimated Equations Method, in order to assess any possible improvements. RESULTS Participants´ burden did not improve, as measured by Zarit Test (p = 0,338), nor did their physical (p = 0,917) or mental health (p = 0,345). However there was an improvement in their hygiene caregiving (p = 0,001) and mobility care giving (p = 0,001). CONCLUSIONS Caregivers found useful the education program, providing them with an informal support group. Interventions need to be longer and more customized as well as adapted to specific demands. There is a lack of validated questionnaires to assess improvements in care knowledge. There is a need to develop programs that contemplate continuity of care from primary to specialized caregiving. TRIAL REGISTRATION Cluster randomized trial: ESCPD2010.
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Affiliation(s)
- Ana Rodríguez-Gonzalo
- Hospital Universitario Ramón y Cajal, Crta. Colmenar Viejo, Km. 9.100, Madrid 28034 Spain
| | - Carlos García-Martí
- Hospital Universitario Ramón y Cajal, Crta. Colmenar Viejo, Km. 9.100, Madrid 28034 Spain
| | | | | | - Silvia Morel-Fernández
- Hospital Universitario Ramón y Cajal, Crta. Colmenar Viejo, Km. 9.100, Madrid 28034 Spain
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12
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Kaba A, Beran T. Twelve tips to guide effective participant recruitment for interprofessional education research. MEDICAL TEACHER 2014; 36:578-584. [PMID: 24787522 DOI: 10.3109/0142159x.2014.907489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The success of research in interprofessional education is largely due to the participation of students. Their recruitment is, however, perhaps the most challenging part of any study, and, yet, is a key determinant of the results. AIM The aim of this article is to provide a "how to guide" for medical education researchers to facilitate the recruitment of students across health professions. RESULTS The 12 tips are (1) establish clear expectations with your research team from the start; (2) do your homework: invest time and energy in pre-recruitment preparation; (3) develop a plan: be realistic about your resources; (4) create a "Buzz" about your interprofessional research; (5) prepare multiple communication methods - can't just rely on one! (6) engage volunteers across professions to participate; (7) address the participant's willingness to take part in the research; (8) demonstrate good interpersonal skills; (9) be diligent in tracking participants; (10) show appreciation and share results; (11) consider participant incentives: are they really important? (12) maintain tenacity - no one said interprofessional recruitment was easy! CONCLUSIONS Interprofessional studies offer numerous logistical, administrative and scheduling challenges; the 12 tips are provided to help medical education researchers develop and manage the successful recruitment of students across the health professions.
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13
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Morrison K, Winter L, Gitlin LN. Recruiting Community-Based Dementia Patients and Caregivers in a Nonpharmacologic Randomized Trial: What Works and How Much Does It Cost? J Appl Gerontol 2014; 35:788-800. [PMID: 24799354 DOI: 10.1177/0733464814532012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/22/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the yield and cost of three recruitment strategies-direct mail, newspaper advertisements, and community outreach-for identifying and enrolling dementia caregivers into a randomized trial testing a nonpharmacologic approach to enhancing quality of life of patients and caregivers (dyads). METHOD Enrollment occurred between 2006 and 2008. The number of recruitment inquiries, number and race of enrollees, and costs for each recruitment strategy were recorded. RESULTS Of 284 inquiries, 237 (83%) dyads enrolled. Total cost for recruitment across methodologies was US$154 per dyad. Direct mailings resulted in the most enrollees (n = 135, 57%) and was the least costly method (US$63 per dyad) compared with newspaper ads (US$224 per dyad) and community outreach (US$350 per dyad). Although enrollees were predominately White, mailings yielded the highest number of non-Whites (n = 37). DISCUSSION Direct mailings was the most effective and least costly method for enrolling dyads in a nonpharmacologic dementia trial.
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Affiliation(s)
| | | | - Laura N Gitlin
- Johns Hopkins University, Center for Innovative Care in Aging
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14
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Etkin CD, Farran CJ, Barnes LL, Shah RC. Recruitment and enrollment of caregivers for a lifestyle physical activity clinical trial. Res Nurs Health 2012; 35:70-81. [PMID: 22083931 PMCID: PMC3729020 DOI: 10.1002/nur.20466] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2011] [Indexed: 11/09/2022]
Abstract
This article presents the efficacy of the recruitment framework used for a clinical trial with sedentary family caregivers of persons with Alzheimer's disease. An integrated social marketing approach with principles of community-based participatory research provided the theoretical framework for organizing recruitment activities. This multi-pronged approach meant that caregivers were identified from a range of geographic locations and numerous sources including a federally funded Alzheimer's disease center, health care providers, community based and senior organizations, and broad-based media. Study enrollment projections were exceeded by 11% and resulted in enrolling n = 211 caregivers into this clinical trial. We conclude that social marketing and community-based approaches provide a solid foundation for organizing recruitment activities for clinical trials with older adults.
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Affiliation(s)
- Caryn D Etkin
- College of Nursing, Rush University Medical Center, 600 S. Paulina St., 1080 AAC, Chicago, IL 60612, USA
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15
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McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Larson EB, Teri L. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease: results of a randomized, controlled trial. J Am Geriatr Soc 2011; 59:1393-402. [PMID: 21797835 DOI: 10.1111/j.1532-5415.2011.03519.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimer's disease (AD). DESIGN Randomized, controlled trial with blinded assessors. SETTING Independent community living. PARTICIPANTS One hundred thirty-two people with AD and their in-home caregivers. INTERVENTIONS Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control and received three or six in-home visits. MEASUREMENTS Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of sleep percentage, number of awakenings, and total sleep time. RESULTS Participants in walking (P=.05), light (P=.04), and combination treatment (P=.01) had significantly greater improvements in total wake time at posttest (effect size 0.51-0.63) than controls but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants. There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months. Participants with better adherence (4 d/wk) to walking and light exposure recommendations had significantly less total wake time (P=.006) and better sleep efficiency (P=.005) at posttest than those with poorer adherence. CONCLUSION Walking, light exposure, and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.
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16
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Comparison of recruitment efforts targeted at primary care physicians versus the community at large for participation in Alzheimer disease clinical trials. Alzheimer Dis Assoc Disord 2010; 24:165-70. [PMID: 19571728 DOI: 10.1097/wad.0b013e3181aba927] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inefficient and delayed recruitment into clinical trials in Alzheimer disease are major obstacles impeding progress in the discovery of more effective therapeutic strategies to combat this disease. Despite widespread recognition of this problem, limited empirical data demonstrating the effectiveness of specific recruitment strategies are available to guide recruitment endeavors. This study was designed to evaluate the effectiveness of recruitment efforts targeting either the primary care health professionals (PCPs) or patients and families with a community grass-roots outreach event. The primary outcome measure was actual study recruitment and participation in the 4 months postintervention. No research subjects were recruited from the PCP intervention, whereas 69 subjects were recruited into clinical studies from the community grass-roots outreach event activity (0% vs. 28%, P<0.0001, Fisher exact test). Barriers to recruitment success in the PCP arm included a perception of perceived harm to subjects from research participation and fear of losing patients through clinical research participation. Our results suggest that outreach efforts directed at the potential study subject/caregiver are not only cost-effective but are able to easily accomplish the desired result of direct recruitment into clinical research studies.
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Murphy MR, Escamilla MI, Blackwell PH, Lucke KT, Miner-Williams D, Shaw V, Lewis SL. Assessment of caregivers' willingness to participate in an intervention research study. Res Nurs Health 2007; 30:347-55. [PMID: 17514708 DOI: 10.1002/nur.20186] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the study was to identify factors that influenced family caregivers' decisions to participate in an intervention research study. In interviews conducted before and after the intervention, caregivers (n=21) described reasons for participation. A focused content analysis was used to examine responses. Themes that emerged included: (a) caregivers recognized a need for help; (b) expectations and motivations toward change; (c) recognition of self worth as caregivers; (d) timeliness of recruitment strategies; (e) support of research staff affected recruitment; and (f) caregivers recognized the benefits of participation. These findings support the importance of many different strategies for effective recruitment of caregivers in future studies.
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Affiliation(s)
- Margaret R Murphy
- University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, TX, USA
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18
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Gattuso J, Hinds P, Tong X, Srivastava K. Monitoring child and parent refusals to enrol in clinical research protocols. J Adv Nurs 2006; 53:319-26. [PMID: 16441537 DOI: 10.1111/j.1365-2648.2006.03724.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this paper is to report the rates and reasons for refusal given by 817 eligible participants from 10 completed and ongoing nursing and behavioural medicine studies in paediatric oncology from 1994 to 2004. BACKGROUND Eligible participants have the right to accept or decline participation in research studies. Information about rates of refusal and reasons for refusal could be useful in determining participant-perceived burden related to study participation, in accurately estimating the time needed to accrue an adequate number of participants to achieve the study aims, and in interpreting study findings from certain groups of participants. METHODS A 13-item survey form about study characteristics was completed prospectively for each study included in this report; categories of reasons for refusal were inductively identified and defined using a semantic content analytic technique. RESULTS The overall rate of refusal was 23.6% (range: 6.7-46.7%). The studies that involved blood sampling or end-of-life decision-making had the highest refusal rates and an instrumentation study had the lowest. Eligible male participants had consistently higher rates of refusal than did females across the 10 studies. Nine categories of refusal were inductively identified, with the most commonly reported reason being the burden of the research methods. CONCLUSION A careful informed consent process will still result in some refusals. The refusal rates reported here can be used to help future researchers more accurately estimate accrual periods for studies involving blood sampling or investigating sensitive topics in paediatric oncology.
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Affiliation(s)
- Jami Gattuso
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
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19
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Nichols L, Martindale-Adams J, Burns R, Coon D, Ory M, Mahoney D, Tarlow B, Burgio L, Gallagher-Thompson D, Guy D, Arguelles T, Winter L. Social marketing as a framework for recruitment: illustrations from the REACH study. J Aging Health 2004; 16:157S-76S. [PMID: 15448292 PMCID: PMC2579268 DOI: 10.1177/0898264304269727] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recruitment is often the most challenging aspect of research with older persons. Social marketing--applying marketing techniques to influence the behavior of target audiences to improve their welfare--can help researchers identify factors that influence recruitment. METHODS Illustrations of social marketing principles are provided from the Resources for Enhancing Alzheimer's Caregiver Health project, a national Alzheimer's caregivers study that targeted ethnic and racial minorities. RESULTS Social marketing principles--the six Ps of participants, product, price, place, promotion, and partners--provide a theoretical framework for organizing and planning recruitment activities, including developing varying strategies to define the target audience (participants), develop the intervention (product), manage time and trouble (price), target the audience, improve accessibility (place), promote the study, and develop and work with partners. DISCUSSION Strategies to enhance recruitment are often undertaken without a comprehensive plan. A social marketing plan provides a framework to map out the steps in recruitment that will be needed and to plan for allocations of time, staff, and resources.
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Affiliation(s)
- Linda Nichols
- Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104 and University of Tennessee Health Science Center, USA
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20
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McCurry SM, Logsdon RG, Vitiello MV, Teri L. Treatment of sleep and nighttime disturbances in Alzheimer's disease: a behavior management approach. Sleep Med 2004; 5:373-7. [PMID: 15222994 DOI: 10.1016/j.sleep.2003.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Revised: 11/07/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSES Sleep and nighttime behavioral disturbances are widespread in community-dwelling dementia patients, but little is known about the usefulness of behavioral interventions for treating them. This article presents data from three cases enrolled in an ongoing study of sleep problems in community-dwelling Alzheimer's disease (AD) patients: nighttime insomnia treatment and education for Alzheimer's disease. PATIENTS AND METHODS All subjects received written materials describing age- and dementia-related changes in sleep, and standard principles of good sleep hygiene. Caregivers also received education about dementia, listings of relevant community resources, and general support. Subjects' sleep-wake activity was measured at baseline, post-test (2 months), and 6-month follow-up using an Actillume wrist-movement recorder, which was worn continuously for 1 week. RESULTS Post-test actigraphic improvements in sleep quantity and sleep efficiency, number of nighttime awakenings, and amount of daytime sleep, as well as subjective sleep ratings were observed. One subject maintained improvements at 6-month follow-up. Subjects varied widely in the type of sleep problems reported and behavioral strategies implemented by family caregivers, illustrating the complexity that characterizes nighttime behavioral disturbances in AD. CONCLUSIONS This paper provides clinical and empirical evidences that behavioral strategies including standard sleep hygiene recommendations can be helpful in treating sleep and nighttime behavioral disturbances in dementia patients.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, 9709 3rd Avenue N.E., Suite 507, Seattle, WA 98115-2053, USA.
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21
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McCurry SM, Gibbons LE, Logsdon RG, Vitiello M, Teri L. Training Caregivers to Change the Sleep Hygiene Practices of Patients with Dementia: The NITE-AD Project. J Am Geriatr Soc 2003; 51:1455-60. [PMID: 14511168 DOI: 10.1046/j.1532-5415.2003.51466.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the feasibility of training caregivers to implement sleep hygiene recommendations in dementia patients. DESIGN A randomized, controlled trial. SETTING Community. PARTICIPANTS Twenty-two community-dwelling patients with Alzheimer's disease (AD) and their family caregivers. INTERVENTIONS All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=10) also received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient. Control subjects (n=12) received general dementia education and caregiver support. MEASUREMENTS Success implementing sleep hygiene recommendations was measured using daily log reports to calculate the percentage of days that caregivers reported that patients met individualized sleep scheduling, daytime-napping, and walking goals. RESULTS Caregivers in active treatment were more successful in setting goals related to sleep scheduling and increasing daytime activity than control caregivers who received written materials only. Among patients who were candidates for sleep hygiene changes, active treatment subjects were also significantly (P<.01) more likely than controls to maintain a consistent bedtime (83% vs 38% of days attempted) and a consistent rising time (96% vs 59%), to nap less during the day (70% vs 28%), and to walk daily (86% vs 7%). CONCLUSION This study provides evidence that sleep hygiene interventions are feasible with community-dwelling AD patients. Caregivers were able to help patients change sleep scheduling, napping, and walking routines, but clinicians who recommend sleep hygiene changes for their dementia patients should be aware that many caregivers need active assistance setting up and implementing a sleep hygiene program. Simply providing caregivers with education is often insufficient.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health Psychiatry, University of Washington, Seattle, Washington 98115, USA.
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22
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Recruiting Community-Dwelling Elderly at Risk for Physical Disability into Exercise Research. J Aging Phys Act 2003. [DOI: 10.1123/japa.11.2.229] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article describes the process of identifying 100 community-dwelling elderly adults at risk for physical disability, yet not functionally disabled, for participation in a research project to develop appropriate exercise programs for at-risk elderly. Over a period of 14 months, initial contact was made with 941 older adults, 11% of whom (101 people) were eligible for and willing to complete all stages of the study protocol. The most successful recruitment strategies were a mass mailing followed by a telephone call and advertising in a newspaper with a large circulation (rather than a local paper). Aspects of the recruitment and retention of study participants are discussed.
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23
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Cohen-Mansfield J. Consent and refusal in dementia research: conceptual and practical considerations. Alzheimer Dis Assoc Disord 2003; 17 Suppl 1:S17-25. [PMID: 12813220 DOI: 10.1097/00002093-200304001-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses types of consent refusals, rates of refusal, factors that affect consent, and methods to increase rates of consent in elderly research participants and in those with dementia in particular. Refusals can be categorized according to several types: complete refusal, refusal that is time-contingent, partial refusal, and contingent agreement. Rates of consent vary greatly across studies of persons with dementia. This variation can also be affected by different methodologies of calculating rates, in addition to differences in content of studies, populations, and procedures. To warrant consent, a study must first be scientifically sound, with a high likelihood of advancing knowledge, and must provide maximal protection to participants. Consent rates are affected by the following factors: levels of anticipated risks and benefits of the study, relationships among the different caregivers involved in the care of the potential subject, the ability of the researcher to properly identify and locate the person who needs to provide consent, characteristics and attitudes of the person providing consent, and the method of obtaining consent, including timing, location, method of presentation, and type of consent requested. An understanding of these issues can assist the researcher in tailoring research procedures so as to maximize rates of consent. It also raises ethical issues that warrant further discussion concerning the process of obtaining consent from and for persons with dementia.
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Affiliation(s)
- J Cohen-Mansfield
- Research Institute on Aging of the Hebrew Home of Greater Washington, George Washington University Medical Center, Rockville, Maryland 20852, USA
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Serfaty M, Kennell-Webb S, Warner J, Blizard R, Raven P. Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia. Int J Geriatr Psychiatry 2002; 17:1120-7. [PMID: 12461760 DOI: 10.1002/gps.760] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Disturbance of sleep is common in individuals with dementia where there may be reversal of the sleep-wake cycle. People with dementia of the Alzheimer's type have melatonin secretion rhythm disorders. There is some evidence that treatment with exogenous melatonin is an effective treatment for sleep disturbance associated with dementia. A randomised double blind placebo controlled cross over trial was undertaken to test the hypothesis that slow release exogenous melatonin 6 mg improves sleep for people with dementia. METHODS Forty-four participants with DSM-IV diagnoses of dementia with sleep disturbance were selected for a seven week randomised double blind cross over trial of slow release melatonin 6 mg versus placebo. Sleep parameters were objectively measured using wrist actigraphy. RESULTS Twenty-five out of 44 completed the trial. Sleep was significantly disturbed in the sample population. Melatonin had no effect on median total time asleep (n=25, z=1.35, p=0.18), number of awakenings (n=25, z=0.32, p=0.75) or sleep efficiency (n=25, z=0.17, p=0.24). Nor were there any carry over effects from melatonin. CONCLUSIONS Contrary to previous findings, we found no evidence that two weeks of exogenous melatonin is effective in improving sleep in people with dementia, although possible benefits of melatonin following longer periods of administration cannot be discounted.
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Affiliation(s)
- Marc Serfaty
- Royal Free and University College Medical School, London, UK.
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25
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Teri L, Logsdon RG, McCurry SM. Nonpharmacologic treatment of behavioral disturbance in dementia. Med Clin North Am 2002; 86:641-56, viii. [PMID: 12168563 DOI: 10.1016/s0025-7125(02)00006-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of the current literature on non-pharmacologic treatment of behavioral problems in patients with dementia, and offers practical guidelines for healthcare professionals interested in using this approach with their patients. Because effective treatment begins with accurate assessment, we provide a brief discussion of the state-of-the-art in assessment of behavioral problems. The article discusses current trends in clinical care along with specific strategies for treating and preventing some of the most common and debilitating behavioral problems of dementia patients: depression, agitation/aggression, wandering, and sleep disturbance. Because caregivers are essential informants and participants in patient care, we conclude by addressing the role of the caregiver in nonpharmacologic treatment.
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Affiliation(s)
- Linda Teri
- Department of Psychosocial and Community Health, University of Washington, 9709 3rd Avenue NE, Suite 507, Seattle, WA 98115, USA.
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26
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Neufeld A, Harrison MJ, Hughes KD, Spitzer D, Stewart MJ. Participation of immigrant women family caregivers in qualitative research. West J Nurs Res 2001; 23:575-91. [PMID: 11569331 DOI: 10.1177/019394590102300604] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The recruitment of articulate, expressive participants is an essential part of methodology in qualitative research. This article presents the authors' experience in the recruitment of immigrant women of Chinese and South Asian origin in an ethnographic study. The study included women caring for an adult or child family member who had a chronic health problem. Knowledge of women family caregivers' health is restricted by the failure to include diverse groups of women in research. In this article, the authors discuss issues related to recruitment and participation of immigrant women in research, including establishing access to diverse groups of women, benefits for immigrant women, and placing the researcher and research process on the same level. Practical research strategies to address these issues and engage the women in research that portrays their perspectives are presented. The authors' discussion concludes with reflection on their experience and that of other researchers.
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Affiliation(s)
- A Neufeld
- Faculty of Nursing, University of Alberta
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Abstract
OBJECTIVES This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study. METHODS Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant. RESULTS Recruitment rates varied by method implemented and referral source. Overall, 100 participants were enrolled for a total cost of $10,127, yielding an average per participant cost of $101.00. The Formal Recruitment Method, used at agencies with large participant pools, emerged as the most cost-effective strategy. DISCUSSION Recruitment costs varied greatly, depending on the referral sites and their available pool of participants. Substantial time, money, and personnel need to be budgeted for recruitment efforts given the expected costs, the competing pressures in the health care region, and the variability of participant response.
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Affiliation(s)
- B A Tarlow
- Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, MA, USA
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