Concealment and fabrication by experienced research subjects

BACKGROUND

Subjects who enroll in multiple studies have been found to use deception at times to overcome restrictive screening criteria. Deception undermines subject safety as well as study integrity. Little is known about the extent to which experienced research subjects use deception and what type of information is concealed, withheld, or distorted.

PURPOSE

This study examined the prevalence of deception and types of deception used by subjects enrolling in multiple studies.

METHODS

Self-report of deceptive behavior used to gain entry into clinical trials was measured among a sample of 100 subjects who had participated in at least two studies in the past year.

RESULTS

Three quarters of subjects reported concealing some health information from researchers in their lifetime to avoid exclusion from enrollment in a study. Health problems were concealed by 32% of the sample, use of prescribed medications by 28%, and recreational drug use by 20% of the sample. One quarter of subjects reported exaggerating symptoms in order to qualify for a study and 14% reported pretending to have a health condition in order to qualify.

LIMITATIONS

Although this study finds high rates of lifetime deceptive behavior, the frequency and context of this behavior is unknown. Understanding the context and frequency of deception will inform the extent to which it jeopardizes study integrity and safety.

CONCLUSION

The use of deception threatens both participant safety and the integrity of research findings. Deception may be fueled in part by undue inducements, overly restrictive criteria for entry, and increased demand for healthy controls. Screening measures designed to detect deception among study subjects would aid in both protecting subjects and ensuring the quality of research findings.

The efficacy of mirtazapine in the treatment of cocaine dependence with comorbid depression

BACKGROUND

Prior findings concerning the use of mirtazapine in the treatment of a variety of substance use disorders and its antagonistic actions at the serotonin 5-HT(2A) receptor suggest that this drug may have efficacy in the treatment of cocaine dependence in the presence of a depressive disorder.

METHODS

Depressed cocaine-dependent subjects received either mirtazapine (target dose 45 mg daily) or placebo for 12 weeks. Urine concentrations of benzoylecgonine and self-report were used to assess cocaine consumption. Depression and sleep quality were evaluated using the Hamilton Depression Rating Scale (HAM-D) and the Pittsburgh Sleep Quality Index, respectively.

RESULTS

Cocaine consumption during the treatment period did not differ significantly between the mirtazapine (n = 11) and placebo (n = 13) groups in this study. In week 4 sleep latency was significantly lower in the active medication than in the placebo group. Positive effects of mirtazapine treatment on early insomnia were suggested by an item analysis of the HAM-D.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The results of this study suggest that mirtazapine is superior to placebo in improving sleep in patients with comorbid depression and cocaine dependence, but is not more effective than placebo in reducing cocaine use.

The hospital patient representative: a key player in quality improvement

A national survey of hospital patient representatives was conducted to identify and analyze basic demographic and occupational data for patient representatives. A total of 387 randomly selected U.S. hospitals were surveyed with a response rate of 66% (256 hospitals). Only 172 responses were completed appropriately. Of those who responded appropriately, we found the typical patient representative to be a female between 30 and 50 years old, with a bachelor's degree and about 6 years of experience as a patient representative. The majority of the respondents held a positive view of their role as the liaison between the patient and the administration as well as a facilitator for patients, families, staff, and administration problem solving. Several of the respondents stated that patient representatives strive to meet the needs and expectations of patients through their role as liaison with the administration. This role has a positive and crucial impact on improving the quality of care in healthcare organizations.

Quality improvement and the hospital patient representative

A national survey of hospital patient representatives was conducted. This study sought to identify and analyse basic demographic and occupational data of patient representatives. An analysis of the patient representatives' perceived roles in the hospital is also conducted. A total of 387 randomly selected United States hospitals were surveyed with a response rate of 66% (256 hospitals). We were able to use only 172 'usable' responses. Of those who responded, we found the typical patient representative to be a female aged 30-50 years old, married with a college degree, and about 6 years of experience from a northeast hospital. In general, the majority of the respondents were very positive of their role in the liaison activity between the patient and the administration.

A step towards quality improvement: the hospital patient representative program

The hospital patient representative is the liaison between patients and other hospital staff members and administration. This person may be known by different titles, ie, patient representative, guest representative, patient advocate, and others. Unfortunately, no recent studies have been conducted to identify current demographic characteristics of a typical hospital patient representative; data from older studies is outdated and no longer useful. This paper presents the results of a national survey of hospital patient representatives. This study sought to identify and analyze basic demographic and occupational data of this group. An analysis of the patient representative perceived roles in the hospital was also conducted.

Effect of nitrofurans and chlortetracycline on microorganisms associated with shrimp

Nitrofuran AF-2 displayed greater inhibitory effect than did nitrofuran Z when a mixed bacterial culture, including several proteolytic bacteria, isolated from shrimp was subjected to these compounds in vitro. Nitrofuran Z exhibited greater bactericidal properties than did chlortetracycline in all cultures used. Only 10 mug of nitrofuran AF-2 per ml was sufficient to inhibit the growth of mixed bacteria in nutrient broth, whereas 50 mug of nitrofuran Z per ml was necessary to accomplish the same inhibition. A 50-mug amount of chlortetracycline per ml displayed about the same inhibitory effect as either 10 mug of AF-2 per ml or 20 mug of Z per ml. The isolated proteolytic bacteria showed greater suppression of growth when subjected to AF-2 than when subjected to Z; however, both nitrofurans were effective in preventing growth. The addition of either 1 mug of AF-2 per ml or 5 mug of Z per ml to nutrient broth inhibited the growth of Achromobacter aquarmarinus, whereas chlortetracycline was less effective, requiring about 20 mug to suppress growth to the same degree.