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Taylor JA, Thompson DM, Hall DA, Walker DM, McMurran M, Casey A, Featherstone D, MacDonald C, Stockdale D, Hoare DJ. The TinMan study: feasibility trial of a psychologically informed, audiologist-delivered, manualised intervention for tinnitus. Int J Audiol 2020; 59:905-914. [PMID: 32678998 DOI: 10.1080/14992027.2020.1788730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop a manualised psychological treatment for tinnitus that could enhance audiologist usual care, and to test feasibility of evaluating it in a randomised controlled trial. DESIGN Feasibility trial, random allocation of patients to manualised treatment or treatment as usual, and mixed-methods evaluation. Study sample: Senior audiologists, and adults with chronic tinnitus. RESULTS Recruitment reached 63% after 6 months (feasibility pre-defined as 65%). Only nine patients (47%) were retained for the duration of the trial. Patients reported that the treatment was acceptable and helped reassure them about their tinnitus. Audiologists reported mixed feelings about the kinds of techniques that are presented to them as 'psychologically informed'. Audiologists also reported lacking confidence because the training they had was brief, and stated that more formal supervision would have been helpful to check adherence to the treatment manual. CONCLUSIONS The study indicate potential barriers to audiologist use of the manual, and that a clinical trial of the intervention is not yet feasible. However, positive indications from outcome measures suggest that further development work would be worthwhile. Refinements to the manual are indicated, and training and supervision arrangements to better support audiologists to use the intervention in the clinic are required. Trial Registration: ISRCTN13059163.
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Affiliation(s)
- John A Taylor
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Deborah A Hall
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mary McMurran
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Amanda Casey
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - Carol MacDonald
- Department of Psychology, University of Stirling, Stirling, UK
| | | | - Derek J Hoare
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Sanchez VA, Hall DA, Millar B, Escabi CD, Sharman A, Watson J, Thasma S, Harris P. Recruiting ENT and Audiology patients into pharmaceutical trials: evaluating the multi-centre experience in the UK and USA. Int J Audiol 2018; 57:S55-S66. [PMID: 29355055 DOI: 10.1080/14992027.2018.1425002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recruiting into clinical trials on time and on target is a major challenge and yet often goes unreported. This study evaluated the adjustment to procedures, recruitment and screening methods in two multi-centre pharmaceutical randomised controlled trials (RCTs) for hearing-related problems in adults. DESIGN Recruitment monitoring and subsequent adjustment of various study procedures (e.g. eligibility criteria, increasing recruiting sites and recruitment methods) are reported. Participants were recruited through eight overarching methods: trial registration, posters/flyers, print publications, Internet, social media, radio, databases and referrals. The efficiency of the recruitment was measured by determining the number of people: (1) eligible for screening as a percentage of those who underwent telephone pre-screening and (2) randomised as a percentage of those screened. STUDY SAMPLE A total of 584 participants completed the pre-screening steps, 491 screened and 169 participants were randomised. RESULTS Both RCTs completed adjustments to the participant eligibility, added new study sites and additional recruitment methods. No single recruitment method was efficient enough to serve as the only route to enrolment. CONCLUSION A diverse portfolio of methods, continuous monitoring, mitigation strategy and adequate resourcing were essential for achieving our recruitment goals.
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Affiliation(s)
- Victoria A Sanchez
- a Department of Communication Sciences and Disorders , University of South Florida , Tampa , FL , USA
| | - Deborah A Hall
- b National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit , Nottingham , UK.,c Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine , University of Nottingham , Nottingham , UK , and
| | - Bonnie Millar
- b National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit , Nottingham , UK.,c Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine , University of Nottingham , Nottingham , UK , and
| | - Celia D Escabi
- a Department of Communication Sciences and Disorders , University of South Florida , Tampa , FL , USA
| | - Alice Sharman
- d Autifony Therapeutics Ltd, Imperial Incubator, Imperial College London , London , UK
| | - Jeannette Watson
- d Autifony Therapeutics Ltd, Imperial Incubator, Imperial College London , London , UK
| | - Sornaraja Thasma
- d Autifony Therapeutics Ltd, Imperial Incubator, Imperial College London , London , UK
| | - Peter Harris
- d Autifony Therapeutics Ltd, Imperial Incubator, Imperial College London , London , UK
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Al-Dakhil LO, Alanazy R, AlHamad RE, Al-Mandeel H, Alobaid A. Attitudes of Patients in Developing Countries Toward Participating in Clinical Trials: A Survey of Saudi Patients Attending Primary Health Care Services. Oman Med J 2016; 31:284-9. [PMID: 27403241 PMCID: PMC4927729 DOI: 10.5001/omj.2016.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/28/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Clinical trials are experimental projects that include patients as subjects. A number of benefits are directly associated with clinical trials. Healthcare processes and outcomes can be improved with the help of clinical trials. This study aimed to assess the attitudes and beliefs of patients about their contribution to and enrolment in clinical trials. METHODS A cross-sectional study design was used for data collection and analysis. A questionnaire was developed with six categories to derive effective outcomes. RESULTS Of the 2000 participants approached to take part in the study, 1081 agreed. The majority of the study population was female, well educated, and unaware of clinical trials. Only 324 subjects (30.0%) had previously agreed to participate in a clinical trial. The majority (87.1%) were motivated to participate in clinical trials due to religious aspects. However, fear of any risk was the principal reason (79.8%) that reduced their motivation to participate. CONCLUSIONS The results of this study revealed that patients in Saudi Arabia have a low awareness and are less willing to participate in clinical trials. Different motivational factors and awareness programs can be used to increase patient participation in the future.
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Affiliation(s)
- Lateefa O. Al-Dakhil
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Reem Alanazy
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Rakan E. AlHamad
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hazem Al-Mandeel
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alobaid
- Department of Gynecology, Women’s Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Jacobs BL, Daignault S, Lee CT, Hafez KS, Montgomery JS, Montie JE, Humrich JE, Hollenbeck BK, Wood DP, Weizer AZ. Prostate capsule sparing versus nerve sparing radical cystectomy for bladder cancer: results of a randomized, controlled trial. J Urol 2015; 193:64-70. [PMID: 25066875 PMCID: PMC4368062 DOI: 10.1016/j.juro.2014.07.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Prostate capsule sparing and nerve sparing cystectomies are alternative procedures for bladder cancer that may decrease morbidity while achieving cancer control. However, to our knowledge the comparative effectiveness of these approaches has not been established. We evaluated functional and oncologic outcomes in patients undergoing these procedures. MATERIALS AND METHODS We performed a single institution trial in patients with bladder cancer in whom transurethral prostatic urethral biopsy and transrectal prostate biopsy were negative. Men were randomized to prostate capsule sparing or nerve sparing cystectomy with neobladder creation and stratified by Sexual Health Inventory for Men score (greater than 21 vs 21 or less). Our primary end point was 12-month overall urinary function as measured by Bladder Cancer Index. Secondary end points included sexual function, cancer control and complications. RESULTS A total of 40 patients were enrolled in the study with 20 patients in each arm. Urinary function at 12 months decreased by 13 and 28 points in the prostate capsule and nerve sparing groups, respectively (p = 0.10). Sexual function followed a similar pattern (p = 0.06). There was no difference in recurrence-free, metastasis-free or overall survival (each p >0.05). The rate of incidentally detected prostate cancer was similar (p = 0.15). CONCLUSIONS Our study provides a randomized comparison of prostate capsule sparing and nerve sparing cystectomy techniques. We found no difference in functional or oncologic outcomes between the 2 approaches, although our study was underpowered due to a lack of patient accrual.
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Affiliation(s)
- Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Daignault
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Cheryl T Lee
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Khaled S Hafez
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S Montgomery
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - James E Montie
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jean E Humrich
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan
| | | | - David P Wood
- Department of Urology, William Beaumont School of Medicine, Royal Oak, Michigan
| | - Alon Z Weizer
- Divisions of Oncology and Health Services Research, University of Michigan, Ann Arbor, Michigan.
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Randomized controlled trial versus comparative cohort study in verifying the therapeutic role of lymphadenectomy in endometrial cancer. Int J Clin Oncol 2012. [PMID: 23203151 DOI: 10.1007/s10147-012-0499-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A consensus regarding the therapeutic role of lymphadenectomy in endometrial cancer has not been reached because of conflicting negative results of randomized controlled trials and positive results of a cohort study. Since the effects of new treatments tend to be overestimated in observational studies, positive results of an observational study should be validated by a future trial. However, special difficulties are presented in randomized controlled trials in surgery. External validity is important for guaranteeing the reliability of a result of the trial. Physicians' recruitment of eligible patients into a trial depends on the confidence of those physicians for a surgical procedure, workplace environment and feelings of personal responsibility relevant to patients' risk of recurrence. When two surgical procedures are compared in a randomized controlled trial, technical quality control may be reduced in the complicated surgery group due to experienced surgeons' non-participation. It is highly possible that the recruitment issue is a threat to external validity. Therefore, a randomized controlled trial may not be the best format for demonstrating the full benefits of complicated surgery. Multiple studies have demonstrated that the results of well-designed observational studies can be reliable and are comparable with those of randomized controlled trials. Journal editors and funding sources are requested to become more generous with observational studies, especially prospective cohort studies.
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Sibai T, Carlisle H, Tornetta P. The darker side of randomized trials: recruitment challenges. J Bone Joint Surg Am 2012; 94 Suppl 1:49-55. [PMID: 22810448 DOI: 10.2106/jbjs.l.00240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Randomized trials are thought to provide optimal evidence if carried out correctly. Their application to important questions is the best guide to clinical decision-making. However, these trials are expensive to complete and have a variety of challenges in design and application. This article will review some of the factors that affect our ability to recruit patients into randomized controlled trials for conditions that may be treated surgically by different methods or for conditions for which both nonsurgical and surgical treatments exist.
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Affiliation(s)
- Tarek Sibai
- Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, D2N, Boston, MA 02118, USA
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Abstract
Exponents of evidence-based medicine do not undermine the importance of clinical expertise and skills, but they emphasize that decision-making in medicine should be based on the best available evidence derived from the systematic analysis of observations made in an objective, unbiased and a reproducible fashion. The randomized controlled trial (RCT) is the most scientifically rigorous means of hypothesis testing in epidemiology. Discrepancies between established surgical and other interventions and best available evidence are common. These can be in the form of significant delay in adopting a new intervention despite strong supportive evidence, adopting an intervention before supportive evidence becomes available for reasons of novelty or pear pressure and the lack of supportive evidence for many established common practices. This is compounded further by the paucity of good quality evidence for most surgical procedures. This is arguably because of the inherent difficulties in conducting surgical RCT. The practical, ethical and financial ramifications are complex and the nature of surgical disease often compromise the chances of success or completion of RCT. Carrying out surgical RCT may have more implications on the clinician's authority, autonomy and income and their results are more likely to be influenced by his/her expertise and competence than medical RCT. Furthermore, the success of surgical RCT is often jeopardized by very low recruitment rates. The aim of this study is to discuss the dilemma of producing evidence in surgery.
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Affiliation(s)
- Ned S Abraham
- Coffs Harbour Health Campus, The Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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Abraham NS, Young JM, Solomon MJ. A systematic review of reasons for nonentry of eligible patients into surgical randomized controlled trials. Surgery 2006; 139:469-83. [PMID: 16627056 DOI: 10.1016/j.surg.2005.08.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 08/24/2005] [Accepted: 08/25/2005] [Indexed: 12/23/2022]
Abstract
BACKGROUND The low recruitment rates into surgical randomized controlled trials (RCTs) threaten the validity of their findings. We reviewed the reasons for nonentry of eligible patients into surgical RCTs that would form the basis for future prospective research. METHODS A systematic review of the English language literature for studies reporting reasons for nonentry of eligible patients into surgical RCTs and of recommendations made to improve the low recruitment rates. RESULTS We reviewed 401 articles, including 94 articles presenting the results of 62 studies: 23 reports of recruitment into real surgical RCTs, 11 surveys of patients regarding hypothetical surgical RCTs, 10 surveys of clinicians and 18 literature reviews. The most frequently reported patient-related reasons for nonentry into surgical RCTs were preference for one form of treatment, dislike of the idea of randomization, and the potential for increased demands. Distrust of clinicians caused by a struggle to understand, explicit refusal of a no-treatment (placebo) arm, and the mere inability to make a decision were frequently reported in studies of real RCTs and patient surveys, but were not emphasized in surveys of clinicians and review articles. Difficulties with informed consent, the complexity of study protocols, and the clinicians' loss of motivation attributable to lack of recognition were the most commonly reported clinician-related reasons. CONCLUSIONS There seems to be a discrepancy between real reasons for nonentry of eligible patients into surgical RCTS and those perceived by the clinicians, which require further prospective research. A summary and discussion of main recommendations sighted in the literature is presented.
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Affiliation(s)
- Ned S Abraham
- Coffs Harbour Health Campus, Faculty of Medicine, The University of New South Wales, Coffs Harbour, NSW Australia 2450.
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