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Mollart L, Adams J, Foureur M. Pregnant women and health professional's perceptions of complementary alternative medicine, and participation in a randomised controlled trial of acupressure for labour onset. Complement Ther Clin Pract 2016; 24:167-73. [DOI: 10.1016/j.ctcp.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022]
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A feasibility randomised controlled trial of acupressure to assist spontaneous labour for primigravid women experiencing a post-date pregnancy. Midwifery 2016; 36:21-7. [DOI: 10.1016/j.midw.2016.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/09/2016] [Accepted: 02/23/2016] [Indexed: 11/20/2022]
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Daly JM, Levy BT, Xu Y, Levy SM, Fontana M. Recruitment strategies at the Iowa site for parent/infant pairs in a longitudinal dental caries study. Clin Trials 2016; 13:311-8. [PMID: 26908537 DOI: 10.1177/1740774516630550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS Recruitment of parent/infant pairs can be more difficult and challenging than recruitment of adult subjects alone as the parent has to consider themselves along with the infant to be study participants. In order to determine which recruitment methods most effectively resulted in accrual of subjects, recruitment efforts at the University of Iowa were evaluated, one of three clinical sites involved in a longitudinal prospective study of dental caries. METHODS Enrollment goals were 300 parent/infant pairs within a year. Recruitment strategies included (1) a direct mailing to potential subjects who were University of Iowa Hospitals and Clinics patients and potentially met inclusion criteria; (2) face-to-face recruitment visits at medical offices; (3) provision of recruitment materials to staff at off-campus agencies and medical offices serving low-income individuals; (4) a campus-wide mass e-mail; (5) recruitment materials to daycare centers and neighborhood centers; and (6) recruitment at a children's museum. RESULTS From these recruitment efforts, 515 potential participants expressed interest and were screened for this study and 348 (68%) were enrolled during an 11-month time period. The face-to-face strategy had the highest recruitment rate of 25%, followed by direct individual mailings at 9% and follow-up telephone calls at 7%. For the face-to-face strategy, the contact at the children's museum was most successful compared to the other office settings. The lowest rate of recruitment of 0.09% was attained with the mass e-mail. However, in terms of actual numbers recruited, the mass e-mail remained an important modality since it yielded 21 recruits and was much less time-intensive. CONCLUSION An intensive, multi-pronged recruitment strategy proved successful in meeting enrollment goals and resulted in finishing the enrollment prior to the projected study deadline. Effective recruitment approaches are imperative for a study's success and each recruitment strategy needs to be budgeted and planned for in a study. Investigators may need to adapt their approach to attain the needed number of subjects. Planning needs to include the numbers needed to be approached to attain your recruitment goal, how you will recruit, who will be responsible, and the costs and time commitment for various strategies.
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Affiliation(s)
- Jeanette M Daly
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Barcey T Levy
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Yinghui Xu
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Steven M Levy
- College of Dentistry, University of Iowa, Iowa City, IA, USA
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Shergis JL, Parker S, Coyle ME, Zhang AL, Xue CC. Key considerations for conducting Chinese medicine clinical trials in hospitals. Chin Med 2013; 8:3. [PMID: 23414529 PMCID: PMC3577434 DOI: 10.1186/1749-8546-8-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/14/2013] [Indexed: 11/28/2022] Open
Abstract
Conducting clinical trials of Chinese medicines (CM) in hospitals presents challenges for researchers. The success of hospital-based CM clinical trials may be influenced by the protocol design, including the maintenance of CM theory in compliance with scientific rigour and hospital guidelines and justified treatment approaches with results that can translate into clinical practice. Other influences include personnel and resources such as a dedicated team open to CM with an established research culture and the ability to maximise participant recruitment. This article identifies the key challenges and limitations of conducting CM clinical trials in Australian hospitals.
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Affiliation(s)
- Johannah L Shergis
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia
| | - Shefton Parker
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia
| | - Meaghan E Coyle
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia
| | - Anthony L Zhang
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia
| | - Charlie C Xue
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia
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McCulloch M, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM. Colon cancer survival with herbal medicine and vitamins combined with standard therapy in a whole-systems approach: ten-year follow-up data analyzed with marginal structural models and propensity score methods. Integr Cancer Ther 2011; 10:240-59. [PMID: 21964510 DOI: 10.1177/1534735411406539] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference-namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified.
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McCulloch M, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM. Lung Cancer Survival With Herbal Medicine and Vitamins in a Whole-Systems Approach. Integr Cancer Ther 2011; 10:260-79. [DOI: 10.1177/1534735411406439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Complementary and alternative medicines are used by up to 48% of lung cancer patients but have seen little formal assessment of survival efficacy. In this 10-year retrospective survival study, the authors investigated Pan-Asian medicine + vitamins (PAM+V) therapy in a consecutive case series of all non-small-cell lung cancer patients (n = 239) presenting at a San Francisco Bay Area Chinese medicine center (Pine Street Clinic). They compared short-term treatment lasting the duration of chemotherapy/radiotherapy with long-term therapy continuing beyond conventional therapy. They also compared PAM+V plus conventional therapy with conventional therapy alone, using concurrent controls from the Kaiser Permanente Northern California and California Cancer Registries. They adjusted for confounding with Kaplan-Meier, Cox regression, and newer methods – propensity score and marginal structural models (MSMs), which when analyzing data from observational studies or clinical practice records can provide results comparable with randomized trials. Long-term use of PAM+V beyond completion of chemotherapy reduced stage IIIB deaths by 83% and stage IV by 72% compared with short-term use only for the duration of chemotherapy. Long-term PAM+V combined with conventional therapy reduced stage IIIA deaths by 46%, stage IIIB by 62%, and stage IV by 69% compared with conventional therapy alone. Survival rates for stage IV patients treated with PAM+V were 82% at 1 year, 68% at 2 years, and 14% at 5 years. PAM+V combined with conventional therapy improved survival in stages IIIA, IIIB, and IV, compared with conventional therapy alone. Prospective trials using PAM+V with conventional therapy for lung cancer patients are justified.
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Affiliation(s)
- Michael McCulloch
- Pine Street Foundation, San Anselmo, CA, USA
- University of California at Berkeley School of Public Health, Berkeley, CA, USA
| | | | - Mark van der Laan
- University of California at Berkeley School of Public Health, Berkeley, CA, USA
| | - Alan Hubbard
- University of California at Berkeley School of Public Health, Berkeley, CA, USA
| | | | - Alan Kramer
- San Francisco Oncology Associates, San Francisco, CA, USA
| | - Jin Gao
- Chinese Academy of Sciences, Beijing, China
| | - John M. Colford
- University of California at Berkeley School of Public Health, Berkeley, CA, USA
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Scott C, Walker J, White P, Lewith G. Forging convictions: the effects of active participation in a clinical trial. Soc Sci Med 2011; 72:2041-8. [PMID: 21636195 DOI: 10.1016/j.socscimed.2011.04.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 11/27/2022]
Abstract
This qualitative study explored non-specific influences on participation in, and outcomes of, a randomised controlled trial. It was nested within a single-blind clinical trial of western acupuncture which compared real acupuncture with two types of placebo control administered to National Health Service (NHS) patients awaiting hip and knee replacement surgery in England. Data collection (2004-2008) was based on narrative-style interviews and participant observation. The results indicate that trial recruitment and retention depend on a set of convictions forged largely as a result of contextual factors peripheral to the intervention, including the friendliness and helpfulness of research centre staff and status of the administering practitioner. These convictions also influence the reporting of the study outcomes, particularly if participants experience uncertainties when choosing an appropriate response. The findings suggest that participants in clinical trials are actively involved in shaping the research process, rather than passive recipients of treatment. Thus the outcomes of trials, notably those involving contact interventions, should be regarded not as matters of fact, but as products of complex environmental, social, interpretive and biological processes. In this paper, we develop and present a 'theory of active research participation' which offers a framework for understanding the impact of non-specific processes in clinical trials.
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Affiliation(s)
- Clare Scott
- Pain Service, Imperial College Healthcare NHS Trust, St Mary's Hospital, Salton House, South Wharf Road, London W2 1NY, UK
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Whitebird RR, Kreitzer MJ, Lewis BA, Hanson LR, Crain AL, Enstad CJ, Mehta A. Recruiting and retaining family caregivers to a randomized controlled trial on mindfulness-based stress reduction. Contemp Clin Trials 2011; 32:654-61. [PMID: 21601010 DOI: 10.1016/j.cct.2011.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 04/19/2011] [Accepted: 05/05/2011] [Indexed: 11/25/2022]
Abstract
Caregivers for a family member with dementia experience chronic long-term stress that may benefit from new complementary therapies such as mindfulness-based stress reduction. Little is known however, about the challenges of recruiting and retaining family caregivers to research on mind-body based complementary therapies. Our pilot study is the first of its kind to successfully recruit caregivers for a family member with dementia to a randomized controlled pilot study of mindfulness-based stress reduction. The study used an array of recruitment strategies and techniques that were tailored to fit the unique features of our recruitment sources and employed retention strategies that placed high value on establishing early and ongoing communication with potential participants. Innovative recruitment methods including conducting outreach to health plan members and generating press coverage were combined with standard methods of community outreach and paid advertising. We were successful in exceeding our recruitment goal and retained 92% of the study participants at post-intervention (2 months) and 90% at 6 months. Recruitment and retention for family caregiver interventions employing mind-body based complementary therapies can be successful despite many challenges. Barriers include cultural perceptions about the use and benefit of complementary therapies, cultural differences with how the role of family caregiver is perceived, the use of group-based designs requiring significant time commitment by participants, and travel and respite care needs for busy family caregivers.
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Affiliation(s)
- Robin R Whitebird
- HealthPartners Research Foundation 8170 33rd Avenue S, MS#21111R, Bloomington, MN 55425, USA.
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Pastore LM, Dalal P. Recruitment strategies for an acupuncture randomized clinical trial of reproductive age women. Complement Ther Med 2009; 17:229-35. [PMID: 19632551 DOI: 10.1016/j.ctim.2009.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/03/2009] [Accepted: 03/31/2009] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the most effective recruitment strategies for an acupuncture clinical trial of reproductive age women. DESIGN The underlying study is an acupuncture randomized clinical trial for an ovulatory disorder that affects approximately 6.5% of reproductive age women (Polycystic Ovary Syndrome). Study participation involved 2 months of intervention and 3 months of follow-up with US$170 compensation. Success of each recruitment method used during the first 37 study months was analyzed. SETTING Clinical trial in the Dept. of OB/GYN at the University of Virginia, US. The original geographic residency target was an 80 mile radius around a college town in Virginia (population 155,000), and was expanded to the state capital (population 850,000) in recruitment Year 2. MAIN OUTCOME MEASURES Number of study inquiries (phone calls or emails) over time and by recruitment source. RESULTS In the first 37 months of recruitment (January 2006-January 2009), there were 800 study inquiries (582 by phone, 218 by email), of which 749 were screened via telephone questionnaire. The most successful recruitment methods were flyers (28% of inquiries and 26% of participants) and direct mailing to targeted zip codes (26% and 27%, respectively). The direct mailing cost US$110/inquiry, while the flyers cost less than US$300 in total. Study inquiries were least likely in May and November. Almost all prospective participants (94%) were acupuncture-naive. CONCLUSIONS Posters/flyers and direct mailings proved to be the most successful recruitment methods for this CAM study. Active recruitment with multiple methods was needed for continual enrollment.
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Affiliation(s)
- Lisa M Pastore
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22908-0712, USA.
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