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Sauvat L, Verhoeven PO, Gagnaire J, Berthelot P, Paul S, Botelho-Nevers E, Gagneux-Brunon A. Vaccines and monoclonal antibodies to prevent healthcare-associated bacterial infections. Clin Microbiol Rev 2024; 37:e0016022. [PMID: 39120140 PMCID: PMC11391692 DOI: 10.1128/cmr.00160-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
SUMMARYHealthcare-associated infections (HAIs) represent a burden for public health with a high prevalence and high death rates associated with them. Pathogens with a high potential for antimicrobial resistance, such as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and Clostridioides difficile, are responsible for most HAIs. Despite the implementation of infection prevention and control intervention, globally, HAIs prevalence is stable and they are mainly due to endogenous pathogens. It is undeniable that complementary to infection prevention and control measures, prophylactic approaches by active or passive immunization are needed. Specific groups at-risk (elderly people, chronic condition as immunocompromised) and also healthcare workers are key targets. Medical procedures and specific interventions are known to be at risk of HAIs, in addition to hospital environmental exposure. Vaccines or monoclonal antibodies can be seen as attractive preventive approaches for HAIs. In this review, we present an overview of the vaccines and monoclonal antibodies in clinical development for prevention of the major bacterial HAIs pathogens. Based on the current state of knowledge, we look at the challenges and future perspectives to improve prevention by these means.
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Affiliation(s)
- Léo Sauvat
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul O Verhoeven
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Julie Gagnaire
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Philippe Berthelot
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stéphane Paul
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- CIRI - Centre International de Recherche en Infectiologie, GIMAP team, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Faculty of Medicine, Université Jean Monnet St-Etienne, St-Etienne, France
- Department of Infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
- CIC 1408 Inserm, Axe vaccinologie, University Hospital of Saint-Etienne, Saint-Etienne, France
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De Lucia A, Donisi V, Pasini I, Polati E, Del Piccolo L, Schweiger V, Perlini C. Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain. JMIR Aging 2024; 7:e57196. [PMID: 39235831 DOI: 10.2196/57196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people's experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management. OBJECTIVE This study's objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management. METHODS A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis. RESULTS Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants' opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations. CONCLUSIONS The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people.
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Affiliation(s)
- Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Polati
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Carcel C, Clancy L, Harris K, Peters R, Byrne A, Bassett K, Freed R, Hoyos CM, Rodgers A, Lindley R, Chalmers J, Xu Y, Woodward M, Ouyang M, Naismith SL, Anderson C. Randomised controlled decentralised feasibility trial of a fixed low-dose combination antihypertensive drug strategy to attenuate cognitive decline in high-risk adults. BMJ Open 2024; 14:e080862. [PMID: 39181551 PMCID: PMC11344491 DOI: 10.1136/bmjopen-2023-080862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVES The Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures of cognition, in adults at high risk of dementia. DESIGN A decentralised double-blind, placebo-controlled, randomised feasibility trial with a four-stage screening process. SETTING Conducted with participants online in the state of New South Wales, Australia. PARTICIPANTS Participants were aged 50-70 years with moderately elevated BP (systolic >120 and <160 mm Hg or diastolic >80 and <95 mm Hg) and ≥1 additional enrichment risk factor of monotherapy treatment of hypertension, diabetes mellitus, elevated low-density lipoprotein cholesterol, obesity, current smoking or a first degree relative with dementia, which indicated an elevated risk for future cognitive decline. INTERVENTION Triple Pill (active antihypertensive treatment of telmisartan 20 mg, amlodipine 2.5 mg and indapamide 1.25 mg) or placebo Triple Pill (blinded study capsules). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was feasibility of the study expressed as the percentage of participants randomised from those who were screened. Secondary outcomes were the applicability of videoconference measures of cognition and the overall trial, tolerability of the Triple Pill, safety outcomes and medication adherence. RESULTS The proportion (95% CI) of patients randomised to those screened was 5% (2%-10%). The applicability of the trial expressed as percentage of those who completed all remote assessments over the number of randomised participants was 67% (95% CI 05 to 22%). There were no serious adverse events or withdrawals from treatment. All participants adhered to study medication, except for one person who had two capsules left at the end of the study period. CONCLUSIONS The feasibility of this decentralised trial on BP lowering in patients at high risk for dementia is low. However, the applicability of remote assessments of cognitive function is acceptable. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000121864.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Lauren Clancy
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth Peters
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Aisling Byrne
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kimberley Bassett
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ruth Freed
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ying Xu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- The George Institute for Global Health China, Beijing, China
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Deere R, Pallmann P, Shepherd V, Brookes-Howell L, Carson-Stevens A, Davies F, Dunphy E, Gupta P, Hickson M, Hill V, Ingarfield K, Ivins N, Jones F, Letchford R, Lowe R, Nash S, Otter P, Prout H, Randell E, Sewell B, Smith D, Trubey R, Wainwright T, Busse M, Button K. MulTI-domain self-management in older People wiTh OstEoarthritis and multi-morbidities: protocol for the TIPTOE randomised controlled trial. Trials 2024; 25:557. [PMID: 39180101 PMCID: PMC11344358 DOI: 10.1186/s13063-024-08380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Four out of five people living with osteoarthritis (OA) also suffer with at least one other long-term health condition. The complex interaction between OA and multiple long-term conditions (MLTCs) can result in difficulties with self-care, restricted mobility, pain, anxiety, depression and reduced quality of life. The aim of the MulTI-domain Self-management in Older People wiTh OstEoarthritis and Multi-Morbidities (TIPTOE) trial is to evaluate the clinical and cost-effectiveness of the Living Well self-management support intervention, co-designed with people living with OA, integrated into usual care, in comparison to usual care alone. METHODS TIPTOE is a multi-centre, two-arm, individually randomised controlled trial where 824 individuals over 65 years old with knee and/or hip joint pain from their OA affected joint and at least one other long-term health condition will be randomised to receive either the Living Well Self-Management support intervention or usual care. Eligible participants can self-refer onto the trial via a website or be referred via NHS services across Wales and England. Those randomised to receive the Living Well support intervention will be offered up to six one-to-one coaching sessions with a TIPTOE-trained healthcare practitioner and a co-designed book. Participants will be encouraged to nominate a support person to assist them throughout the study. All participants will complete a series of self-reported outcome measures at baseline and 6- and 12-month follow-up. The primary outcome is symptoms and quality of life as assessed by the Musculoskeletal Health Questionnaire (MSK-HQ). Routine data will be used to evaluate health resource use. A mixed methods process evaluation will be conducted alongside the trial to inform future implementation should the TIPTOE intervention be found both clinically and cost-effective. An embedded 'Study Within A Project' (SWAP) will explore and address barriers to the inclusion of under-served patient groups (e.g. oldest old, low socioeconomic groups, ethnic groups). DISCUSSION TIPTOE will evaluate the clinical and cost-effectiveness of a co-designed, living well personalised self-management support intervention for older individuals with knee and/or hip OA and MLTCs. The trial has been designed to maximise inclusivity and access. TRIAL REGISTRATION ISRCTN 16024745 . Registered on October 16, 2023.
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Affiliation(s)
- Rachel Deere
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Philip Pallmann
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Victoria Shepherd
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lucy Brookes-Howell
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ffion Davies
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emma Dunphy
- Healthcare NHS Foundation Trust is Homerton Hospital, Homerton Row, London, E9 6SR, UK
| | - Preeti Gupta
- Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XN, UK
| | - Mary Hickson
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Val Hill
- Public and Patient Involvement Member C/O Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Ingarfield
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nicola Ivins
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona Jones
- Population Health Research Institute, St George's University, London, UK
- Bridges Self-Management, St George's University, London, UK
| | - Robert Letchford
- Cardiff and Vale University Health Board, Heath Park, Cardiff, CF14 4XN, UK
| | - Rachel Lowe
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Sarah Nash
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Paula Otter
- Bridges Self-Management, St George's University, London, UK
| | - Hayley Prout
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Elizabeth Randell
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Bernadette Sewell
- Faculty of Medicine, Health and Life Science, Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Debs Smith
- Public and Patient Involvement Member C/O Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Robert Trubey
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Tom Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Monica Busse
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
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Lanot A, Boyer A, Lobbedez T, Béchade C. Exploring clinical practice guidelines in PD: When to guide and when to draw the line. Perit Dial Int 2024:8968608241245900. [PMID: 38644579 DOI: 10.1177/08968608241245900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Antoine Lanot
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Annabel Boyer
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
| | - Thierry Lobbedez
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Clémence Béchade
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
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Janssens WH, Verhoestraete P, Piers RD, Van Den Noortgate NJ. Short-Term Opioid Treatment of Acute Locomotor Pain in Older Adults: Comparison of Effectiveness and Safety between Tramadol and Oxycodone: A Randomized Trial. Geriatrics (Basel) 2024; 9:46. [PMID: 38667513 PMCID: PMC11050500 DOI: 10.3390/geriatrics9020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. MATERIALS AND METHODS Multi-center prospective randomized study. Patients were 70 years or older, admitted to the acute geriatric ward of three hospitals, suffering from acute moderate to severe locomotor pain, and opioid-naive. Patients were randomized into two treatment groups: tramadol versus oxycodone. The Consort reporting guidelines were used. RESULTS Forty-nine patients were included. Mean numeric rating scale (NRS) decreased significantly between day 0 and 2 of the inclusion in both groups. A sustained significant decrease in mean NRS was seen at day 7 in both groups. Nausea was significantly more prevalent in the tramadol group, with a trend towards a higher prevalence of delirium and falls and three serious adverse events in the same group. CONCLUSIONS Opioid therapy may be considered as a short-term effective treatment for moderate to severe acute locomotor pain in older adults. Oxycodone may possibly be preferred for safety reasons. These results can have implications for geriatric practice, showing that opioids for treatment of acute moderate to severe locomotor pain in older patients are effective and safe if carefully monitored for side effects. Opioid therapy may be considered as a short-term treatment for moderate to severe acute locomotor pain in older adults, if carefully monitored for (side) effects, while oxycodone may possibly be preferred for safety reasons. These results can have implications for daily practice in geriatric, orthopedic, and orthogeriatric wards, as well as in terminal care, more precisely for the treatment of moderate to severe acute locomotor pain in older adults.
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Affiliation(s)
- Wim Henri Janssens
- Department of Geriatrics, University Hospital Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium
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Szabo‐Reed AN, Hall T, Vidoni ED, Van Sciver A, Sewell M, Burns JM, Cullum CM, Gahan WP, Hynan LS, Kerwin DR, Rossetti H, Stowe AM, Vongpatanasin W, Zhu DC, Zhang R, Keller JN, Binder EF. Recruitment methods and yield rates for a multisite clinical trial exploring risk reduction for Alzheimer's disease (rrAD). ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12422. [PMID: 37841653 PMCID: PMC10576444 DOI: 10.1002/trc2.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The risk reduction for Alzheimer's disease (rrAD) trial was a multisite clinical trial to assess exercise and intensive vascular pharmacological treatment on cognitive function in community-dwelling older adults at increased risk for Alzheimer's disease. METHODS Eligibility, consent, and randomization rates across different referral sources were compared. Informal interviews conducted with each site's project team were conducted upon study completion. RESULTS Initially, 3290 individuals were screened, of whom 28% were eligible to consent, 805 consented to participate (87.2% of those eligible), and 513 (36.3% of those consented) were randomized. Emails sent from study site listservs/databases yielded the highest amount (20.9%) of screened individuals. Professional referrals from physicians yielded the greatest percentage of consented individuals (57.1%). Referrals from non-professional contacts (ie, friends, family; 75%) and mail/phone contact from a site (73.8%) had the highest yield of randomization. DISCUSSION Professional referrals or email from listservs/registries were most effective for enrolling participants. The greatest yield of eligible/randomized participants came from non-professional and mail/phone contacts. Future trials should consider special efforts targeting these recruitment approaches. Highlights Clinical trial recruitment is commonly cited as a significant barrier to advancing our understanding of cognitive health interventions.The most cited referral source was email, followed by interviews/editorials on the radio, television, local newspapers, newsletters, or magazine articles.The referral method that brought in the largest number of contacts was email but did not result in the greatest yield of consents or eligible participants.The sources that yielded the greatest likelihood of consent were professional referrals (ie, physician), social media, and mail/phone contact from study site.The greatest yield of eligible/randomized participants came from non-professional contacts and mail/phone contact from a site.Findings suggest that sites may need to focus on more selective referral sources, such as using contact mailing and phone lists, rather than more widely viewed recruitment sources, such as social media or TV/radio advertisements.
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Affiliation(s)
- Amanda N. Szabo‐Reed
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Tristyn Hall
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasUSA
| | - Eric D. Vidoni
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Angela Van Sciver
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
| | - Monica Sewell
- Department of Internal MedicineDivision of Geriatrics & Nutritional ScienceWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Jeffrey M. Burns
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - C. Munro Cullum
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
- Department of NeurologyUT Southwestern Medical CenterDallasTexasUSA
| | - William P. Gahan
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Linda S. Hynan
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Diana R. Kerwin
- Kerwin Research Center and Memory CareDallasTexasUSA
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Heidi Rossetti
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
| | - Ann M. Stowe
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Wanpen Vongpatanasin
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - David C. Zhu
- Department for RadiologyMichigan State UniversityEast LansingMichiganUSA
| | - Rong Zhang
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasUSA
- Department of NeurologyUT Southwestern Medical CenterDallasTexasUSA
| | - Jeffrey N. Keller
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Ellen F. Binder
- Department of Internal MedicineDivision of Geriatrics & Nutritional ScienceWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
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Shapiro LN, Gray MF, Freitag C, Taneja P, Kariya H, Crane PK, O'Hare AM, Vig EK, Taylor JS. Expanding the ethnographic toolkit: Using medical documents to include kinless older adults living with dementia in qualitative research. J Aging Stud 2023; 65:101140. [PMID: 37268383 DOI: 10.1016/j.jaging.2023.101140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/04/2023]
Abstract
Ethnographic research with cognitively impaired older adults can be challenging, in part because cognitive impairment raises questions about the ability to provide informed consent. Relying on proxy consent is a commonly used strategy, but often excludes people with dementia who lack close kin (de Medeiros, Girling, & Berlinger, 2022). In this paper, we describe how we have analyzed existing research data from a well-established and ongoing prospective cohort study, the Adult Changes in Thought Study, along with unstructured text from the medical records of participants who had no living spouse or adult children when they developed dementia, as a way of studying the circumstances, life trajectories, caregiving resources, and care needs of this vulnerable and difficult-to-research group. In this article, we detail this methodology, exploring what can and cannot be gleaned from it, what the ethical implications may be, and how and whether this type of research can be considered ethnographic. In conclusion, we argue that collaborative interdisciplinary research using existing, longitudinal research data and text from medical records deserves to be considered as a potentially useful addition to the ethnographic toolkit. We anticipate that this is a methodology that could be applied more broadly, and paired with more traditional ethnographic methods, might be one way to make research with this population more inclusive.
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Affiliation(s)
- Lily N Shapiro
- Kaiser Permanente Washington Health Research Institute, USA.
| | | | | | | | | | | | - Ann M O'Hare
- University of Washington and VA Puget Sound Health Care System, USA
| | - Elizabeth K Vig
- University of Washington and VA Puget Sound Health Care System, USA
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9
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Goodwin VA, Low MSA, Quinn TJ, Cockcroft EJ, Shepherd V, Evans PH, Henderson EJ, Mahmood F, Ni Lochlainn M, Needham C, Underwood BR, Arora A, Witham MD. Including older people in health and social care research: best practice recommendations based on the INCLUDE framework. Age Ageing 2023; 52:afad082. [PMID: 37261448 PMCID: PMC10234283 DOI: 10.1093/ageing/afad082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. AIMS The aim of this work was to develop recommendations to guide all research relevant to older people. METHODS A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. RESULTS A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. CONCLUSION Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research.
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Affiliation(s)
| | - Mikaela S A Low
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Emma J Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Philip H Evans
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- National Institute for Health and Care Research, Clinical Research Network, UK
| | - Emily J Henderson
- Ageing and Movement Disorders Research Group, Bristol Medical School, University of Bristol, Bristol, UK
| | - Farhat Mahmood
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mary Ni Lochlainn
- National Institute for Health and Care Research, Clinical Research Network, UK
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | | | | | - Amit Arora
- Elderly Care Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle, UK
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10
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Murphy AL, Turner JP, Rajda M, Allen KG, Pinter K, Gardner DM. Effectiveness and cost analysis of methods used to recruit older adult sedative users to a deprescribing randomized controlled trial during the COVID-19 pandemic. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100214. [PMID: 36540425 PMCID: PMC9751000 DOI: 10.1016/j.rcsop.2022.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background Recruitment to clinical trials is a challenge for researchers that became more pronounced because of COVID-19 public health protective measures, especially with respect to studies enrolling older adults. We completed an effectiveness and cost analysis of the recruitment methods used in The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, a randomized controlled trial of a deprescribing intervention that recruited older adults with chronic use of sedatives during the pandemic. Methods Study recruitment began during the COVID-19 pandemic. Strategies included random digit dialing (RDD), a targeted mail campaign and advertising through newspapers, online platforms (Google and Facebook), and television. Other awareness raising and recruitment strategies involved seniors' organizations, pharmacies, television news stories, and referrals. Recruitment effectiveness and cost analysis involved enrollment rate (ER), cost per randomized participant (CPRP), fractional cost (FC), fractional enrollment (FE), fractional enrollment-cost ratio (FEC), and efficacy index (EI) calculations. Results There were 1295 interested older adults with 594 randomized into the study for an enrollment rate of 46%. The efficacy index (EI) was highest for Facebook ads (EI = 0.683) followed by television (EI = 0.426), and newsprint ads (EI = 0.298). The cost of RDD was highest per randomized participant at $1117.90 and produced the lowest EI (0.013). Conclusion Facebook ads had the best efficacy index for recruiting older adults to the YAWNS NB study during the COVID-19 pandemic and television ads produced the most enrollments. RDD was expensive and yielded few recruits. Recruitment costs can be significant for recruiting community-dwelling older adults. This experience can inform recruitment strategy and budget development for future community studies enrolling older adults, especially in the context of the COVID-19 pandemic.
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Affiliation(s)
- Andrea L. Murphy
- College of Pharmacy and Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada,Corresponding author.
| | - Justin P. Turner
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Victoria, Australia,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Malgorzata Rajda
- Sleep Disorders Clinic, Nova Scotia Health, and Department of Psychiatry, Dalhousie Univeristy, Halifax, Nova Scotia, Canada
| | - Kathleen G. Allen
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kamilla Pinter
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David M. Gardner
- Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
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11
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Seah B, Espnes GA, Hong WT, Wang W. Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial. BMC Geriatr 2022; 22:932. [PMID: 36460959 PMCID: PMC9719210 DOI: 10.1186/s12877-022-03605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only. METHODS A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data. RESULTS Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention. CONCLUSION Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention. TRIAL REGISTRATION This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.
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Affiliation(s)
- Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore. .,Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore.
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, Trondheim, N-7491, Norway
| | - Wee Tin Hong
- Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore
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12
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Gagneux-Brunon A, Ward JK, Bonneton M, Verger P, Launay O, Botelho-Nevers E. Intention to participate in COVID-19 vaccine clinical trials in May 2021: a cross-sectional survey in the general French population. Hum Vaccin Immunother 2022; 18:2072630. [PMID: 35561252 PMCID: PMC9481082 DOI: 10.1080/21645515.2022.2072630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In May 2021, while the immunization campaign was in progress, the emergence of new SARS-CoV-2 variants led us to assess attitudes toward participation in a COVID-19 vaccine clinical trial (VCT) in France. Between the 10th and the 23rd of May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over and a specific sample of the French population over 65. Among the 3,056 respondents, 28.0% (856) would consider participation in a COVID-19 VCT. Factors independently negatively associated with willingness to participate in a COVID-19 VCT were female gender with an adjusted odd ratio (aOR) 0.42 and 95% confidence interval (95% CI) 0.35–0.51, and mistrust in health actors (in their own physician and pharmacists, health ministry, government, scientists in medias, medias and pharmaceutical companies) with aOR 0.86 (95% CI 0.84–0.88) by one-point increase in mistrust in health actors score. Factors positively associated with willingness to participate in a COVID-19 VCT were COVID-19 vaccination or intention to get vaccinated with aOR 4.89 (95% CI 3.15–7.61), being a healthcare worker with aOR 2.051 (95% CI 1.51–2.80), being at risk for severe COVID-19 with aOR 1.39 (95% CI 1.14–1.69) and altruism as the main reason for getting vaccination with aOR 1.56 (95% CI 1.29–1.88). In May 2021, despite COVID 19 vaccine availability, 28% of the French population would agree to participate in a COVID-19 VCT. Mistrust in health actors contributes to a reduction in the intention to participate. Attitudes toward COVID-19 vaccination predict attitudes toward participation in a COVID-19 VCT.
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Affiliation(s)
- Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France.,CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France.,Chaire PREVACCI, Université Jean Monnet, Saint-Etienne, France.,Inserm, F-CRIN, I-REIVAC/COVIREIVAC, Paris, France
| | - Jeremy K Ward
- Laboratory VITROME (Aix Marseille Université, IRD, AP-HM,SSA), Marseille, France.,Laboratory CERMES3 (INSERM, CNRS, EHESS, Université deParis), Villejuif, France
| | - Marion Bonneton
- Inserm, F-CRIN, I-REIVAC/COVIREIVAC, Paris, France.,CIC 1417, INSERM, Assistance Publique - Hôpitaux de Paris, Université de Paris, Hôpital Cochin, Paris, France
| | - Pierre Verger
- Laboratory VITROME (Aix Marseille Université, IRD, AP-HM,SSA), Marseille, France.,Observatoire régional de la santé Paca, Marseille, France
| | - Odile Launay
- Inserm, F-CRIN, I-REIVAC/COVIREIVAC, Paris, France.,CIC 1417, INSERM, Assistance Publique - Hôpitaux de Paris, Université de Paris, Hôpital Cochin, Paris, France
| | - Elisabeth Botelho-Nevers
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France.,CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France.,Chaire PREVACCI, Université Jean Monnet, Saint-Etienne, France
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13
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Smrke U, Plohl N, Mlakar I. Aging Adults' Motivation to Use Embodied Conversational Agents in Instrumental Activities of Daily Living: Results of Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042373. [PMID: 35206564 PMCID: PMC8872482 DOI: 10.3390/ijerph19042373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
The rapidly increasing share of ageing adults in the population drives the need and interest in assistive technology, as it has the potential to support ageing individuals in living independently and safely. However, technological development rarely reflects how needs, preferences, and interests develop in different ways while ageing. It often follows the strategy of “what is possible” rather than “what is needed” and “what preferred”. As part of personalized assistive technology, embodied conversational agents (ECAs) can offer mechanisms to adapt the technological advances with the stakeholders’ expectations. The present study explored the motivation among ageing adults regarding technology use in multiple domains of activities of daily living. Participants responded to the questionnaire on the perceived importance of instrumental activities of daily living and acceptance of the idea of using ECAs to support them. Latent profile analysis revealed four profiles regarding the motivation to use ECAs (i.e., a low motivation profile, two selective motivation profiles with an emphasis on physical and psychological well-being, and a high motivation profile). Profiles were compared in terms of their acceptance of ECA usage in various life domains. The results increase the knowledge needed in the development of assistive technology adapted to the expectations of ageing adults.
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Affiliation(s)
- Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška Cesta 46, 2000 Maribor, Slovenia;
| | - Nejc Plohl
- Department of Psychology, Faculty of Arts, University of Maribor, Koroška Cesta 160, 2000 Maribor, Slovenia;
| | - Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška Cesta 46, 2000 Maribor, Slovenia;
- Correspondence:
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14
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Ginossar T, Diaz Fuentes C, Oetzel J. Understanding Willingness to Participate in Cancer Clinical Trials Among Patients and Caregivers Attending a Minority-Serving Academic Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:179-187. [PMID: 32666504 PMCID: PMC10685662 DOI: 10.1007/s13187-020-01802-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advances in cancer treatment are impeded by low accrual rates of patients to cancer clinical trials (CCTs). The national rates of recruitment of underserved groups, including racial/ethnic minorities, are limiting the generalizability of research findings and are likely to enhance inequities in cancer outcomes. The goal of this study was to examine willingness to participate (WTP) in CCTs and factors associated with this willingness among patients and caregivers attending a minority-serving university cancer center in the Southwest. A cross-sectional survey design was utilized (n = 236, 135 patients and 101 caregivers). Fear was the strongest predictor of WTP in CCTs. The only ethnic differences observed related to Spanish-speaking patients exhibiting increased WTP in CCTs, and Spanish-speaking caregivers' decreased WTP, compared to others. These results underscore the importance of future interventions to reduce CCT-related fear among patients and caregivers, with particular need for family-focused tailored interventions designed to meet the needs of Spanish-speaking patients and caregivers.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, 87103, USA.
| | | | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, 3240, New Zealand
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15
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Lee SS, McGrattan A, Soh YC, Alawad M, Su TT, Palanisamy UD, Hussin AM, Kassim ZB, Mohd Ghazali ANB, Christa Maree Stephan B, Allotey P, Reidpath DD, Robinson L, Mohan D, Siervo M. Feasibility and Acceptability of a Dietary Intervention to Reduce Salt Intake and Increase High-Nitrate Vegetable Consumption in Malaysian Middle-Aged and Older Adults with Elevated Blood Pressure: Findings from the DePEC-Nutrition Trial. Nutrients 2022; 14:nu14030430. [PMID: 35276789 PMCID: PMC8839221 DOI: 10.3390/nu14030430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
The DePEC-Nutrition trial is a complex dietary and behavioural intervention of salt intake reduction combined with increased high-nitrate vegetable consumption among Malaysian middle-aged and older adults with elevated blood pressure. This study aimed to assess the feasibility and acceptability of the trial. Participants were recruited from the South East Asia Community Observatory (SEACO) database and randomised into one of four groups: (1) low salt; (2) high-nitrate vegetable; (3) combined high-nitrate vegetable and low salt; and (4) control. The intervention included a combination of group counselling sessions, information booklets, reinforcement videos and text messages to modify dietary behaviour. The primary outcomes evaluated were the measures of feasibility and acceptability of (1) recruitment, follow-up attendance and retention; (2) data collection procedures and clinical outcome measures; and (3) individual and combined multi-modal dietary interventions. A total of 74 participants were recruited, and the 10-month retention rate was 73%. Data collection procedures were acceptable with minimal missing data. All intervention strategies were feasible and acceptable, with group counselling being the most acceptable strategy. This study provides important insights into improving the screening process of participants, facilitating their access to the research facilities and refining the measurement protocols and dietary recommendations, which are instrumental in formulating the design of a full-scale definitive DePEC-Nutrition trial.
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Affiliation(s)
- Siew Siew Lee
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
| | - Andrea McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Yee Chang Soh
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Mawada Alawad
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Uma Devi Palanisamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Azizah Mat Hussin
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang 43000, Malaysia;
| | - Zaid bin Kassim
- District Health Office, Pejabat Kesihatan Daerah (PKD) Segamat, Segamat 85000, Malaysia; (Z.b.K.); (A.N.b.M.G.)
| | | | | | - Pascale Allotey
- International Institute for Global Health, United Nations University, Kuala Lumpur 56000, Malaysia;
| | - Daniel D. Reidpath
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
- International Centre for Diarrhoeal Disease Research, ICDDR, B, Dhaka 1212, Bangladesh
| | - Louise Robinson
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK;
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- Correspondence: ; Tel.: +60-3-5515-9658
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Nottingham NG7 2UH, UK;
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16
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Castillo AF, Davis AL, Fischhoff B, Krishnamurti T. Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients. Health Informatics J 2021; 27:14604582211059463. [PMID: 34825829 DOI: 10.1177/14604582211059463] [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: 11/16/2022]
Abstract
Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient-provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.
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Affiliation(s)
| | - Alexander L Davis
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
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17
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Viana JN, Edney S, Gondalia S, Mauch C, Sellak H, O'Callaghan N, Ryan JC. Trends and gaps in precision health research: a scoping review. BMJ Open 2021; 11:e056938. [PMID: 34697128 PMCID: PMC8547511 DOI: 10.1136/bmjopen-2021-056938] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine progress and gaps in global precision health research, examining whether precision health studies integrate multiple types of information for health promotion or restoration. DESIGN Scoping review. DATA SOURCES Searches in Medline (OVID), PsycINFO (OVID), Embase, Scopus, Web of Science and grey literature (Google Scholar) were carried out in June 2020. ELIGIBILITY CRITERIA Studies should describe original precision health research; involve human participants, datasets or samples; and collect health-related information. Reviews, editorial articles, conference abstracts or posters, dissertations and articles not published in English were excluded. DATA EXTRACTION AND SYNTHESIS The following data were extracted in independent duplicate: author details, study objectives, technology developed, study design, health conditions addressed, precision health focus, data collected for personalisation, participant characteristics and sentence defining 'precision health'. Quantitative and qualitative data were summarised narratively in text and presented in tables and graphs. RESULTS After screening 8053 articles, 225 studies were reviewed. Almost half (105/225, 46.7%) of the studies focused on developing an intervention, primarily digital health promotion tools (80/225, 35.6%). Only 28.9% (65/225) of the studies used at least four types of participant data for tailoring, with personalisation usually based on behavioural (108/225, 48%), sociodemographic (100/225, 44.4%) and/or clinical (98/225, 43.6%) information. Participant median age was 48 years old (IQR 28-61), and the top three health conditions addressed were metabolic disorders (35/225, 15.6%), cardiovascular disease (29/225, 12.9%) and cancer (26/225, 11.6%). Only 68% of the studies (153/225) reported participants' gender, 38.7% (87/225) provided participants' race/ethnicity, and 20.4% (46/225) included people from socioeconomically disadvantaged backgrounds. More than 57% of the articles (130/225) have authors from only one discipline. CONCLUSIONS Although there is a growing number of precision health studies that test or develop interventions, there is a significant gap in the integration of multiple data types, systematic intervention assessment using randomised controlled trials and reporting of participant gender and ethnicity. Greater interdisciplinary collaboration is needed to gather multiple data types; collectively analyse big and complex data; and provide interventions that restore, maintain and/or promote good health for all, from birth to old age.
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Affiliation(s)
- John Noel Viana
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shakuntla Gondalia
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Chelsea Mauch
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Hamza Sellak
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Data61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Nathan O'Callaghan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Jillian C Ryan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
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18
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Frailty should now be measured in all randomized controlled trials including older people. J Hypertens 2021; 39:419-420. [PMID: 33543884 DOI: 10.1097/hjh.0000000000002724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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19
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Meekes WMA, Ford C, Stanmore EK. Recruitment and retention of older adults in Assisted Living Facilities to a clinical trial using technology for falls prevention: A qualitative case study of barriers and facilitators. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1296-1307. [PMID: 32914917 PMCID: PMC8451871 DOI: 10.1111/hsc.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Older adults often have health complexities and higher levels of attrition. Even though they are the main users of healthcare, they are often not included in health research because the health research may not be well designed to accommodate their evolving health needs. One research area in which participation of older adults is essential focuses on improving physical function. In this field, there are many innovations and new technologies developed. Barriers and facilitators to recruit older adults to research that improves physical function by using technology are not well explored yet. This study aims to explore barriers and facilitators regarding recruitment and retention of older adults living in Assisted Living Facilities to a randomised controlled trial study that aimed to improve physical function by using technology. Nine semi-structured interviews were conducted with four Scheme Managers, three therapists and two researchers. The interviews were transcribed. After open, axial and selective coding, the codes were thematic analysed in ATLAS.ti. Scheme Managers, therapists, researchers and older adults' peers appear to play an important role in the recruitment and retention of older adults living in Assisted Living Facilities. Additionally, the technology itself and the presentation of the research appear to influence recruitment. Creating a social setting, inviting people face-to-face, demonstrating the technology, showing the benefits by presenting results from a pilot study and alleviating people's fears were experienced as important factors for recruitment. The results from this study can help other researcher to improve recruitment and retention strategies so evidence-based practice in care for older adults can be improved to enhance quality of life of older adults.
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Affiliation(s)
- Wytske M. A. Meekes
- Tranzo, Tilburg School of Social and Behavioural SciencesTilburg UniversityTilburgNetherlands
| | - Claire Ford
- School of Health Sciences, Jean McFarlane BuildingThe University of ManchesterManchesterUK
| | - Emma K. Stanmore
- School of Health Sciences, Jean McFarlane BuildingThe University of ManchesterManchesterUK
- Manchester Academic Health Science Centre, Core Technology FacilityThe University of ManchesterManchesterUK
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Rodríguez-Torres E, González-Pérez MM, Díaz-Pérez C. Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemp Clin Trials Commun 2021; 23:100829. [PMID: 34401599 PMCID: PMC8358641 DOI: 10.1016/j.conctc.2021.100829] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.
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Affiliation(s)
| | | | - Clemente Díaz-Pérez
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, USA
- The Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, USA
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21
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Cordes T, Zwingmann K, Rudisch J, Voelcker-Rehage C, Wollesen B. Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk - A randomized controlled trial. Exp Gerontol 2021; 153:111484. [PMID: 34293413 DOI: 10.1016/j.exger.2021.111484] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Older nursing home residents are often characterized by multimorbidity and dependency in activities of daily living. Most exercise studies in this setting aim at residents who are still able to walk despite the huge group of residents that is unable to walk. Thus, little is known about the effectiveness to improve cognitive and motor functions as well as well-being within this target group, e.g., by use of chair-based exercises. The aim of this study was to determine the effects of a 16-week multicomponent chair-based exercise intervention on motor functions, cognition and well-being for nursing home residents who are unable to walk. METHODS A two-arm single-blinded multicenter randomized controlled trial integrated N = 52 nursing home residents with a mean age of 81 ± 11 years (63% female), randomly assigned to a training (n = 26, 16 weeks; twice a week; 60 min) or a wait-list control group (n = 26). The intervention followed the F.I.T.T. principles (frequency, intensity, time and type) and was continuously adapted to residents' performance level. The outcomes motor function (hand grip strength, sitting balance, manual dexterity), cognitive performance (cognitive status, working memory) and psychosocial resources (physical and mental well-being (SF12), satisfaction with life (SWLS), depressive symptoms (CES-D)) were assessed at baseline (pre-test) and after 16-weeks (post-treatment). Statistics were performed using ANOVA for repeated measures. RESULTS The results of the ANOVA showed significant improvements of the intervention group for hand grip strength (Pre: M = 12.67, SD = 5.28; Post: M = 13.86, SD = 4.79; Group × Time: F(1, 17) = 10.816, p = .002, ηp2 = 0.241), manual dexterity (Pre: M = 4.50, SD = 5.17; Post: M = 5.30, SD = 4.25; Group × Time: F(1, 7) = 9.193, p = .008, ηp2 = 0.365), cognition (Pre: M = 10.31, SD = 6.87; Post: M = 11.06, SD = 7.50; Group × Time: F(1, 15) = 12.687, p = .001, ηp2 = 0.284), and depression (Pre: M = 5.19, SD = 5.12; Post: M = 4.38, SD = 4.62; Group × Time: F(1, 14) = 5.135, p = .031, ηp2 = 0.150) while the values of the control group decreased. CONCLUSION The multicomponent chair-based intervention over 16 weeks was able to improve motor functions and cognition in nursing home residents who are unable to walk. Other psychological factors remained stable within the intervention group, which can be interpreted as a good result for this target group. All of the investigated parameters showed a significant decrease in the control group. The intervention seemed to cause physiological adaptations even in very old age. Study results encourage to further differentiate the heterogeneous group of nursing home residents concerning mobility aspects and to include chair-based interventions as feasible program to prevent further decline of functional performance and maintain independence in activities of daily living for a better physical and mental well-being.
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Affiliation(s)
- Thomas Cordes
- Institute of Human Movement Science, University of Hamburg, Mollerstr, 10, 20148 Hamburg, Germany.
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Chemnitz University of Technology, 09126 Chemnitz, Germany.
| | - Julian Rudisch
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, Horstmarer Landweg 62 b, 48149 Muenster, Germany.
| | - Claudia Voelcker-Rehage
- Institute of Human Movement Science and Health, Chemnitz University of Technology, 09126 Chemnitz, Germany; Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, Horstmarer Landweg 62 b, 48149 Muenster, Germany.
| | - Bettina Wollesen
- Institute of Human Movement Science, University of Hamburg, Mollerstr, 10, 20148 Hamburg, Germany; Biological Psychology and Neuroergonomics, TU Berlin, Fasanenstr. 1, 10623 Berlin, Germany.
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22
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Puente-Maestú L, Ortega F, Pedro JGD, Rodríguez-Nieto MJ, Gómez-Seco J, Gáldiz B, Ojanguren I, Muñoz X, Blanco I, Burgos F, Rodríguez-Chiaradía DA, Gea J, García-Rio F. Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population. Arch Bronconeumol 2021; 57:471-478. [PMID: 35698953 DOI: 10.1016/j.arbr.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/13/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V?O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V?O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS Height, sex and age resulted predictive of both V?O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V?O2peak=0.017·height?(cm)-0.023·age?(years)+0.864·sex?(female=0/male=1)±179?l?min-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS This study provides new and accurate V?O2 peak and WR rate reference values for individuals of European Spanish descent.
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Affiliation(s)
- Luis Puente-Maestú
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Francisco Ortega
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Garcia de Pedro
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, IIS-Fundación Jiménez Diaz, Autónoma University Madrid, Madrid, Spain
| | | | - Batxi Gáldiz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Cruces Universitary Hospital, Barakaldo, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Iñigo Ojanguren
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Xavier Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; Servicio Neumologia Hospital Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades respiratorias CIBERes, Barcelona, Spain; Departamento de Biología Celular, Fisiología e Inmunología Univertsidad Autónoma de Barcelona, Cataluña, Spain
| | - Isabel Blanco
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felip Burgos
- University of Barcelona Respiratory Diagnostic Center Hospital Clínic, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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23
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Sethi S, Kumar A, Mandal A, Shaikh M, Hall CA, Kirk JMW, Moss P, Brookes MJ, Basu S. The UPTAKE study: implications for the future of COVID-19 vaccination trial recruitment in UK and beyond. Trials 2021; 22:296. [PMID: 33879208 PMCID: PMC8057665 DOI: 10.1186/s13063-021-05250-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Developing a safe and effective vaccine will be the principal way of controlling the COVID-19 pandemic. However, current COVID-19 vaccination trials are not adequately representing a diverse participant population in terms of age, ethnicity and comorbidities. Achieving the representative recruitment targets that are adequately powered to the study remains one of the greatest challenges in clinical trial management. To ensure accuracy and generalisability of the safety and efficacy conclusions generated by clinical trials, it is crucial to recruit patient cohorts as representative as possible of the future target population. Missing these targets can lead to reduced validity of the study results and can often slow down drug development leading to costly delays. Objective This study explores the key factors related to perceptions and participation in vaccination trials. Methods This study involved an anonymous cross-sectional online survey circulated across the UK. Statistical analysis was done in six phases. Multi-nominal logistic models examined demographic and geographic factors that may impact vaccine uptake. Results The survey had 4884 participants of which 9.44% were Black Asian Minority Ethnic (BAME). Overall, 2020 (41.4%) respondents were interested in participating in vaccine trials; 27.6% of the respondents were not interested and 31.1% were unsure. The most interested groups were male (OR = 1.29), graduates (OR = 1.28), the 40–49 and 50–59 age groups (OR = 1.88 and OR = 1.46 respectively) and those with no health issues (OR = 1.06). The least interested groups were BAME (OR = 0.43), those from villages and small towns (OR = 0.66 and 0.54 respectively) and those aged 70 and above (OR = 1.11). Conclusions In order to have a vaccination that is generalisable to the entire population, greater work needs to be done in engaging a diverse cohort of participants. Public health campaigns need to be targeted in improving trial recruitment rates for the elderly, BAME community and the less educated rural population.
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Affiliation(s)
- Sonika Sethi
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, West Midlands, WV10 0QP, UK.
| | - Aditi Kumar
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, West Midlands, WV10 0QP, UK
| | | | - Mohammed Shaikh
- National Institute for Health Research, Clinical Research Network, Coventry, West Midlands, UK
| | - Claire A Hall
- National Institute for Health Research, Clinical Research Network, Coventry, West Midlands, UK
| | - Jeremy M W Kirk
- National Institute for Health Research, Clinical Research Network, Coventry, West Midlands, UK.,Research Institute in Healthcare Sciences (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Paul Moss
- University of Birmingham, Birmingham, UK
| | - Matthew J Brookes
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, West Midlands, WV10 0QP, UK.,National Institute for Health Research, Clinical Research Network, Coventry, West Midlands, UK.,Research Institute in Healthcare Sciences (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Supratik Basu
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, West Midlands, WV10 0QP, UK.,National Institute for Health Research, Clinical Research Network, Coventry, West Midlands, UK.,Research Institute in Healthcare Sciences (RIHS), University of Wolverhampton, Wolverhampton, UK
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Babateen AM, Shannon OM, O’Brien GM, Okello E, Khan AA, Rubele S, Wightman E, Smith E, McMahon N, Olgacer D, Koehl C, Fostier W, Mendes I, Kennedy D, Mathers JC, Siervo M. Acceptability and Feasibility of a 13-Week Pilot Randomised Controlled Trial Testing the Effects of Incremental Doses of Beetroot Juice in Overweight and Obese Older Adults. Nutrients 2021; 13:769. [PMID: 33653009 PMCID: PMC7996834 DOI: 10.3390/nu13030769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Nitrate-rich food can increase nitric oxide production and improve vascular and brain functions. This study examines the feasibility of a randomised controlled trial (RCT) testing the effects of prolonged consumption of different doses of dietary nitrate (NO3-) in the form of beetroot juice (BJ) in overweight and obese older participants. A single-blind, four-arm parallel pilot RCT was conducted in 62 overweight and obese (30.4 ± 4 kg/m2) older participants (mean ± standard deviation (SD), 66 ± 4 years). Participants were randomized to: (1) high-NO3- (HN: 2 × 70 mL BJ/day) (2) medium-NO3- (MN: 70 mL BJ/day), (3) low-NO3- (LN: 70 mL BJ on alternate days) or (4) Placebo (PL: 70 mL of NO3--depleted BJ on alternate days), for 13 weeks. Compliance was checked by a daily log of consumed BJ, NO3- intake, and by measuring NO3- and NO2- concentrations in plasma, saliva, and urine samples. Fifty participants completed the study. Self-reported compliance to the interventions was >90%. There were significant positive linear relationships between NO3- dose and the increase in plasma and urinary NO3- concentration (R2 = 0.71, P < 0.001 and R2 = 0.46 P < 0.001, respectively), but relationships between NO3- dose and changes in salivary NO3- and NO2- were non-linear (R2 = 0.35, P = 0.002 and R2 = 0.23, P = 0.007, respectively). The results confirm the feasibility of prolonged BJ supplementation in older overweight and obese adults.
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Affiliation(s)
- Abrar M. Babateen
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia;
| | - Oliver M. Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Gerard M. O’Brien
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Edward Okello
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Anmar A. Khan
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia;
| | - Sofia Rubele
- Department of Geriatrics, St Bortolo Hospital, Vicenza, 37030 Verona, Italy;
| | - Emma Wightman
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Ellen Smith
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Nicholas McMahon
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4067, Australia;
| | - Dilara Olgacer
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Christina Koehl
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - William Fostier
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Inês Mendes
- Endocrinology and Nutrition Department, Divino Espirito Santo Hospital, D. Manuel I Avenue, 9500-370 Azores, Portugal;
| | - David Kennedy
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - John C. Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Mario Siervo
- School of Life Sciences, Queen’s Medical Centre, The University of Nottingham Medical School, Nottingham NG7 2UH, UK
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25
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Sedrak MS, Freedman RA, Cohen HJ, Muss HB, Jatoi A, Klepin HD, Wildes TM, Le-Rademacher JG, Kimmick GG, Tew WP, George K, Padam S, Liu J, Wong AR, Lynch A, Djulbegovic B, Mohile SG, Dale W. Older adult participation in cancer clinical trials: A systematic review of barriers and interventions. CA Cancer J Clin 2021; 71:78-92. [PMID: 33002206 PMCID: PMC7854940 DOI: 10.3322/caac.21638] [Citation(s) in RCA: 231] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.
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Affiliation(s)
| | | | | | - Hyman B. Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - Tanya M. Wildes
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - William P. Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA, USA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Andrea Lynch
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA, USA
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Florisson S, Aagesen EK, Bertelsen AS, Nielsen LP, Rosholm JU. Are older adults insufficiently included in clinical trials?-An umbrella review. Basic Clin Pharmacol Toxicol 2020; 128:213-223. [PMID: 33210799 DOI: 10.1111/bcpt.13536] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 02/01/2023]
Abstract
Treatment guidelines are primarily based on randomized clinical trials (RCTs). RCTs tend to some extent to exclude older adults despite the fact that physicians need guidance when treating this patient group. By summarizing existing literature, we aimed to (a) quantify the proportion of RCTs and other clinical studies (CTs) that did not adequately include older adults; (b) identify the main barriers for this non-inclusion; and (c) identify suggested solution for inclusion of older adults in RCTs and other CTs. In this umbrella review, Embase and PubMed were searched for relevant papers, and 2701 papers were identified. The subsequent screening resulted in 22 papers. The Critical Appraisal Skills Program was used as quality assessment tool to evaluate these 22 papers. We found that: (a) The most frequent outcome designating missing inclusion of older adults was the use of age limit as exclusion criterion in studies-the proportion of this was 10%-60%; (b) barriers for inclusion were mainly exclusion criteria, logistic challenges and financial constraints; and (c) more extensive inclusion would require more explicit inclusion criteria, merely application of exclusion criteria when absolutely needed, change of researchers' attitude, further inclusion of supporting relatives to overcome the logistical challenges and more financial funding.
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Affiliation(s)
- Sandra Florisson
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Emilie Kørschen Aagesen
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann Sophia Bertelsen
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jens-Ulrik Rosholm
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Smith EM, Miller WC, Mitchell I, Mortenson WB, Mihailidis A. Evaluation of the feasibility of an error-minimized approach to powered wheelchair skills training using shared control. Disabil Rehabil Assist Technol 2020; 18:333-342. [PMID: 33216664 DOI: 10.1080/17483107.2020.1849434] [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
BACKGROUND Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population. OBJECTIVE The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT. METHODS A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes). RESULTS Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology. CONCLUSIONS Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.
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Affiliation(s)
- Emma M Smith
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland.,GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - William C Miller
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Ian Mitchell
- Department of Computer Science, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Forsat ND, Palmowski A, Palmowski Y, Boers M, Buttgereit F. Recruitment and Retention of Older People in Clinical Research: A Systematic Literature Review. J Am Geriatr Soc 2020; 68:2955-2963. [DOI: 10.1111/jgs.16875] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Noah D. Forsat
- Department of Rheumatology and Clinical Immunology Charité–University Medicine Berlin Berlin Germany
| | - Andriko Palmowski
- Department of Rheumatology and Clinical Immunology Charité–University Medicine Berlin Berlin Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery Charité–University Medicine Berlin Berlin Germany
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology Charité–University Medicine Berlin Berlin Germany
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Puente-Maestú L, Ortega F, Pedro JGD, Rodríguez-Nieto MJ, Gómez-Seco J, Gáldiz B, Ojanguren I, Muñoz X, Blanco I, Burgos F, Rodríguez-Chiaradía DA, Gea J, García-Rio F. Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population. Arch Bronconeumol 2020:S0300-2896(20)30375-6. [PMID: 33172709 DOI: 10.1016/j.arbres.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V˙O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V˙O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS Height, sex and age resulted predictive of both V˙O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V˙O2peak=0.017⋅height(cm)-0.023⋅age(years)+0.864⋅sex(female=0/male=1)±179lmin-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS This study provides new and accurate V˙O2 peak and WR rate reference values for individuals of European Spanish descent.
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Affiliation(s)
- Luis Puente-Maestú
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Francisco Ortega
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Garcia de Pedro
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, IIS-Fundación Jiménez Diaz, Autónoma University Madrid, Madrid, Spain
| | | | - Batxi Gáldiz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Cruces Universitary Hospital, Barakaldo, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Iñigo Ojanguren
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Xavier Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; Servicio Neumologia Hospital Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades respiratorias CIBERes, Barcelona, Spain; Departamento de Biología Celular, Fisiología e Inmunología Univertsidad Autónoma de Barcelona, Cataluña, Spain
| | - Isabel Blanco
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felip Burgos
- University of Barcelona Respiratory Diagnostic Center Hospital Clínic, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Marshall MR, Karaboyas A. Temporal changes in dialysate [Na +] prescription from 1996 to 2018 and their clinical significance as judged from a meta-regression of clinical trials. Semin Dial 2020; 33:372-381. [PMID: 32893392 DOI: 10.1111/sdi.12906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the last two decades, the clinical care of dialysis patients has refocused sharply on fluid volume control. Dialysate [Na+] is a key, albeit under-investigated, clinical tool for manipulation of fluid volume on dialysis. In the article, we firstly use data from the Dialysis Outcomes and Practice Patterns Study to document the global decrease in dialysate [Na+] that has occurred from 1996 to 2018, and demonstrate the virtual disappearance of [Na+] profiling from routine dialysis practice over the same period. Second, we used data from previously synthesized randomized clinical trial evidence combined with that of a more recently published trail to assess the clinical significance of these changes, estimating the effects of different levels of low dialysate [Na+] on key clinical outcomes. Our analyses suggest that current levels of dialysate [Na+] in some health jurisdictions are possibly causing harm to many patients, especially given that real world populations are significantly less robust and more vulnerable than clinical trial ones. To quote a recent editorial, "more evidence needed before lower dialysate sodium concentrations can be recommended." That evidence is coming, and no further changes should be made to default customary practice until it is available.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Hosie A, Kochovska S, Ries N, Gilmore I, Parker D, Sinclair C, Sheehan C, Collier A, Caplan GA, Visser M, Xu X, Lobb E, Sheahan L, Brown L, Lee W, Sanderson CR, Amgarth-Duff I, Green A, Edwards L, Agar MR. Older Persons' and Their Caregivers' Perspectives and Experiences of Research Participation With Impaired Decision-Making Capacity: A Scoping Review. THE GERONTOLOGIST 2020; 62:e112-e122. [PMID: 32866239 DOI: 10.1093/geront/gnaa118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human research ethics statements support equitable inclusion of diverse groups. Yet older people are under-represented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. RESEARCH DESIGN AND METHODS Scoping review of literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. RESULTS From 4171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods and foci, with hypothetical scenarios, quantitative analyses and examination of proxy consent predominating. Participants (n=7331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%) and older persons with dementia/cognitive impairment (6%). Synthesis identified two themes: willingness to participate and decision-making approaches. DISCUSSION AND IMPLICATIONS Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media.
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Affiliation(s)
- Annmarie Hosie
- School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,The Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Nola Ries
- Faculty of Law, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Imelda Gilmore
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Craig Sinclair
- ARC Centre of Excellence in Population Ageing Research, University of New South Wales, Kensington, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care Department, Calvary Health Care Kogarah, Kogarah, New South Wales Australia
| | - Aileen Collier
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Gideon A Caplan
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mandy Visser
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Xiaoyue Xu
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Faculty of Medicine, School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Elizabeth Lobb
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Palliative Care Department, Calvary Health Care Kogarah, Kogarah, New South Wales Australia
| | - Linda Sheahan
- South Eastern Sydney Local Health District, Clinical Ethics Service, Randwick, New South Wales, Australia.,Sydney Health Ethics, University of Sydney, Camperdown, New South Wales, Australia
| | - Linda Brown
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Wei Lee
- The Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Christine R Sanderson
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Ingrid Amgarth-Duff
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Anna Green
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Layla Edwards
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Meera R Agar
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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Olson NL, Albensi BC. Race- and Sex-Based Disparities in Alzheimer's Disease Clinical Trial Enrollment in the United States and Canada: An Indigenous Perspective. J Alzheimers Dis Rep 2020; 4:325-344. [PMID: 33024940 PMCID: PMC7504979 DOI: 10.3233/adr-200214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Randomized clinical trials (RCT) involve labor-intensive, highly regulated, and controlled processes intended to transform scientific concepts into clinical outcomes. To be effective and targeted, it is imperative they include those populations who would most benefit from those outcomes. Alzheimer's disease (AD) is most detrimental to the aging population, and its clinical manifestation is influenced by socio-economic factors such as poverty, poor education, stress, and chronic co-morbidities. Indigenous populations in the United States and Canada are among the minority populations most influenced by poor socio-economic conditions and are prone to the ravages of AD, with Indigenous women carrying the added burden of exposure to violence, caregiving stresses, and increased risk by virtue of their sex. Race- and sex-based disparities in RCT enrollment has occurred for decades, with Indigenous men and women very poorly represented. In this review, we examined literature from the last twenty years that reinforce these disparities and provide some concrete suggestions and guidelines to increase the enrollment numbers in AD RCT among this vulnerable and poorly represented population.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
- Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Anzuoni K, Field TS, Mazor KM, Zhou Y, Garber LD, Kapoor A, Gurwitz JH. Recruitment Challenges for Low-Risk Health System Intervention Trials in Older Adults: A Case Study. J Am Geriatr Soc 2020; 68:2558-2564. [PMID: 32710671 DOI: 10.1111/jgs.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess factors associated with trial participation in the context of a low-risk intervention intended to reduce adverse drug events in recently hospitalized older adults. DESIGN Mixed methods: analysis of data collected during enrollment efforts and focus groups. SETTING A large, multispecialty group practice. PARTICIPANTS Individuals 50 years and older, recently discharged from the hospital and prescribed at least one high-risk medication, were eligible for the trial. Enrollees, decliners, and their caregivers were eligible to participate in focus groups. MEASUREMENTS Reasons for declining to participate during the initial invitation as well as reasons for not providing consent were recorded. Focus groups were conducted with eligible individuals to explore reasons for enrolling or declining. We conducted multivariable logistic regression to compare characteristics (including sex, age, healthcare proxy, number and type of medications, visiting nurse services, reason for admission, and length of hospital stay) of those who enrolled with those who did not enroll. RESULTS Of 3,606 individuals determined eligible, 3,147 (87%) declined, 98 (3%) verbally consented to participate but did not complete written consent, and 361 (10%) provided written consent and were considered enrolled. Individuals 80 year and older (odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.30-0.65) and those with visiting nurse services (OR = 0.64; 95% CI = 0.48-0.85) were least likely to enroll. Among those who provided a reason for declining (2,473), the most common was the belief they did not need additional medication assistance (18%). Another 332 (11%) declined because they were receiving visiting nurse services. CONCLUSION Recruiting older adults recently discharged from the hospital to participate in trials of low-risk, system-level interventions is challenging and may underenroll the oldest individuals and those potentially at the highest risk for adverse events, limiting generalizability of study findings. Alternative study designs may be more effective than individually randomized trials in assessing low-risk, system-level interventions.
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Affiliation(s)
- Kathryn Anzuoni
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Terry S Field
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kathleen M Mazor
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Yanhua Zhou
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Lawrence D Garber
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Reliant Medical Group, Worcester, Massachusetts, USA
| | - Alok Kapoor
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Reliant Medical Group, Worcester, Massachusetts, USA
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Levenberg K, Proctor DN, Maman SR, Luck JC, Miller AJ, Aziz F, Radtka JF, Muller MD. A prospective community engagement initiative to improve clinical research participation in patients with peripheral artery disease. SAGE Open Med 2020; 8:2050312120930915. [PMID: 32587692 PMCID: PMC7294489 DOI: 10.1177/2050312120930915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
Objective: Patients diagnosed with peripheral artery disease are difficult to recruit into clinical trials. However, there is currently no high-quality, patient-centered information explaining why peripheral artery disease patients choose to participate or not participate in clinical research studies. Methods: The current study was a prospective community engagement initiative that specifically asked patients with and without peripheral artery disease: (1) what motivates them to participate in clinical research studies, (2) their willingness to participate in different research procedures, (3) the barriers to participation, (4) preferences about study design, and (5) demographic and disease-related factors influencing participation. Data were gathered through focus groups (n = 19, participants aged 55–79 years) and mailed questionnaires (n = 438, respondents aged 18–85 years). Results: More than half of the respondents stated that they would be willing to participate in a study during evening or weekend time slots. Peripheral artery disease patients (n = 45) were more willing than those without peripheral artery disease (n = 360) to participate in drug infusion studies (48% versus 18%, p < 0.001) and trials of investigational drugs (44% versus 21%, p < 0.001). Motivating factors and barriers to participation were largely consistent with previous studies. Conclusion: Adults in our geographic region are interested in participating in clinical research studies related to their health; they would like their doctor to tell them what studies they qualify for and they prefer to receive a one-page advertisement that has color pictures of the research procedures. Peripheral artery disease patients are more willing than those without peripheral artery disease to participate in drug infusion studies, trials of investigational drugs, microneurography, and spinal/epidural infusions.
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Affiliation(s)
- Kate Levenberg
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - David N Proctor
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Stephan R Maman
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - J Carter Luck
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Amanda J Miller
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Faisal Aziz
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - John F Radtka
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Matthew D Muller
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Department of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Master of Science in Anesthesia Program, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Babateen AM, Rubele S, Shannon O, Okello E, Smith E, McMahon N, O'Brien G, Wightman E, Kennedy D, Mathers JC, Siervo M. Protocol and recruitment results from a 13-week randomized controlled trial comparing the effects of different doses of nitrate-rich beetroot juice on cognition, cerebral blood flow and peripheral vascular function in overweight and obese older people. Contemp Clin Trials Commun 2020; 18:100571. [PMID: 32405570 PMCID: PMC7212182 DOI: 10.1016/j.conctc.2020.100571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/11/2020] [Accepted: 04/19/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nitrate-rich food can increase NO production and may induce positive effects on brain function. This study examined the feasibility of a randomized clinical trial (RCT) testing the effects of prolonged consumption of incremental doses of dietary nitrate (NO3 -) in overweight and obese older participants. Secondary aims tested dose-dependent changes in cognitive, vascular and pulmonary functions and cerebral blood flow (CBF). METHODS This was a single blind, four-arm parallel RCT conducted in 60 overweight and obese older participants. Eligible participants were randomized to:1) high NO3 - (140 ml of beetroot juice (BJ) per day, ~800 mg of NO3 -/day), 2) moderate NO3 - (70 ml of BJ per day, ~400 mg of NO3 -/day), 3) low NO3 - (70 ml on alternate days, ~400 mg of NO3 -) or 4) NO3 - depleted (70 ml on alternate days, ~0.001 mg of NO3). Measurements of cognitive, vascular and pulmonary functions and CBF were conducted at baseline and 13-weeks NO3 - intake was assessed by six 24-h recalls, and by measuring NO3 - intake biomarkers. Feasibility was assessed by obtaining qualitative feedback and evaluating trial recruitment, retention, compliance with study visits and measurement protocols. RESULTS Participant recruitment started in July 2018 and ended in April 2019. Of all the recruitment strategies that were used, advertisement of the study via Facebook generated the highest response rate. Sixty-two participants consented and were enrolled. Overall, characteristics of included participants matched our recruitment criteria. CONCLUSION The findings from this study provide evidence of the acceptability and feasibility of an intervention investigating the effects of incremental doses of high-nitrate BJ over a prolonged period. TRIAL REGISTRATION The intervention study was registered with clinical trial ISRCTN registry (ISRCTN14746723) on 27 December 2018.
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Affiliation(s)
- Abrar M. Babateen
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sofia Rubele
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Oliver Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Edward Okello
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Ellen Smith
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon-Tyne, NE1 8ST, UK
| | - Nicholas McMahon
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Gerry O'Brien
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Emma Wightman
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon-Tyne, NE1 8ST, UK
| | - David Kennedy
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon-Tyne, NE1 8ST, UK
| | - John C. Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Mario Siervo
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Marshall MR, Vandal AC, de Zoysa JR, Gabriel RS, Haloob IA, Hood CJ, Irvine JH, Matheson PJ, McGregor DOR, Rabindranath KS, Schollum JBW, Semple DJ, Xie Z, Ma TM, Sisk R, Dunlop JL. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial. J Am Soc Nephrol 2020; 31:1078-1091. [PMID: 32188697 PMCID: PMC7217404 DOI: 10.1681/asn.2019090877] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and mortality. There is a global trend to lower dialysate sodium with the goal of reducing fluid overload. METHODS To investigate whether lower dialysate sodium during hemodialysis reduces left ventricular mass, we conducted a randomized trial in which patients received either low-sodium dialysate (135 mM) or conventional dialysate (140 mM) for 12 months. We included participants who were aged >18 years old, had a predialysis serum sodium ≥135 mM, and were receiving hemodialysis at home or a self-care satellite facility. Exclusion criteria included hemodialysis frequency >3.5 times per week and use of sodium profiling or hemodiafiltration. The main outcome was left ventricular mass index by cardiac magnetic resonance imaging. RESULTS The 99 participants had a median age of 51 years old; 67 were men, 31 had diabetes mellitus, and 59 had left ventricular hypertrophy. Over 12 months of follow-up, relative to control, a dialysate sodium concentration of 135 mmol/L did not change the left ventricular mass index, despite significant reductions at 6 and 12 months in interdialytic weight gain, in extracellular fluid volume, and in plasma B-type natriuretic peptide concentration (ratio of intervention to control). The intervention increased intradialytic hypotension (odds ratio [OR], 7.5; 95% confidence interval [95% CI], 1.1 to 49.8 at 6 months and OR, 3.6; 95% CI, 0.5 to 28.8 at 12 months). Five participants in the intervention arm could not complete the trial because of hypotension. We found no effect on health-related quality of life measures, perceived thirst or xerostomia, or dietary sodium intake. CONCLUSIONS Dialysate sodium of 135 mmol/L did not reduce left ventricular mass relative to control, despite improving fluid status. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The Australian New Zealand Clinical Trials Registry, ACTRN12611000975998.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd., Singapore
| | - Alain C Vandal
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Janak R de Zoysa
- Department of Renal Medicine, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
- Waitemata Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruvin S Gabriel
- Department of Cardiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Imad A Haloob
- Department of Renal Medicine, Bathurst Base Hospital, New South Wales, Bathurst, Australia
| | - Christopher J Hood
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - John H Irvine
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Philip J Matheson
- Department of Nephrology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - David O R McGregor
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Kannaiyan S Rabindranath
- Department of Nephrology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - John B W Schollum
- Nephrology Service, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - David J Semple
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Zhengxiu Xie
- Middlemore Clinical Trials, Auckland, New Zealand; and
| | - Tian Min Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
| | - Rose Sisk
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanna L Dunlop
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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Deane CS, Phillips BE, Smith K, Steele AM, Libretto T, Statton SA, Atherton PJ, Etheridge T. Challenges and practical recommendations for successfully recruiting inactive, statin-free older adults to clinical trials. BMC Res Notes 2020; 13:174. [PMID: 32209122 PMCID: PMC7092412 DOI: 10.1186/s13104-020-05017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/13/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To outline the challenges and provide practical recommendations for recruiting inactive, statin-free older adults to facilitate feasible study designs. Data was obtained from a double-blind randomised-controlled clinical trial investigating the effects of acipimox versus placebo on muscle function and metabolism in older (65-75 years), inactive, statin-free males. The initial recruitment target was 20 volunteers within 12 months (November 2016-November 2017). RESULTS Recruitment occurred via the Exeter 10,000 database containing 236 'eligible' males, a Facebook campaign reaching > 8000 ≥ 65 years old males, 400 directly-addressed letters to ≥ 66 year old males, > 1500 flyers distributed within the community, > 40 emails to local community groups, 4 recruitment talks, 2 magazine adverts and 1 radio advert. Widespread recruitment efforts reaching > 120,000 people led to the recruitment of 20 volunteers (18 completed the clinical trial) within a 25-month timeframe, highlighting the challenge of the timely recruitment of inactive, statin-free older adults for clinical trials. We recommend recruitment for future clinical trials should take a multi-pronged approach from the outset, prioritising the use of volunteer databases, Facebook campaigns and delivering recruitment talks.
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Affiliation(s)
- Colleen S Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, UK.
- Living Systems Institute, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.
| | - Bethan E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Kenneth Smith
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Anna M Steele
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Tina Libretto
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Sarah A Statton
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Philip J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Timothy Etheridge
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, UK
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Marshall MR. The benefit of early survival on PD versus HD—Why this is (still) very important. Perit Dial Int 2020; 40:405-418. [DOI: 10.1177/0896860819895177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There are a number of misconceptions around the identified early survival benefit of peritoneal dialysis (PD) relative to hemodialysis (HD), including that such benefits “even out in the end” since the relative risk of death over time eventually encompasses 1.0 (or even an estimate that is unfavorable to PD); that the early benefit is, in fact, most likely due to unmeasured confounding; and such benefits are only due to the influence of central venous catheters and “crash starters” in the HD group. In fact, the early survival benefit results in a substantial gain of patient life years in PD cohorts relative to HD ones, even if it the benefit appears to “even out in the end,” is relatively insensitive to unmeasured confounding, and persists even when the effects of central venous catheters are accounted for. In this review, the calculations and arguments are made to support these tenets. Survival on dialysis is still one of the most important considerations for all stakeholders in the end-stage kidney disease community, including patients who rank it among their top priorities. Shared decision-making is a fundamental patient right and requires both balanced information and an iterative mechanism for a consensual decision based on shared understanding and purpose. A cornerstone of this process should be an explicit discussion of the early survival benefit of PD relative to HD.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore
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39
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Nishi M, Okano I, Sawada T, Midorikawa N, Inagaki K. Cementless Bipolar Hemiarthroplasty for Low-energy Intracapsular Proximal Femoral Fracture in Elderly East-Asian Patients: A Longitudinal 10-year Follow-up Study. Hip Pelvis 2019; 31:206-215. [PMID: 31824875 PMCID: PMC6892899 DOI: 10.5371/hp.2019.31.4.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Short-term outcomes following cemented and cementless hemiarthroplasties (HAs) are reported to be comparable, however, long-term outcomes of cementless HA—especially among Asian patients—is limited. We aimed to assess long-term outcomes in elderly East-Asian patients with intracapsular proximal femoral fractures treated with cementless HA. Materials and Methods We enrolled 135 patients treated with cementless HA who met our inclusion criteria. We documented bone/implant-related complications (e.g., incidences of revision hip surgery, femoral stem subsidence, dislocation, intraoperative and postoperative periprosthetic fractures, contralateral hip fractures). We included those patients who are still alive 10 years after the index surgery in the final functional analysis of the existence of pain, ambulatory status, and residential status. Results The mean age at injury was 78.3 years (range: 60–85 years). At the 10-year follow-up, 26 of the original patients (19.3%) had survived. During follow-up, revision hip surgery was conducted in two patients (1.5%). We recorded the incidence of intraoperative fractures, postoperative periprosthetic fractures, and contralateral fractures in two (1.5%), eight (5.9%), and six patients (4.4%), respectively. Among the 10-year survivors, six patients (23.1% of the survivors) complained of groin pain, but generally reported the pain to be tolerable. Conclusion Among elderly East-Asian patients, the incidence of revision surgery after cementless HA may be lower than that in their European counterparts, whereas the incidence of periprosthetic fractures can still be considerably higher. For patients undergoing cementless HA, prevention of such secondary fractures is of critical importance.
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Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan.,Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Takatoshi Sawada
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Natsuki Midorikawa
- Department of Orthopaedic Surgery, Ohta-Nishinouchi Hospital, Fukushima, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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A systematic review of pharmacists' interventions to support medicines optimisation in patients with visual impairment. Int J Clin Pharm 2019; 41:1400-1407. [PMID: 31531815 DOI: 10.1007/s11096-019-00907-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 01/17/2023]
Abstract
Background People with visual impairment often report poorer health and encounter many challenges when using medicines. Pharmacists can play a significant role in optimising medicines use for these patients. However, little is known about pharmacists' current practices when providing services to this population nor the impact of such services, if any, on medicines optimisation-related outcomes. Aim of the review This systematic review aims to identify the types, and assess the effectiveness of, interventions provided by pharmacists on medicines optimisation-related outcomes. Method Systematic searches of the following electronic databases were carried out from date of inception to March 2018: Cochrane Library; MEDLINE; EMBASE; International Pharmaceutical Abstracts; Scopus; and Cumulative Index to Nursing and Allied Health Literature. Several trial registries and grey literature resources were also searched. Any randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies, or interrupted time series analyses reporting on interventions provided by pharmacists to adult visually impaired patients and/or their caregivers in order to improve medicines optimisation-related outcomes of medicine safety, adherence, patient satisfaction, shared decision making, or quality of life were included. Results A total of 1877 titles/abstracts were screened, and 27 full text articles were assessed for eligibility. On examination of full texts, no studies met the inclusion criteria for this review. Conclusion This review highlights the need for future research that would be vital for promoting the safe and effective use of medicines and the delivery of pharmaceutical care services to people with visual impairment.
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41
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Fahim C, Hylton D, Simunovic M, Agzarian J, Finley C, Hanna WC, Shargall Y. Development of the IRIS-AR strategy: an intervention to improve rates of accrual and retention for the VTE-PRO randomized controlled trial. Trials 2019; 20:447. [PMID: 31324209 PMCID: PMC6642524 DOI: 10.1186/s13063-019-3536-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Venous Thromboembolism Prophylaxis (VTE-PRO) randomized trial is a pilot study evaluating the impact of extended-duration prophylaxis on venous thromboembolic events in patients undergoing lung cancer resection. Enrolled VTE-PRO participants self-inject either low-molecular weight heparin or a saline placebo for 30 days postoperatively. Study outcomes include feasibility, incidence of venous thromboembolism, and venous thromboembolism-related morbidity and mortality. Initial analyses demonstrated low rates of accrual and retention for the VTE-PRO pilot. Therefore, the purpose of the current study was to develop a knowledge translation intervention to improve VTE-PRO pilot trial accrual and retention. METHODS Eligible participants were surveyed to identify the barriers to VTE-PRO participation. The Theoretical Domains Framework was used to categorize these barriers. Barriers were mapped to the capabilities, opportunities, and behavior (COM-B) behavioral change wheel to identify potential interventions to support trial accrual and retention. The resulting knowledge translation intervention was titled Inform, Remind, Involve and Support to improve Accrual and Retention (IRIS-AR). Key informant interviews with patients were held to refine and confirm the validity of identified barriers and perceived acceptability of the proposed IRIS-AR intervention. Institutional Review Board approval was granted for this study. RESULTS The resulting intervention included: information booklets and counseling sessions to identify unique participant challenges to trial participation (Inform); daily reminders to administer injections (Remind); involvement of family/caregivers in study processes (Involve); and leverage of an existing home-care nursing program to provide injection support when needed (Support). Twenty-six key informant participants were interviewed. The most common barriers to trial participation included lack of social support and fear of needle injection. Participants generally supported use of information booklets, involvement of family/caregivers, and support by a home-care nursing program; however, not all supported the use of daily reminders. CONCLUSION Developed using theory and integrated knowledge translation, the IRIS-AR presents a patient-centered intervention that leverages existing programs to promote trial engagement. The proposed strategy can likely be adapted to improve compliance with other patient-directed interventions. TRIAL REGISTRATION ClinicalTrials.gov, NCT02334007 . Registered on 8 January 2015.
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Affiliation(s)
- Christine Fahim
- Bloomberg School of Public Health, Johns Hopkins University, Hampton House, Room 663, 624 N Broadway, Baltimore, MD, 21205, USA. .,Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Danielle Hylton
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Wael C Hanna
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Yaron Shargall
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Jayasinghe N, Moallem BI, Kakoullis M, Ojie MJ, Sar-Graycar L, Wyka K, Reid MC, Leonard JP. Establishing the Feasibility of a Tablet-Based Consent Process with Older Adults: A Mixed-Methods Study. THE GERONTOLOGIST 2019; 59:124-134. [PMID: 29757375 DOI: 10.1093/geront/gny045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study This mixed-methods study explored the feasibility and acceptability of using a tablet-based research consent process with adults aged ≥65 years. Design and Methods In the first phase, focus group participants reported on their perceptions of a tablet-based consent process. In the second phase, older adults were randomized to view either a tablet-based or paper-based consent for a mock clinical trial. Measurements included: time to complete, adverse/unexpected events, user-friendliness, immediate comprehension, and retention at a 1-week delay. Results Focus group participants (N = 15) expressed interest in the novel format, cautioning that peers would need comprehensive orientation to use the technology. In the randomized pilot (N = 20), retention was 100% and all participants completed the protocol without the occurrence of adverse/unexpected events. Although the participants took longer to complete the tablet-based consent than the paper-based version, user-friendliness, immediate comprehension, and retention of the tablet-based consent were similar to the paper-based consent. Discussion and Implications The findings suggest that a tablet-based consent process is feasible to implement with older adults and acceptable to this population, but we would underscore that efforts to optimize design of tablet-based consent forms for older adults are warranted.
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Affiliation(s)
| | - B Isabel Moallem
- Weill Cornell Medicine, New York, New York.,Langone Medical Center, New York University, New York, New York
| | - Margo Kakoullis
- Weill Cornell Medicine, New York, New York.,Langone Medical Center, New York University, New York, New York
| | - Mary-Jane Ojie
- Weill Cornell Medicine, New York, New York.,Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Katarzyna Wyka
- Weill Cornell Medicine, New York, New York.,City University of New York, Graduate School of Public Health and Health Policy, New York, New York
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Whiteside K, Flett L, Mitchell A, Fairhurst C, Cockayne S, Rodgers S, Torgerson D. Using pens as an incentive for trial recruitment of older adults: An embedded randomised controlled trial. F1000Res 2019; 8:315. [PMID: 30984388 PMCID: PMC6446499 DOI: 10.12688/f1000research.18300.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Meeting recruitment targets for randomised controlled trials is challenging. This trial evaluated the effectiveness of including a pen within the trial invitation pack on the recruitment of older adults into a randomised controlled trial. Methods: This trial was embedded within the Occupational Therapist Intervention Study, a falls-prevention randomised controlled trial. Potential participants (n = 1862), who were posted an invitation pack from two General Practitioner practices, were randomised to either not receive a pen (n = 1295) or receive a pen (n = 648) with their invitation pack, using a 2:1 ratio. The primary outcome was the likelihood of being randomised, and therefore fully recruited, to the host trial. To be randomised to the host trial, participants had to: return a consent form and screening form; be eligible on their screening form; and return a baseline questionnaire and a monthly falls calendar. Secondary outcomes were: the likelihood of returning (and time to return) a screening form; being eligible for the host trial; and remaining in the trial for at least 3 months. Results: The likelihood of being randomised to the host trial did not differ between the pen group (4.5%) and no pen group (4.3%; odds ratio 1.04; 95% confidence interval: 0.65 to 1.67; p = 0.86). There were marginal differences in secondary outcomes in favour of the pen group, particularly in screening form return rates, though these differences were not statistically significant. Conclusion: Pens may not be an effective incentive for the recruitment of older adults into randomised controlled trials, though future trials are required. Registration: ISRCTN22202133; SWAT 37.
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Affiliation(s)
- Katie Whiteside
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Lydia Flett
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - OTIS Study Group
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Ahmed H, Farewell D, Jones HM, Francis NA, Paranjothy S, Butler CC. Antibiotic prophylaxis and clinical outcomes among older adults with recurrent urinary tract infection: cohort study. Age Ageing 2019; 48:228-234. [PMID: 30165433 PMCID: PMC6424374 DOI: 10.1093/ageing/afy146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults. METHODS this was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertain ≥3 months' prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation. RESULTS of 4,043 men and 15,653 women aged ≥65 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45-0.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51-0.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64-0.94). In women, prophylaxis was also associated with a reduced risk of clinical recurrence (HR, 0.57; 95% CI, 0.55-0.59) and acute antibiotic prescribing (HR, 0.61; 95% CI, 0.59-0.62), but estimates of the risk of UTI-related hospitalisation were inconsistent between our main analysis (HR, 1.16; 95% CI, 1.05-1.28) and sensitivity analysis (HR, 0.82; 95% CI, 0.72-0.94). CONCLUSIONS antibiotic prophylaxis was associated with lower rates of UTI recurrence and acute antibiotic prescribing in older adults. To fully understand the benefits and harms of prophylaxis, further research should determine the frequency of antibiotic-related adverse events and the impact on antimicrobial resistance and quality of life.
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Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Hywel M Jones
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Nick A Francis
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
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Bryant J, Turon H, Waller A, Freund M, Mansfield E, Sanson-Fisher R. Effectiveness of interventions to increase participation in advance care planning for people with a diagnosis of dementia: A systematic review. Palliat Med 2019; 33:262-273. [PMID: 30260290 DOI: 10.1177/0269216318801750] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Advance care planning involves considering, discussing and documenting future wishes in case a person is unable to make or communicate decisions. Given people with dementia are at high risk of future decisional incapacity, it is critical that advance care planning occurs early in the illness trajectory. Aim: To determine (1) the number of intervention studies published between 1997 and July 2017 that aimed to increase advance care planning for persons with dementia, (2) the methodological quality of studies and (3) the effectiveness of interventions in increasing advance care planning for persons with dementia. Design: Systematic review. Data sources: Medline, Cochrane, EMBASE, PsycINFO and CINAHL were searched for articles published from 1997 to July 2017. Studies were included if they utilised a methodologically robust study design and reported on an intervention designed to increase participation in advance care planning for persons with dementia that was targeted at the person with dementia and/or a carer/family member. Methodological quality was assessed independently by two authors. Results: Four studies met the criteria for inclusion. Methodological quality was variable. Two studies did not report analyses comparing advance care planning outcomes for intervention and control participants. A third study found no effect for a nurse-facilitator intervention. The fourth study found that a structured conversation about end-of-life care with a family member increased the likelihood of advance care orders being listed in residents’ records. Conclusion: There is little evidence about effective strategies to improve participation in advance care planning for persons with dementia. Methodologically rigorous intervention trials are needed to test interventions that encourage timely participation.
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Affiliation(s)
- Jamie Bryant
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Heidi Turon
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Amy Waller
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Megan Freund
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elise Mansfield
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rob Sanson-Fisher
- 1 Health Behaviour Research Collaborative, The University of Newcastle, Newcastle, NSW, Australia
- 2 Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
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Palac HL, Alam N, Kaiser SM, Ciolino JD, Lattie EG, Mohr DC. A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Simple Architecture (Part 1). J Med Internet Res 2018; 20:e11049. [PMID: 30389650 PMCID: PMC6238104 DOI: 10.2196/11049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 12/20/2022] Open
Abstract
Background The ability to identify, screen, and enroll potential research participants in an efficient and timely manner is crucial to the success of clinical trials. In the age of the internet, researchers can be confronted with large numbers of people contacting the program, overwhelming study staff and frustrating potential participants. Objective This paper describes a “do-it-yourself” recruitment support framework (DIY-RSF) that uses tools readily available in many academic research settings to support remote participant recruitment, prescreening, enrollment, and management across multiple concurrent eHealth clinical trials. Methods This work was conducted in an academic research center focused on developing and evaluating behavioral intervention technologies. A needs assessment consisting of unstructured individual and group interviews was conducted to identify barriers to recruitment and important features for the new system. Results We describe a practical and adaptable recruitment management architecture that used readily available software, such as REDCap (Research Electronic Data Capture) and standard statistical software (eg, SAS, R), to create an automated recruitment framework that supported prescreening potential participants, consent to join a research registry, triaging for management of multiple trials, capture of eligibility information for each phase of a recruitment pipeline, and staff management tools including monitoring of participant flow and task assignment/reassignment features. The DIY-RSF was launched in July 2015. As of July 2017, the DIY-RSF has supported the successful recruitment efforts for eight trials, producing 14,557 participant records in the referral tracking database and 5337 participants in the center research registry. The DIY-RSF has allowed for more efficient use of staff time and more rapid processing of potential applicants. Conclusions Using tools already supported at many academic institutions, we describe the architecture and utilization of an adaptable referral management framework to support recruitment for multiple concurrent clinical trials. The DIY-RSF can serve as a guide for leveraging common technologies to improve clinical trial recruitment procedures.
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Affiliation(s)
- Hannah L Palac
- AbbVie Inc, North Chicago, IL, United States.,Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nameyeh Alam
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susan M Kaiser
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Nkimbeng M, Roberts L, Thorpe RJ, Gitlin LN, Delaney A, Tanner EK, Szanton SL. Recruiting Older Adults With Functional Difficulties Into a Community-Based Research Study: Approaches and Costs. J Appl Gerontol 2018; 39:644-650. [PMID: 29991313 DOI: 10.1177/0733464818786612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial in Baltimore City tested whether an interdisciplinary team of occupational therapists, nurses, and handymen reduces disability and health expenditures in community-dwelling older adults with functional difficulties. This study describes methods and associated costs of recruiting 300 low-income, cognitively intact, older adults with functional difficulties into this study. Sources of participant enrollment included direct mailings (35%), government program referrals (19%), community-based organizations (16%), ambassador referrals (15%), and media (4%). Fifty six (30%) of 187 older adults referred through government organizations were enrolled, while 49 (7.6%) of 648 referred from community-based organizations were enrolled. Total recruitment costs were US$81,453.12. Costs per participant for mailings, media, ambassadors, and community-based organizations were respectively US$745.10, US$256.82, US$22.28, and US$1.00. Direct mailings yielded the most participants but was the most costly method per participant. Ambassadors were least expensive and may offer a low-cost addition to community outreach for recruitment of older adults into research.
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Affiliation(s)
| | | | - Roland J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Impact of informed consent content and length on recruitment of older adults into a community based primary prevention trial. Contemp Clin Trials Commun 2018; 11:89-94. [PMID: 30003171 PMCID: PMC6039536 DOI: 10.1016/j.conctc.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
Abstract
Aims To compare recruitment, refusal and randomisation rates of older adults into a general practice-based clinical trial with two versions (varied format, content and language) of the Participant Information and Consent Form (PICF). Methods This prospective PICF study was conducted within the STAREE (STAtins in Reducing Events in the Elderly) clinical trial. Participants phone screened between October 2015 to February 2016 formed Group 1 and were mailed the extended PICF version and participants phone screened between October 2016 to February 2017 formed Group 2 and were mailed the shortened PICF version. Participants who attended a subsequent baseline screening visit were guided through a comprehensive informed consent process. Results During the screening phase of the trial, the likelihood of refusing trial participation was lower in Group 2 compared to Group 1 equating to an overall 23% reduction in risk (RR 0.77, P = 0.005, 95% CI 0.62–0.95). Group 2 had a 6.4% higher randomisation rate compared with Group 1 (65.3% versus 58.9% respectively) but this difference was not statistically significant. Factors associated with trial participation were male gender, age between 70 and 75 years and living alone (all p < .0.05). Conclusions Whilst avoiding lengthy and complex PICF documents may assist with initial trial engagement, it needs to be supplemented with other strategies to support ongoing trial interest to randomisation and beyond. Participants refused trial participation throughout the screening phase indicating that the PICF was only one factor among several affecting an individual's decision to participate in this clinical trial. A short and concise clinical trial document is recommended. Avoiding lengthy and complex clinical trial documents may contribute to increasing older adult trial participation rates. Strategies are sought to increase participation of older adults in research to garner more age-specific public health data.
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Chatters R, Newbould L, Sprange K, Hind D, Mountain G, Shortland K, Powell L, Gossage-Worrall R, Chater T, Keetharuth A, Lee E, Woods B. Recruitment of older adults to three preventative lifestyle improvement studies. Trials 2018; 19:121. [PMID: 29458392 PMCID: PMC5819193 DOI: 10.1186/s13063-018-2482-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). METHODS During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. RESULTS Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. CONCLUSIONS Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. TRIAL REGISTRATION International Standard Randomised Controlled Trial Registry, ID: ISRCTN28645428 (Putting Life In Years RCT). Registered on 11 April 2012; International Standard Randomised Controlled Trial Registry, ID: ISRCTN67209155 (Lifestyle Matters RCT). Registered on 22 March 2012; ClinicalTrials.gov , ID: NCT03054311 (Lifestyle Matters feasibility study). Registered retrospectively on 19 January 2017.
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Affiliation(s)
- Robin Chatters
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Louise Newbould
- Research Fellow Mental Health and Addiction Research Group Department of Health Sciences ARRC Building University of York, Heslington, York YO10 5DD UK
| | - Kirsty Sprange
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Gail Mountain
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Katy Shortland
- Sheffield NIHR Clinical Research Facility, O Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Lauren Powell
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Tim Chater
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Anju Keetharuth
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Ellen Lee
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Bob Woods
- DSDC Wales, Bangor University, Normal Site, Bangor, LL57 2PZ UK
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The impact of frailty on coagulation and responses to warfarin in acute older hospitalised patients with atrial fibrillation: a pilot study. Aging Clin Exp Res 2017; 29:1129-1138. [PMID: 28255906 DOI: 10.1007/s40520-017-0733-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/31/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND The evidence on coagulation changes with frailty is not consistent and clinical studies suggest that frail older people may be at an increased risk of bleeding complications with anticoagulant therapy. AIMS This study aims to assess the impact of frailty on coagulation function and on response to warfarin. METHODS Inpatients aged over 65 years with atrial fibrillation (AF) were recruited. Frailty was determined using the Reported Edmonton Frail Scale. The Overall Haemostatic Potential (OHP) and Calibrated Automated Thrombogram (CAT) were used to globally assess coagulation function. RESULTS Data of 95 participants were analysed, mean age 85.5 ± 6.2, 40% female, and 50.5% frail. Among participants not on anticoagulants (N = 36), there was an increased fibrin generation and decreased thrombin generation compared to the local established normal ranges in young healthy volunteers; the frail had significantly reduced fibrin generation compared to the non-frail. In the warfarin-treated group (N = 59), there was no difference on coagulation profiles between the frail and the non-frail from any of the coagulation tests. CONCLUSION In this cohort of acute hospitalised patients with AF, the observed decreased fibrin generation in the frail may reflect decreased acute phase response as suggested with the lower plasma fibrinogen in that group. There was no difference in coagulation profiles between the frail and the non-frail amongst those taking warfarin. Compared to young healthy volunteers, older inpatients had increased fibrin generation and decreased thrombin generation. The findings reflect the complex interaction between age, frailty, acute illness, and coagulation.
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