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Muchira JM, Mogos MF, Park C, Logan J, Piano MR. A Mother-Child Dyadic Approach to Evaluating Subclinical Cardiovascular Disease in Young Children: A Feasibility Study. J Cardiovasc Nurs 2024; 39:307-317. [PMID: 36066587 DOI: 10.1097/jcn.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular (CV) risk factors can be transmitted from mothers to their children. However, it is challenging to measure and identify subclinical CV risk in young children using traditional CV risk methods and metrics. OBJECTIVE The purpose of this study was to determine the feasibility of recruiting mother-child dyads and measuring arterial stiffness (pulse wave velocity, augmentation index/pressure), blood pressure (BP), BP circadian pattern, specifically nocturnal BP dipping, and CV health metrics in mothers and in children aged 1 to 5 years. METHODS All BP and arterial stiffness measures were obtained using the noninvasive automated oscillometric Mobil-O-Graph device. Also measured were blood cholesterol level; glucose level; body mass index (BMI); and smoking, diet, and physical activity history. Descriptive statistics were used for assessing recruitment feasibility and Pearson correlations for mother-child associations. RESULTS Thirty-five mother-child dyads completed the protocol. Recruitment reach was 89% and retention rate was 80%. Mothers were 34.3 ± 5.4 years old with a mean systolic BP (SBP) of 114.6 ± 9.5 mm Hg and BMI of 26.0 ± 6.5. Children were 3 ± 1.4 years old with a mean SBP of 103.3 ± 9.4 mm Hg and BMI z -scores of -0.3 ± 1.5. Arterial stiffness parameters were within normal ranges for mothers and children. Twenty-three percent of mothers did not exhibit nocturnal dipping (<10% decrease between day and nighttime SBP). Maternal SBP was positively correlated with child BMI z -scores ( r = 0.42, P = .022) as well as mother-child augmentation pressure ( r = 0.51, P = .010). CONCLUSIONS Our findings support using a mother-child approach and novel noninvasive approaches to assess and target CV risk in mothers and their young children.
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Goldfarb MJ, Saylor MA, Bozkurt B, Code J, Di Palo KE, Durante A, Flanary K, Masterson Creber R, Ogunniyi MO, Rodriguez F, Gulati M. Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1176-e1188. [PMID: 38602110 DOI: 10.1161/cir.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.
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Halm MA, Ruppel H, Sexton JR, Guzzetta CE. Facilitating Family Presence During Resuscitation and Invasive Procedures Throughout the Life Span. Crit Care Nurse 2024; 44:e1-e13. [PMID: 38096905 DOI: 10.4037/ccn2023733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
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Hallot S, Debay V, Foster N, Burns KEA, Goldfarb M. Development and initial validation of a family activation measure for acute care. PLoS One 2024; 19:e0286844. [PMID: 38295115 PMCID: PMC10830022 DOI: 10.1371/journal.pone.0286844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/24/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Activation of a family member refers to their desire, knowledge, confidence, and skills that can inform engagement in healthcare. Family activation combined with opportunity can lead to engagement in care. No tool currently exists to measure family activation in acute care. Therefore, we aimed to develop and validate a tool to measure family activation in acute care. METHODS An interdisciplinary team of content experts developed the FAMily Activation Measure (FAM-Activate) through an iterative process. The FAM-Activate tool is a 4-item questionnaire with 5 Likert-type response options (ranging from strongly agree to strongly disagree). Scale scores are converted to a 0-100 point scoring range so that higher FAM-Activate scores indicate increased family activation. An overall FAM-Activate score (range 0-100) is calculated by adding the scores for each item and dividing by 4. We conducted reliability and predictive validity assessments to validate the instrument by administering the FAM-Activate tool to family members of patients in an acute cardiac unit at a tertiary care hospital. We obtained preliminary estimates of family engagement and satisfaction with care. RESULTS We surveyed 124 family participants (age 54.1±14.4; 73% women; 34% non-white). Participants were predominantly the adult child (38%) or spouse/partner (36%) of patients. The mean FAM-Activate score during hospitalization was 84.1±16.1. FAM-Activate had acceptable internal consistency (Cronbach's a = 0.74) and showed test-retest responsiveness. FAM-Activate was moderately correlated with engagement behavior (Pearson's correlation r = 0.47, P <0.0001). The FAM-Activate score was an independent predictor of family satisfaction, after adjusting for age, gender, relationship, and living status. CONCLUSION The FAM-Activate tool was reliable and had predictive validity in the acute cardiac population. Further research is needed to explore whether improving family activation can lead to improved family engagement in care.
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Affiliation(s)
- Sophie Hallot
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Vanessa Debay
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Nadine Foster
- Patient and Family Partnership Committee, Canadian Critical Care Trials Group, Markham, ON, Canada
- Division of Critical Care, University of Calgary, Calgary, AB, Canada
| | - Karen E. A. Burns
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Igwe J, Wangdak Yuthok TY, Cruz E, Mueller A, Lan RH, Brown‐Johnson C, Idris M, Rodriguez F, Clark K, Palaniappan L, Echols M, Wang P, Onwuanyi A, Pemu P, Lewis EF. Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control. J Am Heart Assoc 2023; 12:e030042. [PMID: 38108253 PMCID: PMC10863780 DOI: 10.1161/jaha.123.030042] [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] [Indexed: 12/19/2023]
Abstract
The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.
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Affiliation(s)
- Joseph‐Kevin Igwe
- Department of MedicineStanford University, School of MedicineStanfordCA
- Department of MedicineMorehouse School of MedicineAtlantaGA
- American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials Research FellowDurhamNC
| | | | - Erin Cruz
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Adrienne Mueller
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Roy Hao Lan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Muhammed Idris
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Fatima Rodriguez
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Kira Clark
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Latha Palaniappan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Melvin Echols
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Paul Wang
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Priscilla Pemu
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Eldrin F. Lewis
- Department of MedicineStanford University, School of MedicineStanfordCA
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Ogungbe O, Grant JK, Ayoola AS, Bansah E, Miller HN, Plante TB, Sheikhattari P, Commodore-Mensah Y, Turkson-Ocran RAN, Juraschek SP, Martin SS, Lin M, Himmelfarb CR, Michos ED. Strategies for Improving Enrollment of Diverse Populations with a Focus on Lipid-Lowering Clinical Trials. Curr Cardiol Rep 2023; 25:1189-1210. [PMID: 37787858 DOI: 10.1007/s11886-023-01942-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. RECENT FINDINGS Barriers to participation in trials occur at the study, participant, health system, sponsor, and policy level, requiring a multilevel approach to effectively increase participation of under-represented groups in research. Increasing the representation of marginalized and under-represented groups in leadership positions in clinical trials can ensure that their perspectives and experiences are considered. Trial design should prioritize patient- and community-indicated needs. Women and individuals from racially/ethnically diverse populations remain under-represented in lipid-lowering and other cardiovascular clinical trials relative to their disease burden in the population. This limits the generalizability of trial results to the broader population in clinical practice. Collaboration between community stakeholders, researchers, and community members can facilitate shared learning about trials and build trust.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jelani K Grant
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Eyram Bansah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hailey N Miller
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Payam Sheikhattari
- School of Community Health & Policy, Morgan State University, Baltimore, MD, 21251, USA
- Prevention Sciences Research Center, Morgan State University, Baltimore, MD, 21251, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
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Blakeman JR, Eckhardt AL. Cardiovascular Disease in Women: An Update for Nurses. Nurs Clin North Am 2023; 58:439-459. [PMID: 37536791 DOI: 10.1016/j.cnur.2023.05.009] [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: 08/05/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women but is often underrecognized and undertreated. Women are more likely to experience delay in treatment and worse outcomes, even though they experience similar symptoms as men. Women are more likely to experience ischemia related to microvascular dysfunction, which is not readily diagnosed by commonly used diagnostic tests. Nurses are ideally positioned to be patient advocates and use evidence-based guidelines to encourage primary prevention and ensure prompt treatment. This paper provides an update on CVD in women for clinical nurses based on the latest research evidence.
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Affiliation(s)
- John R Blakeman
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790, USA.
| | - Ann L Eckhardt
- Department of Graduate Nursing, College of Nursing and Health Innovation, University of Texas at Arlington, Pickard Hall 516, 411 S. Nedderman Dr, Arlington, TX 76019, USA
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Goldfarb M, Alviar C, Berg D, Katz J, Lee R, Liu S, Maitz T, Padkins M, Prasad R, Roswell R, Shah K, Thompson A, van Diepen S, Zakaria S, Morrow D. Family Engagement in the Adult Cardiac Intensive Care Unit: A Survey of Family Engagement Practices in the Cardiac Critical Care Trials Network. Circ Cardiovasc Qual Outcomes 2023; 16:e010084. [PMID: 37539538 PMCID: PMC10530193 DOI: 10.1161/circoutcomes.123.010084] [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: 03/30/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Cardiovascular and critical care professional societies recommend incorporating family engagement practices into routine clinical care. However, little is known about current family engagement practices in contemporary cardiac intensive care units (CICUs). METHODS We implemented a validated 12-item family engagement practice survey among site investigators participating in the Critical Care Cardiology Trials Network, a collaborative network of CICUs in North America. The survey includes 9 items assessing specific engagement practices, 1 item about other family-centered care practices, and 2 open-ended questions on strategies and barriers concerning family engagement practice. We developed an engagement practice score by assigning 1 point for each family engagement practice partially or fully adopted at each site (max score 9). We assessed for relationships between the engagement practice score and CICU demographics. RESULTS All sites (N=39; 100%) completed the survey. The most common family engagement practices were open visitation (95%), information and support to families (85%), structured care conferences (n=82%), and family participation in rounds (77%). The median engagement practice score was 5 (interquartile range, 4). There were no differences in engagement practice scores by geographic region or CICU type. The most commonly used strategies to promote family engagement were family presence during rounds (41%), communication (28%), and family meetings (28%). The most common barriers to family engagement were COVID-related visitation policies (38%) and resource limitations (13%). CONCLUSIONS Family engagement practices are routinely performed in many CICUs; however, considerable variability exists. There is a need for strategies to address the variability of family engagement practices in CICUs.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Carlos Alviar
- Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
| | - David Berg
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason Katz
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | - Ran Lee
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shuangbo Liu
- Section of Cardiology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Theresa Maitz
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Mitchell Padkins
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rajnish Prasad
- Wellstar Center for Cardiovascular Care, Wellstar Kennestone Regional Medical Center, Marietta, GA, USA
| | | | - Kevin Shah
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Andrea Thompson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sean van Diepen
- Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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Goldfarb M. Family engagement in critical care cardiology: A guide for clinicians. Can J Cardiol 2022; 39:562-565. [PMID: 36216036 DOI: 10.1016/j.cjca.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
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10
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Benizri N, Hallot S, Burns K, Goldfarb M. Patient and Family Representation in Randomized Clinical Trials Published in 3 Medical and Surgical Journals: A Systematic Review. JAMA Netw Open 2022; 5:e2230858. [PMID: 36083584 PMCID: PMC9463605 DOI: 10.1001/jamanetworkopen.2022.30858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Patient and family engagement in research may improve the design, conduct, and dissemination of clinical research, but little is known about whether these stakeholder groups are involved in the design and conduct of randomized clinical trials. OBJECTIVE To characterize the involvement and role of patient and family representatives in the design and conduct of randomized clinical trials by reviewing randomized clinical trials from 3 peer-reviewed medical and surgical journals with high impact factors. EVIDENCE REVIEW In this systematic review, the first 50 consecutive randomized clinical trials published on or after January 1, 2021, until September 30, 2021, from each of 3 medical and surgical journals with high impact factors were reviewed for patient or family involvement in trial design and/or conduct. The manuscript, supplemental data, and trial registry records were searched for trial design and governance structures. Two independent, blinded reviewers screened citations and extracted data. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. FINDINGS Only 7 of 150 randomized clinical trials (5%) reported patient or family representation in their study design or conduct. Most studies with patient or family representation (n = 5) were from a single journal. Stakeholder involvement was mainly in the execution phase (n = 7), although in 2 studies stakeholders were also involved in the translation phase. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that patient or family involvement in the design and conduct of randomized clinical trials in the publications with high impact factors is lacking. We found that when patient or family groups are involved in research, the focus was mainly on the execution phase of research design. There is a need to increase stakeholder involvement in the research design, conduct, and translation of randomized clinical trials.
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Affiliation(s)
- Nissim Benizri
- Division of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sophie Hallot
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Goldfarb M, Debigaré S, Foster N, Soboleva N, Desrochers F, Craigie L, Burns KE. Development of a Family Engagement Measure for the Intensive Care Unit. CJC Open 2022; 4:1006-1011. [DOI: 10.1016/j.cjco.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022] Open
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