The organization and impacts of clinical research delivery workforce redeployment during the COVID-19 pandemic: a qualitative case study of one research-intensive acute hospital trust

Primary and secondary care collaboration in clinical research

More patients are seen in primary care than in any other part of the health system in the UK. Our NHS datasets are the envy of the world and provide us with huge opportunities to support our patients and populations. In this paper, we demonstrate the breadth of primary care research, recruitment and delivery options. We show how research can affect many different aspects of patient care and demonstrate, through the delivery and publication of game-changing research, the ability of recruitment in primary care to answer questions that are relevant to secondary care activity. Indeed, these complex and innovative study designs and their collaborative delivery across the multitude of diseases (acute and chronic) show the strength of primary care. Collaboration across boundaries, specialties and healthcare settings will provide increased opportunities for clinical research development and, most importantly, deliver the highest quality research to support our patients.

Lessons learnt while designing and conducting a longitudinal study from the first Italian COVID-19 pandemic wave up to 3 years

BACKGROUND

Several scientific contributions have summarized the "lessons learnt" during the coronavirus disease 2019 (COVID-19) pandemic, but only a few authors have discussed what we have learnt on how to design and conduct research during a pandemic. The main intent of this study was to summarize the lessons learnt by an Italian multidisciplinary research group that developed and conducted a longitudinal study on COVID-19 patients infected during the first wave in March 2020 and followed-up for 3 years.

METHODS

A qualitative research approach embedded into the primary CORonavirus MOnitoRing study (CORMOR) study was developed, according to the the consolidated criteria for reporting qualitative research. Multiple data collection strategies were performed: each member was invited to report the main lessons learnt according to his/her perspective and experience from the study design throughout its conduction. The narratives collected were summarized and discussed in face-to-face rounds. The narratives were then thematically analysed according to their main topic in a list that was resent to all members to check the content and their organization. The list of the final "lessons learnt" has been agreed by all members, as described in a detailed fashion.

RESULTS

Several lessons were learnt while designing and conducting a longitudinal study during the COVID-19 pandemic and summarised into ten main themes: some are methodological, while others concern how to conduct research in pandemics/epidemics/infectious disease emergencies.

CONCLUSIONS

The multidisciplinary approach, which also included patients' perspective, helped us to protect the consistency and quality of the research provided in pandemic times. The lesson learnt suggest that our research approach may benefit from changes in education, clinical practice and policies.

If Providing Best Care Means Being at the Cutting Edge of Research, Should It Be Implemented System-wide? Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

The COVID-19 pandemic intensified debates about the desirability of integrating health research systems into healthcare systems. An excellent evaluation undertaken prior to the pandemic examined a purposeful strategy to improve healthcare through an expansion in research capacity in the Townsville Hospital and Health Service (THHS), a regional service in northern Queensland. This comment puts that evaluation into a rapidly developing wider context, drawing on other work showing an association between research engagement in healthcare organisations and their improved healthcare. In most previous studies this impact arose as a by-product of the research activity. The Townsville scheme went further. But while the evaluation identified some progress and impacts, they were patchy, not system-wide. Recent pre-pandemic studies showed that going even further and integrating a health research system across a national healthcare system markedly improved healthcare, despite continuing challenges. The UK's research experiences during COVID-19 are giving additional momentum to this approach globally.

Exploration of Lived Experiences and Measurement of Burnout Among US Clinical Research Nurses

OBJECTIVE

The aims of this study were to explore the experiences of US clinical research nurses supporting the conduct of clinical trials before and during the COVID-19 pandemic and assess dimensions of burnout among these nurses using the Maslach Burnout Inventory-Human Services Survey.

BACKGROUND

Clinical research nurses are a subspecialty of nursing that supports clinical trial conduct. Postpandemic clinical research nurse well-being, including indicators of burnout, has not been established.

METHODS

A cross-sectional descriptive study via online survey was conducted.

RESULTS

A sample of US clinical research nurses scored overall high for the Maslach category of Emotional Exhaustion, moderate for Depersonalization, and moderate for Personal Achievement. Themes included together or apart, rewarding but challenging, and surviving or thriving.

CONCLUSION

Supportive measures such as workplace appreciation and consistent change communication may benefit clinical research nurse well-being and reduce burnout during times of unpredicted crisis and beyond.

Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges

During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.