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Strategies to Maximize Enrollment in a Prospective Study of Comatose Children in the PICU.

ABSTRACT: To analyze barriers to recruitment encountered during a prospective study in the PICU and evaluate strategies implemented to improve recruitment.Prospective observational study of continuous electroencephalogram monitoring in comatose children.PICUs at four North American institutions.Patients with a Glasgow Coma Scale score of less than or equal to 8 for at least an hour.Four strategies to increase recruitment were sequentially implemented.The baseline enrollment rate was 2.1 subjects/mo, which increased following the single-site introduction of real-time patient screening using an online dashboard (4.5 subjects/mo), deferred consenting (5.2 subjects/mo), and weekend screening (6.1 subjects/mo). However, the subsequent addition of three new study sites was the greatest accelerator of enrollment (21 subjects/mo), representing a 10-fold increase from baseline (p < 0.0001).Identifying barriers to recruitment and implementing creative strategies to increase recruitment can successfully increase enrollment rates in the challenging ICU environment.

SUBMITTER: McBain KL

PROVIDER: S-EPMC4779671 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Strategies to Maximize Enrollment in a Prospective Study of Comatose Children in the PICU.

McBain Kristin L KL Payne Eric T ET Sharma Rohit R Frndova Helena H Abend Nicholas S NS Sánchez Sarah M SM Gallentine William B WB Cornett Karen M KM Nash Kendall B KB Snead O Carter OC Parshuram Christopher S CS Hutchison Jamie S JS Hahn Cecil D CD

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20160301 3

<h4>Objectives</h4>To analyze barriers to recruitment encountered during a prospective study in the PICU and evaluate strategies implemented to improve recruitment.<h4>Design</h4>Prospective observational study of continuous electroencephalogram monitoring in comatose children.<h4>Setting</h4>PICUs at four North American institutions.<h4>Patients</h4>Patients with a Glasgow Coma Scale score of less than or equal to 8 for at least an hour.<h4>Interventions</h4>Four strategies to increase recruitm ...[more]

PMID: 26825045

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Project description:BackgroundAlthough there is a great deal of literature regarding effective recruitment and challenges of recruiting specific patient populations, there is less known about best practices for recruitment of nurses as study subjects.ObjectivesThe purpose of this article is to report our experience with recruitment and retention for a randomized trial of an online educational program to prepare oncology nurses to discuss oncology clinical trials with patients.MethodsThe study population included currently employed oncology nurses with direct patient interaction. There were three phases of this study: (1) qualitative interviews, (2) a pilot test, and (3) the randomized trial. Phase 3 was rolled out in five waves of recruitment. The distinct phases of the study-and the gradual roll out of recruitment during Phase 3-allowed us to test and refine our recruitment and retention methods for the randomized trial. Upon analysis of our response rate and attrition after the first wave of recruitment in Phase 3, we made several changes to improve recruitment and retention, including adding incentives, shortening the survey, and increasing the number of reminders to complete the program.ResultsThe response rate was higher when we used both e-mail and U.S. postal mail solicitations. After the first wave of recruitment in the final phase, changes in our strategies did not increase our overall response rate significantly; however, the rate of attrition following baseline declined.DiscussionRecruitment planning is an important component of successful clinical research. The use of the Internet for both recruitment of subjects and testing of interventions remains a cost-effective and potentially high yield methodology. Our research demonstrated several successful approaches to yield increased participation and retention of subjects, including seeking formal relationships with professional organizations as sponsors or supporters, providing meaningful incentives to participants, keeping surveys or questionnaires as short as possible, and planning multiple follow-up contacts from the outset.

Project description:BACKGROUND:Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions. OBJECTIVE:This exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge. METHODS:We performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3-6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate). FINDINGS:Global psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (?2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=-0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons. CONCLUSION:These results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission. CLINICAL IMPLICATIONS:If the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.

Project description:Physical attractiveness is a key factor in social communication, and through this communication process, we attractively brand and express ourselves. Thus, this study investigated the biomechanical strategies used by women to express gait attractiveness. Our aim was to extend the current literature by examining this aspect of dynamic motion from the perspective of expressed, rather than perceived attractiveness. In this regard, we obtained motion capture data from 17 women, including seven professional fashion models. The participants walked on a treadmill under two conditions: 1) a normal condition in which they were instructed to walk as casually as possible; and 2) an attractive-conscious condition where they were asked to walk as attractively as possible. Then, we used whole-body kinematic data to represent motion energy at each joint, flexibility of the upper body, and the up-down/forward-backward silhouettes of the limbs, and compared these parameters between the two conditions by using statistical parametric mapping. During the attractive-conscious condition, the non-model women increased the energy of the hip and thoracolumbar joints, which emphasized the motions of their bosoms and buttocks. They also increased their upper body flexibility (possibly reflecting fertility) and continued to face front and downward. Conversely, although the fashion models partially shared the same strategy with the non-models (e.g., hip energy, upper body flexibility, and head bending downward), the strategy of the former was prominent in the stretching of the knee during the push-off phase and pulling the upper arm back, allowing them to showcase their youth and emphasize their chests. In addition, the fashion models used a wider variety of strategies to express their gait attractiveness. The findings indicate that the biomechanical strategy used to express gait attractiveness in women involves showcasing femininity, fertility, and youth. Our results not only deepen the understanding of human movement for self-expression through gait attractiveness, but they also help us comprehend self-branding behavior in human social life.

Project description:BackgroundEarly mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe.MethodsA 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h.ResultsData of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events.ConclusionTherapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.

Dataset Information

Strategies to Maximize Enrollment in a Prospective Study of Comatose Children in the PICU.

Publications

Strategies to Maximize Enrollment in a Prospective Study of Comatose Children in the PICU.

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