Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

© 2019 Author(s). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJConducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity. Aim : To identify variability in the research infrastructure of UK intensive care units (ICUs) and their ability to conduct research and recruit patients into clinical trials. Design: We evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analysis of two datasets (one dataset had been analysed previously) was undertaken in the thematic analysis. Findings: The synthesis yielded an overarching core theme of Normalising Research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: Organisational, Human, Study, Practical resources, Clinician, and Patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined. Conclusions: The central and transferable tenet of Normalising Research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is requisite for all healthcare individuals from organisational to direct patient contact level.Peer reviewedFinal Published versio

Characterising the research profile of the critical care physiotherapy workforce and engagement with critical care research: a UK national survey

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objective: To characterise the research profile of UK critical care physiotherapists including experience, training needs, and barriers and enablers to engagement in critical care research. 'Research' was defined broadly to encompass activities related to quantitative and qualitative studies, service evaluations, clinical audit and quality improvements. Design: Closed-question online survey, with optional free-text responses. Setting: UK critical care community. Participants: UK critical care physiotherapists, regardless of clinical grade or existing research experience. Results: 268 eligible survey responses were received during the 12-week study period (21 incomplete, 7.8%). Respondents were based in university-affiliated (n=133, 49.6%) and district general (n=111, 41.4%) hospitals, and generally of senior clinical grade. Nearly two-thirds had postgraduate qualifications at master's level or above (n=163, 60.8%). Seven had a doctoral-level qualification. Respondents reported a range of research experience, predominantly data acquisition (n=144, 53.7%) and protocol development (n=119, 44.4%). Perceived research training needs were prevalent, including topics of research methods, critical literature appraisal, protocol development and statistical analysis (each reported by ≥50% respondents). Multiple formats for delivery of future research training were identified. Major barriers to research engagement included lack of protected time (n=220, 82.1%), funding (n=177, 66.0%) and perceived experience (n=151, 56.3%). Barriers were conceptually categorised into capability, opportunity and motivation themes. Key enabling strategies centred on greater information provision about clinical research opportunities, access to research training, secondment roles and professional networks. Conclusions: UK critical care physiotherapists are skilled, experienced and motivated to participate in research, including pursuing defined academic research pathways. Nonetheless wide-ranging training needs and notable barriers preclude further involvement. Strategies to harness the unique skills of this profession to enhance the quality, quantity and scope of critical care research, benefiting from a multiprofessional National Clinical Research Network, are required.Peer reviewedFinal Published versio

Physical Rehabilitation Core Outcomes In Critical illness (PRACTICE): protocol for development of a core outcome set

Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Existing data on physical rehabilitation interventions in critical illness are challenged by outcome heterogeneity that limits data synthesis and translation of research findings into clinical practice. This protocol describes the PRACTICE study to develop a core outcome set (COS) for trials of physical rehabilitation interventions delivered across the continuum of a patient's recovery from the intensive care unit until reintegration in the community following hospital discharge. Methods: Mixed methods will be used including: systematic reviews of quantitative and qualitative literature; qualitative interviews with patients and caregivers; a modified Delphi consensus process with researcher, clinician and patient/caregiver stakeholder groups; and consensus meetings for ratification of findings, resolving uncertainty, or developing an action plan for COS implementation. Discussion: The PRACTICE COS will inform relevant stakeholders about important outcomes regarding physical rehabilitation in critical illness, and may enhance the future design and conduct of trials in this area.Peer reviewe

Summer Active Reading Programme : evaluation report and executive summary

This reports an efficacy trial of a reading for pleasure book-gifting and summer events programme at the transition from primary to secondary school. The trial involved 205 pupils transitioning from 48 primary schools to 10 secondary schools. A process evaluation comprising observations, questionnaires and focus groups examined engagement, stakeholders perspectives and fidelity of implementation

TextNow Transition Programme : evaluation report and executive summary

This reports an efficacy trial of a reading for pleasure coaching programme at the transition from primary to secondary school. The trial involved 501 pupils transitioning from 34 primary schools to 62 secondary schools. A process evaluation comprising observations, questionnaires and focus groups examined engagement, stakeholders perspectives and fidelity of implementation

Guidelines on the management of acute respiratory distress syndrome.

The Faculty of Intensive Care Medicine and Intensive Care Society Guideline Development Group have used GRADE methodology to make the following recommendations for the management of adult patients with acute respiratory distress syndrome (ARDS). The British Thoracic Society supports the recommendations in this guideline. Where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH2O) was recommended. For patients with moderate/severe ARDS (PF ratio<20 kPa), prone positioning was recommended for at least 12 hours per day. By contrast, high frequency oscillation was not recommended and it was suggested that inhaled nitric oxide is not used. The use of a conservative fluid management strategy was suggested for all patients, whereas mechanical ventilation with high positive end-expiratory pressure and the use of the neuromuscular blocking agent cisatracurium for 48 hours was suggested for patients with ARDS with ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios less than or equal to 27 and 20 kPa, respectively. Extracorporeal membrane oxygenation was suggested as an adjunct to protective mechanical ventilation for patients with very severe ARDS. In the absence of adequate evidence, research recommendations were made for the use of corticosteroids and extracorporeal carbon dioxide removal

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness:executive summary of a Cochrane Collaboration systematic review

Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and func-\ud tional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation\ud has been shown to be bene\ud fi\ud cial when delivered during ICU admission. This review aimed to determine the effectiveness of\ud exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related\ud quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials compar-\ud ing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or\ud ‘\ud usual care\ud ’\ud programme\ud in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Sys-\ud tem Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases\ud were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were per-\ud formed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies\ud evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies\ud evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta-\ud analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of out-\ud come measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality\ud of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited.\ud Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis

Can the UK 24-item family satisfaction in the intensive care unit questionnaire be used to evaluate quality improvement strategies aimed at improving family satisfaction with the ICU? A qualitative study

Acknowledgements We thank the participants in the FREE and EBCD studies who gave their time to participate. We also thank Professor David Harrison for extracting the open-text comments from the FREE study database. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The FREE Study was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme (11/2003/56). The EBCD study was funded by the NIHR HS&DR Programme (10/1009/14). The funder had no involvement in study design; in collection, analysis and interpretation of data; in the writing of this paper; or in the decision to submit the article for publication. LH is supported by the NIHR Oxford Biomedical Research Centre (BRC). LL was employed by the Nuffield Department of Primary Care Health Sciences, University of Oxford and supported by the NIHR Oxford BRC during the period the work was conducted. BC is funded by an NIHR Clinical Trials Fellowship (CTF-2017-06-016). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.Peer reviewedPostprin