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

Factors that influence success when training videofluoroscopic swallowing study analysts

Background: The literature relating to videofluoroscopic swallowing study (VFSS) training is sparse. The available evidence suggests that the learner, environment, and training design might influence VFSS analysts’ skill development. Aims: To identify the factors that VFSS analysts perceive to influence VFSS training. Methods & Procedures: In this qualitative study we interviewed nine speech pathologists from three countries who train VFSS analysts. The interviews followed a semi-structured guide to obtain data describing the trajectory of skill development and the influence of the learner, environment, and training design. We completed a thematic analysis using a simultaneously deductive and inductive approach. Outcomes & Results: Participants indicated that they believed that a trainee’s clinical experience, cognitive attributes, and learning preferences may influence their skill development. Trainers perceived a need to balance increasing the complexity of the task against maintaining the trainee’s confidence. The opportunity to practise and receive feedback was considered important. Barriers to practice were discussed. Training was perceived to have increased in complexity as the field of dysphagia has matured. Participants discussed the interacting demands of time and competency in this evolving environment. Conclusions & Implications: VFSS analytical skill development requires an investment of time by the trainee, trainer, and service. Trainers perceived that the trajectory of training and the time taken to reach competency varied according to the trainee, trainer, training design, and training environment factors. Future research into the impact of these influences and training content is needed to identify ways to provide sufficient practice and support learner differences to reduce the costs and time associated with training

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

The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults,”

Abstract Objective: To determine the validity of the esophageal Doppler monitor (EDM) and echo-esophageal Doppler (Echo-ED) in measuring cardiac output in the critically ill. Design: Systematic search of relevant international literature and data synthesis. Search strategy: Literature search (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003

Bench-to-bedside review: The promise of rapid infection diagnosis during sepsis using polymerase chain reaction-based pathogen detection

Early infection diagnosis as the cause of a patient's systemic inflammatory syndrome is an important facet of sepsis care bundles aimed at saving lives. Microbiological culture provides the main route for infection diagnosis but by its nature cannot provide time-critical results that can impact on early management. Consequently, broad-spectrum and high-potency antibiotics are essential during the immediate management of suspected sepsis in critical care but are associated with the development of drug-resistant organisms and superinfections. Established molecular laboratory techniques based on polymerase chain reaction (PCR) technology can detect pathogen DNA rapidly and have been developed for translation into a clinical diagnostic setting. In the setting of sepsis in critical care, emerging commercial systems are now available for the analysis of whole blood within hours, with the presumed aim of adoption into the current care bundles. In this review, we consider the importance of early infection diagnosis in sepsis, how this is limited by culture approaches and how the emerging PCR methods are showing promise in early clinical observational studies. The strengths and weaknesses of culture and PCR pathogen detection in whole-blood samples will be highlighted and recommendations made for urgent appropriately powered diagnostic validation studies in advance of clinical effectiveness trials before these emerging PCR pathogen detection techniques can be considered for adoption in clinical practice