Recruitment barriers in a randomized controlled trial from the physicians' perspective – A postal survey

BACKGROUND: The feasibility of randomized trials often depends on successful patient recruitment. Although numerous recruitment barriers have been identified it is unclear which of them complicate recruitment most. Also, most surveys have focused on the patients' perspective of recruitment barriers whereas the perspective of recruiting physicians has received less attention. Therefore, our aim was to conduct a postal survey among recruiting physicians of a multi-center trial to weigh barriers according to their impact on recruitment. METHODS: We identified any potential recruitment barriers from the literature and from our own experience with a multi-center trial of respiratory rehabilitation in patients with chronic obstructive pulmonary disease. We developed and pilot-tested a self-administered questionnaire where recruiting physicians were asked to express their agreement with statements about recruitment barriers on a Likert-type scale from 1 (full agreement with statement = very substantial recruitment barrier) to 7 (no agreement with statement = no recruitment barrier). RESULTS: 38 of 55 recruiting physicians returned questionnaires (69% response rate), of which 35 could be analyzed (64% useable response rate). Recruiting physicians reported that "time constraints" (median agreement of 3, interquartile range 2-5) had the most negative impact on recruitment followed by "difficulties including identified eligible patients" (median agreement of 5, IQR 3-6). Other barriers such as "trial design barriers", "lack of access to treatment", "individual barriers of recruiting physicians" or "insufficient training of recruiting physicians" were perceived to have little or no impact on patient recruitment. CONCLUSION: Physicians perceived time constraints as the most relevant recruitment barrier in a randomized trial. To overcome recruitment barriers interventions, that are affordable for both industry- and investigator-driven trials, need to be developed and tested in randomized trials. TRIAL REGISTRATION: ISRCTN84612310

Dielectronic Recombination of Argon-Like Ions

We present a theoretical investigation of dielectronic recombination (DR) of Ar-like ions that sheds new light on the behavior of the rate coefficient at low-temperatures where these ions form in photoionized plasmas. We provide results for the total and partial Maxwellian-averaged DR rate coefficients from the initial ground level of K II -- Zn XIII ions. It is expected that these new results will advance the accuracy of the ionization balance for Ar-like M-shell ions and pave the way towards a detailed modeling of astrophysically relevant X-ray absorption features. We utilize the AUTOSTRUCTURE computer code to obtain the accurate core-excitation thresholds in target ions and carry out multiconfiguration Breit-Pauli (MCBP) calculations of the DR cross section in the independent-processes, isolated-resonance, distorted-wave (IPIRDW) approximation. Our results mediate the complete absence of direct DR calculations for certain Ar-like ions and question the reliability of the existing empirical rate formulas, often inferred from renormalized data within this isoelectronic sequence