Overcoming difficulties with equipoise to enable recruitment to a randomised controlled trial of partial ablation vs radical prostatectomy for unilateral localised prostate cancer

Objective: To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation vs Radical prosTatectomy in intermediate-risk unilateral clinically localised prostate cancer) feasibility study and how this affected recruitment. Subjects and Methods: PART included a QuinteT Recruitment Intervention (QRI) to optimise recruitment. Phase I aimed to understand recruitment, and included: scrutinising recruitment data, interviewing the trial management group and recruiters (n = 13), and audio-recording recruitment consultations (n = 64). Data were analysed using qualitative content and thematic analysis methods. In Phase II, strategies to improve recruitment were developed and delivered. Results: Initially many recruiters found it difficult to maintain a position of equipoise and held preconceptions about which treatment was best for particular patients. They did not feel comfortable about approaching all eligible patients, and when the study was discussed, biases were conveyed through the use of terminology, poorly balanced information, and direct treatment recommendations. Individual and group feedback led to presentations to patients becoming clearer and enabled recruiters to reconsider their sense of equipoise. Although the precise impact of the QRI alone cannot be determined, recruitment increased (from a mean [range] of 1.4 [0–4] to 4.5 [0–12] patients/month) and the feasibility study reached its recruitment target. Conclusion: Although clinicians find it challenging to recruit patients to a trial comparing different contemporary treatments for prostate cancer, training and support can enable recruiters to become more comfortable with conveying equipoise and providing clearer information to patients

Utility of routine screening for alpha-1 antitrypsin deficiency in patients with bronchiectasis

Alpha-1 antitrypsin deficiency (AATD) is a cause of bronchiectasis. Guidelines for bronchiectasis from the British Thoracic Society do not recommend to routinely test patients for AATD. In contrast, guidelines for AATD recommend routine screening. This contradiction, in part, results from the lack of data from large studies performing comprehensive screening. We screened 1600 patients with bronchiectasis at two centres in the UK from 2012 to 2016. In total, only eight individuals with AATD were identified representing 0.5% of the overall population. We conclude that routine screening for AATD in bronchiectasis in the UK has a low rate of detection. Further studies are required in different geographical regions, which may have a higher prevalence of AATD.info:eu-repo/semantics/publishedVersio

The trial is owned by the team, not by an individual:A qualitative study exploring the role of teamwork in recruitment to randomised controlled trials in surgical oncology

BACKGROUND: Challenges exist in recruitment to trials involving interventions delivered by different clinical specialties. Collaboration is required between clinical specialty and research teams. The aim of this study was to explore how teamwork influences recruitment to a multicentre randomised controlled trial (RCT) involving interventions delivered by different clinical specialties. METHODS: Semi-structured interviews were conducted in three centres with a purposeful sample of members of the surgical, oncology and research teams recruiting to a feasibility RCT comparing definitive chemoradiotherapy with chemoradiotherapy and surgery for oesophageal squamous cell carcinoma. Interviews explored factors known to influence healthcare team effectiveness and were audio-recorded and thematically analysed. Sampling, data collection and analysis were undertaken iteratively and concurrently. RESULTS: Twenty-one interviews were conducted. Factors that influenced how team working impacted upon trial recruitment were centred on: (1) the multidisciplinary team (MDT) meeting, (2) leadership of the trial, and (3) the recruitment process. The weekly MDT meeting was reported as central to successful recruitment and formed the focus for creating a ‘study team’, bringing together clinical and research teams. Shared study leadership positively influenced healthcare professionals’ willingness to participate. Interviewees perceived their clinical colleagues to have strong treatment preferences which led to scepticism regarding whether the treatments were being described to patients in a balanced manner. CONCLUSIONS: This study has highlighted a number of aspects of team functioning that are important for recruitment to RCTs that span different clinical specialties. Understanding these issues will aid the production of guidance on team-relevant issues that should be considered in trial management and the development of interventions that will facilitate teamwork and improve recruitment to these challenging RCTs. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN89052791

Individual and environmental factors that influence longevity of newcomers to nursing and midwifery: a scoping review protocol

Objective: The objective of this review is to identify and map the literature that describes the individual and environmental factors that influence nurses and midwives to stay in or leave their discipline within the first three years of practice. Introduction: The turnover rate of newcomers within their first three years of nursing and midwifery is higher than in later years and is contributing to a worldwide shortage. Both individual and environmental factors, often in combination, contribute to this attrition. Many studies demonstrate the associations of factors with turnover or intention to stay; however, the scope of factors has not been documented. Inclusion criteria: Newcomers are defined as registered nurses and registered midwives within the first three years of entering their discipline. Quantitative and qualitative studies and systematic reviews that explore individual or environmental factors that influence the decision to leave or to remain in nursing and midwifery in any context will be considered. Factors may include coping, anxiety, mindfulness, practice environment, or combinations such as resilience, satisfaction, and burnout. Articles must have been peer reviewed. Literature published since 1974 in English will be considered. Newcomers who have completed skills-based training will be excluded. Methods: The JBI method for scoping reviews will be followed. An extensive search of multiple databases and gray literature will be undertaken. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Data extracted will be synthesized and results reported using a mind map, tables, and narrative form

A survey of parental self-efficacy experiences: maximising potential through health visiting and universal parenting support

Aims: To examine parental self-efficacy experiences for users of a parenting support programme and consider the pertinence of self-efficacy theory to health visiting (public health nursing) practice. Background: Commonly, successful parenting training programmes are underpinned by social learning principles and aim to strengthen parental self-efficacy. However, research examining programme effectiveness rarely discusses how self-efficacy outcomes are achieved. Design: A descriptive survey was completed as the first part of a realistic evaluation study examining how a UK parenting support programme worked. Method: The first part of the realistic evaluation involved validating outcome measures (the Parenting Self-Agency Measure and Self-Efficacy for Parenting Tasks Index subscales) and administering a questionnaire survey. The questionnaire was completed by adults accessing a parenting support programme during a 10-month period (n = 168). Data were analysed using descriptive and inferential statistics. Results. Women were the main users of the programme, which included informal drop-in groups as well as more formalised health visiting services and parenting training courses. The Parenting Self-Agency Measure results indicated good general parental self-efficacy; however, the task-specific Self-Efficacy for Parenting Tasks Indexes scales suggested that parents were less self-efficacious in disciplining children. Lower self-efficacy scores correlated with high ratings for ‘feeling tired’, ‘receiving negative comments’ and ‘giving-in to a child’s demands’. Conclusions: Study results indicate that the domain general and task-specific measures provide different, but helpful, insights into parental self-efficacy experiences. By identifying factors associated with the levels of general and task-specific parental self-efficacy, health visitors can gain a fuller appreciation of support needs. Relevance to practice: To maximise potential through parenting support, attention should be given to addressing factors associated with poorer self-efficacy experiences, including parental tiredness. Equally, practice should be directed at developing community environments that offer exposure to positive praise and the opportunity to practice new skills without facing criticism

Have Anglo-Catholics lost their vision for mission agencies? : an empirical enquiry among newly ordained clergy in Britain

Attitude toward Christian mission agencies was investigated in a sample of 827 Anglican clergy ordained in the UK from 2002 to 2006. The Scale of Attitude Toward Mission Agencies (SATMA) consisted of six items related to the work that agencies do, and whether clergy wished to engage with this work. It had a high internal consistency reliability (Cronbach's alpha = 0.80). After controlling for theological liberalism or conservatism, attitudes were most positive among evangelicals and least positive among Anglo-Catholics. Both liberal and conservative Anglo-Catholic clergy showed less positive attitudes toward mission agencies than did other clergy

Dynamics of an Acoustic Polaron in One-Dimensional Electron-Lattice System

The dynamical behavior of an acoustic polaron in typical non-degenerate conjugated polymer, polydiacetylene, is numerically studied by using Su-Schrieffer-Heeger's model for the one dimensional electron-lattice system. It is confirmed that the velocity of a polaron accelerated by a constant electric field shows a saturation to a velocity close to the sound velocity of the system, and that the width of a moving polaron decreases as a monotonic function of the velocity tending to zero at the saturation velocity. The effective mass of a polaron is estimated to be about one hundred times as heavy as the bare electron mass. Furthermore the linear mode analysis in the presence of a polaron is carried out, leading to the conclusion that there is only one localized mode, i.e. the translational mode. This is confirmed also from the phase shift of extended modes. There is no localized mode corresponding to the amplitude mode in the case of the soliton in polyacetylene. Nevertheless the width of a moving polaron shows small oscillations in time. This is found to be related to the lowest odd symmetry extended mode and to be due to the finite size effect.Comment: 12 pages, latex, 9 figures (postscript figures abailble on request to [email protected]) to be published in J. Phys. Soc. Jpn. vol.65 (1996) No.