Bibliographies thématiques / Patients recruitment

Littérature scientifique sur le sujet « Patients recruitment »

Auteur : Grafiati
Publié le 11 mars 2023

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Articles de revues sur le sujet "Patients recruitment"

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Arnal, Jean-Michel, et Aude Garnero. « Lung recruitment in ARDS patients ». Acta medica Lituanica 19, no 3 (1 octobre 2012) : 201–5. http://dx.doi.org/10.6001/actamedica.v19i3.2449.

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Lung recruitment is used to improve oxygenation and decrease the risk of ventilator induced lung injuries. Assessing the potential of recruitability is a pre-requisite for a rational recruitment strategy and setting of PEEP. Using a low flow pressure-volume loop is helpful to assess the potential of recruitability at the bedside. For patients with a high potential of recruitability, recruitment maneuvers are efficient with an appropriate setting of PEEP to maintain the lung recruited. Recruitment maneuvers use pressures from 40 to 60 cmH2O for a short period of time, either with the sustained inflation or the staircase method. PEEP setting after the maneuver is important; a decreasing PEEP trial is a useful practical method.
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Duffett, Richard, et J. Cookson. « Recruitment of patients with panic disorder ». Psychiatric Bulletin 17, no 12 (décembre 1993) : 770. http://dx.doi.org/10.1192/pb.17.12.770.

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Hoppu, Kalle. « Patient Recruitment—European Perspective ». Pediatrics 104, Supplement_3 (1 septembre 1999) : 623–26. http://dx.doi.org/10.1542/peds.104.s3.623.

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A considerable number of patients have to be recruited in a clinical trial to obtain solid results. In pediatric studies, patient recruitment is frequently problematic. In the simple common childhood illnesses, the number of recruitable patients is certainly large, but they may be hard to reach, and the imbalance between potential benefit and inconvenience of participation may reduce motivation to enroll. In severe diseases, the balance may be right, but the available number of patients may be small. Good communication with the child and family, as well as the motivation of colleagues to admit, is another key element in success. Proper study design, including realistically identified sources of patients, reasonable inclusion, and exclusion criteria, also are required.
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Smith, Alan D., et Dean R. Manna. « E-recruitment of patients for clinical trials ». International Journal of Electronic Healthcare 1, no 4 (2005) : 413. http://dx.doi.org/10.1504/ijeh.2005.006688.

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Tannock, IF. « The recruitment of patients into clinical trials ». British Journal of Cancer 71, no 6 (juin 1995) : 1134–35. http://dx.doi.org/10.1038/bjc.1995.221.

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Zosmer, A., M. Epstein et T. Al-Shawaf. « Ethical recruitment of patients for PGS trial ». Human Reproduction 23, no 6 (11 avril 2008) : 1472. http://dx.doi.org/10.1093/humrep/den116.

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Vluggen, Stan, Ciska Hoving, Lieve Vonken, Nicolaas C. Schaper et Hein de Vries. « Exploring factors influencing recruitment results of nurses recruiting diabetes patients for a randomized controlled trial ». Clinical Trials 17, no 4 (5 mai 2020) : 448–58. http://dx.doi.org/10.1177/1740774520914609.

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Background Effective recruitment of patients by health professionals is challenging but pivotal to the success of clinical trials. Many trials fail to include the required number of participants, which affects the power of the study, generalizability of results, and timely dissemination of positive outcomes. Existing research is inconclusive regarding factors influencing recruitment results, and most research does not focus on perceptions of recruiting health professionals themselves. Therefore, thorough evaluations of recruitment facilitators and barriers in trials are needed in order to optimize future patient recruitment in trials. We observed divergent recruitment results among nurses who recruited diabetes patients to our trial, which examined the effectiveness of an eHealth programme. Therefore, we aimed to describe nurses’ recruitment results and related shifts over time, and to qualitatively explore factors influencing nurses’ recruitment results. Methods Nurses’ recruitment results and related temporal shifts were derived from trial data (NTR6840). Based on their recruitment results, nurses were categorized as non-, low-, medium-, or high-recruiters. Subsequently, a subset of nurses per group participated in an individual semi-structured telephone interview. Interviews were analysed using NVivo software, applying an inductive coding approach. Results Ninety-six nurses participated in our trial and recruited on average seven patients (range: 0–32). Fifteen nurses did not recruit any patients. Most patients were recruited close to recruitment onset. Nurses who did not recruit patients close to recruitment onset generally ended up recruiting no patients. Data show a relatively high number of early recruited patients that progressively declined over time. High-recruiters were generally successful throughout the entire recruitment period. Recruitment facilitators and barriers comprised organizational, study, patient, and especially recruiter characteristics. Contrary to non- and low-recruiters, medium- and high-recruiters reported more in-depth knowledge about the study and trial requirements, expressed more personal participation-related benefits and fewer barriers, and incorporated more recruitment activities, reminders, and barrier-focused coping strategies. Conclusion and implications To optimize patient recruitment to clinical trials, suggested intervention targets include the continued inclusion of recruiters after initial recruitment onset and the encouragement of early recruitment success. A personalized approach may aid recruiters to become and remain successful. Primarily, it is important to provide recruiters with sufficient information on trial requirements and to address salient benefits for participation in the trial, both for themselves and for their patients. Finally, teaching recruiters skills on how to overcome barriers may further enhance motivation and recruitment capacities.
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Rowlands, Ceri, Leila Rooshenas, Katherine Fairhurst, Jonathan Rees, Carrol Gamble et Jane M. Blazeby. « Detailed systematic analysis of recruitment strategies in randomised controlled trials in patients with an unscheduled admission to hospital ». BMJ Open 8, no 2 (février 2018) : e018581. http://dx.doi.org/10.1136/bmjopen-2017-018581.

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ObjectivesTo examine the design and findings of recruitment studies in randomised controlled trials (RCTs) involving patients with an unscheduled hospital admission (UHA), to consider how to optimise recruitment in future RCTs of this nature.DesignStudies within the ORRCA database (Online Resource for Recruitment Research in Clinical TriAls;www.orrca.org.uk) that reported on recruitment to RCTs involving UHAs in patients >18 years were included. Extracted data included trial clinical details, and the rationale and main findings of the recruitment study.ResultsOf 3114 articles populating ORRCA, 39 recruitment studies were eligible, focusing on 68 real and 13 hypothetical host RCTs. Four studies were prospectively planned investigations of recruitment interventions, one of which was a nested RCT. Most recruitment papers were reports of recruitment experiences from one or more ‘real’ RCTs (n=24) or studies using hypothetical RCTs (n=11). Rationales for conducting recruitment studies included limited time for informed consent (IC) and patients being too unwell to provide IC. Methods to optimise recruitment included providing patients with trial information in the prehospital setting, technology to allow recruiters to cover multiple sites, screening logs to uncover recruitment barriers, and verbal rather than written information and consent.ConclusionThere is a paucity of high-quality research into recruitment in RCTs involving UHAs with only one nested randomised study evaluating a recruitment intervention. Among the remaining studies, methods to optimise recruitment focused on how to improve information provision in the prehospital setting and use of screening logs. Future research in this setting should focus on the prospective evaluation of the well-developed interventions to optimise recruitment.
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Joubert, R., U. Raeth et T. Moehler. « Variation in enrollment of colorectal cancer patients in clinical trials ». Journal of Clinical Oncology 27, no 15_suppl (20 mai 2009) : e15094-e15094. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e15094.

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e15094 Background: Correct estimation of patient enrollment is an important success factor for planning clinical studies including studies for metastatic colorectal cancer (CRC). Methods: We reviewed all CRC studies published in the Journal of Clinical Oncology and Annals of Oncology between 01/2007 and 10/01/2008. 43 studies were found and the following data were collected from 39 studies: indication, phase, number of sites, number of patients enrolled, mean patient age, recruitment time, sponsor (Industry, NIH, Organization, University), region, line of treatment and type of drug (6 categories). 4 studies were omitted from analysis as recruitment data were largely missing. Our analysis is based on a literature review as information from unpublished trials is unavailable. This implies some limitations regarding the data interpretation. Results: An average enrollment of 0.92 Patient/Site/Month (range 0.10–7.38) was observed for these trials. The highest recruitment efficacy with a median of 4.11 Pt/S/M (range 1.81–7.38) was found in 5 single institution phase II trials. For multi-center phase II and III studies the median enrollment was 1.82 and 0.32 Pt/S/M respectively, with significant higher recruitment in phase II studies. The highest enrollment rate was observed for studies located in Europe or in USA (0.77 and 2.21 Pt/S/M respectively, p=0.03). No correlation was seen with the mechanism of action (targeted drug vs. chemotherapy), sponsor (NIH vs. Industry vs. IIT), line of treatment (first line vs. 2nd and subsequent line). For phase I recruitment analysis we retrieved 2 studies that investigated novel agents in solid tumor patients including advanced or metastatic colorectal cancer patients with a median recruitment of 0.46 Pt/S/M. For phase Ib and I/II recruitment analysis 5 studies were found with a median recruitment of 0.78 Pt/S/M. Conclusions: Single institution phase II clinical trials on novel agents with high potential to change future treatment standard demonstrate almost a tenfold higher than average recruitment rate for multi-center trials (0.45 Pt/S/M). Despite some limitations in the interpretation of results our analysis provides important information to support estimation of patient recruitment in future clinical trials for colorectal cancer. No significant financial relationships to disclose.
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Bentley, Kia J. « Voluntary Recruitment of Psychiatric Patients for Clinical Research ». International Journal of Mental Health 20, no 2 (juin 1991) : 94–104. http://dx.doi.org/10.1080/00207411.1991.11449199.

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Thèses sur le sujet "Patients recruitment"

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Yan, Shiu-man Yolanda. « Patient recruitment strategies in clinical trials ». Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B24872623.

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殷小曼 et Shiu-man Yolanda Yan. « Patient recruitment strategies in clinical trials ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31970874.

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Sapey, Elizabeth. « Inflammation and neutrophil recruitment in ageing subjects and patients with chronic obstructive pulmonary disease ». Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/1211/.

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The neutrophil is central to the development of COPD. To enter lung, neutrophils must migrate accurately from the circulation to inflamed tissue. It is unclear which migratory stimuli are important and whether COPD neutrophils vary in their migratory behaviour, either to controls or patients with similar lung disease. COPD sputum and plasma samples were collected on 11 occasions over one month. Significant correlations were demonstrated between the inflammatory biomarkers and between inflammatory biomarkers and markers of disease. IL-8 correlated most strongly both with other inflammatory mediators, neutrophil counts and indices of disease. Neutrophils from healthy older subjects migrated with maintained speed but reduced accuracy to IL-8. Differences could not be accounted for by surface receptor expression or shedding, but inhibition of CXCR2 gave young neutrophils and old migratory phenotype, suggesting altered downstream signalling. COPD neutrophils migrated with increased speed and reduced accuracy compared with control groups. They formed less pseudopodia when migrating, and had reduced surface expression of CXCR1 and CXCR2. Inhibitory studies suggested that CXCR2 was the predominant receptor in migration to biological samples. Treating COPD cells with a PI3 Kinase inhibitor differentially altered their migration, reducing speed but increasing accuracy, so that cells now resembled those from controls.
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Morandi, Tiffany. « Safety and efficacy of lung recruitment maneuvers in post-­‐operative pediatric cardiac surgical patients ». Thesis, The University of Arizona, 2013. http://hdl.handle.net/10150/281775.

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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
OBJECTIVE: To demonstrate the safety of lung recruitment maneuvers in post-operative pediatric cardiac surgical patients. To assess the ability of lung recruitment maneuvers to improve lung function. HYPOTHESIS: We hypothesize that ventilator recruitment strategies be well-­tolerated in cardiac patients, and that they may benefit such patients by improving physiologic variables such as lung function and oxygenation. METHODS: Sixty‐two pediatric post-operative cardiac surgical patients were randomly selected to include in this retrospective chart review. Study subjects were selected from all patients who met inclusion criteria in the year immediately following implementation of a lung recruitment protocol in a local free‐standing pediatric hospital. Physiologic variables before, during, and after lung recruitment were recorded as well as patient demographics, diagnoses, morbidities and mortality. RESULTS: A statistically significant increase in dynamic compliance of the lungs and renal non-invasive regional oximetry was noted immediately after each recruitment maneuver. There was no statistically significant change in blood pressure, heart rate or oxygen saturation during the maneuvers. There was a transient increase in central venous pressure during the maneuvers (average increase < 1 mmHg). Of the 62 patients, there were 7 cases of pneumonia and 5 cases of small pneumothorax, often resolving without intervention. Significance: Demonstrating recruitment maneuvers are safe in pediatric patients with cardiac disease will allow practitioners to confidently utilize them when caring for ventilated patients. Such patients may benefit from potential improvements in lung function and decreased ventilator-associated morbidities.
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Reinius, Henrik. « Open lung concept in high risk anaesthesia : Optimizing mechanical ventilation in morbidly obese patients and during one lung ventilation with capnothorax ». Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-268498.

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Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV) with capnothorax are examples of such situations. In Paper I (30 patients with BMI > 40 kg/m2 scheduled for bariatric surgery) a recruit­ment maneuver followed by positive end-expiratory pressure (PEEP) re­duced the amount of atelectasis and improved oxygenation for a prolonged period of time. PEEP or a recruitment maneuver alone did not reduce the amount of atelectasis. In paper II we investigated whether it is possible to predict respiratory function impairment in morbidly obese patients without pulmonary disease from a preoperative lung function test. Patients with mild signs of airway obstruction (reduced end-expiratory flow) in the preoperative spirometry developed less atelectasis during anaesthesia. In paper III we developed an experimental model of sequential OLV with capnothorax using electrical impedance tomography (EIT) that in real-time detected lung separation and dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left side caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation. In paper IV we used our model of OLV with capnothorax and applied a CO2-insufflation pressure of 16 cm H2O. We demonstrated that a PEEP level of 12-16 cm H2O is needed for optimal oxygenation and lowest possible driving pressure without compromising hemodynamic variables. Thus, the optimal PEEP was closely related to the level of the capnothorax insufflation pressure. With insufficient PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the non-ventilated lung occurred.
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Fletcher, Kate Elizabeth. « An investigation of practice and practitioner factors that influence the recruitment of patients to primary care based randomised controlled trials : case study of the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study ». Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3519/.

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Background: Patient recruitment to trials is problematic; many fail to achieve targets, leaving them underpowered and unable to address their hypothesis. Few solutions have been identified in existing literature. This thesis aimed to: identify factors associated with recruitment; and understand clinicians’ experiences of recruiting patients to a primary care based randomised controlled trial (RCT). This was explored using The Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) trial as a case study. Methods: Mixed methods were used: a systematic review to identify factors influencing recruitment to primary care based RCTs; quantitative analysis of BAFTA data to identify factors associated with recruitment; and qualitative interviews with General Practitioners involved with BAFTA, to understand their experience of participation. Results: Existing literature demonstrated that influences on recruitment include: study workload; study question; concerns about patients. Recommendations to address these issues are not based on strong empirical evidence. BAFTA identified factors associated with patient recruitment (practice size; GP age; recruitment year); and patterns over time. Interviews identified differences in attitude between high and low recruiters, including risk perception and motivation. Conclusions: This thesis demonstrates how practitioners can influence patient recruitment. Revised recruitment methods need testing in prospective trials.
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Kulikov, Yuri. « Patient recruitment in a challenging surgical trial : issues and possible solutions ». Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/66691/.

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Randomised Controlled Trials (RCTs) are regarded as a ‘gold standard’ technique to evaluate and compare clinical interventions. Strict ethical criteria dictate the participation of humans in clinical research, based on informed consent, voluntary decision making and putting patients’ interests first. Demand for RCTs in Trauma and Orthopaedics is high, but patient recruitment continues to pose a significant challenge, especially when the treatments being compared are obviously different. Lack of blinding, treatment preference and negative perception of random allocation to interventions are among the obstacles which need to be considered. Based on review and analysis of current knowledge, an attempt is made to develop a new recruitment process that incorporates high ethical standards and provision of the best possible clinical care for an individual patient. By integrating the principle of clinical equipoise, modern technology and statistical concepts, such as subjective probability, the Patient Eligibility Assessment through Clinical Equipoise (PEACE) framework has been introduced. This provides an alternative that could be used in trials where the fixed eligibility criteria approach is likely to fail. It was tested involving 77 real clinical cases from a national multi-centre trauma RCT, which compared contrasting treatments. A new trial recruitment approach aiming to avoid direct contact between a patient and a treating clinician was rolled out in the same trial. The feedback was collected from both the clinicians and the patients involved. Thematic analysis of 23 semi-structured interviews improved understanding of the various factors influencing patients’ decision about trial participation. Further typological analysis provided a valuable insight into the different attitudes that patients adopted when faced with the dilemma. In particular, that many are positive towards research involvement, but not comfortable with randomisation based on fixed eligibility criteria. According to these results, a new model for patient recruitment is suggested, which could be researched and tested in future trials.
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Heikari, J. M. (Juho-Matti). « The use of social media in patient recruitment for clinical trials in medical device start-up from the perspective of social media agencies and patient recruitment firms:case Synoste ». Master's thesis, University of Oulu, 2017. http://urn.fi/URN:NBN:fi:oulu-201711293189.

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The aim of this research is to provide novel approach how to use social media in patient recruitment for clinical trials. This research has been commissioned by a Finland based company Synoste, and is limited to consider the patient recruitment in a medical device start-up with a very limited number of patients. To be able to produce new approach into existing literature, this study has been conducted as a qualitative case study from the perspective of social media agencies and patient recruitment firms. Understanding the factors, such as scarce information about the clinical trials, possible benefits, lack of support by patients and families as well as lack of encouragement to participate by practicing physicians all affect a decision of an individual, whether to participate into a clinical trial or not. Understanding these factors enables to analyze proper social media strategies for patient recruitment. Challenges and benefits of different social media strategies have been discussed in the theoretical part of this study also. Theoretical framework concludes previous literature about the research subject together by focusing on the different aspects of promotion, including channels, content, communication and messages. Theoretical framework created a base for a request for quotation (RFQ), which was used to collect approaches from social media agencies and patient recruitment firms. These companies were selected by searching Finland based marketing companies with a high level of competence about the use of social media. Due to the lack of actual patient recruitment firms in Finland, and to get more comprehensive approach about the overall situation, a few professional patient recruitment firms out of Finland are also included for this study. Empirical analysis follows both abductive and inductive reasoning. The participant companies suggested a wide variation of different strategies for the use of social media in patient recruitment. The right kind of content and advertising, selecting the most suitable channels to reach target group and driving traffic to trial website are important stages when planning the social media strategy for patient recruitment. The main findings of this research indicate that increasing the awareness and targeting, as well as Google advertising can be used as effective methods to recruit patients into clinical trials, when social media is not used as an only strategy for patient recruitment. Due to the fact, that the use of social media misses the establishes practices, there is not a “right way” to use social media in a patient recruitment process.
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Hutchison, Catherine B. « A randomised controlled trial of an audiovisual patient information intervention in cancer clinical trials ». Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/442.

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Introduction and background Recruitment to cancer clinical trials needs to be improved, as does patient understanding about clinical trials, to enable patients to make an informed choice about whether or not to take part. The main reason that clinically eligible patients do not take part in clinical trials is because they refuse; poor understanding of the research has been associated with patient refusal. Audiovisual patient information (AVPI) has been shown to improve knowledge/understanding in various areas of practice but there is limited information about its effect in the cancer clinical trial setting, particularly in relation to recruitment rates. Understanding the research is necessary for informed consent, and it was hypothesised that if patient understanding about clinical trials was increased with AVPI, then this could result in a reduction in the number of patients refusing clinical trials, and therefore provide an ethical approach to improving recruitment. This study aimed to test the impact of an audiovisual patient information intervention on recruitment to randomised cancer clinical trials (refusal rates), patient understanding of the information given, and levels of anxiety. Reasons for patients’ decisions about trial participation were also assessed. Method An AVPI intervention was developed that aimed to address the common misconceptions associated with randomisation and clinical equipoise, as well as improve patient understanding generally of randomised cancer trials, and of other core clinical trial informational requirements, such as voluntariness. Patients were randomised to receive either AVPI in addition to the standard trial-specific written information, or the written information alone. A new questionnaire was developed to assess patient understanding (also referred to as knowledge) in the randomised trial setting and, following testing with patients and research nurses, this was shown to be reliable and valid. Patients completed self-report questionnaires to assess their understanding (new knowledge questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory), at baseline and after they had made their decision about clinical trial entry, when their perceptions of the intervention, as well as factors contributing to their decision were also determined (this tool incorporated Jenkins and Fallowfield’s (2005) questionnaire which assessed reasons for accepting and declining randomised cancer trials). Results A total of 173 patients with breast cancer (65%), colorectal cancer (32%) and lung cancer (3%) were entered into the main study. The median age was 60 (range 37-92 years). There was no difference in clinical trial recruitment rates between the two groups: 72.1% in the AVPI group and 75.9% in the standard information group. The estimated odds ratio for refusal (intervention/no intervention) was 1.19 (95% ci 0.55-2.58, p=0.661). Knowledge scores increased more in the intervention group compared to the standard group (U= 2029, p=0.0072). The change in anxiety score between the arms was also statistically significant (p=0.011) with anxiety improving in the intervention arm more than in the no-intervention arm. The estimated difference in the median anxiety change score between the groups is –4.6 (95% ci –7.0 to –2.0). Clinical trial entry was not influenced by tumour type, stage of cancer, age, educational qualifications or previous research experience, however, there was a modest association with deprivation status (p=0.046) where more affluent patients were the least likely to consent to a trial. Educational qualifications and stage of cancer were independently associated with knowledge: patients who were better educated had higher levels of knowledge about randomised trials, and patients who had limited stage of cancer had higher baseline knowledge than patients with advanced cancer. Acceptability of the intervention was high with 93% of those who watched it finding it useful, and 42% stating that it made them want to take part in the clinical trial. Personal benefit and altruism were key motivating factors for clinical trial participation, with reasons for refusal being less clear. Discussion and conclusions Although the potential for AVPI to increase clinical trial recruitment rates was highlighted in the literature, in this study, AVPI was not shown to have any effect on refusal rates to randomised cancer trials. However, by improving patient understanding prior to decision making, AVPI was shown to be a useful addition to the consent process for randomised cancer trials. AVPI addresses the fundamental ethical challenges of informed consent by improving patient understanding, and supports the ethical framework integral to Faden and Beauchamp’s (1986) theory of informed consent. The new knowledge questionnaire was shown to be a sensitive and effective instrument for measuring understanding of randomised clinical trials in the cancer setting, although it would benefit from further testing. The AVPI appears to reduce anxiety at the decision making time point and has been shown to be an acceptable medium for patients. This study confirms existing findings from studies assessing factors affecting decision making, with personal benefit and altruism being key motivating factors, and reasons for refusal being less clear. The need for further qualitative work in this area is highlighted to gain a deeper understanding of what is important to patients, in terms of why they refuse clinical trial participation. Implications for practice and further research Several implications for practice have been identified, including using AVPI as part of the standard information package for patients considering randomised cancer trials, and focussing on patient and staff education in this area. The knowledge questionnaire could be introduced to routine practice as a tool to determine patient understanding prior to decision making, allowing clinicians the opportunity to correct any misconceptions prior to consent. Further research focussing on AVPI specific to individual trials would be helpful, to determine if a more customised approach would be of benefit in terms of clinical trial recruitment. The importance of studying other aspects of the consent process such as the interaction between the clinician and the patient, in addition to more detailed exploration of the factors affecting patients’ decisions were highlighted.
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Fritzsche, Katrin. « Der Sauerstoffverbrauch der Lunge (VO2pulm) bei Patienten mit Acute Lung Injury (ALI) und Acute Respiratory Distress Syndrome (ARDS) unter mechanischer Beatmung und PEEP-Variation, gemessen als VO2-Differenz zwischen indirekter Kalorimetrie und Berechnung über das inverse Fick´ sche Prinzip ». Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2007. http://nbn-resolving.de/urn:nbn:de:swb:14-1196375360464-83262.

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Bei Patienten mit einem akuten Lungenversagen (ALI oder ARDS) ist der Sauerstoffverbrauch der Lunge (VO2pulm) durch pathophysiologische Prozesse insbesondere die Ausbildung von Atelektasen stark beeinträchtigt. Aufgrund der Annahme, dass eine Steigerung der Anzahl ventilierter Lungenareale zu einer Erhöhung des pulmonalen Sauerstoffverbrauchs führt, haben wir den Einfluss eines definierten Rekrutierungsmanövers (PEEP/PEAK + 10 cmH2O) auf den pulmonalen Sauerstoffverbrauch (VO2pulm), pulmonalen kapillären Blutfluss (PCBF), der den nicht geshunteten Anteil am HZV darstellt, und den transpulmonalen Shunt (Qs/Qt) untersucht. In der vorliegenden Studie wurde der VO2pulm als Differenz zwischen dem Sauerstoffverbrauch des gesamten Körpers, gemessen über die indirekte Kalorimetrie (VO2cal), und dem über das inverse Fick`sche Prinzip errechneten Sauerstoffverbrauch (VO2Fick) bestimmt. Im Rahmen einer klinisch-prospektiven Studie konnten nach Annahme des Studienprotokolls durch die zuständige Ethikkommission 13 beatmete Patienten, welche die Consensus-Kriterien eines ALI oder ARDS erfüllten, eingeschlossen werden. Nach Sicherstellung einer adäquaten Volumensituation und Messung der Ausgangsparameter wurde der PEEP um 10 cmH2O erhöht. Um ein stabiles Atemzugvolumen (VT 6-8 ml/kgKG) und damit gleichbleibende Bedingungen für die alveoläre Ventilation bis auf das von uns durchgeführte Rekrutierungsmanöver zu gewährleisten, wurde zeitgleich der Spitzendruck ebenfalls um 10 cmH2O erhöht. Nach 15 und 60 min wurden die Zieldeterminanten pulmonaler Sauerstoffverbrauch (VO2pulm), PCBF und transpulmonaler Shunt erneut bestimmt. Die Messung der indirekten Kalorimetrie (VO2cal) wurde mit dem Deltatrac TM, MBM 200® durchgeführt, VO2Fick über die Thermodilutionsmethode ermittelt, die partielle CO2-Rückatmungsmethode (David®) zur Bestimmung des PCBF genutzt und der transpulmonale Shunt (Qs/Qt) mittels der Formel nach BERGGREN berechnet. Die statistische Auswertung der Daten erfolgte mittels T-Tests für gepaarte Stichproben. Nach dem Manöver konnte eine signifikante Steigerung des PCBF von 4,44 ± 1,15 l/min auf 5,4 ± 1,68 l/min nach 15 min, respektive 5,12 ± 1,67 l/min nach 60 min nachgewiesen werden (p&lt;0,025). Dieser Anstieg wurde von einer signifikanten Reduktion des transpulmonalen Shunts (Qs/Qt) von 0,24 ± 0,08 auf 0,16 ± 0,07 nach 15 min und 0,16 ± 0,07 nach 60 min begleitet (p&lt;0,005). Diese Veränderungen der pulmonalen Hämodynamik gehen mit statistisch relevanten Verbesserungen der Oxygenierung sowie der Atemmechanik einher. Eine signifikante Steigerung des pulmonalen Sauerstoffverbrauchs konnte für die gesamte Studienpopulation nicht festgestellt werden. In dieser Untersuchung steigt der Sauerstoffverbrauch der Lunge deskriptiv von baseline 10,1 +/- 30,59 ml/min über 11,42 +/- 27,42 ml/min nach 15 min, respektive auf 28,69 +/- 56,75 ml/min nach 60 min an. Die signifikante Steigerung des pulmonal-kapillären Blutflusses und die konsekutive Reduktion des transpulmonalen Shunts schon 15 min nach dem Manöver impliziert einen Anstieg der an der alveolären Ventilation teilnehmenden alveolokapillären Einheiten, was einer Rekrutierung von vorher atelektatischen Lungenabschnitten entspricht. Insbesondere bei ARDS-Patienten und Respondern konnten Rekrutierungs-induzierte Veränderungen detektiert werden, wohingegen die Patienten mit ALI oder Nonresponder keinerlei statistische Unterschiede während der Intervention zeigten. Trotz stattgefundener Wiederbelüftung von Atelektasen konnte ein statistisch relevanter Unterschied bezüglich des pulmonalen Sauerstoffverbrauchs durch das Rekrutierungsmanöver für die gesamte Studienpopulation nicht festgestellt werden.
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Livres sur le sujet "Patients recruitment"

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A, Cramer Joyce, dir. Patient recruitment in clinical trials. New York : Raven Press, 1992.

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A, Cramer Joyce, dir. Patient recruitment in clinical trials. New York : Raven Press, 1996.

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Research, Institute of Clinical, dir. Patient recruitment in clinical research : A guide to Europe. Marlow : Institute of Clinical Research, 2005.

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A, Brescia Bonnie, dir. Reinventing patient recruitment : Revolutionary ideas for clinical trial success. Aldershot, Hampshire, England : Gower, 2006.

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Diana L., Ph.D. Anderson. A Guide to Patient Recruitment and Retention. Thomson CenterWatch, 2004.

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Bachenheimer, Joan F., et Bonnie A. Brescia. Reinventing Patient Recruitment : Revolutionary Ideas for Clinical Trial Success. Taylor & Francis Group, 2017.

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Diana L., Ph.D. Anderson. A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies. CenterWatch, 2001.

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Bachenheimer, Joan F., et Bonnie A. Brescia. Reinventing Patient Recruitment : Revolutionary Ideas for Clinical Trial Success. Taylor & Francis Group, 2017.

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Bachenheimer, Joan F., et Bonnie A. Brescia. Reinventing Patient Recruitment : Revolutionary Ideas for Clinical Trials Success. Ashgate Publishing, 2007.

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Bachenheimer, Joan F., et Bonnie A. Brescia. Reinventing Patient Recruitment : Revolutionary Ideas for Clinical Trial Success. Taylor & Francis Group, 2017.

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Chapitres de livres sur le sujet "Patients recruitment"

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Probstfield, Jeffrey L., William B. Applegate, J. David Curb, Nemat O. Borhani, C. Morton Hawkins, Jeffrey A. Cutler, Barry R. Davis et al. « The Systolic Hypertension in the Elderly Program (SHEP) : Rationale, Design, Recruitment, and Baseline Data ». Dans How Should Elderly Hypertensive Patients Be Treated ?, 135–42. Tokyo : Springer Japan, 1989. http://dx.doi.org/10.1007/978-4-431-68340-7_11.

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Ball, Lorenzo, Noemi Baretta, Simone Bazurro et Paolo Pelosi. « Chest Sonography to Assess Lung Recruitment in Patients with Acute Respiratory Distress Syndrome ». Dans Thoracic Ultrasound and Integrated Imaging, 241–45. Cham : Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-319-93055-8_15.

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Lovas, A., et Z. Molnár. « Alveolar Recruitment in Patients with Assisted Ventilation : Open Up the Lung in Spontaneous Breathing ». Dans Annual Update in Intensive Care and Emergency Medicine 2018, 205–15. Cham : Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-73670-9_17.

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van der Zee, P., et D. Gommers. « Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS ». Dans Annual Update in Intensive Care and Emergency Medicine 2019, 59–69. Cham : Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-06067-1_5.

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Minois, Nathan, Guillaume Mijoule, Stéphanie Savy, Valérie Lauwers-Cances, Sandrine Andrieu et Nicolas Savy. « Performances of Poisson–Gamma Model for Patients’ Recruitment in Clinical Trials When There Are Pauses in Recruitment or When the Number of Centres is Small ». Dans Statistics and Simulation, 285–99. Cham : Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-76035-3_20.

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Ting, George O., Rosemary E. Leitch et Michaelene Ouwendyk. « Patient Recruitment and Selection ». Dans Contributions to Nephrology, 29–38. Basel : KARGER, 2004. http://dx.doi.org/10.1159/000081649.

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Vermillion, Krista K. « Clinical Trials, Patient Recruitment and Advertising ». Dans Learning from Disease in Pets, 209–24. Boca Raton : Taylor & Francis, 2020. | Series : CRC one health one welfare : CRC Press, 2020. http://dx.doi.org/10.1201/9780429056178-11.

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Moghanaki, Drew, et Tomer Z. Karas. « Patient Recruitment and Retention in Procedural Trials ». Dans Clinical Trials Design in Operative and Non Operative Invasive Procedures, 259–67. Cham : Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-53877-8_30.

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He, Weili, et Xiting Cao. « Approaches for Patient Recruitment Modeling and Simulation ». Dans Practical Considerations for Adaptive Trial Design and Implementation, 299–318. New York, NY : Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1100-4_16.

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Busse, O., B. Müffelmann, J. Glahn et S. Kunz. « Strategies of Early Patient Recruitment : A Community-Based Study ». Dans Thrombolytic Therapy in Acute Ischemic Stroke III, 124–29. Tokyo : Springer Japan, 1995. http://dx.doi.org/10.1007/978-4-431-68459-6_15.

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Actes de conférences sur le sujet "Patients recruitment"

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Payne, Katie, Natasha Carroll et Katherine Miles. « 66 Increasing recruitment to GOSH sample bank ». Dans GOSH Conference 2020 – Our People, Our Patients, Our Hospital. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2020. http://dx.doi.org/10.1136/archdischild-2020-gosh.66.

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Borges, Guilherme Ferreira, Hélio Rubens de Carvalho Nunes, Gustavo José Luvizutto, Taís Regina da Silva et Rodrigo Bazan. « Lessons of a multicenter noninvasive brain stimulation trial in patients with unilateral spatial neglect after stroke : barriers to trial participation from a developing country ». Dans XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.482.

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Background: There is a high demand for stroke rehabilitation in the Brazilian public health system, however most studies that addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in highincome countries. Objectives: Analyze the USN patient recruitment in a multicenter non-invasive brain stimulation clinical trial performed in Brazil. Design and setting: Observation study of reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial performed at Botucatu Medical School. Methods: We evaluated reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Results: 173 of 1956 potential neglect patients (8.8%) passed initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to exclusion of 21/87 patients (24.1%). Low socioeconomic status led to exclusion of 37/173 patients (21.4%). Difficulty in transportation to access treatment was the most common reason (16/37 patients, 43.3%). Conclusions: The analyzed Brazilian institutions have potential for conducting studies in USN. Recruitment of stroke survivors with USN was restricted by the study design and limited financial support. Cognitive impairment, presence of stent or craniectomy and lack of transportation was the most common barriers to participate in a multicenter non-invasive brain stimulation trial in patients with unilateral spatial neglect after stroke.
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Puukila, S., T. Bouchier, C. G. De Pasquale, A. D. Bersten, A. Nemec-Bakk et D. L. Dixon. « Macrophage Recruitment Mediators in the Lung of Chronic Heart Failure Patients ». Dans American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3407.

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Margret Sharmila, F., P. Tharun Kumar, G. Darvin Arockia Dass et S. Subramanian. « An Online Recruitment of Clinicians and Appointment of Patients using Mobile Application ». Dans 2021 Third International Conference on Intelligent Communication Technologies and Virtual Mobile Networks (ICICV). IEEE, 2021. http://dx.doi.org/10.1109/icicv50876.2021.9388565.

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Schranz, Christoph, Jorn Kretschmer et Knut Moller. « Hierarchical individualization of a recruitment model with a viscoelastic component for ARDS patients ». Dans 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). IEEE, 2013. http://dx.doi.org/10.1109/embc.2013.6610725.

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Digby, Genevieve C., Christine L. D'Arsigny, Andrew J. Samis, Ramiro J. Arellano, Glorianne V. Ropchan et Christopher M. Parker. « Hemodynamic Responses To Lung Volume Recruitment Maneuvers In Post-Operative Cardiac Surgery Patients ». Dans American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado. American Thoracic Society, 2011. http://dx.doi.org/10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4747.

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Joubert, Richard, Moehler Thomas et Ulrich Raeth. « Abstract 5014 : Analysis of recruitment of patients into clinical trials for colorectal cancer ». Dans Proceedings : AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011 ; Orlando, FL. American Association for Cancer Research, 2011. http://dx.doi.org/10.1158/1538-7445.am2011-5014.

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Stamp, Gregory FW, Samuel P. Dearman, Lynsey Brown et Matt Philips. « 64 The impact of targeted enhanced recruitment (TERS) : benefiting trainees, trusts and patients ». Dans Leaders in Healthcare 2021. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/leader-2021-fmlm.64.

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Brooks, CF, CB Matheson-Monnet et A. Argyropoulos. « P32 Using social media as a recruitment strategy to recruit patients, GPs and pharmacists ». Dans Crafting the future of qualitative health research in a changing world abstracts. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/bmjopen-2019-qhrn.66.

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Joubert, Richard, Stefanella Bortini, Ulrich Raeth et Thomas Moehler. « Abstract 5522 : Analysis of recruitment of non small cell lung cancer patients into clinical trials ». Dans Proceedings : AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012 ; Chicago, IL. American Association for Cancer Research, 2012. http://dx.doi.org/10.1158/1538-7445.am2012-5522.

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Rapports d'organisations sur le sujet "Patients recruitment"

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Brown, Candace, Chudney Williams, Ryan Stephens, Jacqueline Sharp, Bobby Bellflower et Martinus Zeeman. Medicated-Assisted Treatment and 12-Step Programs : Evaluating the Referral Process. University of Tennessee Health Science Center, novembre 2021. http://dx.doi.org/10.21007/con.dnp.2021.0013.

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Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT. Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected from a database before project implementation. Eligible participants were diagnosed with OUD, receiving buprenorphine (opiate agonist), and at least 18. Participants were provided with temporary sponsors to attend Narcotics Anonymous, Alcoholics Anonymous, and Medication-Assisted Recovery meetings together. The primary endpoint was the change in positive opiate urine drug screens over 6 months between participants and controls. Results Between March 29, 2021, and April 16, 2021, 166 patients were scheduled at the clinic. Of those scheduled, 146 were established patients, and 123 were scheduled for face-to-face visits. Of these, 64 appeared for the appointment, 6 were screened, and 3 were enrolled. None of the participants attended a 12-step meeting. Enrollment barriers included excluding new patients and those attending virtual visits, the high percentage of patients who missed appointments, and lack of staff referrals. The low incidence of referrals was due to time constraints by both staff and patients. Implications for Nursing Practice Low enrollment limited our ability to determine whether combining medication management with a 12-step program improves abstinence. Failure to keep appointments is common among patients with OUD, and virtual meetings are becoming more prevalent post-COVID. Although these factors are unlikely to be controllable, developing strategies to expedite the enrollment process for staff and patients could hasten recruitment.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust et Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations : Investigating effectiveness and screening program implementation considerations : An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, octobre 2019. http://dx.doi.org/10.57022/clzt5093.

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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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