How Much Is the Lack of Retention Evidence Costing Trial Teams in Ireland and the United Kingdom?

Abstract BackgroundEvidence to support the use of many retention strategies in clinical trials is lacking. Despite this, trial teams still need to have some form of retention strategy in their trials to try and avoid high attrition rates. This study aimed to estimate how much this lack of retention evidence might be costing trials in Ireland and the United Kingdom.Methods We selected the top ten most routinely used retention strategies by Clinical Trial Units in the United Kingdom and made assumptions as to how each of these strategies was most likely to be conducted and the costs involved. We applied our costing model to a hypothetical trial scenario in both Ireland and the United Kingdom as well as to three published trial protocols. We developed the costing model and calculated the costs in Microsoft Excel.Results Retention strategies can be extremely expensive, some of the costliest interventions included “a timeline of participant visits for sites” (with integrated participant reminders) (€1,418.44 - €108,471.99), “routine site visits by CTU staff” (€777.67 - €14,753.48), and “data collection scheduled with routine care” (€900 - €32,503.25). Others such as “telephone reminders for questionnaire response” (€34.58 - €568.62), “inclusion of pre-paid envelopes” (€93.44 - €942.50), and “targeted recruitment of sites/GPs” (€30 - €1,620) were less costly compared to the other interventions. DiscussionThe resources invested in the use of some retention interventions may outweigh known or imagined benefits on retention. Where benefits are imagined, evaluation should be a priority. Conclusion More evaluation of the effectiveness and cost of trial retention strategies is needed to avoid widespread use of strategies that are both expensive and ineffective.

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Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH)

10.1101/2021.09.16.21263629 ◽

2021 ◽

Author(s):

Christopher A Martin ◽

Daniel Pan ◽

Joshua Nazareth ◽

Avinash Aujayeb ◽

Luke Bryant ◽

...

Keyword(s):

Cohort Study ◽

United Kingdom ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Secondary Analysis ◽

Protective Equipment ◽

Primary Analysis ◽

Questionnaire Response ◽

The United Kingdom ◽

The Uk

Abstract Objectives: To determine the prevalence and predictors of self-reported access to appropriate personal protective equipment (aPPE) for healthcare workers (HCWs) in the United Kingdom (UK) during the first UK national COVID-19 lockdown (March 2020) and at the time of questionnaire response (December 2020 - February 2021). Design: Two cross sectional analyses using data from a questionnaire-based cohort study. Setting: Nationwide questionnaire from 4th December 2020 to 28th February 2021. Participants: A representative sample of HCWs or ancillary workers in a UK healthcare setting aged 16 or over, registered with one of seven main UK healthcare regulatory bodies. Main outcome measure: Binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK (primary analysis) and at the time of questionnaire response (secondary analysis). Results: 10,508 HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 3702 (35.2%) of HCWs reported aPPE at all times in the primary analysis; 6806 (83.9%) reported aPPE at all times in the secondary analysis. After adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector, work region, working hours, night shift frequency and trust in employing organisation), older HCWs (per decade increase in age: aOR 1.2, 95% CI 1.16 - 1.26, p<0.001) and those working in Intensive Care Units (1.61, 1.38 - 1.89, p<0.001) were more likely to report aPPE at all times. Those from Asian ethnic groups compared to White (0.77, 0.67 - 0.89, p<0.001), those in allied health professional (AHPs) and dental roles (vs those in medical roles; AHPs: 0.77, 0.68 - 0.87, p<0.001; dental: 0.63, 0.49 - 0.81, p<0.001), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥21 patients 0.74, 0.61 - 0.90, p=0.003) were less likely to report aPPE at all times in the primary analysis. aPPE at all times was also not uniform across UK regions (reported access being better in South West and North East England than London). Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times (2.18, 1.97 - 2.40, p<0.001). With the exception of occupation, these factors were also significantly associated with aPPE at all times in the secondary analysis. Conclusions: We found that only a third of HCWs in the UK reported aPPE at all times during the period of the first lockdown and that aPPE had improved later in the pandemic. We also identified key sociodemographic and occupational determinants of aPPE during the first UK lockdown, the majority of which have persisted since lockdown was eased. These findings have important public health implications for HCWs, particularly as cases of infection and long-COVID continue to rise in the UK.

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SAT0198 Drug survival and efficacy of abatacept in rheumatoid arthritis patients in routine care – 7 year experience from a single centre in the united kingdom

10.1136/annrheumdis-2018-eular.5716 ◽

2018 ◽

Author(s):

N. Nolkha ◽

T. Sheeran ◽

S. Venkatachalam

Keyword(s):

Rheumatoid Arthritis ◽

United Kingdom ◽

Routine Care ◽

Single Centre ◽

Drug Survival ◽

The United Kingdom

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Remediation of the Site of a Former Active Handling Building in the United Kingdom

ASME 2009 12th International Conference on Environmental Remediation and Radioactive Waste Management, Volume 2 ◽

10.1115/icem2009-16041 ◽

2009 ◽

Author(s):

J. Armitage ◽

R. M. Cornell ◽

A. Staples

Keyword(s):

United Kingdom ◽

Radioactive Contamination ◽

Assessment Tools ◽

Microsoft Excel ◽

System A ◽

The United Kingdom ◽

Set Up ◽

The Uk ◽

Regulatory Controls ◽

The Impact

In 2000, Nuvia Limited was contracted to carry out the decommissioning of a former Active Handling Building A59 on the United Kingdom Atomic Energy Authority (UKAEA) site at Winfrith in the UK. This is in support of UKAEA’s mission, which is to carry out environmental restoration of its nuclear sites and to put them to alternative uses wherever possible. Recently UKAEA has been reorganised and responsibility for the site lies with Research Sites Restoration Limited (RSRL) with funding provided by the National Decommissioning Authority (NDA). Following major decommissioning operations the main containment building structure and the two suites of concrete shielded caves were demolished between June 2006 and March 2007 leaving just the base slab for final removal and the site remediation operations undertaken. The base slab contained a quantity of encast, internally contaminated items including more than 100 steel mortuary tubes set up to 6.6m deep into the slab. At the outset it was suspected that some leakage of radioactive contamination had occurred into the ground although the precise location/s of the leakage was unknown. As a result the scope of the work required the underlying soil to be carefully monitored for the presence of radioactive contamination and, if detected, its remediation to an end state suitable for unrestricted use without planning or nuclear regulatory controls. These latter operations form the basis of this paper, which reviews some of the significant tasks undertaken during the process and describes the waste monitoring procedures utilised on the concrete and soil debris. Extensive dewatering was required to support the removal of the deeper mortuary tubes and the impact this had upon the operations and associated excavations will be described. Further, the demolition of an external active effluent tank and excavation and monitoring of the surrounding soils due to the presence of significant local contamination will be a key feature of the paper. A number of significant problems that were encountered during the operations will also be identified with a narrative about how these arose and were subsequently overcome. The use of Nuvia’s Groundhog™ system, a gamma radiation ground surveying and global positioning system, together with a well defined sampling grid enabled the footprint of the base slab to be surveyed and subsequently remediated to an agreed standard by the end of 2008 to allow infilling with non-calcareous soil ahead of final landscaping as the last step for completion of the project. One area of particular significance to the remediation process has been the use of office-based contaminated land assessment tools including ReCLAIM, a Microsoft Excel spreadsheet based tool used to assess current and future impacts of radiological contamination at nuclear licensed sites. This tool is particularly recommended to others working on similar projects.

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Physical Therapists’ Use of Therapeutic Exercise for Patients With Clinical Knee Osteoarthritis in the United Kingdom: In Line With Current Recommendations?

Physical Therapy ◽

10.2522/ptj.20080077 ◽

2008 ◽

Vol 88 (10) ◽

pp. 1109-1121 ◽

Cited By ~ 54

Author(s):

Melanie A Holden ◽

Elaine E Nicholls ◽

Elaine M Hay ◽

Nadine E Foster

Keyword(s):

United Kingdom ◽

Knee Osteoarthritis ◽

Physical Therapists ◽

Exercise Adherence ◽

Therapeutic Exercise ◽

Cross Sectional Survey ◽

Questionnaire Response ◽

Clinical Behavior ◽

Knee Oa ◽

The United Kingdom

Background and Purpose Physical therapists have an important role in the management of clinical knee osteoarthritis (OA) through designing and supervising exercise programs. This study explored whether their current use of therapeutic exercise for patients with this condition is in line with recent recommendations. Subjects and Methods A cross-sectional survey was conducted with a random sample of chartered (licensed) physical therapists (N=2,000) practicing in the United Kingdom. This survey included a vignette describing a patient with clinical knee OA as well as clinical management questions relating to the respondents’ use of therapeutic exercise. Results The questionnaire response rate was 58% (n=1,152), with 538 respondents stating they had treated a patient with clinical knee OA in the preceding 6 months. In line with recent recommendations, 99% of the physical therapists stated they would use therapeutic exercise for this patient population, although strengthening exercises were favored over aerobic exercises. Although nearly all physical therapists would monitor exercise adherence, only 12% would use an exercise diary. Seventy-six percent of physical therapists would provide up to 5 treatment sessions, and only 34% would offer physical therapy follow-up after discharge. Discussion and Conclusions The measure of physical therapists’ current clinical practice was self-reported clinical behavior on the basis of a vignette. Although this is a valid measure of clinical behavior, in practice, physical therapists may use therapeutic exercise differently. There are disparities between physical therapists’ current use of therapeutic exercise for clinical knee OA and recent recommendations. Identifying potential ways to overcome these disparities is an important step toward optimizing the outcome from therapeutic exercise for patients with clinical knee OA.

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