The impact of conducting preclinical systematic reviews on researchers and their research: A mixed method case study.

BACKGROUND: Systematic reviews (SRs) are cornerstones of evidence-based medicine and have contributed significantly to breakthroughs since the 1980's. However, preclinical SRs remain relatively rare despite their many advantages. Since 2011 the Dutch health funding organisation (ZonMw) has run a grant scheme dedicated to promoting the training, coaching and conduct of preclinical SRs. Our study focuses on this funding scheme to investigate the relevance, effects and benefits of conducting preclinical SRs on researchers and their research. METHODS: We recruited researchers who attended funded preclinical SR workshops and who conducted, are still conducting, or prematurely stopped a SR with funded coaching. We gathered data using online questionnaires followed by semi-structured interviews. Both aimed to explore the impact of conducting a SR on researchers' subsequent work, attitudes, and views about their research field. Data-analysis was performed using Excel and ATLAS.ti. RESULTS: Conducting preclinical SRs had two distinct types of impact. First, the researchers acquired new skills and insights, leading to a change in mindset regarding the quality of animal research. This was mainly seen in the way participants planned, conducted and reported their subsequent animal studies, which were more transparent and of a higher quality than their previous work. Second, participants were eager to share their newly acquired knowledge within their laboratories and to advocate for change within their research teams and fields of interest. In particular, they emphasised the need for preclinical SRs and improved experimental design within preclinical research, promoting these through education and published opinion papers. CONCLUSION: Being trained and coached in the conduct of preclinical SRs appears to be a contributing factor to many beneficial changes which will impact the quality of preclinical research in the long-term. Our findings suggest that this ZonMw funding scheme is helpful in improving the quality and transparency of preclinical research. Similar funding schemes should be encouraged, preferably by a broader group of funders or financers, in the future.

Recovering the Relational Starting Point of Compassion Training: A Foundation for Sustainable and Inclusive Care.

The cultivation of compassion through meditation training is of increasing interest to scientists, health-care providers, educators, and policymakers as an approach to help address challenging personal and social issues. Yet people encounter critical inner psychological barriers to compassion that limit the effectiveness of compassion training-including the lack of a secure base, aversion to suffering, feeling alone in suffering, and reductive impressions of others. These barriers emerge, in part, from a lack of relational support and are exacerbated by modernist conceptions that present meditation as an autonomous, self-help practice. This article proposes a solution centered on relationality that is derived from the integration of diverse areas of psychology with contemplative traditions. Theories and findings from social, developmental, and health psychology can inform meditation programs and help recover important relational elements of compassion training from traditional cultures that address common barriers to compassion and thus promote more sustainable and inclusive care. In so doing, this article illustrates the value of psychological theories for translating important contextual elements from contemplative traditions into diverse modern settings.

Building towards common psychosocial measures in U.S. cohort studies: principal investigators' views regarding the role of religiosity and spirituality in human health.

BACKGROUND: The goal of this study was to understand prospective cohort study Principal Investigators' (PIs') attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research. METHODS: One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation. RESULTS: The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of religiosity. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates for the outcome under study; (2) studies that posit a plausible biological mechanism of effect; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research among investigators; and (5) NIH funding for R/S research. CONCLUSIONS: Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide new leverage points for reducing health disparities.

Practitioner Engagement by Academic Researchers: A Scoping Review of Nursing, Midwifery, and Therapy Professions Literature.

BACKGROUND: Engagement of frontline practitioners by academic researchers in the research process is believed to afford benefits toward closing the research practice gap. However, little is known about if and how academic researchers engage nurses, midwives, or therapists in research activities or if evidence supports these claims of positive impact. METHOD: A scoping review was undertaken using the Arksey and O'Malley (2005) framework to identify the extent to which this phenomenon has been considered in the literature. RESULTS: An iterative search carried out in CINAHL, Pubmed, Medline, and Embase retrieved 32 relevant papers published 2000 to 2017, with the majority from the last 2-years. Retained papers described or evaluated active engagement of a practitioner from nursing, midwifery, and therapy disciplines in at least one stage of a research project other than as a study participant. Engagement most often took place in one research activity with few examples of engagement throughout the research process. Limited use of theory and variations in terms used to describe practitioner engagement by researchers was observed. Subjective perspectives of practitioners' experiences and a focus on challenges and benefits were the most prominently reported outcomes. Few attempts were found to establish effects which could support claims that practitioner engagement can enhance the use of findings or impact health outcomes. CONCLUSION: It is recommended that a culture of practitioner engagement is cultivated by developing guiding theory, establishing consistent terminology, and building an evidence base through empirical evaluations which provide objective data to support claims that this activity can positively influence the research practice gap.

Discordant attitudes and beliefs about cancer clinical trial participation between physicians, research staff, and cancer patients.

BACKGROUND/AIMS: Essential to bringing innovative cancer treatments to patients is voluntary participation in clinical trials but approximately 8% of American cancer patients are enrolled onto a trial. We used a domain-oriented framework to assess barriers to cancer clinical trial enrollment. METHODS: Physicians (MD, DO, fellows, residents) and research staff (physician assistants, nurse practitioners, staff and research nurses, clinical assistants, and program coordinators) involved in clinical research at a comprehensive cancer center completed an online survey in 2017; adult cancer patients not currently enrolled in a trial were interviewed in 2018. To inform the construct of our physician/staff and patient surveys and to assess barriers to clinical trial enrollment, we first conducted in-depth interviews among 14 key informants representing medical, hematologic, gynecologic, neurologic, radiation oncology, as well as members of the clinical research team (one clinical research coordinator, one research nurse practitioner). Perceived structural, provider- and patient-level barriers to clinical trial enrollment were assessed. Differences in perceptions, attitudes, and beliefs toward clinical trial enrollment between (1) physicians and staff, (2) patients by ethnicity, and (3) physicians/staff and patients were examined. RESULTS: In total, 120 physicians/staff involved in clinical research (39.2% physicians, 60.8% staff; 48.0% overall response rate) and 150 cancer patients completed surveys. Nearly three-quarters of physician/staff respondents reported difficulty in keeping track of the eligibility criteria for open studies but was more often cited by physicians than staff (84.4% vs 64.3%, p = 0.02). Physicians more often reported lack of time to present clinical trial information than did staff(p < 0.001); 44.0% of staff versus 18.2% of physicians reported patient family interaction as a clinical trial enrollment barrier (p = 0.007). Hispanic patients more often stated they would join a trial, even if standard therapy was an option compared to non-Hispanic patients (47.7% vs 20.8%, p = 0.002). Comparing the beliefs and perceptions of physicians/staff to those of patients, patients more often reported negative beliefs about clinical trial enrollment (e.g. being in a trial does not help patients personally, 32.9% vs 1.8%, p < 0.001) but less often felt they had no other options when agreeing to join (38.1% vs 85.6%, p < 0.001), and less often refused clinical trial enrollment due to lack of understanding (9.1% vs 63.3%, p = 0.001) than reported by physicians/staff. CONCLUSION: Our findings indicate a wide gap between physician/staff and patient attitudes and beliefs about clinical trial enrollment and highlight the importance of focusing future initiatives to raise awareness of this incongruency. Reconciling these differences will require tailored education to reduce implicit biases and dispel misperceptions. Strategies to improve the quality of patient-provider communication and address infrastructure and resource issues are also needed to improve patient enrollment onto cancer clinical trials.

Using a 'rich picture' to facilitate systems thinking in research coproduction.

BACKGROUND: In coproduction research, traditional 'end-users' are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold diverse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate divergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a 'rich picture' in a coproduction project with policy-level partners. METHODS: Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system's users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. RESULTS: Guided by provocative questions, participants discussed and challenged each other's thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. CONCLUSION: In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.

Allegiance effects in mindfulness-based interventions for psychiatric disorders: A meta-re-analysis.

Objectives: A recent meta-analysis reported that mindfulness-based interventions (MBIs) outperform specific active control conditions but not evidence-based treatments (EBTs) across various psychiatric conditions. Given both comparison conditions represent bona fide treatments, the superiority of MBIs over other bona fide treatments is unexpected. The current study examined researcher allegiance (RA) as a potential source of bias that may explain this result. Method: All studies from the original meta-analysis that compared MBIs with bona fide psychological treatments were included. RA was independently coded using established methods. A series of meta-analyses examined the RA-outcome association and the degree to which RA may account for the effect of EBT status. Results: Sixty independent comparisons (n = 5,627) were included. MBIs outperformed bona fide treatment comparisons overall (g = 0.13), but effects were smaller with EBT comparisons. RA towards MBIs was associated with larger effects. No evidence for superiority of MBIs was found when RA was absent or balanced. Further, EBT status no longer predicted effects when controlling for RA. Conclusions: RA appears to be a potential source of bias in MBI research that should be considered when interpreting existing studies (clinical trials, meta-analyses) and planning future studies. RA may account for smaller effects when using EBT comparisons.

Understanding the unintended consequences of public health policies: the views of policymakers and evaluators.

BACKGROUND: Public health policies sometimes have unexpected effects. Understanding how policies and interventions lead to outcomes is essential if policymakers and researchers are to intervene effectively and reduce harmful and other unintended consequences (UCs) of their actions. Yet, evaluating complex mechanisms and outcomes is challenging, even before considering how to predict assess and understand outcomes and UCs when interventions are scaled up. We aimed to explore with UK policymakers why some policies have UCs, and how researchers and policymakers should respond. METHODS: We convened a one-day workshop with 14 people involved in developing, implementing or evaluating social and public health policies, and/or evaluating possible unintended effects. This included senior evaluators, policymakers from government and associated agencies, and researchers, covering policy domains from public health, social policy, poverty, and international development. RESULTS: Policymakers suggested UCs happen for a range of reasons: poor policy design, unclear articulation of policy mechanisms or goals, or unclear or inappropriate evidence use, including evaluation techniques. While not always avoidable, it was felt that UCs could be partially mitigated by better use of theory and evidence, better involvement of stakeholders in concurrent design and evaluation of policies, and appropriate evaluation systems. CONCLUSIONS: UCs can be used to explore the mechanisms underpinning social change caused by public health policies. Articulating these mechanisms is essential for truly evidence-informed decision-making, to enable informed debate about policy options, and to develop evaluation techniques. Future work includes trying to develop a holistic stakeholder-led evaluation process.

Perspectives on gender parity in bioanalysis: an interview with Michael R Borenstein.

Biography MR Borenstein is Senior Associate Dean of Operations for Temple University School of Pharmacy, Associate Professor of Medicinal Chemistry, Director of the Office of Continuing Professional Education and Director of the Admissions Committee for the PharmD program. He formally served as Chair of the Department of Pharmaceutical Sciences. He is a registered pharmacist licensed to practice in Pennsylvania. His teaching responsibilities include biochemistry and medicinal chemistry. At the graduate level, he developed and taught pharmaceutical analysis and practical chromatography. His area of expertise and research involves the development of analytical techniques to investigate drug disposition in various biologic matrices and novel support materials for chromatography. He received a BA in liberal arts, a BS in pharmacy and a PhD in medicinal chemistry all from Temple University. He completed postdoctoral studies in neuropharmacology and neurochemistry at Hahnemann School of Medicine (now Drexel University) and at Temple University's Department of Chemistry.

Spirituality in Aotearoa, New Zealand: Personal Reflections From a Spirituality in Health Care Researcher.

Spirituality is about what is of utmost value; it is a values lens that asks "what really matters most to me, my family, our community, our country, and our world." This personal reflection comes from a New Zealand academic who works in the spirituality and health care research field. Although largely biographical, this reflection offers some insight into the New Zealand context and this emergent field.

Secondary trauma among trauma researchers: Lessons from the field.

OBJECTIVE: There is a substantial body of research that indicates that professionals treating traumatized clients or patients may suffer from burnout, compassion fatigue, vicarious trauma, or secondary traumatic stress and that those who are most empathic are most vulnerable. However, there is limited research on the effects of participant trauma on trauma researchers. This is the focus of the current study. METHOD: Drawing on case illustrations from a large trauma-related study, we demonstrate the effects of participant trauma on trauma interviewers. RESULTS: The experiences of fieldworkers in this study often mirror the syndromes found among "flooded" therapists, suggesting that it is the listening, and not so much the purpose for which one is listening, that can result in trauma-by-proxy. CONCLUSION: Recommendations: Ethics applications should include a provision for the proper care for trauma researchers, who may, without support, develop symptoms of secondary traumatic stress. Training and regular supervision should become a mandatory part of trauma research practice, and if trauma levels are high, the principal researcher may need to invite a trauma counselor to do debriefing. In contexts where trauma levels are as high as in South Africa, fieldworkers are entitled to debriefing by an appropriately trained professional. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Participation in research improves overall patient management: insights from the Global Rheumatic Heart Disease registry (REMEDY).

BACKGROUND: Rheumatic heart disease (RHD) is a major public health problem in low- and middle-income countries (LIMCs), with a paucity of high-quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined. AIM: The purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi-centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012. METHOD: We conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site. RESULTS: The majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow-up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling. CONCLUSION: Our study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers' knowledge and efficiency in caring for RHD patients.

Great expectations: An analysis of researchers' and policy makers' perceptions of the potential value of the Australian indigenous burden of disease study for policy.

The "Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples" was commissioned by the Australian government as part of the Australian Burden of Disease study. This paper explores the extent to which key actors in the research and policy communities expected the Indigenous Burden of Disease study's findings to inform, influence, or drive federal decisions concerning Indigenous health in Australia. This qualitative research undertook interviews with 13 key informants with significant involvement in the Indigenous Burden of Disease study: six researchers, five policy makers, and two knowledge brokers. Interviews were recorded, transcribed, and analyzed, and the findings were triangulated with a review of the literature. Policy makers and researchers anticipated that the Indigenous Burden of Disease study would improve the available information for policy deliberations about Indigenous health. Beyond that, their expectations about its policy influence differed substantially, with researchers more confident of the study's capacity to guide health priorities, and policy makers situating findings in the context of other critical inputs. Expectations of policy influence are shaped by the disciplinary perspectives of actors, and their relationship to policy outcomes and cannot be examined without also considering the policy, political, and financing context of the study being analyzed.

Reflections: Spirituality and Cancer Researchers.

Spirituality is increasingly acknowledged as an essential element to consider within care for cancer and other chronic health conditions. As our colleagues in frontline healthcare roles integrate these concepts into their professional practice, it seems timely for the cancer research community to reflect on the place of spirituality within our work. This reflections article discusses challenges and opportunities for researchers considering spirituality in their own work roles and within broader discussions about health needs, care and research agendas.