Do I have enough time? The impact of recruiting patients to a randomised controlled trial at recruiting centres.

INTRODUCTION: This paper explores the impact of recruiting patients to a randomised controlled trial (RCT) at recruiting centres. This large multicentre RCT examining the efficacy of chewing gum compared to ibuprofen in the relief of orthodontic pain was carried out across nine recruiting centres. METHOD: The work diaries of clinicians and supporting staff at recruiting centres were analysed over a four-month period from September to December 2011. This quantified the amount of clinical and non-clinical time spent on research duties. RESULTS: Over this time period 98 patients were recruited across seven trial sites. On average, patient recruitment had a direct clinical impact of 19 minutes per patient recruited. The time commitment on trial administration outside the clinical sessions was much higher, averaging at 110 minutes per patient recruited, giving the overall time spent on the trial 129 minutes per patient. CONCLUSIONS: This information will be valuable to lead researchers when calculating the full economic cost of a proposed clinical trial and therefore when applying for grant funding. It may also be valuable to clinicians and their managers when considering becoming a principle investigator (PI) in a RCT. Although the impact on clinical time was 19 minutes per patient recruited, there is a considerably higher (almost six times greater) time commitment in administration around the recruitment of patients.

Anxiety levels, patient satisfaction and failed appointment rate in anxious patients referred by general practitioners to a dental hospital unit.

OBJECTIVE: To reduce the high failed appointment rate and anxiety levels among previously identified anxious new patients referred by general practitioners to a unit of restorative dentistry. A letter was drawn up which contained more explanatory information about the purpose and content of the initial dental appointment. DESIGN: The study was a single centre, double blind trial. SETTING: Referrals of nervous/anxious patients from general practitioners to the Manchester Dental Hospital. SUBJECTS: 185 patients were randomly allocated to the control group (n = 94) who received the standard hospital appointment information and the experimental group (n = 91) who received the new more informative letter. MAIN OUTCOME MEASURES: The effect of the new letter on patient attendance was recorded and anxiety levels were measured before and after seeing the clinician. RESULTS: 70 patients attended from the control group and 58 patients from the experimental group, giving 59 and 44 fully completed forms respectively. Both groups of patients were generally happy with the information that they were given. The attendance of patients in the experimental group and the control group were not significantly different. Preconsultation state anxiety levels were not reduced in the experimental group by the provision of the additional information but after the consultation both groups showed a significant reduction in state anxiety (P < 0.001). CONCLUSION: The new more informative letter did not improve attendance among this group of nervous patients. Other strategies for increasing initial attendance will therefore need to be identified and evaluated. In this study, the most important factor in reducing anxiety levels during the consultation appeared to be contact with the clinician rather than preparatory written postal information.

Study of the phosphorylatable light chains of skeletal and gizzard myosins by nuclear magnetic resonance spectroscopy.

31P and 1H n.m.r. studies of the phosphorylatable light chains from rabbit fast skeletal and chicken gizzard muscles in the isolated state and in the intact myosin molecule indicate that the N-terminal region of the light chain containing the sites of phosphorylation has independent segmental flexibility. The ionization behaviour of serine phosphate in both rabbit skeletal and chicken gizzard P light chains exhibits cooperativity and is compatible with the phosphate group being influenced by neighbouring positively charged side-chains. No marked difference in phosphate ionization behaviour was apparent between the monophosphorylated P light chains of rabbit skeletal and chicken gizzard myosins. From 1H and 31P n.m.r. studies of the overall conformation, side-chain ionization properties and the spectral effects of titration with an anionic paramagnetic reagent bound at the basic N-terminal region, it is concluded that Thr-18 and Ser-19 are phosphorylated in the bisphosphorylated P light chain of gizzard myosin, the latter residue being the site of monophosphorylation. In the presence of F-actin the mobility of the serine phosphate of the P light chain of intact gizzard myosin was reduced. No interaction between the isolated P light chain and F-actin was however detected. These results are discussed with reference to the observed conformational features of the P light chain.

Two-site phosphorylation of the phosphorylatable light chain (20-kDa light chain) of chicken gizzard myosin.

When prepared under specified conditions chicken gizzard myosin was obtained which when incubated with ATP gave rise to a diphosphorylated as well as the monophosphorylated form of P light chain. Formation of the diphosphorylated light chain occurred more readily with these myosin preparations, but could also be obtained by prolonged incubation of the isolated whole light chain fraction with kinase preparations from rabbit skeletal and chicken gizzard muscles. Using isolated light chains as substrate the more readily formed monophosphorylated light chain contained serine phosphate while the diphosphorylated form contained serine and threonine phosphates.