Recruitment Problems Research Articles

Sequential analysis in neonatal research-systematic review.

Sequential trial designs have not been frequently used in Neonatology. They might potentially be able to reduce the number of patients in drug trials, although this is not always the case. What is known: • In evaluating rare diseases in fragile populations, traditional designs come at their limits. About 20% of pediatric trials are discontinued, mainly because of recruitment problems. What is new: • Sequential trials involving newborns were infrequently used and only a few (n = 21) are available for analysis. • The sequential design allowed to non-significantly reduce the number of enrolled neonates by a median of 24 (31%) patients (IQR - 4.75 to 136.5, p = 0.0674).

The Trouble with Peace: The Royal Army Medical Corps’ Cold War Recruitment Conundrums

This article examines the Royal Army Medical Corps’ (RAMC) recruitment problems throughout the Cold War (1945–1980s). It explores why the RAMC experienced difficulties in attracting new personnel, how the army tried to alleviate these shortages, and the impact of chronic understaffing on the quality of military health care for generations of soldiers and their families. It concludes by reflecting on the enduring dilemmas of recruiting professionals in peacetime.

Right from the start: protocol for a pilot study for a randomised trial of the New Baby Programme for improving outcomes for children born to socially vulnerable mothers

BackgroundChildren born to mothers who experience social complexity (e.g. substance misuse, intimate partner violence, mental ill health, a history of maltreatment) are at increased risk for a range of adverse outcomes at birth and during development. Home visiting programmes have been advocated as a strategy for improving outcomes for disadvantaged mothers and children, such as the Nurse-Family Partnership for young, socially disadvantaged first-time mothers. However, no evidence-based programme is available for multiparous women or older first-time mothers. The New Baby Programme was developed in Northern Ireland. It augments the universal health visiting service available in the UK with a content designed to promote maternal health and well-being in pregnancy, maximise secure attachments of children and parents and enhance sensitive parenting and infant cognitive development.Methods/DesignThis pilot study is designed to investigate whether it is possible to recruit and retain socially vulnerable mothers in a randomised trial that compares the effects of the New Baby Programme with standard antenatal and postnatal care. Feasibility issues include the referral/recruitment pathway (including inclusion and exclusion criteria), the consent and randomisation, the ability to maintain researcher blinding, the acceptability of the intervention to participants, and the feasibility and acceptability of the outcome measures. The results of the study will inform a definitive phase-3 RCT.DiscussionTrials of complex social interventions often encounter challenges that lead to the trial being abandoned (e.g. because of problems in recruitment) or present considerable analytic challenges relating to dropout, attrition and bias. This pilot study aims to maximise the chances of successful implementation.Trial registrationISRCTN35456296 retrospectively registered

Development of a framework to improve the process of recruitment to randomised controlled trials (RCTs): the SEAR (Screened, Eligible, Approached, Randomised) framework

BackgroundResearch has shown that recruitment to trials is a process that stretches from identifying potentially eligible patients, through eligibility assessment, to obtaining informed consent. The length and complexity of this pathway means that many patients do not have the opportunity to consider participation. This article presents the development of a simple framework to document, understand and improve the process of trial recruitment.MethodsEight RCTs integrated a QuinteT Recruitment Intervention (QRI) into the main trial, feasibility or pilot study. Part of the QRI required mapping the patient recruitment pathway using trial-specific screening and recruitment logs. A content analysis compared the logs to identify aspects of the recruitment pathway and process that were useful in monitoring and improving recruitment. Findings were synthesised to develop an optimised simple framework that can be used in a wide range of RCTs.ResultsThe eight trials recorded basic information about patients screened for trial participation and randomisation outcome. Three trials systematically recorded reasons why an individual was not enrolled in the trial, and further details why they were not eligible or approached, or declined randomisation. A framework to facilitate clearer recording of the recruitment process and reasons for non-participation was developed: SEAR – Screening, to identify potentially eligible trial participants; Eligibility, assessed against the trial protocol inclusion/exclusion criteria; Approach, the provision of oral and written information and invitation to participate in the trial, and Randomised or not, with the outcome of randomisation or treatment received.ConclusionsThe SEAR framework encourages the collection of information to identify recruitment obstacles and facilitate improvements to the recruitment process. SEAR can be adapted to monitor recruitment to most RCTs, but is likely to add most value in trials where recruitment problems are anticipated or evident. Further work to test it more widely is recommended.

Serbian Church representation in Moscow in the last quarter of XIX – early XX centuries. The problem of recruitment

Serbian Church representation in Moscow in the last quarter of XIX – early XX centuries. The problem of recruitment

Patient and Nurse Experiences in a Rural Chronic Disease Management Program: A Qualitative Evaluation.

Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable. A rural, Midwest county clinic's chronic disease management program. Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed. Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues. Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a supportive community health care resource for patients with chronic disease.

ТЕРРОРИСТИЧЕСКИЙ РЕКРУТИНГ НА ПОСТСОВЕТСКОМ ПРОСТРАНСТВЕ: СОВРЕМЕННЫЕ ТЕНДЕНЦИИ И РИСКИ ДЛЯ РОССИИ

The object of the author’s research is terrorism, as a threat to the national security of the Russian Federation. The subject area is the problem of terrorist recruitment on the scale of the post-Soviet space. The main purpose of the article is to assess the risks of terrorist recruitment for the Russian Federation in a special territorial angle - the post-Soviet space. The authors completed the following research stages: selection of potential collaborating countries of the recruitment system, the comparative analysis and ranking of these states with subsequent identification of the most likely participants in the system, identification of forms and potential scenarios of terrorist recruiting. The researchers come to the conclusion that the conditions for terrorist recruitment have developed to the greatest degree in Tajikistan, Kyrgyzstan and Azerbaijan. Probable form of recruiting can be, for example, prison jamaat, and the environment for it- a migration corridor or a pseudo-religious community.

Effects of compensation on the job performance among hospital employees!! - a meta analysis

Hospitals are considered as life saving institutions and the service quality through the better performance of employees is an essential parameter to serve thecustomers. To sustain within the competition and to achieve the competitive advantage, it is vital to focus on the attitudes and job performance of the employees. Failure to design appropriate compensation system will have unfavorable impact on productivity and job satisfaction and overall effectiveness of the hospital. Though compensation in terms of salary increment, reward, health insurance, workers compensation, retirement plan and paid holiday were applied in the study hospital, the effect of such compensation was not tested still. Hence, the aim of this paper is to assess the effect of compensation on job performance of hospital employees. In order to address the objective, both primary and secondary sources of data were used. The required data was collected from 206 employees identified through stratified random sampling technique. The data collected through questionnaire was analysed by SPSS ( version 21) and descriptive statistics such as frequency, percentage, mean and standard deviation and inferential statistics such as onesample t-test, correlation and multiple linear regressions were used arrive the meaningful results. The findings show that 65% of the variance of the employee performance was significantly explained by three independent variables namely; compensation, salary and rewards. It is concluded that there is a significant effect of salary, reward and indirectcompensation on employee job performance in the hospital. It is recommended that hospital management needs to improve its compensation system time to tome and further studies to be conducted to investigate the strategies used to deal with the problems of employees recruitment and retention among others.

Współpraca szkół zawodowych z biznesem: perspektywa pracodawców

The article identifies the barriers in cooperation between vocational schools and employers, which are connected with the economic and social environment of schools. The main source of information on employers’ perspective is a survey of employers cooperating with vocational schools in Lublin (Poland). The survey results shows that employers are set on increasing the number of hours of students’ practical vocational training in the workplace, but are reluctant to undertake more costly and more demanding forms of cooperation with schools, like participating in vocational exams, training teachers or providing equipment for school workshops. It was argued that employers’ limited willingness to cooperate stems i.a. from fragmentation of the enterprise sector in Poland, poorly developed cooperative bonds between enterprises, and the small scale of recruitment problems during most of the last two decades.

Insufficient recruitment and premature discontinuation of clinical trials in Switzerland: qualitative study with trialists and other stakeholders.

Premature discontinuation occurs in about 25% of randomised clinical trials in Switzerland; it mainly affects investigator-initiated trials and is mostly due to problems with recruitment of patients. The aim of this study was to qualitatively investigate reasons for trial discontinuation due to poor patient recruitment and suggestions to address those reasons in the Swiss context. We conducted semi-structured interviews with trialists whose trials were discontinued because of recruitment problems, other experienced trialists, and stakeholders in clinical research in Switzerland. Interviews were audio-recorded, transcribed verbatim, and anonymised. We analysed the transcripts using deductive coding and built up themes that were continuously discussed within the research team. Of 65 invited Swiss trialists and stakeholders, 39 (60%) agreed to be interviewed and contributed to this analysis. We identified four main themes of reasons for poor recruitment: (1) Switzerland has a decentralised healthcare system with many small hospitals and few patients per hospital, many research regulations, no standardisation of medical records across hospitals, and a heterogeneous ethics assessment of study protocols. There is little collaboration of different stakeholders in clinical research and a lack of prioritisation of projects. (2) Limited human and financial resources, especially in the academic setting, compromise research questions and size of clinical trials. When funding is used up this typically triggers discontinuation of already delayed clinical trials. (3) Investigators face underdeveloped research networks and a limited collaborative attitude among clinical researchers. They typically embark on clinical studies with a great deal of optimism but insufficient preparation. (4) Swiss patients have universal health coverage and many treatment options. Negative media coverage of clinical research and a lack of accessible information for patients about ongoing clinical studies frequently make participation in clinical trials less attractive. More interactive structures and collaboration across stakeholders were mentioned as potential solutions to tackle the problems. Recruitment of participants into clinical trials in Switzerland is challenging because of various, often interlinked factors related to the Swiss health system, available funding, investigators, and patients. Common goals and concerted efforts by involved stakeholders appear necessary to achieve improvement.

Duration-Variable Participant Recruitment for Urban Crowdsourcing With Indeterministic Trajectories

For urban crowdsourcing applications, the data sensing tasks can be achieved by vehicles traveling on the roads, which can save the expenses on constructing dedicated infrastructures. In this paper, to efficiently handle the crowdsourcing recruitment problem, we propose to recruit participants with the duration-variable principle and prove that it performs better compared to the strategy that recruits vehicles for all required time periods. The duration-variable principle enables recruitment of vehicular sensing resources across different time epochs to maximize the crowdsourcing profits. To ensure the utilization of limited budget, we formulate the duration-variable participant recruitment (DPR) problem with the consideration of indeterministic trajectories to determine which vehicle subset is chosen and how many epochs are provided for each selected vehicle. Since the formulated problem is NP-hard, we propose a two-step DPR algorithm by maximizing the available sensing resource utilization efficiency in each recruitment round, which is shown to be near-optimal and has low computational complexity. Experiments on real traces show that the proposed DPR scheme exceeds three other solutions in providing higher spatial coverage for urban crowdsourcing applications.

Load Balanced Mobile User Recruitment for Mobile Crowdsensing Systems

In this letter, we study the mobile user recruitment problem for mobile crowdsensing systems. Instead of minimizing the overall sensing cost or user utility, this letter aims to optimize the load balancing of the mobile users, which is particularly important for the resource-constrained individual user. We refer to such a problem as the load balanced mobile user recruitment (LB-MUR) problem. Specifically, we first formulate the LB-MUR problem as a mixed integer linear programming (LP) and prove that it is NP-hard. Then an efficient polynomial-time suboptimal algorithm is proposed, which is based on LP relaxation. Furthermore, we derive the approximation ratio of the proposed algorithm. Finally, we evaluate the effectiveness of the proposed scheme through simulations.

Telephone-first strategy designed to cope with increase in patient demand does not necessarily suit all practices

Many general practices in the UK struggle with rising patient demand combined with staff recruitment problems.

Scheme to ease capital’s recruitment problems

A preceptorship framework has been launched for nurses working in London.

Randomised clinical trials in perinatal health care: a cost-effective investment.

To compare the health and economic impacts of implementing efficacious treatment interventions with maintaining standard practice in maternal and perinatal health care. We identified randomised clinical trials (RCTs) in the Perinatal Society of Australia and New Zealand trials database that commenced recruitment during 2008 and had completed recruitment by 2015. Data from clinical trial registries and publications were collated to calculate the potential cost savings achievable by implementing efficacious treatment interventions. Projected net cost savings over 5 years. Twenty-three eligible RCTs covering a range of behavioural and clinical interventions were identified, of which six reported interventions superior to standard practice (four trials) or placebo (two). The outcomes (but not the costs) of 17 trials were excluded from analysis (no difference between intervention and comparator groups in seven trials, recruitment problems in six, findings not yet published in four). The total funding amount for the 23 trials was $20.3 million; the potential cost savings over 5 years if the findings of the six trials reporting superior interventions were implemented was estimated to be $26.3 million if 10% of the eligible populations received the effective interventions, and $262.8 million with 100% implementation. Our retrospective analysis highlights the value of research in perinatal care and the importance of implementing positive findings for realising its value. Future trials in maternal and perinatal health care may provide significant returns on investment by informing clinical practice, improving patient outcomes and reducing health care costs.

Discontinuation of a randomised controlled trial in general practice due to unsuccessful patient recruitment.

BackgroundA randomised controlled trial (RCT) in general practice, recruiting incident patients with (sub)acute sciatica, was discontinued because of insufficient recruitment.AimTo describe factors that influenced the recruitment process and ultimately led to discontinuation of this trial, and to enable others to learn from this experience.Design & settingA pragmatic RCT was designed to compare two pain medication prescription strategies for treatment of (sub)acute sciatica in general practice. After 1 year of patient recruitment, the trial was prematurely terminated.MethodTo analyse the underperforming recruitment, patient information systems of 20 general practices were screened twice a month to search for eligible patients and identify reasons for non-eligibility. Secondly, after study termination, an open question was distributed to the participating GPs for their views on the recruitment process.ResultsA total of 116 GPs from 37 general practices collaborated in the trial. Only eight of 234 patients were included after 12 months. The 22 GPs who offered their opinion on the main reasons for unsuccessful recruitment considered that these were the low incidence rate and strict eligibility criteria, a strong patient and/or GP preference, and time constraints.ConclusionFor this RCT, multiple factors were related to recruitment problems but it remains unknown which determinants prevailed. As the research question is unanswered but remains relevant, it is recommended that GPs’ daily practice is taken into account when designing an RCT, a pilot study should be performed for feasibility of recruitment, and GP assistants should be involved at an early stage.

Development of a curriculum and training program in Woman Veterans Health for Internal Medical Residents.

Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health. An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women's Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores. Total of 47 Internal Medicine residents rotated through Women's Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p < 0.0001). This study shows how to equip physicians in training with information on women's health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.

12 tips for developing trainee-led initiatives to promote recruitment to training in shortage specialties.

This article was migrated. The article was marked as recommended. The healthcare needs of the global population are changing, leaving many medical specialties facing ballooning demand in the context of under-filled specialty training programmes. In this paper we draw on a synthesis of existing literature and our experiences of developing a series of initiatives to tackle the challenge of recruitment to specialty training in geriatric medicine in the UK. We propose a set of strategies that can contribute to the development and success of such initiatives and commend these to healthcare professionals, both junior and senior, who are working in so-called 'shortage' specialities facing recruitment challenges. A common theme throughout the twelve tips is the need to empower trainees to deliver such initiatives. Trainees' unique insight into training programmes, coupled with their burgeoning enthusiasm for their chosen specialty, ought to be harnessed, as it offers a ripe source of potential ideas and solutions to tackle recruitment problems.

Reproductive Ecology, Spawning Behavior, and Juvenile Distribution of Mountain Whitefish in the Madison River, Montana

AbstractMountain Whitefish Prosopium williamsoni were historically common throughout much of the U.S. Intermountain West. However, within the last decade Mountain Whitefish have exhibited population‐level declines in some rivers. In the Madison River, Montana, anecdotal evidence indicates Mountain Whitefish abundance has declined and the population is skewed toward larger individuals, which is typically symptomatic of recruitment problems. Describing reproductive development, spawning behavior, and juvenile distribution will form a foundation for investigating mechanisms influencing recruitment. We collected otoliths and gonadal samples from fish of all size‐classes to characterize fecundity, age at maturity, and spawning periodicity. We implanted radio tags in mature Mountain Whitefish and relocated tagged fish in autumn 2012–2014. Timing of spawning was determined from spawning status of captured females and from density of eggs collected on egg mats. In spring 2014, we seined backwater and channel sites to describe age‐0 whitefish distribution. Mountain Whitefish were highly fecund (18,454 eggs/kg body weight) annual spawners, and age at 50% maturity was 2.0 years for males and 2.6 years for females. In 2013 and 2014, spawning occurred between the third week of October and first week of November. During spawning, spawning adults and collected embryos were concentrated in the downstream 26 km of the study site, a reach characterized by a complex, braided channel. This reach had the highest CPUE of age‐0 Mountain Whitefish, and the percentage of spawning adults in the 25 km upstream from a sampling site was positively associated with juvenile CPUE. Within this reach, age‐0 Mountain Whitefish were associated with silt‐laden backwater and eddy habitats. Future investigations on mechanisms influencing recruitment should be focused on the embryological phase and age‐0 fish.Received June 19, 2016; accepted March 28, 2017 Published online July 24, 2017

Semantic interoperability as a basis of meaningful analytics

The main objective of the article is to show how ontologies, which are basic items of the semantic interoperability, can be used as a basis of meaningful analytics. It opens the way to solve a lot of problems like expert selection. The author discovers the pointed problem on the boarder between information technologies and recruitment problems like boolean search. The article contains a real example of boolean search query regarding information technologies such J2EE, JDBC, JAXB, JPA, Servlets, JAX-WS and others. The weekness of understanding of meaning some terms by a finder leads to incorrect results of the search. Only ontologies can handle synonyms and other kinds of relations between two terms – it is very important for avoiding of a confusion. Unfortunately, where is a misunderstanding of meaning following terms – classification, taxonomy, ontology. The existing articles do not solve the problem of unified understanding – it is an aspect of author’s investigation. The author shows how the analytical hierarchy process in the couple with ontologies can be used for empowering of existing approaches for solving the problem of expert selection. All conclusions are based on the detailed analysis of existing open publications. The pointed combination opens new horizons for predictive meaningful analytics.