- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT04344418
Harnessing Alternative Resources to Aid Kenyans With Acute Illness (HARAKA-2)
12 april 2020 uppdaterad av: Dr. Wangari Waweru-Siika, Aga Khan University
Impact of Nurse-Led Focused Cardiac Ultrasound Versus Usual Care on Time to Diagnosis in Adults With Cardiorespiratory Failure: A Two-Cluster Stepped Wedge Clinical Feasibility Trial
Kenya does not have enough experts to perform heart scans in patients who are very sick and in need of urgent intervention.
The purpose of this research is to find out whether training Kenyan nurses to perform basic heart scans would shorten the time it takes to know whether the heart and lungs are working normally in very sick patients, to guide treatment.
Patients will be placed into one of two groups: One group will have a quick scan of the heart and lungs carried out by trained nurses to see how well these organs are working, in addition to receiving the normal care offered at the hospital.
The other group will receive the normal care offered in the hospital only and will not have a scan performed by these nurses.
The time it takes to make a diagnosis between the two groups will then be compared.
Should the group that has heart scans by nurses be found to spend less time waiting for a diagnosis to be made, more nurses in Kenya will be trained to provide this service, to minimise delays in our emergency departments.
Studieöversikt
Status
Okänd
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Echocardiography is a useful, non-invasive diagnostic tool in time-critical emergencies.
A national shortage of cardiologists and of doctors in Kenya however further compounds the problem of insufficient staff for emergency care and of any capacity building efforts.
To achieve the goals of Sustainable Development Goal Number 3 (SDG-3) and realise the government's vision of universal healthcare for all, alternatives to the human resource challenge are key.
Modifying the Scope of Practice of Kenyan nurses is one possible solution.
Task-shifting traditionally cardiologist roles such as focused cardiac ultrasound (FoCUS) could shorten the time it takes to make a diagnosis in patients with cardiorespiratory failure of likely cardiac origin, making prolonged turnaround times in our public facilities a thing of the past.
Our overarching aim is to harness the power of nurses doing FoCUS.
The central hypothesis of this work is that in patients with cardiorespiratory failure, a nurse-led FoCUS-guided service would shorten time to diagnosis, supporting interventions and improving outcomes among the critically ill.
Insight into potential barriers and enablers for the implementation of a nurse-performed FoCUS service in Kenya is crucial for the success of such a service redesign.
Studietyp
Interventionell
Inskrivning (Förväntat)
732
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studiekontakt
- Namn: Wangari Waweru-Siika, FRCA
- Telefonnummer: +254708612258
- E-post: wangari.waweru-siika@kellogg.ox.ac.uk
Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
18 år och äldre (Vuxen, Äldre vuxen)
Tar emot friska volontärer
Nej
Kön som är behöriga för studier
Allt
Beskrivning
Inclusion Criteria:
Any one of:
- Systolic blood pressure <90 millimetres of mercury (mmHg)
- Mean arterial pressure (MAP)<65 millimetres of mercury (mmHg)
- Shock index >1 (heart rate/systolic blood pressure)
- Respiratory rate > 30 breaths/minute
- Oxygen saturations <94%
- Arterial oxygen partial pressure (paO2) <60 millimetres of mercury (mmHg)
- Arterial carbon dioxide partial pressure (paCO2) >50 millimetres of mercury(mmHg)
Exclusion Criteria:
- Trauma
- Pregnancy
- Patients requiring immediate life-saving interventions eg cardiopulmonary resuscitation (CPR) or defibrillation
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Diagnostisk
- Tilldelning: Icke-randomiserad
- Interventionsmodell: Sekventiell tilldelning
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Aktiv komparator: Usual care
The control arm will consist of usual care ie a combination of physical examination, lab tests and imaging.
The need for a formal echocardiographic evaluation by a cardiologist or cardiac sonographer in patients assigned to the control arm will be at the discretion of the clinical teams, as is usual care at the Kenyatta National Hospital (KNH) and Aga Khan University Hospital Nairobi (AKUHN).
A diagnosis will be selected based on the same pre-defined checklist and the time the diagnosis is made recorded.
|
The control arm will consist of usual care ie a combination of physical examination, lab tests and imaging.
The need for a formal echocardiographic evaluation by a cardiologist or cardiac sonographer in patients assigned to the control arm will be at the discretion of the clinical teams, as is usual care at KNH and AKUHN
|
Experimentell: Nurse-performed focused cardiac ultrasound (FoCUS)
The experimental arm will consist of nurse-performed FoCUS for patients with cardiorespiratory failure.
A FoCUS-trained nurse will perform a FoCUS examination within 30 minutes of triage by the triage clinician.
The Philips Lumify® handheld ultrasound device (HUD) with a phased array probe will be used and studies limited to a maximum of 10 minutes each.
A presumptive diagnosis will then be selected by the nurse from a FoCUS checklist based on pre-defined thresholds for each FoCUS target condition and the time the diagnosis is made recorded.
Additional imaging and lab tests may be requested at the discretion of the clinical team but the FoCUS nurses will be blinded to the results of these.
|
A FoCUS-trained nurse will perform a FoCUS examination within 30 minutes of triage by the triage clinician.
The Philips Lumify® handheld ultrasound device (HUD) with a phased array probe will be used and studies limited to a maximum of 10 minutes each.
A presumptive diagnosis will then be selected by the nurse from a FoCUS checklist based on pre-defined thresholds for each FoCUS target condition and the time the diagnosis is made recorded.
Additional imaging and lab tests may be requested at the discretion of the clinical team but the FoCUS nurses will be blinded to the results of these.
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Time to diagnosis
Tidsram: 24 hours
|
Difference in median time to diagnosis between nurse-performed FoCUS and usual care.
|
24 hours
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Number of patients with cardiorespiratory failure who have a FoCUS exam performed in A&E
Tidsram: 10 months
|
Number of patients with cardiorespiratory failure who have a FoCUS
|
10 months
|
Proportion of patients with cardiorespiratory failure who have a FoCUS exam performed in A&E
Tidsram: 10 months
|
Proportion of patients with cardiorespiratory failure who have a FoCUS
|
10 months
|
Diagnostic accuracy of nurse-performed FoCUS
Tidsram: 10 months
|
Sensitivity and specificity of novice FoCUS compared to a reference standard (cardiologist opinion)
|
10 months
|
Number of FoCUS protocol components suitable for inclusion in a local FoCUS curriculum
Tidsram: 10 months
|
Number of FoCUS protocol components suitable for inclusion in a local FoCUS curriculum
|
10 months
|
Proportion of novice scanners able to access remote supervision for FoCUS practice.
Tidsram: 10 months
|
Proportion of novice scanners able to access remote supervision for FoCUS practice.
|
10 months
|
Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Sponsor
Utredare
- Huvudutredare: Wangari Waweru-Siika, FRCA, Aga Khan University, Nairobi
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart (Förväntat)
1 juni 2020
Primärt slutförande (Förväntat)
30 april 2021
Avslutad studie (Förväntat)
30 april 2021
Studieregistreringsdatum
Först inskickad
7 april 2020
Först inskickad som uppfyllde QC-kriterierna
12 april 2020
Första postat (Faktisk)
14 april 2020
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
14 april 2020
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
12 april 2020
Senast verifierad
1 april 2020
Mer information
Termer relaterade till denna studie
Andra studie-ID-nummer
- 31-20
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
JA
IPD-planbeskrivning
Available on request
Tidsram för IPD-delning
6 months after publication
Kriterier för IPD Sharing Access
Available on request
IPD-delning som stöder informationstyp
- STUDY_PROTOCOL
- SAV
- ICF
- ANALYTIC_CODE
- CSR
Läkemedels- och apparatinformation, studiedokument
Studerar en amerikansk FDA-reglerad läkemedelsprodukt
Nej
Studerar en amerikansk FDA-reglerad produktprodukt
Nej
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