ABSTRACT
BACKGROUND: Low-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons' perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research. DESIGN AND METHODS: A qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis. RESULTS: Themes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent. CONCLUSIONS: Our findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research. Significance for public healthMany people from culturally and linguistically diverse (CALD) backgrounds remain excluded from medical research such as clinical trials due to a range of language and cultural factors that can be amplified when this population is ageing. This exclusion has implications for the ability of CALD populations to benefit from participating in medical research and for applying research findings to CALD populations. It is essential to develop and implement strategies to include CALD communities in medical research and to uphold the ethical obligation of obtaining informed consent to research. The findings of this study have guided the development of a tablet-based resource which can be used in clinical and community contexts to raise awareness about the purpose of medical research. The resource has been carefully designed to be appropriate for participants' cultural background as well as their preferred language and literacy level. Such a resource has potential to address some of the cultural and linguistic barriers to clinical trial participation of CALD populations.
ABSTRACT
OBJECTIVE: To investigate whether the pleth variability index (PVI), derived noninvasively from a pulse oximeter probe, would predict fluid responsiveness in patients undergoing noncardiac surgeries. DESIGN: A clinical, prospective, observational study. SETTING: Operating room of a tertiary care hospital. PARTICIPANTS: Twenty-nine adult patients undergoing a range of noncardiac surgeries, requiring general anesthesia, tracheal intubation, and mechanical ventilation. INTERVENTIONS: Intravenous volume expansion with 500 mL of colloid following induction of general anesthesia and after a period of hemodynamic stability before the start of surgery. MEASUREMENTS AND MAIN RESULTS: Baseline values for PVI and stroke volume index, derived from an esophageal Doppler monitor, were compared with final values after the volume expansion. Patients were classified into fluid responders and nonresponders based on a stroke volume index increase of ≥ 10%. The optimal cut-off value for baseline pleth variability index for predicting fluid responsiveness was determined. There were 17 responders (59%) to the 500-mL volume expansion. Baseline PVI value was significantly different between responders and nonresponders (16.5 ± 6.4% v 10.3 ± 2.7%; p = 0.004). Receiver operating characteristic analysis demonstrated significant predictive ability of an increase in stroke volume index for PVI with area under the curve of 0.84 (95% confidence interval = 0.69-0.99). The optimal cut-off value for baseline PVI was 10.5%, with a sensitivity of 88% and a specificity of 67%. CONCLUSIONS: Pleth variability index is predictive of fluid responsiveness in adult patients undergoing noncardiac surgery.
