Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.

Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers’ and participants’ experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners’ contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusions Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A continuous dynamic process of monitoring progress within trials and tailoring strategies to particular circumstances, whilst not compromising trial protocols, should allow maximal recruitment and retention.

Recruitment and Retention in Front-line Services: The case of childcare

This article highlights how problems of recruitment and retention in front-line services create a particular challenge to traditional HRM models and solutions. Private day nurseries make an interesting example of the challenges facing managers in the service sector as the combination of a feminised workforce, a price-sensitive service, public-private competition and state regulation create particular difficulties. We report on a study of 33 day nurseries involving interviews with managers and employees over an eight-month period. Our findings show that childcare providers have to cope with recruitment and retention problems associated with high-end interactive service provision compounded by gender segregation and small business characteristics. Our analysis of employer and employee perspectives examines labour market issues affecting recruitment, and categorises the reasons for staff turnover into internal 'push' factors, external 'pull' factors, outside factors and functional turnover.

Phosphorus Retention in a Constructed Wetland System used to Treat Dairy Wastewater

The aim of this study was to develop an input/output mass balance to predict phosphorus retention in a five pond constructed wetland system (CWS) at Greenmount Farm, County Antrim, Northern Ireland. The mass balance was created using 14-months of flow data collected at inflow and outflow points on a weekly basis. Balance outputs were correlated with meteorological parameters, such as daily air temperature and hydrological flow, recorded daily onsite. The mass balance showed that phosphorus retention within the system exceeded phosphorus release, illustrating the success of constructed wetland systems to remove nutrients from agricultural effluent from a dairy farm. Pond 5 showed the greatest relative retention of 86%. Comparison of retention and mean air temperature highlighted a striking difference in trends between up-gradient and down-gradient ponds, with Ponds 1 and 2 displaying a positive quadratic relationship and ponds 3 through 5 displaying a negative quadratic relationship.

Retention of toxic chromium from aqueous phase by H3PO4-activated lignin: Effect of salts and desorption studies

In this study, the feasibility of using H₃PO₄-activated lignin for hexavalent chromium adsorption has been investigated. The composite of activated lignin was characterized using FTIR, XRD and SEM with EDAX analysis. It was observed that the pH had a strong effect on the adsorption capacity; adsorption of Cr(VI) was more favorable at acidic pH with maximum uptake at pH 2. The adsorption equilibrium data were best represented by Koble-Corrigan isotherm. The monolayer sorption capacity obtained from the Langmuir model was found to be 77.85 mg/g. Adsorption showed pseudo-second order rate kinetics and the process involving the rate-controlling step is complex as it involves both film and intraparticle diffusion processes. The NaOH desorbing agent was able to release approximately 84% of metal ions. Thermodynamic parameters showed that the sorption process is exothermic and non-spontaneous. The overall Cr(VI) retention on the activated lignin surface perhaps includes both the physical adsorption of Cr(VI) and the consequent reduction of Cr(VI) to Cr(III). (C) 2011 Elsevier B.V. All rights reserved.