An Improved Research Community in Canada enhanced by EDGE

This post has been written by Rebecca Xu, 3CTN- Canada

Successful clinical trials management for the 3CTN Coordinating Centre (CC) and for 3CTN sites requires a flexible system to track trial-related activities. The system has to work well at two levels: for the CC and the sites. The CC needs to have a system to support the identification and communication of portfolio trials to patients and the public. Also, such a system is important for the evaluation of 3CTN against its milestones and deliverables laid out in its business plan. In addition, to demonstrate an increase in recruitment to academic clinical trials in Canada. 3CTN required each participating site to establish an accurate baseline for recruitment. This is used to continuously evaluate the performance and impact of the Network. A flexible system facilitates this evaluation. Among all Canadian cancer centres responding to the initial 3CTN expression of interest, there was a demand for a clinical trial management system (CTMS) to manage the clinical trial projects, track clinical trial activities, staffing, milestones, metrics and finances centrally and in an organized fashion. The optimal solution to track the metrics and research activities is a common platform for all member sites and the 3CTN Coordinating Centre.

3CTN went looking for a CTMS solution. After consultation with a wide variety and number of stakeholders, and following the recommendation of a working group, based on the positive impact in the UK and first Canadian site (i.e. Juravinski Cancer Centre), the EDGE Clinical Research Management System (EDGE) was selected by 3CTN as the preferred system to roll out at the CC and Canadian cancer centres that expressed interest.

The EDGE system, which was developed in the U.K by the University of Southampton and University Hospitals Southampton National Health Service Foundation Trust, was first introduced in 2001. Since then, EDGE has been used by all the U.K. cancer research networks and several other networks established by the Department of Health in the U.K.  EDGE provides an innovative cloud-based clinical management system that empowers administrators and investigators to make the most of their research data. EDGE is specifically designed to give a real-time view of clinical research activity within a single hospital or across various research networks.
 
The CC formally adopted EDGE in September 2014, with the first goal being the tracking of the portfolio. The CC EDGE hosts a comprehensive listing of all 3CTN-endorsed cancer clinical trials. It allows management of the portfolio, including trial application, and timeline tracking of the review and approval process in a clear, efficient and measurable system. In addition to portfolio tracking, the CC can process all data in EDGE and extract the aggregate and site efficiency metrics with ease. It provides a real time and accurate picture of the high impact academic clinical trials across Canada. The national benchmarking data has also proven to be useful to facilitate ongoing process improvement.

EDGE provides an efficient way to collect and process the data without imposing an excessive burden to 3CTN sites. This common platform limits duplication of data entry and ensures ease of data transfer between 3CTN member sites and the CC. For sites that had already adopted a different CTMS prior to 3CTN, EDGE provides portal capability and flexibility to take-in data from the various systems used by sites.
 
Since the adoption of EDGE by 3CTN, the CC has developed comprehensive implementation supports. These supports include: live demonstrations of the system, project planning, training and first line support to facilitate the roll-out to interested cancer centres. Regional super users were hired to assist with implementation and to ensure sites use EDGE effectively. These super users are situated throughout the Network, and collaborate with the CC to promote best practices, and to determine how EDGE can best be used to benefit all sites across the country.

At the site level, most sites using EDGE are tracking recruitment. Many sites are starting to use EDGE to track regulatory processes and finances for their active recruiting trials, as well as legacy data. The EDGE users are especially pleased with the powerful reporting capabilities of EDGE, which allows them to follow trends in research activities over time. Prior to the implementation of EDGE, sites had numerous files, over a number of file directories to keep track of the progress of trial activation, ethics submissions, contract processes, budgets, and trial metrics (screening and accrual reports).  From a logistics standpoint, having one place to access all clinical trial information is very efficient, and ultimately improves patient care as it enables everyone to use the most up to date documents and information. All members of the patient care team are able to see the progress of a trial from delivery of the protocol to trial activation, and the screening and accrual of patients.  “EDGE provides us with a wealth of knowledge to know which trials are accruing and which are not and why not” states Richard McClelland from London Regional Cancer Centre. Being a network-customized and web-based application, EDGE has led to better communication and collaboration within the cancer clinical trial community, and across the country.

As a result of CC and site level implementation, the EDGE system is helping to improve the conduct of cancer clinical trials across Canada. It enables reliable and real-time measurement of trial metrics and improves the ability of sites and the CC to analyze and use trial data to advantage which should lead to more efficient activity across the Network.

Source of article from: Canadian Cancer Clinical Trial Network 3CTN Pulse Newsletter February 2017 

A Blog with Gratitude

As 2016 draws to a close, it will soon become a time of delicate reflection on the year that has passed. For some of us, the Christmas holidays leaves us with a distinct feeling of bittersweetness, which is often combined with inner determination that “next year will be better.” What could have gone better this year, and how? What should I do to become happier and more satisfied next year? These feelings do not just apply to our personal lives, but they also sometimes cross over to our professional lives, too.

Many researchers are currently exploring the role of gratitude in the workplace; that is, when one expresses appreciation for what one has, or what went right, at work. First off, it is worth noting that, on average, people who regularly express gratitude are better off psychologically. For instance, grateful people are happier, they experience more positive moods,[1] and they report greater perceived support from other people compared to people who do not regularly express gratitude.[2] The chances are, however, that gratitude is not part of your workplace culture, and expressing appreciation in the workplace is not something that occurs very frequently.[3] A lack of gratitude increases the risk of low performance and dissatisfaction in the workplace.[4]

In a recent study conducted in Canada, researchers tested what happens when workers are encouraged to reflect on the things they are grateful for at work[5]. In a study of employees (aged 18-82), half were encouraged to focus on and describe three things that they were grateful for at work, while the other half described three things that they were grateful for in life. After, the employees completed surveys about how satisfied they currently felt with their job, and how satisfied they expected to be with their job in 6 months’ time. Results indicated that employees who described three things that they were thankful for at work reported significantly higher levels of work satisfaction and greater anticipatory work satisfaction in 6 months’ time (compared to those who reflected on things that they were grateful for in life; see graphs below).

Whilst we are not always able to control what happens in the workplace, good or bad, these results demonstrate that we can control how we choose to perceive what happens in the workplace, and which aspects we choose to focus on. We can either focus on the negative aspects of the workplace, or we can actively choose to find things that we like about our workplace and express gratitude toward them frequently, which, in turn, maximises fulfilment and bolsters optimism for the future.

As 2016 draws to a close, it will soon become a time of delicate reflection on the year that has passed. For some of us, the Christmas holidays leaves us with a distinct feeling of bittersweetness, combined with inner determination that “next year will be better.” What could have gone differently this year, and how? What should I do to become happier and more satisfied next year? Well, why not let this Christmas be a time for gratitude. By reflecting on just three things that you are grateful for at work (e.g., things that have gone well this year), you will heighten the likelihood of starting 2017 full of optimistic thoughts and boosted satisfaction. Make gratitude a habit, and the rewards shall be reaped.

Please let us take this opportunity to express our gratitude to you – our users. We wish you all a very Merry Christmas and an exceedingly Happy and EDGEtastic New Year.

Most importantly – thank you.

[1] Watkins, P. C., Woodward, K., Stone, T., & Kolts, R. L. (2003). Gratitude and happiness: Development of a measure of gratitude, and relationships with subjective wellbeing. Behaviour and Personality, 31, (5), 431-452.

[2] Wood, A. M., Maltby, J., Gillett, R., Linley, P.A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42, 854-871.

[3] Simon-Thomas, E. R., & Smith, J. A. (2013). How Grateful are Americans. Retreived from http://www.greatergood.berkeley.edu/article/item/how_grateful_are_americans

[4] Judge, T. A., Thoresen, C. J., Bono, J. E., & Patton, G. K. (2001). The job satisfaction-job performance relationship: A qualitative and quantitative review. Psychological Bulletin, 127, (3), 376-407.

[5] Buote, V. (2014). Being thankful at work: The impact of gratitude in the workplace. 

EDGE Usability Survey 2016

Positive results!

In May, we, the team at EDGE HQ, administered our first ever usability survey. We collected responses from an astounding 251 of our users, who each took the time to complete a wide series of questions relating to the functionality of EDGE. The survey aimed to examine the overall usability of EDGE, the extent to which users understood what EDGE is used for and why it was implemented by their institution, and, most crucially, users’ general satisfaction with EDGE.

The results from the survey were overwhelmingly positive. A staggering 80% of users (whom we quite appropriately labelled “Masters of the Universe”) agreed that they found EDGE intuitive and easy to use, 87% percent agreed that they felt confident using EDGE, and almost 80% were satisfied with the ease and the amount of time that it takes to complete tasks using EDGE. This provided us with reassurance regarding the things that we are doing well, including the specific functions of EDGE that our users find useful in their work.

There is, however, still some room for improvement, and your responses in the survey have helped us to identify what these niggles are and what we need to do about them. As a primary example, results from the survey revealed that almost 30% of respondents did not receive any formal training to use the system. We also received a number of comments regarding specific functions of EDGE that users could not work out or understand, some of which we categorised as training issues. Whilst it is likely that some of the untrained users were new staff members or researchers that were assigned to projects using EDGE, we truly rely on everybody using and understanding the EDGE system well. We aim for each and every one of you to experience the excellent benefits that the system offers, as this will ultimately impact positively on your work.

What are we doing about training?

Based on your responses and feedback, we have recently deployed a number of key changes to training, which we will implement over the course of the next few months. The Knowledge Team at EDGE have commenced work on some exciting new training modules, which we aim to provide online for users who may have missed out on formal training, or for users who would simply like to brush up on their EDGE skills. We also aim to create a batch of short 2-3 minute training "bite" videos. While we already have a number of training videos that you can find under the EDGE support tab, these shorter videos will quickly, yet effectively explain some of the quirky functions that EDGE provides. The training and expertise (“EDGEpertise”) of our users is of fundamental importance to us, and our immediate aim is to make training as effective and accessible as possible. We will keep you updated regarding our progress via this blog.

We wish to offer a huge thank you to those of you who completed the survey – your feedback is invaluable to us. We look forward to administering the survey again next year to pick your brains further regarding the overall usability of EDGE. We have no doubt that our next survey will lead to further excellent ideas regarding how to make the work of our users easier, satisfying, and more efficient (as it has done this year after just one survey). As always, we gratefully appreciate your input.

Meanwhile, if you identify as one of our EDGE Masters, or if you have any tales about how EDGE has made your research quicker and more efficient, we would be very interested in hearing all about them. Please get in contact with the EDGE researcher, Dr. Kenny Brackstone, at K.Brackstone@soton.ac.uk or tweet us at @edgeclinical.

Once again, thank you.

EDGE News

The past month has followed the standard school holidays trend, whereby the volume of calls received by the EDGE team drops which allows us to turn our attentions to the plethora of other tasks that we are working away on in the background.

One of our objectives over the past year has been to try and encourage our users to upgrade their browsers in order to see improved performance speeds on EDGE, especially when running large reports that return a lot of data.  Just a few of the benefits of browser upgrades can be found on the NHS Supply Chain website:

‘Why should you update your browser?

Old browsers are more prone to viruses, spyware, malware and other security issues. Whilst you will be protected by your trust’s firewalls there are other reasons why you should upgrade your Internet browser…

• Old browsers are slow - In comparison to newer browsers, old browsers such as IE 6, 7 and 8 can take longer to display the web page you want to view as browsers are trying to perform several complicated tasks at once.
• Old browsers are more likely to crash - When a web page downloads, your browser is performing several tasks and interpreting new programming information that was not available when the browser was originally launched.  
• You can’t view websites properly with old browsers - As web design and development becomes more sophisticated, you may not be able to view some websites as intended e.g. images may not be displayed, video may not play and content displayed may appear misaligned’

Supporting EDGE across multiple browsers also increases the time it takes for us to develop and test current and new functionality. The more redundant software we have to support, the more development time each feature requires, this in turn has an additional effect on testing each function within each browser. The overall effect being that new functionality is held up by the use of older browsers.

Microsoft’s dominance in the web browsing market really started with Internet explorers inclusion in Windows 95, where it surpassed Netscape Navigator as the most used browser on the web back in 1998. Microsoft has held that position of dominance for almost two decades until April this year when statistics firm Netmarketshare said that Google Chrome had overtaken it with 41.7 per cent of desktop browsing, compared with Internet explorers 41.3 per cent.

A statement released from Microsoft at the end of last year notified Internet explorer users that ‘Starting from 12 January 2016, only the most current version of Internet Explorer available for a supported operating system will receive technical supports and security updates. Internet Explorer 11 is the last version of Internet Explorer, and will continue to receive security updates, compatibility fixes and technical support on Windows 7, Windows 8.1 and Windows 10’

This ties in with the recently released Review of Data Security, Consent and Opt-Outs, published by Dame Fiona Caldicott https://www.gov.uk/government/publications/review-of-data-security-consent-and-opt-outs within which she highlights under the ‘Leadership Obligation 3: Technology: Ensure Technology is secure and up-to-date’, ‘Data Security Standard 8. No unsupported operating systems, software internet browsers are used within the IT estate’

This guidance is correct, browsers should be updated for security purposes. This is put in no uncertain terms by Ed Bott, an award winning technology writer:

“Any IT professional who is still allowing IE6 to be used in a corporate setting is guilty of malpractice. Think that judgment is too harsh? Ask the security experts at Google, Adobe, and dozens of other large corporations that are cleaning up the mess from a wave of targeted attacks that allowed source code and confidential data to fall into the hands of well-organized intruders. The entry point? According to Microsoft, it’s IE6”

Is this easier said than done though? Well it used to be the case that a number of core applications i.e Spine, and e-RS (formerly choose & book) used to be limited to access from IE 6 and IE 7 browsers, but recently that has changed and the Health & Social Care Information Centre (now NHS Digital) released their new Spine Warranted Environment Specification in 2015 which introduced components for MS Internet Explorer 11, Mozilla Firefox and Google Chrome. Therefore compatibility with current technology is improving but there are no doubt other applications still reliant on older technology.

We have been reviewing EDGE users browser access over the past six months and have seen a significant trend in users upgrading their existing legacy browser to more current versions of the software. These can be seen on the graph below. The only exception is IE7, which has increased from 3.1% of EDGE users to 5%. We believe this increase is probably down to new users introduced onto the system rather than users actually downgrading their browser.

·  

These statistics are positive, identifying a downward trend in use of IE8 and IE9, very little change in IE10 use, but a good increase in use of newer browsers such as IE11, Chrome and Firefox.

The below graph consolidates these statistics into simply ‘old browsers v new browsers’

After initial analysis of browser usage in September 2015, we implemented a formal browser policy for development and test in order to support our customers’ needs and maintain EDGE as a safe and reliable system, and is highlighted in the following points:

·         The new browser policy ceases any support for IE6 due to the lack of users

·         IE7 is now only offered reduced support*

·         IE8, 9, 10, 11 are fully supported however we are aiming to reduce support for IE8 by (date TBC)

·         Google Chrome, Mozilla Firefox, and MS Edge are fully supported.

*reduced support means that functionality will be supported, but any cosmetic issues will not be fixed.

EDGE Team & CIRU Away day

On the 14th July we headed out to Brockenhurst for our away day to the grand and beautiful Rhinefield House Hotel. Using the hotel’s conference facilities our current team of 23 spent the day learning more about each other, developing team skills and building on working relationships. This was beneficial to all as our unit CIRU (Clinical Informatics Research Unit) keeps on expanding with more staff coming on board. 

The day started with presentations from all the team where we each talked about our individual departments and gave knowledge on topics which everyone at CIRU would benefit from. The Knowledge team talked about the Clinical Trials Process which included how R&D and Pharmacy work which of course relates to our customer base. From the development team we learnt about the development journey from when an idea is first initiated right through to when it becomes live on EDGE. We also got to hear from our team of Associate Software Developers who talked about new products they have been working on such as exciting new apps to help with research and patient visits to hospital. Other topics of the day included customer support and communications within the department including our brand and marketing strategy. We also got the chance to hear results from a recent staff and customer survey which gave us the opportunity to discuss as a team. We were also very lucky to have Professor Topher Woelk present to us, who talked about his work and Bioinformatics.

After all of the presentations and after being fed and watered we began the afternoon activities which certainly tested our team work skills. This included team lego building on things related to CIRU and to EDGE, which meant we got to be kids again (it was great). We also took part in a dressing up video challenge which literally got us laughing out loud at the end result!

I would certainly say the day brought us more together as a team as we discovered more about each other and definitely shared some laughs!

Getting Fit at the Desk: Health Implications for Work Practices

With a large percentage of us working full-time, it seems remarkably difficult to envision ourselves fitting in 150 minutes of physical exercise per week as recommended by the Chief Medical Office (CMO). Researchers from Indiana University in the States, however, have recently published promising new findings that attempt to resolve this issue. Soon, after leaving the office at 4.30pm on Friday afternoon after a notoriously busy week, will our guilty consciences be cleaner? Kenny Brackstone at EDGE HQ reports.

First, it is notable that obesity rates in the UK are among the highest in Europe. According to the Health Survey for England (HSE), 61.7% of adults (16 years and over) are classified as overweight or obese. This problem is not exclusive to the UK; the World Health Organisation considers obesity to be a global concern, with 500 million adults over the age of 20 being categorised as obese (World Health Organization, n.d.). Despite the efforts of organisations to enact policies that emphasise healthy work environments, one major problem is that employees tend to be almost entirely desk bound. Many employees are immobile at their workstations 5 days a week, and very few calories are burned off throughout the day (Thompson, Foster, Eide, & Levine, 2008). With this in mind, organizations are beginning to endorse policies that emphasize healthy working environments. One exciting possibility for increasing employee physical activity is the “active workstation.”

Put quite simply, the active workstation allows employees to work at their desk whilst being active - normally either by walking or cycling. The general idea of the active workstation is to increase the amount of physical activity that a person does throughout the day and decrease the amount of sedentary activities while at work. And unlike other exercise interventions put in place by organizations, it does not even require individuals to leave their desks (well, apart from to make coffee or use the toilet, of course).

The studies that have been published so far are generally positive regarding the effects of active workstations and health. For example, employees who were equipped with walking workstations took on average of 2000 more steps per day, equivalent to 100 calories (Thompson, 2008). Further, workers who were equipped with pedalling workstations tended to use these around 60% of working days, pedalling on average about 25 minutes per workday used (Carr, Walaska, & Marcus, 2002). Overall, the research indicates that active workstations increase daily activity, and that employees are more than willing to use them – at least, in the short term.

In a more recent study, researchers from Indiana University set out to learn more about what active workstations do for people psychologically. In the study, 180 students were randomly assigned to one of four conditions: (1) seated, (2) standing, (3) cycling, and (4) walking. Participants spent 35 minutes completing computer tasks in their assigned condition. These consisted of web-based search tasks requiring participants to type out written responses. Upon completion of the tasks, participants completed post-study survey measures of mood and attitudes. The researchers expected that the use of active workstations would result in higher levels of psychological arousal (i.e., feelings of activation and reactivity), reduced feelings of boredom, and lower levels of self-reported task stress (and increased satisfaction). They also assessed performance levels of the designated task.

Their results demonstrated general support for the benefits of walking workstations, whereby participants reported higher satisfaction and arousal, and less boredom and task-related stress compared to the passive conditions (i.e., seated and standing). Most importantly, they found that participants in the walking workstation did not make any more errors than those in the passive conditions. Overall, it seemed that the walking workstation did not decrease task performance. Cycling workstations, however, was related to reduced satisfaction and task performance when compared to the other conditions. The researchers suggested that this may have been due to the fact that arms often have trouble remaining independent during leg-cycling movement (e.g., Balter & Zehr, 2007). This may have contributed to the participants’ commonly reported feelings of awkwardness whilst trying to complete the tasks.

The study suggests that the active workstation – particularly walking workstations – holds benefits that go way beyond physical health. Rather, they also have short-term psychological benefits, and task-performance tends to be unaffected. The researchers dictated that walking workstations could be incorporated into organizations as a worker health intervention. However, they suggested that rather than providing a walking station for every employee, a “sharing” program might be a more efficient and cost-effective option, in which several community workstations are available for use and employees take it in turns to complete tasks throughout the day.

Personally, I wouldn't mind a walking workstation located in the corner of my office if it meant that I was able to burn off those four sneaky biscuits that I had with my tea at lunchtime… so I would be keen to find out if active workstations contain long-term benefits. What are your thoughts on active workstations? Send us your thoughts at @EDGEClinical

By Dr. Kenny Brackstone

Sliter, M., & Yuan, Z. Workout at work: Laboratory test of psychological and performance outcomes of active workstations. Journal of Occupational Health Psychology, 20, 259-271.