OBJECTIVE: The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool was designed to classify randomized clinical trials (RCT) as being more pragmatic or explanatory. We modified the PRECIS tool (called PRECIS-Review tool [PR-tool]) to grade individual trials and systematic reviews of trials. This should help policy makers, clinicians, researchers, and guideline developers to judge the applicability of individual trials and systematic reviews. STUDY DESIGN AND SETTING: To illustrate the usefulness and applicability of the PR-tool, we applied it to two systematic reviews. Each included RCT was scored on the 10 PRECIS domains on a scale of 1-5. After this scoring, a 10-domain average for each individual trial and for the systematic review a single domain average and an overall average was calculated. RESULTS: One review was more pragmatic with an average score of 3.7 (range, 2.9-4.6) on our PR-tool, whereas the other review was more explanatory with an average score of 1.9 (range, 1.1-3.3). The results also suggest that the included studies within each systematic review were rather uniform in their approach, although some domains seemed more prone to heterogeneity. CONCLUSION: The PR-tool provides a useful estimate that gives insight by estimating quantitatively how pragmatic each RCT in the review is, which methodological domains are pragmatic or explanatory, and how pragmatic the review is.
Abstract Background: Cardiovascular disease is the leading cause of the estimated 11–25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. Methods: The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. Discussion: The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. Trial registration: Dutch Trial Registration NL6660, registration date: 16 November 2017.
Peer reviewed research paper SEFI Engineering Education congress 2018 Within higher engineering education, students have to learn to close knowledge gaps that arise in professional assignments, such as capstone projects. These knowledge gaps can be closed through simple inquiry, but can also require more rigorous research. Since professionals work under tight constraints, they face constant trade-offs between quality, risk and efficiency to find answers that are acceptable. This means engineers use pragmatic research tactics that aim for the highest chance to find answers that fit sufficiently to close knowledge gaps in order to solve the problem with optimal use of time and resources. The problem is that research and problem-solving literature richly supplies solid strategies suitable to plan the research in projects as a whole, but hardly supplies flexible tactics to search for information within a project. This paper reports pragmatic tactics that starting bachelor engineering professionals use to acquire sufficiently good answers to questions that arise in the context of their assignments. For this, we conducted semi-structured interviews among computer science engineers with three to five years of work experience. The study reveals three pragmatic tactics: concentric, iterative and probe-response. The ambition level of the project determines when questions are sufficiently answered, and we distinguish tree sufficiency levels: check for viable answer, boost critical demand and change the game. The aim of this research is to add a view that makes pragmatic research choices for novice engineers more open to discussion and realistic.
