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Peralta G, Sánchez-Santiago B. Navigating the challenges of clinical trial professionals in the healthcare sector. Front Med (Lausanne) 2024; 11:1400585. [PMID: 38887672 PMCID: PMC11181308 DOI: 10.3389/fmed.2024.1400585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Clinical trials (CTs) are essential for medical advancements but face significant challenges, particularly in professional training and role clarity. Principal investigators, clinical research coordinators (CRCs), nurses, clinical trial pharmacists, and monitors are key players. Each faces unique challenges, such as maintaining protocol compliance, managing investigational products, and ensuring data integrity. Clinical trials' complexity and evolving nature demand specialized and ongoing training for these professionals. Addressing these challenges requires clear role delineation, continuous professional development, and supportive workplace environments to improve retention and trial outcomes. Enhanced training programs and a collaborative approach are essential for the successful conduct of clinical trials and the advancement of medical research.
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Affiliation(s)
- Galo Peralta
- Central Support Unit, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Blanca Sánchez-Santiago
- Clinical Pharmacology Service, Clinical Trials Unit, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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2
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AlFattani A, AlFirm A, AlBedah N, AlDakhil H, Al Muaythir E, Zeyad L, AlTwaijri Y. Enhancing research support services in health organizations by implementing a "Research Concierge Desk", a case study. Front Res Metr Anal 2024; 9:1335240. [PMID: 38645610 PMCID: PMC11026691 DOI: 10.3389/frma.2024.1335240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Health organizations with teaching and research responsibilities face the need to establish a comprehensive system that addresses the processes and challenges associated with research activities; a system that assists local institutes in becoming research-active by identifying gaps and providing actionable recommendations. The involvement of epidemiologists, biostatisticians, and data scientists is paramount in offering technical and scientific support to health researchers. In our organization, research support services, such as technical, statistical, logistical, and scientific assistance, have been provided to researchers for the past 20 years under the name of "Data Clinic Service". This article discusses the establishment of a physical booth called the "Research Concierge Desk" within a medical center to offer on-site, free-of-charge, and direct consultations to researchers, thereby improving accessibility to data clinic services. The underlying concept of the "Research Concierge Desk" is to align the research workflow for busy clinicians, who require vital assistance in the technical aspects of their research. As well, the desk and its digital platform enabled us to assess research process workflow, such as research submission, data clinic requests, research progress tracking, and researcher satisfaction assessment. We present the initiation of the "Research Concierge Desk" as an innovative solution in hospital settings, outline the available resources, benefits, challenges, and propose areas for improvement. The experience gained from implementing the "Research Concierge Desk" model can greatly benefit other health centers in adopting a similar approach to develop enhanced services for clinical researchers.
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Affiliation(s)
| | | | | | | | | | | | - Yasmin AlTwaijri
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Hoffmann JM, Blümle A, Grossmann R, Yau H, Lang B, Bradbury C. Toward a global harmonization of service infrastructure in academic clinical trial units: an international survey. Front Med (Lausanne) 2023; 10:1252352. [PMID: 37901403 PMCID: PMC10602721 DOI: 10.3389/fmed.2023.1252352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background Clinicians around the world perform clinical research in addition to their high workload. To meet the demands of high quality Investigator Initiated Trials (IITs), Clinical Trial Units (CTUs) (as part of Academic Research Institutions) are implemented worldwide. CTUs increasingly hold a key position in facilitating the international mutual acceptance of clinical research data by promoting clinical research practices and infrastructure according to international standards. Aim In this project, we aimed to identify services that established and internationally operating CTUs - members of the International Clinical Trial Center Network (ICN) - consider most important to ensure the smooth processing of a clinical trial while meeting international standards. We thereby aim to drive international harmonization by providing emerging and growing CTUs with a resource for informed service range set-up. Methods Following the AMEE Guide, we developed a questionnaire, addressing the perceived importance of different CTU services. Survey participants were senior representatives of CTUs and part of the ICN with long-term experience in their field and institution. Results Services concerning quality and coordination of a research project were considered to be most essential, i.e., Quality management, Monitoring and Project management, followed by Regulatory & Legal affairs, Education & Training, and Data management. Operative services for conducting a research project, i.e., Study Nurse with patient contact and Study Nurse without patient contact, were considered to be least important. Conclusion To balance the range of services offered while meeting high international standards of clinical research, emerging CTUs should focus on offering (quality) management services and expertise in regulatory and legal affairs. Additionally, education and training services are required to ensure clinicians are well trained on GCP and legislation. CTUs should evaluate whether the expertise and resources are available to offer operative services.
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Affiliation(s)
- Jean-Marc Hoffmann
- Clinical Trials Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Anette Blümle
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Regina Grossmann
- Clinical Trials Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Henry Yau
- Clinical Trials Centre, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Britta Lang
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Cedric Bradbury
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Cimino J, Braun C. Design a Clinical Research Protocol: Influence of Real-World Setting. Healthcare (Basel) 2023; 11:2254. [PMID: 37628452 PMCID: PMC10454664 DOI: 10.3390/healthcare11162254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The design of a clinical research protocol to evaluate new therapies, devices, patient quality of life, and medical practices from scratch is probably one of the greatest challenges for the majority of novice researchers. This is especially true since a high-quality methodology is required to achieve success and effectiveness in academic and hospital research centers. This review discusses the concrete steps and necessary guidelines needed to create and structure a research protocol. Along with the methodology, some administrative challenges (ethics, regulatory and people-management barriers) and possible time-saving recommendations (standardized procedures, collaborative training, and centralization) are discussed.
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Affiliation(s)
- Jonathan Cimino
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg;
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
| | - Claude Braun
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg;
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
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What does a department need to get involved in clinical trials? Injury 2023:S0020-1383(23)00075-X. [PMID: 36725487 DOI: 10.1016/j.injury.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Clinical trials are conducted to evaluate the usefulness of a drug, medical treatment, surgical intervention, radiological procedure, behavioral intervention, or preventive health care strategy. Clinical trials are challenging, time-consuming, and need careful planning and execution. There are certain requirements for an academic unit to be ready for conducting quality research, especially clinical trials. These include logistical concerns, infrastructure, appropriately trained human resources, conformity with ethical compliances and regulatory compliances as per the laws governing the respective geographical regions. Infrastructure requirements include research division space, robust data archival system, archival of imaging data, laboratory services, information technology division and facilities for the appropriate consenting process. Human resources such as principal investigators, data managers, clinical research assistants and biostatisticians are needed to execute the clinical trial as per the study design. Adherence to ethical and regulatory standards; during the conduct of the clinical trial are imperative. Strict compliance with prevailing governing laws in the country is a prerequisite for a department to get involved in clinical trials. The department also needs to put in place an institutional ethics committee; the composition of which is often governed by regulatory laws. The ethical aspects of the trial undergo a formal scrutiny by an Institute ethics committee that ensures quality care to the patient, and safeguards the patient's rights and privileges. The academic unit of any department forms the core for possible research and pursuit of clinical trials. A department with rich clinical experience and expertise in the filed aids in the execution of quality research. The academic department must consider grant writing and multiple center collaborative research projects in due course of time to further enhance the quality of clinical trials and research output.
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Tini G, Trapani D, Duso BA, Beria P, Curigliano G, Pelicci PG, Mazzarella L. Quantifying geographical accessibility to cancer clinical trials in different income landscapes. ESMO Open 2022; 7:100515. [PMID: 35738201 PMCID: PMC9271515 DOI: 10.1016/j.esmoop.2022.100515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Clinical trials are increasingly perceived as a therapeutic opportunity for cancer patients. Favoring their concentration in few high-expertise academic centers maximizes quality of data collection but poses an issue of access equality. Analytical tools to quantify trial accessibility are needed to rationalize resources. Materials and methods We constructed a distance-based accessibility index (dAI) using publicly available data on demographics, cancer incidence and trials. Multiple strategies were applied to mitigate or quantify clear sources of bias: reporting biases by text mining multiple registries; reliability of simple geographical distance by comparison with high-quality travel cost data for Italy; index inflation due to highly heterogeneous cancer incidence by log-transformation. We studied inequalities by Gini index and time trend significance by Mann–Kendall test. We simulated different resource allocation models in representative countries and identified locations where new studies would maximally improve the national index. Results The dAI approximated well a more realistic but not widely applicable travel cost-based index. Accessibility was unevenly distributed across and within countries (Gini index ∼0.75), with maximal inequalities in high- and upper-middle-income countries (China, United States, Russian Federation). Over time, accessibility increased but less than the total number of trials, most evidently in upper-middle-income countries. Simulations in representative countries (Italy and Serbia) identified ideal locations able to maximally raise the national index. Conclusions Access to clinical trials is highly uneven across and within countries and is not mitigated by simple increase in the number of trials; a rational algorithmic approach can be used to mitigate inequalities. Accessibility to cancer clinical trials grew less than total number of trials over time in upper-middle-income countries. Accessibility is unevenly distributed, with maximal inequalities in high- and upper-middle-income countries. Simulation of resource allocation can identify ideal locations able to raise the national accessibility index.
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Affiliation(s)
- G Tini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - D Trapani
- Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - B A Duso
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy
| | - P Beria
- Department of Architecture and Urban Studies (DAStU), Politecnico of Milano, Milano, Italy
| | - G Curigliano
- Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - P G Pelicci
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - L Mazzarella
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milano, Italy; Division of Early Drug Development, IEO European Institute of Oncology, IRCCS, Milano, Italy.
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7
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cimino J, Braun C. Building a competitive infrastructure to support clinical research in healthcare institution. Eur J Clin Invest 2021; 51:e13641. [PMID: 34146339 DOI: 10.1111/eci.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical research is becoming increasingly popular in Europe at a growth rate much higher than expected, especially in Benelux. Although traditionally thought to be the purview of academic health centres, clinical research to evaluate new drugs, devices and medical practices is being done more and more in healthcare organizations with little or no academic affiliation. METHODS By managing a new infrastructure and centralizing resources and demands, clinical research unit (CRU) has become an effective mechanism for hospital research. The 'infrastructure' or CRU refers to the necessary resources and how the CRU is organized and communicates operationally to conduct clinical research within the institution. The creation of a new CRU within the Robert Schuman Hospital in Luxembourg is described in this article. RESULTS This article discusses the concrete steps and basic elements such as patient-centric and hospital approaches needed to create and structure a CRU to provide academic or industry-sponsored research support in clinical research. CONCLUSIONS Some infrastructure challenges (insufficient engagement, regulatory and administrative barriers) and possible courses of action (standardized procedures, training and centralization) will be discussed.
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Affiliation(s)
- Jonathan Cimino
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, Luxembourg, Luxembourg.,Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Claude Braun
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, Luxembourg, Luxembourg.,Hôpitaux Robert Schuman, Luxembourg, Luxembourg
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Nguyen QN, Nguyen NV, Nguyen DTP, Vidaillac C, Trinh PTM, van Doorn HR, Thwaites GE, Kestelyn E, Vo HTN. Development of a Good Clinical Practice inspection checklist to assess clinical trial sites in Vietnam. BMJ Open 2021; 11:e048256. [PMID: 34312203 PMCID: PMC8314720 DOI: 10.1136/bmjopen-2020-048256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Assessing the capacity of a healthcare institution to conduct and manage clinical research studies is challenging, especially in developing countries where resources are limited. The objective of this study was to develop a practical and transparent tool for the Vietnam Ministry of Health (MOH) to assess institutions' capacity to lead clinical trials in line with local and international regulations. METHODS We reviewed the literature, relevant official international and national guidelines, regulations and checklists for clinical sites' assessment to identify key indicators of clinical research capacity. We developed a Good Clinical Practice (GCP) inspection checklist consisting of a questionnaire with 30 key criteria, including 16 core criteria and 14 recommended criteria, related to four central aspects of clinical research management (ie, governance, operations, infrastructures and human resources). Following a detailed review and assessment by a panel of experts, sponsors and academic investigators, we assessed the checklist's applicability in a pilot study involving 10 sites with various clinical research experiences. RESULTS Independently of their clinical research experience, all participating institutions fulfilled most of the core criteria. In contrast, a significant variability was observed in the compliance to recommended capacity criteria, especially those related to governance (certifications and reporting) as well as operations (existence of a clinical research coordination unit or electronic trial management system). CONCLUSIONS A GCP inspection checklist was successfully developed to support the MOH in the assessment of institutions' capacity to conduct clinical research. Additional efforts from all stakeholders are now warranted to provide local sites with sustainable capacity development resources that will further build up and harmonise Vietnamese clinical research settings.
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Affiliation(s)
- Quang Ngo Nguyen
- Administration of Science Technology and Training, Ministry of Health of Vietnam, Ha Noi, Hanoi, Viet Nam
| | - Nam Vinh Nguyen
- Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam
- Department of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | | | - Celine Vidaillac
- Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam
| | - Phuong Thi Minh Trinh
- Administration of Science Technology and Training, Ministry of Health of Vietnam, Ha Noi, Hanoi, Viet Nam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh city, Viet Nam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ha Thi Nhi Vo
- Administration of Science Technology and Training, Ministry of Health of Vietnam, Ha Noi, Hanoi, Viet Nam
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Fabbri F, Gentili G, Serra P, Vertogen B, Andreis D, Dall'Agata M, Fabbri G, Gallà V, Massa I, Montanari E, Monti M, Pagan F, Piancastelli A, Ragazzini A, Rudnas B, Testoni S, Valmorri L, Zingaretti C, Zumaglini F, Nanni O. How Many Cancer Clinical Trials Can a Clinical Research Coordinator Manage? The Clinical Research Coordinator Workload Assessment Tool. JCO Oncol Pract 2020; 17:e68-e76. [PMID: 32936710 DOI: 10.1200/jop.19.00386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer clinical trials (CTs) are now more complex than ever before and require dedicated personnel (clinical research coordinators [CRCs]) to perform regulatory and administrative activities and protocol- and patient-related procedures. We developed a simple tool to measure the workload (WL) of CRCs involved in cancer research and to estimate personnel requirements within a Clinical Trial Center. METHODS A literature review and 2-month period in which CRCs recorded their activities in a diary provided valuable information that led to the Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Workload Assessment Tool (IWAT) being divided into three sections: Protocol, On-Treatment Patients, and Follow-Up Patients. Twelve full-time senior CRCs from three sites of the Network measured their monthly WL for 30 months to evaluate IWAT reproducibility and accuracy. RESULTS The IWAT proved to be a user-friendly tool (3-6 minutes required for each CT), with high reproducibility (interobserver reproducibility ranged from 82% to 100% for each IWAT item). In December 2017, the Network had 185 ongoing CTs, with a median of 2.5 active centers for each CT. On the basis of 448 total IWAT measures by CRCs, the majority of trials were academic (57%) or dealt with advanced disease (77%). The median IWAT WL score for each study was 20.98 ± 22.90 (range, 2-188) and 475 ± 229 (range, 150 [junior staff] - 930 [extreme heavy WL]) for each CRC. On the basis of our experience, a monthly WL score of 500-600 was considered an appropriate value for a full-time CRC. CONCLUSION The IWAT could prove useful in evaluating CT complexity, estimating appropriate CRC WLs, and defining personnel requirements. Independent validation by other CRCs working in different organizational contexts and in different countries is needed.
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Affiliation(s)
- Francesca Fabbri
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giorgia Gentili
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Patrizia Serra
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Bernadette Vertogen
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Greta Fabbri
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Gallà
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ilaria Massa
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Montanari
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Manuela Monti
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Flavia Pagan
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandra Piancastelli
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Angela Ragazzini
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Britt Rudnas
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Testoni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Linda Valmorri
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Zingaretti
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Federica Zumaglini
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Thajer A, Sommersguter-Reichmann M, Löffler-Stastka H. Implementing a Clinical Research Department to Support Pediatric Studies: A SWOT Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176211. [PMID: 32867050 PMCID: PMC7504077 DOI: 10.3390/ijerph17176211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023]
Abstract
The safety, tolerability, pharmacokinetics and efficacy of most drugs used in pediatrics have not been studied in different age groups and are administered "off-label use". Clinical pediatric drug trials require specific and stringent compliance with laws, regulations, guidelines, and patient/parent/public involvement, which in turn increases resource use and makes support useful from a medical, qualitative, economic, and system perspective. We examined the strengths, weaknesses, opportunities and threats of implementing a Research Department for the Support of Pediatric Studies (RDPS) in Vienna. We used the SWOT ("strengths", "weaknesses", "opportunities", and "threats") analysis to collect comprehensive data and facts on the internal strengths, weaknesses (company analysis), and external opportunities and threats (environmental analysis). The company analysis revealed a productivity gain, due to a highly specialized team and standardized processes. The environmental analysis outlined a considerable 360-degree potential for a qualitative and quantitative medical- and social-scientific expansion of the service portfolio. The establishment of a RDPS leads to the centralization of pediatric studies by bundling tasks and concentration of specialist knowledge, which enables the exploitation of synergies, the standardization of processes, the promotion of professionalism, flexibility, innovations and the reduction of inefficiencies in the form of duplication of tasks. RDPS offers tailored advice and support for different types of pediatric studies.
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Affiliation(s)
- Alexandra Thajer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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Frost J, Britten N. Learning from a Feasibility Trial of a Simple Intervention: Is Research a Barrier to Service Delivery, or is Service Delivery a Barrier to Research? Healthcare (Basel) 2020; 8:E53. [PMID: 32138337 PMCID: PMC7151079 DOI: 10.3390/healthcare8010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linked to a feasibility trial of a clinic-based intervention in secondary care. Data collection involved 24 semi-structured interviews with research managers, clinical research staff, health professionals, and patients. (3) Results: This study required a dynamic network of interactions between heterogeneous health and social care stakeholders, each characterized by differing ways of organizing activities which constitute their core functions; cultures of collaboration and interaction and understanding of what research involves and how it contributes to patient care. These interrelated factors compounded the occupational and organizational boundaries that hindered communication and coordination. (4) Conclusions: Despite the strategic development of multiple organizations to foster inter-professional collaboration, the competing goals of research and clinical practice can impede the conduct of high quality AHSR. To remedy this requires the alignment and streamlining of organizational goals, so that all agencies involved in AHSR develop a shared understanding and mutual respect for the progress of evidence-based medicine and the complex and often nuanced environments in which it is created and practiced.
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Affiliation(s)
- Julia Frost
- St Luke’s Campus, University of Exeter Medical School, Exeter EX1 2LU, UK;
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Abebe KZ, Althouse AD, Comer D, Holleran K, Koerbel G, Kojtek J, Weiss J, Spillane S. Creating an academic research organization to efficiently design, conduct, coordinate, and analyze clinical trials: The Center for Clinical Trials & Data Coordination. Contemp Clin Trials Commun 2019; 16:100488. [PMID: 31763494 PMCID: PMC6861639 DOI: 10.1016/j.conctc.2019.100488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022] Open
Abstract
When properly executed, the randomized controlled trial is one of the best vehicles for assessing the effectiveness of one or more interventions. However, numerous challenges may emerge in the areas of study startup, recruitment, data quality, cost, and reporting of results. The use of well-run coordinating centers could help prevent these issues, but very little exists in the literature describing their creation or the guiding principles behind their inception. The Center for Clinical Trials & Data Coordination (CCDC) was established in 2015 through institutional funds with the intent of 1) providing relevant expertise in clinical trial design, conduct, coordination, and analysis; 2) advancing the careers of clinical investigators and CCDC-affiliated faculty; and 3) obtaining large data coordinating center (DCC) grants. We describe the organizational structure of the CCDC as well as the homegrown clinical trial management system integrating nine crucial elements: electronic data capture, eligibility and randomization, drug and external data tracking, safety reporting, outcome adjudication, data and safety monitoring, statistical analysis and reporting, data sharing, and regulatory compliance. Lastly, we share numerous lessons that can be taken from our experience. Specifically, we focus on 1) funding for DCCs, 2) the importance of DCCs to clinical researchers, 3) the expertise of DCC personnel, and 4) continually striving to improve. In conclusion, the CCDC strives to provide high-quality support for the design, conduct, coordination, and analyses of clinical trials, and we hope this paper will serve as a blueprint for future clinical trialists involved in DCCs.
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Affiliation(s)
- Kaleab Z. Abebe
- Center for Clinical Trials & Data Coordination, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Arai RJ, de Lourdes Noronha I, Nicolau JC, Schmidt C, de Albuquerque GM, Mahaffey KW, Krieger EM, Júnior JOCA. Academic health centers: integration of clinical research with healthcare and education. Comments on a workshop. Clinics (Sao Paulo) 2018; 73:e515s. [PMID: 30281697 PMCID: PMC6131216 DOI: 10.6061/clinics/2017/e515s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Roberto Jun Arai
- Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Comissão de Facilitação de Pesquisa Clínica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Irene de Lourdes Noronha
- Comissão de Facilitação de Pesquisa Clínica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratório de Nefrologia Celular, Genética e Molecular, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Carlos Nicolau
- Comissão de Facilitação de Pesquisa Clínica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Charles Schmidt
- Comissão de Facilitação de Pesquisa Clínica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR
| | - Gustavo Moreira de Albuquerque
- Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University, California, USA
| | - Eduardo Moacyr Krieger
- Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Park YR, Yoon YJ, Koo H, Yoo S, Choi CM, Beck SH, Kim TW. Utilization of a Clinical Trial Management System for the Whole Clinical Trial Process as an Integrated Database: System Development. J Med Internet Res 2018; 20:e103. [PMID: 29691212 PMCID: PMC5941091 DOI: 10.2196/jmir.9312] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background Clinical trials pose potential risks in both communications and management due to the various stakeholders involved when performing clinical trials. The academic medical center has a responsibility and obligation to conduct and manage clinical trials while maintaining a sufficiently high level of quality, therefore it is necessary to build an information technology system to support standardized clinical trial processes and comply with relevant regulations. Objective The objective of the study was to address the challenges identified while performing clinical trials at an academic medical center, Asan Medical Center (AMC) in Korea, by developing and utilizing a clinical trial management system (CTMS) that complies with standardized processes from multiple departments or units, controlled vocabularies, security, and privacy regulations. Methods This study describes the methods, considerations, and recommendations for the development and utilization of the CTMS as a consolidated research database in an academic medical center. A task force was formed to define and standardize the clinical trial performance process at the site level. On the basis of the agreed standardized process, the CTMS was designed and developed as an all-in-one system complying with privacy and security regulations. Results In this study, the processes and standard mapped vocabularies of a clinical trial were established at the academic medical center. On the basis of these processes and vocabularies, a CTMS was built which interfaces with the existing trial systems such as the electronic institutional review board health information system, enterprise resource planning, and the barcode system. To protect patient data, the CTMS implements data governance and access rules, and excludes 21 personal health identifiers according to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule and Korean privacy laws. Since December 2014, the CTMS has been successfully implemented and used by 881 internal and external users for managing 11,645 studies and 146,943 subjects. Conclusions The CTMS was introduced in the Asan Medical Center to manage the large amounts of data involved with clinical trial operations. Inter- and intraunit control of data and resources can be easily conducted through the CTMS system. To our knowledge, this is the first CTMS developed in-house at an academic medical center side which can enhance the efficiency of clinical trial management in compliance with privacy and security laws.
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Affiliation(s)
- Yu Rang Park
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea.,Department of Biomedical Informatics, Asan Medical Center, Seoul, Republic Of Korea.,Health Innovation Bigdata Center, Seoul, Republic Of Korea
| | - Young Jo Yoon
- Office of Clinical Research Information, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea
| | - HaYeong Koo
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea
| | - Soyoung Yoo
- Health Innovation Bigdata Center, Seoul, Republic Of Korea.,Human Research Protection Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea
| | - Chang-Min Choi
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea.,Department of Pulmonology and Critical Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic Of Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic Of Korea
| | - Sung-Ho Beck
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea.,Clinical Trial Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea
| | - Tae Won Kim
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic Of Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic Of Korea
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Hall DA, Ramos AR, Gelfand JM, Videnovic A, Benatar M, Cahill C, Kluger BM, Goldman M. The state of clinical research in neurology. Neurology 2018; 90:e1347-e1354. [PMID: 29549220 DOI: 10.1212/wnl.0000000000005295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study and provide an update on the state of clinical research in neurology in the United States. METHODS US American Academy of Neurology members and chairs of departments of neurology were surveyed regarding clinical research in 2016. NIH data on the neuroscience pipeline and extramural grant funding were also collected. RESULTS The response rate was 32% (n = 254) for nonchair researchers and 58% (n = 67) for department chairs. Researcher respondents were on average 50 years old, 66% were men, and 81% were actively conducting clinical research, with phase II/III clinical trials and outcome measure studies being the most common type of research conducted. Time to conduct research, recruitment, and administrative burden were the major barriers reported. According to department chairs, funding and training opportunities in patient-oriented research have increased over the last 10 years. Overall, applicants to neuroscience-specific NIH institutes for extramural funding have decreased over the same time period. CONCLUSIONS The state of clinical research in neurology has remained relatively stable over the last 10 years, but neurologists still have barriers in conducting clinical research. There has been an interval decrease in neuroscience applicants for NIH funding, which raises concerns about the pipeline and future of clinical research in neurology. These results will serve as a reference for the development of solutions to these issues.
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Affiliation(s)
- Deborah A Hall
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville.
| | - Alberto R Ramos
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Jeffrey Marc Gelfand
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Aleksander Videnovic
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Michael Benatar
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Carolyn Cahill
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Benzi M Kluger
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
| | - Myla Goldman
- From the Department of Neurological Sciences (D.H.), Rush University, Chicago, IL; Department of Neurology (A.R.R., M.B.), University of Miami, FL; Department of Neurology (J.M.G.), University of California San Francisco; Massachusetts General Hospital (A.V.), Boston; Member Insights Department (C.C.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (B.M.K.), University of Colorado, Denver; and Department of Neurology (M.G.), University of Virginia, Charlottesville
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Johnson MR, Kenworthy-Heinige T, Beck DJ, Asghar A, Broussard EB, Bratcher K, Tommessilli LM, Antonelli M, Planeta BM. Research site mentoring: A novel approach to improving study recruitment. Contemp Clin Trials Commun 2018; 9:172-177. [PMID: 29696240 PMCID: PMC5898529 DOI: 10.1016/j.conctc.2018.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 11/06/2022] Open
Abstract
Background/Aims The VA Cooperative Studies Program's (CSP) Network of Dedicated Enrollment Sites (NODES) is a consortium of nine VA medical centers (VAMCs) with teams (nodes) dedicated to enhance performance, compliance, and management of CSP multi-site clinical trials. The West Haven CSP Coordinating Center (WH-CSPCC), study coordinating center for CSP #577, Colonoscopy Versus Fecal Immunochemical Test (FIT) in Reducing Mortality from Colorectal Cancer (CONFIRM) trial, and NODES piloted a “site mentoring” (hub-and-spoke) model. In this model, a node site would work one-on-one with a low enrolling CONFIRM site to identify and overcome barriers to recruitment. The aim was to determine the impact of a research site mentoring model on study recruitment and examine site-level characteristics that facilitate or impede it. Results Sites in the mentorship pilot had an average improvement of 5 ± 4 participants randomized per month (min −2.6; max 11.6; SD 4.3). Four of ten sites (40%) demonstrated continuous improvement in the average number of randomized participants per month after the pilot intervention and at three-month follow-up (post-intervention), as compared to the five-month period preceding the intervention. An additional two sites (20%) demonstrated improvement in the average number of randomized participants per month after the pilot intervention, and sustained that level of improvement at three-month follow-up (post-intervention). Additionally, six of ten sites (60%) demonstrated an increased number of participants screened for eligibility immediately following the intervention and at three-month follow-up (post-intervention). Only one site showed a decreased monthly average of randomized participants shortly after the intervention and through the three-month follow-up period. Conclusions The site mentoring model was successful in improving recruitment at low enrolling CONFIRM sites. An additional feasibility assessment is needed to determine if this mentoring model will be effective with other CSP trials.
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Affiliation(s)
- Marcus R Johnson
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, 508 Fulton Street (152), Durham, NC 27705, USA
| | | | - Danielle J Beck
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
| | - Aliya Asghar
- Tibor Rubin VA Medical Center, 5901 E. 7th Street (09/151-C2), Long Beach, CA 90822, USA
| | - Emily B Broussard
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, MHCL 116 Room 6B-310, Houston, TX 77030, USA
| | - Karen Bratcher
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Building 4, Third Floor B-325, Palo Alto, CA 94304, USA
| | - Lynn M Tommessilli
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
| | - Margaret Antonelli
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
| | - Beata M Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue (151A), West Haven, CT 06516, USA
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Hind D, Reeves BC, Bathers S, Bray C, Corkhill A, Hayward C, Harper L, Napp V, Norrie J, Speed C, Tremain L, Keat N, Bradburn M. Comparative costs and activity from a sample of UK clinical trials units. Trials 2017; 18:203. [PMID: 28464930 PMCID: PMC5414193 DOI: 10.1186/s13063-017-1934-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. METHODS Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. RESULTS Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ = 0.21-0.40) for statisticians/data managers and poor for other roles (κ < 0.20). CONCLUSIONS Some variation in costs is due to factors outside the control of CTUs such as access to core funding and levels of indirect costs levied by host institutions. Research is needed on strategies to control costs appropriately, especially the implementation of risk-based monitoring strategies.
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Affiliation(s)
- Daniel Hind
- CTRU, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Barnaby C. Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Queens Building, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW UK
| | - Sarah Bathers
- Caudwell Children, Minton Hollins, Shelton Old Road, Stoke on Trent, Staffordshire, ST4 7RY UK
| | - Christopher Bray
- Diabetes Trials Unit, OCDEM, Churchill Hospital, Old Road, Oxford, OX3 7LJ UK
| | - Andrea Corkhill
- University of Southampton, Clinical Trials Unit, MP131, Southampton General Hospital, Tremona Road, Southampton, Hants SO16 6YD UK
| | - Christopher Hayward
- Peninsula Clinical Trials Unit, Peninsula College of Medicine & Dentistry, Room N14, ITTC Building 1, Tamar Science Park, Plymouth, Devon PL6 8BX UK
| | - Lynda Harper
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - Vicky Napp
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD UK
| | - Chris Speed
- Newcastle Clinical Trials Unit, Newcastle University, 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Liz Tremain
- National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS UK
| | - Nicola Keat
- Cancer Research UK, Angel Building, 407 St. John Street, London, EC1V 4AD UK
| | - Mike Bradburn
- CTRU, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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Retooling institutional support infrastructure for clinical research. Contemp Clin Trials 2016; 48:139-45. [PMID: 27125563 DOI: 10.1016/j.cct.2016.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/21/2022]
Abstract
Clinical research activities at academic medical centers are challenging to oversee. Without effective research administration, a continually evolving set of regulatory and institutional requirements can divert investigator and study team attention away from a focus on scientific gain, study conduct, and patient safety. However, even when the need for research administration is recognized, there can be struggles over what form it should take. Central research administration may be viewed negatively, with individual groups preferring to maintain autonomy over processes. Conversely, a proliferation of individualized approaches across an institution can create inefficiencies or invite risk. This article describes experiences establishing a unified research support office at the Duke University School of Medicine based on a framework of customer support. The Duke Office of Clinical Research was formed in 2012 with a vision that research administration at academic medical centers should help clinical investigators navigate the complex research environment and operationalize research ideas. The office provides an array of services that have received high satisfaction ratings. The authors describe the ongoing culture change necessary for success of the unified research support office. Lessons learned from implementation of the Duke Office of Clinical Research may serve as a model for other institutions undergoing a similar transition.
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