Planning of clinical trials

Clinical Trials and Clinical Research: A Comprehensive Review

Clinical research is an alternative terminology used to describe medical research. Clinical research involves people, and it is generally carried out to evaluate the efficacy of a therapeutic drug, a medical/surgical procedure, or a device as a part of treatment and patient management. Moreover, any research that evaluates the aspects of a disease like the symptoms, risk factors, and pathophysiology, among others may be termed clinical research. However, clinical trials are those studies that assess the potential of a therapeutic drug/device in the management, control, and prevention of disease. In view of the increasing incidences of both communicable and non-communicable diseases, and especially after the effects that Coronavirus Disease-19 (COVID-19) had on public health worldwide, the emphasis on clinical research assumes extremely essential. The knowledge of clinical research will facilitate the discovery of drugs, devices, and vaccines, thereby improving preparedness during public health emergencies. Therefore, in this review, we comprehensively describe the critical elements of clinical research that include clinical trial phases, types, and designs of clinical trials, operations of trial, audit, and management, and ethical concerns.

Avaliação dos impactos financeiros gerados pela pandemia da Covid-19 aos técnicos de prótese dentária no Brasil

Resumo Introdução a pandemia da Covid-19 e medidas de controle da sua expansão impactaram diferentes segmentos da economia, dentre eles os profissionais da Odontologia. Objetivo este trabalho analisou o impacto financeiro gerado pela pandemia da Covid-19 aos técnicos de prótese dentária (TPDs) no Brasil. Material e método por meio de um estudo transversal descritivo, aplicou-se aos TPDs do Brasil um questionário relacionado ao perfil sociodemográfico e profissional, impacto financeiro e medidas adotadas para minimizar seus efeitos. O questionário foi aplicado de forma on-line em redes sociais entre 27 de janeiro e 15 de fevereiro de 2021. Resultado demonstrou-se que 59,8% dos participantes eram do sexo masculino; 47,5% até 30 anos de idade e 57,3% com menos de 10 anos de prática. As medidas para contenção da propagação do coronavírus impactaram financeiramente 89,6% dos participantes; 72,0% interromperam totalmente seus trabalhos; 97,7% tiveram redução no faturamento; 98,2% tiveram mudança na rotina de trabalho; 94,8% tiveram aumento das despesas do laboratório no período; houve queda do faturamento para 41,2% entre 0% e 25,0% e para 36,3% entre 25,0% e 50,0%; 66,6% continuaram trabalhando durante a pandemia devido à sua situação financeira. Não pensaram em fechar seu laboratório de forma definitiva 71,8% dos participantes; 92,2% seguiram rotineiramente os cuidados de higienização e 21,6% fizeram uso das reservas financeiras. Conclusão os TPDs tiveram impacto financeiro durante o período da pandemia da Covid-19 causado principalmente pela diminuição da carga horária de trabalho, redução do faturamento e aumento do custo operacional devido à mudança na rotina de biossegurança.

Learning from a cluster randomized controlled trial to improve healthcare workers' access to prevention and care for tuberculosis and HIV in Free State, South Africa: the pivotal role of information systems

Background

Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce.

Objective

This mid-term evaluation aimed to analyze how well the intervention was being implemented, seek evidence of impact or harm, and draw lessons.

Methods

Both intervention and comparison sites had been instructed to conduct bi-annual and issue-based infection control assessments (when healthcare workers [HCW] are diagnosed with TB) and offer HCWs confidential TB and HIV counseling and testing, TB treatment and prophylaxis for HIV-positive HCWs. Intervention sites were additionally instructed to conduct quarterly workplace assessments, and also offer HCWs HIV treatment at their occupational health units (OHUs). Trends in HCW mortality, sick-time, and turnover rates (2005–2014) were analyzed from the personnel salary database (‘PERSAL’). Data submitted by the OHUs were also analyzed. Open-ended questionnaires were then distributed to OHU HCWs and in-depth interviews conducted at 17 of the sites to investigate challenges encountered.

Results

OHUs reported identifying and treating 23 new HCW cases of TB amongst the 1,372 workers who used the OHU for HIV and/or TB services; 39 new cases of HIV were also identified and 108 known-HIV-positive HCWs serviced. Although intervention-site workforces used these services significantly more than comparison-site healthcare staff (p<0.001), the data recorded were incomplete for both the intervention and comparison OHUs. An overall significant decline in mortality and turnover rates was documented over this period, but no significant differences between intervention and comparison sites; sick-time data proved unreliable. Severe OHU workload as well as residual confidentiality concerns prevented the proper implementation of protocols, especially workplace assessments and data recording. Particularly, the failure to implement computerized data collection required OHU staff to duplicate their operational data collection duties by also entering research paper forms. The study was therefore halted pending the implementation of a computerized system.

Conclusions

The significant differences in OHU use documented cannot be attributable to the intervention due to incomplete data reporting; unreliable sick-time data further precluded ascertaining the benefit potentially attributable to the intervention. Computerized data collection is essential to facilitate operational monitoring while conducting real-world intervention research. The digital divide still requires the attention of researchers along with overall infrastructural constraints.

Considerations for preparing a randomized population health intervention trial: lessons from a South African-Canadian partnership to improve the health of health workers

Background

Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries.

Objective

We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships.

Design

We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies.

Results

The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise.

Conclusion

Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge.

Inconsistent survey reporting in anesthesia journals

BACKGROUND

As with other types of research, there are concerns about reporting of survey research in anesthesia journals. We hypothesized that use of survey reporting items would be inconsistent in survey research reported in anesthesia journals.

METHODS

After a literature review we constructed a 17-item reporting list for a limited systematic review of survey reporting in 6 anesthesia journals. We identified survey reports by MEDLINE (PubMed) search for January 2000 to April 2009.

RESULTS

The initial search identified 347 publications. Of these, we excluded 107 because they were not questionnaire surveys (often audits), were reviews, or were letters. We therefore identified 240 surveys published as full survey reports. From the 17-item reporting list, the median number of items recorded was 9 (interquartile range: 7 to 10; range 2 to 15). The number (and percentage) of surveys reporting specific items ranged widely for different items: from 9 surveys (4%; 95% confidence interval [CI]: 2% to 7%) for sample size to 240 surveys (100%; 95% CI: 98% to 100%) for response rate. In addition to sample size, the 5 least frequently reported items included the following: reporting confidence intervals, 21 surveys (9%; 95% CI: 6% to 13%); stating a hypothesis, 23 of 240 surveys (10%; 95% CI: 7% to 14%); accounting for nonresponders, 61 surveys (25%; 95% CI: 20% to 31%); and survey design, 67 surveys (28%; 95% CI: 33% to 34%).

CONCLUSIONS

Inconsistent reporting may compromise the transparency and reproducibility of survey reports.

A statistical metadata model for clinical trials' data management

We introduce a statistical, process-oriented metadata model to describe the process of medical research data collection, management, results analysis and dissemination. Our approach explicitly provides a structure for pieces of information used in Clinical Study Data Management Systems, enabling a more active role for any associated metadata. Using the object-oriented paradigm, we describe the classes of our model that participate during the design of a clinical trial and the subsequent collection and management of the relevant data. The advantage of our approach is that we focus on presenting the structural inter-relation of these classes when used during datasets manipulation by proposing certain transformations that model the simultaneous processing of both data and metadata. Our solution reduces the possibility of human errors and allows for the tracking of all changes made during datasets lifecycle. The explicit modeling of processing steps improves data quality and assists in the problem of handling data collected in different clinical trials. The case study illustrates the applicability of the proposed framework demonstrating conceptually the simultaneous handling of datasets collected during two randomized clinical studies. Finally, we provide the main considerations for implementing the proposed framework into a modern Metadata-enabled Information System.

A guide to planning and executing a surgical randomized controlled trial

Evidence-based medicine requires that treatments given to patients demonstrate effectiveness. The randomized controlled trial (RCT) has become the preeminent study design to assess the efficacy of treatments. Randomized controlled trials are frequently used to evaluate pharmaceutical treatments but are less often used in surgery. The lack of surgical RCTs is partly due to ethical and methodological concerns associated with surgical interventions. We provide a guide to planning and conducting a surgical RCT.