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Butler M, Mehra M, Chandasir A, Kaoutzani L, Vale FL. Analysis of the discontinuation and nonpublication of neurooncological randomized clinical trials. Neurooncol Adv 2024; 6:vdae136. [PMID: 39211519 PMCID: PMC11358822 DOI: 10.1093/noajnl/vdae136] [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] [Indexed: 09/04/2024] Open
Abstract
Background Premature discontinuation and nonpublication of clinical trials contribute to research waste and compromise our ability to improve patient outcomes. However, the extent to which these problems exist in neurooncological randomized clinical trials (RCTs) is not known. This study aimed to evaluate the prevalence of discontinuation and nonpublication of neurooncological RCTs, identify contributing factors, and assess trial characteristics associated with each. Methods We performed a retrospective, cross-sectional study of neurooncological RCTs registered in Clinicaltrials.gov before March 7, 2023. Data were collected from Clinicaltrials.gov and associated publications were located. We attempted to contact authors for all trials without associated publications or an identified reason for discontinuation. Results Of 139 included RCTs, 57 (41%) were discontinued. The most common reason for discontinuation identified was slow enrollment or accrual (23%), though 30 trials (53%) were discontinued for unknown reasons. Trials funded by sources other than industry or the National Institutes of Health were more likely to be discontinued (odds ratio 4.2, 95% confidence interval 1.3-13.8). In total, 67 of the 139 (48%) RCTs were unpublished, including 50 of the 57 (88%) discontinued studies and 17 of the 82 (21%) completed studies. Conclusions In our study, discontinuation of neurooncological clinical trials was common and often occurred for unknown reasons. Trials were also frequently unpublished, particularly those that were discontinued. Addressing these findings may provide an opportunity to reduce research waste and improve outcomes for patients with neurological cancers.
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Affiliation(s)
- Molly Butler
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mehul Mehra
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Lydia Kaoutzani
- Wellstar-Medical College of Georgia Health, Department of Neurosurgery, Augusta, Georgia, USA
| | - Fernando L Vale
- Wellstar-Medical College of Georgia Health, Department of Neurosurgery, Augusta, Georgia, USA
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2
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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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Hayoz S, Kasenda B, Schenker AL, Kopp C, Schär S, Thürlimann B, von Moos R, Pless M. Completion and publication of clinical trials in a cooperative group: a cohort study of trials of the Swiss Group for Clinical Cancer Research (SAKK). BMJ Open 2023; 13:e068490. [PMID: 37072360 PMCID: PMC10124283 DOI: 10.1136/bmjopen-2022-068490] [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] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Premature trial discontinuation and non-publication of trial results are still major issues negatively affecting reliable evidence generation. OBJECTIVES To investigate trial completion and publication rate of cancer trials conducted within the Swiss Group for Clinical Cancer Research (SAKK). DESIGN Cohort study of clinical trials. SETTING Cohort of interventional cancer trials conducted in Switzerland with accrual closure between 1986 and 2021 identified from the SAKK trial management system. OUTCOMES Premature trial discontinuation and publication in peer-reviewed journal. RESULTS We included 261 trials; median number of recruited patients was 150.5 (range 1-8028). Most trials (67.0%) were randomised. Overall, 76 of 261 (29.1%) trials were prematurely closed for accrual. The three main reasons for premature closure were insufficient accrual in 28 trials, followed by stopping for futility in 17 or efficacy in 8 trials. We included 240 trials for the publication status (21 excluded, because 8 still in follow-up, for 10 the primary completion date was less than a year ago and for 3 the manuscript was submitted, but to accepted yet). 216 of 240 (90.0%) were published as a full article, 14 were published in other formats, leading to an overall publication rate of 95.8%. The rate of premature discontinuation declined over time, with 34.2%, 27.8% and 23.5% in trials activated before 2000, between 2000 and 2009, and since 2010, respectively. We observed an increasing publication rate in peer-reviewed journals over time: 79.2% (closed before 2000), 95.7% (closed between 2000 and 2009) and 93.2% (closed after 2010). CONCLUSION Insufficient patient recruitment is still the major reason for premature trial discontinuation. SAKK has continuously improved its quality management of trial conduct over time leading to increased successful trial completion and publication. However, there is still room for improvement to increase the number of trials reaching their target sample size.
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Affiliation(s)
- Stefanie Hayoz
- Statistics, Competence Center of SAKK, Bern, Switzerland
| | | | | | - Christoph Kopp
- Statistics, Competence Center of SAKK, Bern, Switzerland
| | - Sämi Schär
- Statistics, Competence Center of SAKK, Bern, Switzerland
| | - Beat Thürlimann
- Department of Internal Medicine, Division Oncology-Haematology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
- Breast Centre, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Roger von Moos
- Medical Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Miklos Pless
- Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
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Morrow RL, Mintzes B, Gray G, Law MR, Garrison S, Dormuth CR. Public reporting of clinical trial findings as an ethical responsibility to participants: a qualitative study. BMJ Open 2023; 13:e068221. [PMID: 36944466 PMCID: PMC10032397 DOI: 10.1136/bmjopen-2022-068221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To understand how the experiences and views of trial participants, trial investigators and others connected to clinical trial research relate to whether researchers have a duty to participants to publicly report research findings. DESIGN Qualitative interview study. SETTING Semistructured interviews held in person or by telephone between March 2019 and April 2021 with participants in the Canadian provinces of Alberta, British Columbia and Ontario. PARTICIPANTS 34 participants, including 10 clinical trial participants, 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators and 3 research ethics board members. ANALYSIS We conducted a thematic analysis, including qualitative coding of interview transcripts and identification of key themes. MAIN OUTCOME MEASURES Key themes identified through qualitative coding of interview data. RESULTS Most clinical trial participants felt that reporting clinical trial results is important. Accounts of trial participants suggest their contributions are part of a reciprocal relationship involving the expectation that research will advance medical knowledge. Similarly, comments from trial investigators suggest that reporting trial results is part of reciprocity with trial participants and is a necessary part of honouring informed consent. Accounts of trial investigators suggest that when drug trials are not reported, this may undermine informed consent in subsequent trials by withholding information on harms or efficacy relevant to informed decisions on whether to conduct or enroll in future trials of similar drugs. CONCLUSION The views of trial participants, trial investigators and others connected to clinical trial research in Canada suggest that researchers have an obligation to participants to publicly report clinical trial results and that reporting results is necessary for honouring informed consent.
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Affiliation(s)
- Richard L Morrow
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | - Garry Gray
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Garrison
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin R Dormuth
- Anaesthesiology, Pharmacology, and Therapeutics, Therapeutics Initiative, The University of British Columbia, Vancouver, British Columbia, Canada
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Hans GH, Almeshal D, Vanlommel L, Roelant E, Verhaegen I, Smits E, Van Boxem K, Fontaine R, Investigators Team TPELICAN. Considerations on the Obstacles That Lead to Slow Recruitment in a Pain Management Clinical Trial: Experiences from the Belgian PELICAN (PrEgabalin Lidocaine Capsaicin Neuropathic Pain) Pragmatic Study. Pain Res Manag 2023; 2023:7708982. [PMID: 37089721 PMCID: PMC10121349 DOI: 10.1155/2023/7708982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/05/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023]
Abstract
Background A qualitative evaluation study of the prematurely terminated PrEgabalin Lidocaine Capsaicin Neuropathic Pain (PELICAN) study was performed. The PELICAN study aimed to examine pain management for localized neuropathic pain (LNP), as epidemiological figures have shown a high percentage of LNP patients in Belgium. The study compared systemic and topical medications according to pain relief, adverse effects, and several measures of quality of life. Objective Achieving better study patient recruitment through qualitative research. To investigate and determine the causes of the observed recruitment problems in the PELICAN study, pain centers involved in the study as well as nonrecruiting pain centers were included. Furthermore, it aimed to highlight the positive and negative lessons learned from the conducted study and the number of obstacles the team had to overcome. Methods A qualitative study, using a mixed methods approach, was performed. Multiple pain centers in Belgium completed an online survey, after which a structured interview was conducted to elaborate the responses in more detail. The broad topics of these meetings were feedback about the study, reviewing survey answers, and actions undertaken to enhance recruitment. Results Different factors contributed to the low recruitment rate in the PELICAN study, such as limited and late referral from the general practitioners to the Belgian pain centers, insufficient internal referrals from nonpain specialists, lack of specific expertise on LNP in some centers, scarcity of staff, limited reimbursement to administer complex analgesic schemes, overestimation of the patient population, and the reluctance of patients to participate in pain research. Additionally, shortcomings in the implemented study design and the need for more logistical investments were identified. Conclusion The findings of the qualitative study demonstrate the need for further, more varied LNP research in Belgium, not limited to pharmacological studies. It also sheds important light on the recruitment obstacles that may be faced during these studies. Future studies could support this research by offering better proposals for feasibility and recruitment, for instance, by designing and conducting a compelling pilot study or applying social media during the recruitment phase. Clinical Trials. This trial is registered with NCT03348735. EUDRACT number 2018-003617-17.
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Affiliation(s)
- Guy H. Hans
- Multidisciplinary Pain Center, Antwerp University Hospital (UZA), Edegem, Belgium
- ASTARC, University of Antwerp (UA), Antwerp, Belgium
| | - Dima Almeshal
- Clinical Trial Center (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Lotte Vanlommel
- Clinical Trial Center (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
- StatUa, Center for Statistics, University of Antwerp (UA), Antwerp, Belgium
| | - Iris Verhaegen
- Clinical Trial Center (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Elke Smits
- Clinical Trial Center (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
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Chalak L, Pilon B, Byrne R, Maitre N. Stakeholder engagement in neonatal clinical trials: an opportunity for mild neonatal encephalopathy research. Pediatr Res 2023; 93:4-6. [PMID: 35477747 DOI: 10.1038/s41390-022-02067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Lina Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Betsy Pilon
- Hope for HIE, PO Box 250472, West Bloomfield, MI, USA
| | - Rachel Byrne
- CP Foundation West Bloomfield, West Bloomfield, MI, USA
| | - Nathalie Maitre
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
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7
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Jull A, Walker N. Trial registration and time to publication in a retrospective cohort of publicly funded randomised controlled trials in New Zealand 1999-2017. BMJ Open 2022; 12:e065050. [PMID: 36202579 PMCID: PMC9540847 DOI: 10.1136/bmjopen-2022-065050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To determine how quickly randomised controlled trials funded by the Health Research Council of New Zealand (HRC) were registered and published, and whether time to publication differed by trial result. DESIGN We created a retrospective cohort of trials offered funding from 1999 to 2017 by seeking lists of candidate studies using the Official Information Act 1982. These lists were supplemented by searching the HRC's online research repository and an open-access database on Figshare. One investigator searched for trial registrations and for dissemination using electronic databases, university websites and ResearchGate. One investigator extracted data from the obtained studies and a second investigator independently corroborated the data entry from a 10% random sample. RESULTS We identified 258 trials that were offered funding, 252 trials were conducted and 229 (90.9%) were registered, 179 prospectively by the date of the final search (24 March 2022). Overall, 236 trials were completed by the date of the last search and in 209 (88.6%) trials the results had been disseminated, 200 (84.7%) of which were by journal publication. We obtained the results for 214 trials, 91 (42.5%) of which were positive, 120 (56.1%) of which were null and 3 (1.4%) of which were negative. Median time to publication was 22.7 months for positive trials and 21.5 months for combined null or negative trials (log rank test p=0.83). Median time since trial completion in the trials that had not been published was 43.6 months (IQR 17.1-108.2 months). CONCLUSIONS Between 1999 and 2017, almost 9 out of every 10 HRC-funded trials had been registered and a similar proportion of completed trials had been published with no difference in time to publication based on type of result. However, only a slim majority of trials had published within the 2-year time frame set by the WHO.
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Affiliation(s)
- Andrew Jull
- School of Nursing, The University of Auckland, Auckland, New Zealand
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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8
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de Jong AJ, Grupstra RJ, Santa-Ana-Tellez Y, Zuidgeest MGP, de Boer A, Gardarsdottir H. Which decentralised trial activities are reported in clinical trial protocols of drug trials initiated in 2019-2020? A cross-sectional study in ClinicalTrials.gov. BMJ Open 2022; 12:e063236. [PMID: 36038171 PMCID: PMC9438113 DOI: 10.1136/bmjopen-2022-063236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Decentralised clinical trial activities-such as participant recruitment via social media, data collection through wearables and direct-to-participant investigational medicinal product (IMP) supply-have the potential to change the way clinical trials (CTs) are conducted and with that to reduce the participation burden and improve generalisability. In this study, we investigated the decentralised and on-site conduct of trial activities as reported in CT protocols with a trial start date in 2019 or 2020. DESIGN We ascertained the decentralised and on-site conduct for the following operational trial activities: participant outreach, prescreening, screening, obtaining informed consent, asynchronous communication, participant training, IMP supply, IMP adherence monitoring, CT monitoring, staff training and data collection. Results were compared for the public versus private sponsors, regions involved, trial phases and four time periods (the first and second half of 2019 and 2020, respectively). SETTING Phases 2, 3 and 4 clinical drug trial protocols with a trial start date in 2019 or 2020 available from ClinicalTrials.gov. OUTCOME MEASURES The occurrence of decentralised and on-site conduct of the predefined trial activities reported in CT protocols. RESULTS For all trial activities, on-site conduct was more frequently reported than decentralised conduct. Decentralised conduct of the individual trial activities was reported in less than 25.6% of the 254 included protocols, except for decentralised data collection, which was reported in 68.9% of the protocols. More specifically, 81.9% of the phase 3 protocols reported decentralised data collection, compared with 73.3% and 47.0% of the phase 2 and 4 protocols, respectively. For several activities, including prescreening, screening and consenting, upward trends in reporting decentralised conduct were visible over time. CONCLUSIONS Decentralised methods are used in CTs, mainly for data collection, but less frequently for other activities. Sharing best practices and a detailed description in protocols can drive the adoption of decentralised methods.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Renske J Grupstra
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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9
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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10
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de Jong AJ, van Rijssel TI, Zuidgeest MGP, van Thiel GJMW, Askin S, Fons-Martínez J, De Smedt T, de Boer A, Santa-Ana-Tellez Y, Gardarsdottir H. Opportunities and Challenges for Decentralized Clinical Trials: European Regulators' Perspective. Clin Pharmacol Ther 2022; 112:344-352. [PMID: 35488483 PMCID: PMC9540149 DOI: 10.1002/cpt.2628] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/20/2022] [Indexed: 01/07/2023]
Abstract
Decentralized clinical trials (DCTs) have the potential to improve accessibility, diversity, and retention in clinical trials by moving trial activities to participants’ homes and local surroundings. In this study, we conducted semi‐structured interviews with 20 European regulators to identify regulatory challenges and opportunities for the implementation of DCTs in the European Union. The key opportunities for DCTs that were recognized by regulators include a reduced participation burden, which could facilitate the participation of underserved patients. In addition, regulators indicated that data collected in DCTs are expected to be more representative of the real world. Key challenges recognized by regulators for DCTs include concerns regarding investigator oversight and participants’ safety when physical examinations and face‐to‐face contact are limited. To facilitate future learning, hybrid clinical trials with both on‐site and decentralized elements are proposed by the respondents.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Tessa I van Rijssel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine J M W van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Scott Askin
- Regulatory Affairs Innovation, Novartis Pharma AG, Basel, Switzerland
| | - Jaime Fons-Martínez
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Tim De Smedt
- Global Regulatory Affairs, UCB Pharma, Brussels, Belgium
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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11
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Chalak L. New Horizons in Mild Hypoxic-ischemic Encephalopathy: A Standardized Algorithm to Move past Conundrum of Care. Clin Perinatol 2022; 49:279-294. [PMID: 35210007 DOI: 10.1016/j.clp.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hypoxic-ischemic encephalopathy (HIE) presents clinically with a neonatal encephalopathy (NE) whereby the mild spectrum is difficult to classify immediately after birth. For decades trials have focused exclusively on infants with moderate-severe HIE s, as these infants were easier to identify after birth and had the highest risk of adverse outcomes. Twenty years after those trials, the PRIME study finally solved the first part of the conundrum by providing a definition of mild HIE in the first 6 hours. There is strong biological plausibility and preclinical evidence supporting the efficacy of therapeutic hypothermia (TH) but there is a lack of comparative clinical data to establish the risk-benefit in mild HIE. The fundamental question of how best to manage mild HIE remains unanswered. This review will summarize (1) the evidence that neonates with mild HIE are at significant risk for adverse outcomes, (2) the gaps/controversies in management, and (3) an algorithm of care is proposed to ensure standardized management of mild HIE and the direction of future trials.
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Affiliation(s)
- Lina Chalak
- Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
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12
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Jacques RM, Ahmed R, Harper J, Ranjan A, Saeed I, Simpson RM, Walters SJ. Recruitment, consent and retention of participants in randomised controlled trials: a review of trials published in the National Institute for Health Research (NIHR) Journals Library (1997-2020). BMJ Open 2022; 12:e059230. [PMID: 35165116 PMCID: PMC8845327 DOI: 10.1136/bmjopen-2021-059230] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To review the consent, recruitment and retention rates for randomised controlled trials (RCTs) funded by the UK's National Institute for Health Research (NIHR) and published in the online NIHR Journals Library between January 1997 and December 2020. DESIGN Comprehensive review. SETTING RCTs funded by the NIHR and published in the NIHR Journals Library. DATA EXTRACTION Information relating to the trial characteristics, sample size, recruitment and retention. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the recruitment rate (number of participants recruited per centre per month). Secondary outcomes were the target sample size and whether it was achieved; consent rates (percentage of eligible participants who consented and were randomised) and retention rates (percentage of randomised participants retained and assessed with valid primary outcome data). RESULTS This review identified 388 individual RCTs from 379 reports in the NIHR Journals Library. The final recruitment target sample size was achieved in 63% (245/388) of the RCTs. The original recruitment target was revised in 30% (118/388) of trials (downwards in 67% (79/118)). The median recruitment rate (participants per centre per month) was found to be 0.95 (IQR: 0.42-2.60); the median consent rate was 72% (IQR: 50%-88%) and the median retention rate was estimated at 88% (IQR: 80%-97%). CONCLUSIONS There is considerable variation in the consent, recruitment and retention rates in publicly funded RCTs. Although the majority of (6 out of 10) trials in this review achieved their final target sample; 3 out of 10 trials revised their original target sample size (downwards in 7 out of 10 trials). Investigators should bear this in mind at the planning stage of their study and not be overly optimistic about their recruitment projections.
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Affiliation(s)
- Richard M Jacques
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rashida Ahmed
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - James Harper
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Adya Ranjan
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Isra Saeed
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca M Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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13
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Stensland KD, Kaffenberger SD, George AK, Morgan TM, Miller DC, Salami SS, Dunn RL, Palapattu GS, Montgomery JS, Hollenbeck BK, Skolarus TA. Prostate cancer clinical trial completion: The role of geography. Contemp Clin Trials 2021; 111:106600. [PMID: 34673273 PMCID: PMC8908357 DOI: 10.1016/j.cct.2021.106600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS One in five cancer clinical trials fails with another third failing to meet enrollment goals. Prior efforts to improve enrollment focus on patient facing interventions, but geographic factors such as regional cancer incidence may doom trials before they even begin. For these reasons, we examined associations of regional prostate cancer incidence with trial termination, and identified scientifically-underserved areas where future trials might thrive. METHODS We merged US phase 2-3 prostate cancer clinical trial data from ClinicalTrials.gov with prostate cancer incidence data from statecancerprofiles.cancer.gov. We matched trial information from 293 closed and 560 active trials with incidence data for 2947 counties. Using multivariable logistic regression, we identified associations with trial termination. We identified 'scientifically-underserved' counties with the highest cancer incidence quintile (>61 annual cases) but lowest active trials quintile (0 or 1 trial). RESULTS Of 293 closed trials, one in three was terminated (n = 96, 32.8%). On multivariable analysis, only lower regional prostate cancer incidence was associated with higher likelihood of premature trial termination (OR 0.98, 95% CI [0.96-0.99] for every 100 cases, p = 0.03). We identified 188 counties with >61 annual prostate cancer cases but 0 or 1 active trials, indicating potential scientifically-underserved areas. CONCLUSIONS In this novel study, we found prostate cancer trials in areas with low prostate cancer incidence were more likely to fail. We also identified scientifically-underserved areas where trials might thrive. Our findings provide a more nuanced understanding of clinical trial feasibility and upstream opportunities for improvement.
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Affiliation(s)
- Kristian D Stensland
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | | | - Arvin K George
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA
| | - Todd M Morgan
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - David C Miller
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Simpa S Salami
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Rodney L Dunn
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA
| | - Ganesh S Palapattu
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Jeffrey S Montgomery
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Brent K Hollenbeck
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA.
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14
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Huo BN, Ai ML, Jia YT, Liu Y, Wang Y, Yin NG, Song L. General characteristics and reasons for the discontinuation of drug clinical trials in mainland China. BMC Med Res Methodol 2021; 21:246. [PMID: 34773983 PMCID: PMC8590359 DOI: 10.1186/s12874-021-01443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although discontinuation is common in clinical trials, no study has been conducted to analyse the current situation and reasons for the suspension or discontinuation of drug clinical trials in China. This study aims to analyse the general characteristics and reasons for the discontinuation of registered clinical trials in mainland China and to identify the associated factors. Methods We conducted a cross-sectional observational study of discontinued trials registered in the Drug Trial Registration and Information Publication Platform before March 31, 2020. All trials with a status of terminated or stopped recorded in the platform were classified as discontinued trials and included in the analysis. The basic characteristics of the discontinued trials were recorded, reasons for trial discontinuation were recorded and divided into 4 categories as drug development strategy, trial planning, trial conduct and studied drug. Pearson’s chi-square test and fisher’s exact test were used to compare the differences in reasons for discontinuation between neoplasm trials and non-neoplasm trials, and to examine the associations of trial characteristics with different reasons related to trials discontinuation. Results Three hundred twelve discontinued trials were included in this study. The studied drugs were mainly chemical drugs [229 (73.4%)], and indications of the studied drugs were mainly neoplasms [77 (24.7%)]. Geographical location of the discontinued trials were mostly in northern [114 (36.5%)] and eastern [96 (30.8%)] China. Study type of the included trials was mainly bioequivalence studies [97 (31.1%)]. The most common reason for trial discontinuation was commercial or strategic decision [84 (26.9%)], followed by futility/lack of efficacy [70 (22.4%)]. The number of trial centers, sample size and whether participants had been enrolled were significantly associated with trial discontinuation (P < 0.05). Multiple center trials showed a higher rate of trial discontinuation due to trial conduct related reasons than single center trials (P < 0.05), trials with sample size > 500 showed a higher rate of trial discontinuation due to studied drug related reasons (P < 0.05), and trials enrolled participants showed a lower rate of trial discontinuation due to commercial or strategic decision and a higher rate of trial discontinuation due to studied drug related reasons than trials without enrolled participants (P < 0.05). Besides, neoplasm trials showed a higher rate of trial discontinuation due to poor recruitment and safety comparing with non-neoplasm trials (P < 0.05). Conclusions Trial discontinuation in China mainly occurred because of commercial or strategic decision and futility/lack of efficacy of the studied drug. Clinical trials with multiple centers and a large sample size may more likely be discontinued due to trial conduct related reasons such as good clinical practice. Discontinuation due to drug safety and lack of efficacy in multiple center trials with a large sample size deserves more attention to avoid resources wastes. Full communication with regulatory authorities such as Center for Drug Evaluation and research institutes to develop a feasible protocol is important for sponsors to avoid trial discontinuation due to protocol issues.
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Affiliation(s)
- Ben-Nian Huo
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Mao-Lin Ai
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Yun-Tao Jia
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Wang
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Nan-Ge Yin
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Lin Song
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China.
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15
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Blümle A, Wollmann K, Bischoff K, Kapp P, Lohner S, Nury E, Nitschke K, Zähringer J, Rücker G, Schumacher M. Investigator initiated trials versus industry sponsored trials - translation of randomized controlled trials into clinical practice (IMPACT). BMC Med Res Methodol 2021; 21:182. [PMID: 34465296 PMCID: PMC8406615 DOI: 10.1186/s12874-021-01359-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Healthcare decisions are ideally based on clinical trial results, published in study registries, as journal articles or summarized in secondary research articles. In this research project, we investigated the impact of academically and commercially sponsored clinical trials on medical practice by measuring the proportion of trials published and cited by systematic reviews and clinical guidelines. METHODS We examined 691 multicenter, randomized controlled trials that started in 2005 or later and were completed by the end of 2016. To determine whether sponsorship/funding and place of conduct influence a trial's impact, we created four sub-cohorts of investigator initiated trials (IITs) and industry sponsored trials (ISTs): 120 IITs and 171 ISTs with German contribution compared to 200 IITs and 200 ISTs without German contribution. We balanced the groups for study phase and place of conduct. German IITs were funded by the German Research Foundation (DFG), the Federal Ministry of Education and Research (BMBF), or by another non-commercial research organization. All other trials were drawn from the German Clinical Trials Register or ClinicalTrials.gov. We investigated, to what extent study characteristics were associated with publication and impact using multivariable logistic regressions. RESULTS For 80% of the 691 trials, results were published as result articles in a medical journal and/or study registry, 52% were cited by a systematic review, and 26% reached impact in a clinical guideline. Drug trials and larger trials were associated with a higher probability to be published and to have an impact than non-drug trials and smaller trials. Results of IITs were more often published as a journal article while results of ISTs were more often published in study registries. International ISTs less often gained impact by inclusion in systematic reviews or guidelines than IITs. CONCLUSION An encouraging high proportion of the clinical trials were published, and a considerable proportion gained impact on clinical practice. However, there is still room for improvement. For publishing study results, study registries have become an alternative or complement to journal articles, especially for ISTs. IITs funded by governmental bodies in Germany reached an impact that is comparable to international IITs and ISTs.
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Affiliation(s)
- Anette Blümle
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110 Freiburg, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Karin Bischoff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Philipp Kapp
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Edris Nury
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Kai Nitschke
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 86, 79110 Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Martin Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
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16
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Calitri R, Carter M, Code C, Lamont R, Dean S, Tarrant M. Challenges of Recruiting Patients Into Group-Based Stroke Rehabilitation Research: Reflections on Clinician Equipoise Within the Singing for People With Aphasia (SPA) Pilot Trial. Front Psychol 2021; 12:624952. [PMID: 34149511 PMCID: PMC8209260 DOI: 10.3389/fpsyg.2021.624952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Raff Calitri
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Mary Carter
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Chris Code
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Ruth Lamont
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Sarah Dean
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Mark Tarrant
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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17
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Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. Sci Rep 2021; 11:3051. [PMID: 33542275 PMCID: PMC7862351 DOI: 10.1038/s41598-021-81204-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Probiotic use may be an efficacious treatment option to effectively manage symptoms of prenatal maternal anxiety and depression. Our primary aim was to test feasibility and acceptability for a probiotic randomized controlled trial (RCT) in pregnant women with pre-existing symptoms. This double-blind pilot RCT included 40 pregnant women with low-risk pregnancies and elevated depressive symptoms and/or anxiety. Once daily, participants orally consumed a probiotic (Ecologic Barrier) or a placebo, from 26 to 30 weeks gestation until delivery. A priori key progression criteria for primary outcomes were determined to decide whether or not a full RCT was feasible and acceptable. Secondary outcomes included depressive symptoms, anxiety, stress, and maternal bonding to offspring. In 19 months, 1573 women were screened; following screening, 155 women (10%) were invited for participation, of whom 135 (87%) received study information, and 40 women (30%) were included. Four out of six a priori determined criteria for success on feasibility and acceptability were met. After 8 weeks of intervention, there was no significant difference between the probiotic and placebo groups for secondary outcomes. The pilot trial was feasible and acceptable, but hampered by recruitment method and study design. Secondary endpoints did not reveal differences between the groups for improving maternal mood.
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18
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Anderson CE, Birkhäuser V, Stalder SA, Bachmann LM, Curt A, Jordan X, Leitner L, Liechti MD, Mehnert U, Möhr S, Pannek J, Schubert M, van der Lely S, Kessler TM, Brinkhof MWG. Optimizing clinical trial design using prospective cohort study data: a case study in neuro-urology. Spinal Cord 2020; 59:1003-1012. [PMID: 33235299 PMCID: PMC7611589 DOI: 10.1038/s41393-020-00588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
Study Design Simulations using data from a prospective cohort study. Objectives To illustrate how prospective cohort data can be employed in randomized controlled trial (RCT) planning to assess feasibility and operational challenges, using TASCI (Transcutaneous tibial nerve stimulation in patients with Acute Spinal Cord Injury to prevent neurogenic detrusor overactivity: a nationwide randomized, sham-controlled, double-blind clinical trial) as a case study. Setting Spinal cord injury rehabilitation centers in Switzerland. Methods TASCI is nested in the multicenter Swiss Spinal Cord Injury Cohort Study (SwiSCI), which prospectively includes patients with acute spinal cord injury. In simulations, data from 640 patients, collected by SwiSCI, were used to investigate different scenarios of patient eligibility and study consent, as well as the performance of the randomization list. Descriptive analysis was used to describe the population of interest and the simulation results; multivariable logistic regression analysis was performed to identify predictors of discharge within the TASCI intervention time period. Results The recruitment target of 114 patients is obtainable within the originally envisioned three-year time period under the most favorable recruitment scenario examined. The distribution of the primary prognostic factor produced imbalance in the randomization lists and informed further discussion of the cut-off values used in stratification. Influxes of patients resulted in overlapping intervention periods for multiple participants, which guided resource allocation. Early discharge was related to the primary prognostic factor and study center, but is only anticipated in about 8% of participants. Conclusions Prospective cohort data are a very valuable resource for planning RCTs.
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Affiliation(s)
- Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Neuro-Urology, REHAB Basel, Basel, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Lotfi S, Janani L, Ghalichi L, Tanha K, Solaymani-Dodaran M. Scientometric measures of prospectively registered clinical trials over time: A comparison of IRCT and ClinicalTrials.gov. Med J Islam Repub Iran 2020; 34:116. [PMID: 33315992 PMCID: PMC7722953 DOI: 10.34171/mjiri.34.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Iranian Registry of Clinical Trials (IRCT) started as a primary registry in 2008. We examined the characteristics and scientometric measures of prospectively registered clinical trials in IRCT over time and compared them with that of ClinicalTrials.gov. Methods: We selected eligible trial records between 2008 and 2016 from the IRCT database. We assessed their characteristics and the journal metrics of ensuing outputs over the study period and compared our findings with the corresponding information from ClinicalTrials.gov reported by Magdalena Zwierzyna et al. and a random sample of trials registered with this registry. We used the chi-square test for comparison of proportions and Mann-Whitney U test for comparison of medians. P-value <0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics V.22. Results: 1751 prospectively registered clinical trials were eligible for analysis, of which 1526 (87%) had parallel-group design, 1541 (88%) reported to be randomized, 753 (43%) used double-blinding design, 485 (%27.7) had sample size more than 100, 1313 (75%) completed within a year, 1539 (87.9%) were single centered and 1529 (87.3%) exclusively used public money. Comparison with ClinicalTrials.gov showed that they are less likely to have multiple centers, funded by private sectors, continue beyond one year; and more likely to be randomized, double-blind and get published as a paper. The sample sizes were similar. Journal scientometric measures remained constant over the study period for both databases but were higher in ClinicalTrials.gov (median SJR=1.67, IQR=1.1-3.23) compared with IRCT (median SJR=0.58, IQR=0.34-0.91). Conclusion: Our findings suggest that clinical trials registered in IRCT are predominantly investigator-initiated studies with acceptable methodological features and high publication rate albeit in journals with substantially lower scientometric measures compared with that of ClinicalTrials.gov. Journal metric indices remained constant despite an increase in the number of registrations in IRCT.
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Affiliation(s)
- Samaneh Lotfi
- Department of Epidemiology and Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghalichi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Kiarash Tanha
- Department of Biostatistics, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology and Public Health, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Division of Epidemiology and Public Health, the University of Nottingham, Nottingham, UK
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20
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Aquilina J, Neves JB, Tran MG. An overview of study designs. Br J Hosp Med (Lond) 2020; 81:1-6. [PMID: 32468947 DOI: 10.12968/hmed.2020.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The numbers of clinical trials have increased exponentially over the last decade, amplifying the pressure to select an appropriate study design to obtain reliable and valid evidence. The ability to find, critically appraise and use evidence to develop new interventions is fundamental to evidence-based medicine. Different study designs have their own advantages and disadvantages, and provide different evidentiary value. This article provides an overview of clinical trials, illustrating that, ultimately, the study design chosen needs to meet experimental and funding limitations, while minimising error.
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Affiliation(s)
- Julian Aquilina
- Faculty of Medical Sciences, University College London, London, UK
| | - Joana B Neves
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Hospitals, London, UK
| | - Maxine Gb Tran
- Division of Surgery and Interventional Sciences, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Hospitals, London, UK
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21
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Blümle A, Haag T, Balmford J, Rücker G, Schumacher M, Binder N. A multi-state model analysis of the time from ethical approval to publication of clinical research studies. PLoS One 2020; 15:e0230797. [PMID: 32218603 PMCID: PMC7100954 DOI: 10.1371/journal.pone.0230797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 03/09/2020] [Indexed: 11/22/2022] Open
Abstract
Background Results of medical research should be made publicly available in a timely manner to enable patients and health professionals to make informed decisions about health issues. We aimed to apply a multi-state model to analyze the overall time needed to publish study results, and to examine predictors of the timing of transitions within the research process from study initiation through completion/discontinuation to eventual publication. Methods Using a newly developed multi-state model approach, we analysed the effect of different study-related factors on each of the transitions from study approval to eventual publication, using a data set of clinical studies approved by a German research ethics committee between 2000 and 2002. Results Of 917 approved studies, 806 were included in our analyses. About half of the clinical studies which began were subsequently published as full articles, and the median time from study approval to publication was 10 years. Differences across model states were apparent; several factors were predictive of the transition from study approval to completion, while funding source and collaboration were predictive of the transition from completion to publication. Conclusions The proposed multi-state model approach permits a more comprehensive analysis of time to publication than a simple examination of the transition from approval to publication, and thus the findings represent an advance on previous studies of this aspect of the research process.
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Affiliation(s)
- Anette Blümle
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Tobias Haag
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Nadine Binder
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Yilmaz T, Gallagher MJ, Cordero-Coma M, Gealy D, Loporchio S, Padula WV, Loporchio D, Statler B, Migliori M. Discontinuation and nonpublication of interventional clinical trials conducted in ophthalmology. Can J Ophthalmol 2020; 55:71-75. [DOI: 10.1016/j.jcjo.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/05/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
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von Elm E, Meerpohl JJ. Trial results reporting: FDA Amendments Act Final Rule needs enforcement. Lancet 2020; 395:316-317. [PMID: 31958401 DOI: 10.1016/s0140-6736(20)30105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Erik von Elm
- Cochrane Switzerland, Center for Primary Care and Public Health, University of Lausanne, 1010 Lausanne, Switzerland.
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Paquette E, Shukla A, Davidson J, Rychlik K, Davis M. Burden or Opportunity? Parent Experiences When Approached for Research in a Pediatric Intensive Care Unit. Ethics Hum Res 2019; 41:2-12. [PMID: 31108571 DOI: 10.1002/eahr.500014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite an ongoing need for pediatric research, low study enrollment may impede study completion, particularly in critical care. We conducted a prospective cross-sectional survey and chart review study to assess parent experiences with research in a pediatric intensive care unit (PICU). Of the 80 parents who completed the study survey, 54% were approached to participate in a research study in the PICU, and 93% agreed to participate. Motivators included altruism, low burden, low risk, and research that would benefit the child. Barriers included risks to the child, the child's being too sick to participate, feeling overwhelmed, not having enough time to participate, the research's being burdensome, and the research's not being explained well. PICU parents had mostly favorable attitudes toward research participation. Compared with non-Hispanic survey respondents, respondents of Hispanic ethnicity less often reported having been approached for research, which further evidences the need to track research recruitment processes to help avoid underinclusion of members of minority populations.
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Affiliation(s)
- Erin Paquette
- Assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and an adjunct professor of law at the Northwestern University Pritzker School of Law
| | - Avani Shukla
- Research assistant at the Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Jacob Davidson
- Medical student and research assistant at Northwestern University Feinberg School of Medicine
| | - Karen Rychlik
- Senior statistician at the Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Matthew Davis
- Professor and the vice chair of the Department of Pediatrics at Northwestern University Feinberg School of Medicine and the senior vice president of community health transformation at the Ann & Robert H. Lurie Children's Hospital of Chicago
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25
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A systematic review describes models for recruitment prediction at the design stage of a clinical trial. J Clin Epidemiol 2019; 115:141-149. [DOI: 10.1016/j.jclinepi.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/26/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
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26
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Grill JD, Kwon J, Teylan MA, Pierce A, Vidoni ED, Burns JM, Lindauer A, Quinn J, Kaye J, Gillen DL, Nan B. Retention of Alzheimer Disease Research Participants. Alzheimer Dis Assoc Disord 2019; 33:299-306. [PMID: 31567302 PMCID: PMC6878201 DOI: 10.1097/wad.0000000000000353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Participant retention is important to maintaining statistical power, minimizing bias, and preventing scientific error in Alzheimer disease and related dementias research. METHODS We surveyed representative investigators from NIH-funded Alzheimer's Disease Research Centers (ADRC), querying their use of retention tactics across 12 strategies. We compared survey results to data from the National Alzheimer's Coordinating Center for each center. We used a generalized estimating equation with independent working covariance model and empirical standard errors to assess relationships between survey results and rates of retention, controlling for participant characteristics. RESULTS Twenty-five (83%) responding ADRCs employed an average 42 (SD=7) retention tactics. In a multivariable model that accounted for participant characteristics, the number of retention tactics used by a center was associated with participant retention (odds ratio=1.68, 95% confidence interval: 1.42, 1.98; P<0.001 for the middle compared with the lowest tertile survey scores; odds ratio=1.59, 95% confidence interval: 1.30, 1.94; P<0.001 for the highest compared with the lowest tertile survey scores) at the first follow-up visit. Participant characteristics such as normal cognition diagnosis, older age, higher education, and Caucasian race were also associated with higher retention. CONCLUSIONS Retention in clinical research is more likely to be achieved by employing a variety of tactics.
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Affiliation(s)
- Joshua D. Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, California
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, California
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, California
| | - Jimmy Kwon
- Department of Statistics, University of California, Irvine, Irvine, California
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, University of Washington, Seattle Washington
| | - Aimee Pierce
- Layton Center on Aging and Alzheimer’s Disease, Oregon Health & Science University, Portland, Oregon
| | - Eric D. Vidoni
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
| | - Jeffrey M. Burns
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
| | - Allison Lindauer
- Layton Center on Aging and Alzheimer’s Disease, Oregon Health & Science University, Portland, Oregon
| | - Joseph Quinn
- Layton Center on Aging and Alzheimer’s Disease, Oregon Health & Science University, Portland, Oregon
| | - Jeff Kaye
- Layton Center on Aging and Alzheimer’s Disease, Oregon Health & Science University, Portland, Oregon
| | - Daniel L. Gillen
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, California
- Department of Statistics, University of California, Irvine, Irvine, California
| | - Bin Nan
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, California
- Department of Statistics, University of California, Irvine, Irvine, California
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Abstract
Communication of clinical trial outcomes is important, but the results of many clinical trials are never published. If we do not publish the results of clinical trials, the lessons learned from those trials will perish. The Oncologist offers a powerful solution through the Clinical Trial Results publishing platform, which uses an established template for authors to easily build a manuscript by simply providing the essential trial data. Through it, every patient's legacy of clinical trial enrollment can matter.
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Affiliation(s)
- Susan E Bates
- Division of Hematology and Oncology, Department of Medicine, Columbia University Medical Center, New York New York, USA
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Rooshenas L, Paramasivan S, Jepson M, Donovan JL. Intensive Triangulation of Qualitative Research and Quantitative Data to Improve Recruitment to Randomized Trials: The QuinteT Approach. QUALITATIVE HEALTH RESEARCH 2019; 29:672-679. [PMID: 30791819 DOI: 10.1177/1049732319828693] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Randomized controlled trials (RCTs) can provide high quality evidence about the comparative effectiveness of health care interventions, but many RCTs struggle with or fail to complete recruitment. RCTs are built on the principles of the experimental method, but their planning, conduct, and interpretation can depend on complex social, behavioral, and cultural factors that may be best understood through qualitative research. Most qualitative studies undertaken alongside RCTs involve interviews that produce data that are used in a supportive or supplicatory role, but there is potential for qualitative research to be more influential. In this article, we describe the research methods underpinning the "QuinteT" (Qualitative Research Integrated Within Trials) approach to understand and address RCT recruitment difficulties. The QuinteT Recruitment Intervention (QRI) brings together multiple qualitative strategies and quantitative data and uses triangulation to understand recruitment issues rapidly. These nuanced understandings are used to inform the implementation of collaborative actions to improve recruitment.
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Discontinuation and nonpublication of interventional clinical trials conducted in patients with mild cognitive impairment and Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:161-164. [PMID: 29955660 PMCID: PMC6021544 DOI: 10.1016/j.trci.2018.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Discontinuation and nonpublication of interventional clinical trials represents a waste of already scarce resources. We sought to identify the prevalence of discontinuation and nonpublication of interventional clinical trials conducted in patients afflicted by mild cognitive impairment and Alzheimer's disease. Methods We conducted a retrospective, cross-sectional study on mild cognitive impairment and Alzheimer's disease–based interventional clinical trials in ClinicalTrials.gov dating back to 1995. The analyzed data included trial phase, intervention type, enrollment, and funding sources. Fisher's exact and χ2 tests were used to determine any potential associations between trial characteristics and completion. Results A total of 744 studies were identified, of which 502 (67%) were industry-sponsored ones. A total of 127 (17%) were discontinued prematurely. Of the 617 completed trials, 450 (73%) were not published, representing approximately 66,655 participants who incurred the risks of trial participation without subsequently contributing to the medical literature. Similarly, there were 18,246 patients from unpublished, discontinued trials. Of the 744 trials examined, 247 publications from 167 trials could be identified via PubMed/MEDLINE and EMBASE searches. Most notably, the odds of nonpublication among industry-sponsored trials were more than 75% higher than those in studies funded by academia (odds ratio = 1.78; 95% confidence interval, 1.14–2.78; P = .01). Furthermore, industry-sponsored trials had a 50% greater odds of study discontinuation compared with trials funded by academia (odds ratio = 1.50; 95% confidence interval, 1.04–2.16; P = .03). Discussion The nonpublication of many trials and preliminary results of trials that are discontinued early dilutes the quality and decreases the comprehensive nature of the medical literature. This occurs in both industry and academia. Publication of inconclusive or negative results ensures that all research activities, regardless of outcome, contribute to global medical knowledge.
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