1
|
van Wijk RC, Imperial MZ, Savic RM, Solans BP. Pharmacokinetic analysis across studies to drive knowledge-integration: A tutorial on individual patient data meta-analysis (IPDMA). CPT Pharmacometrics Syst Pharmacol 2023; 12:1187-1200. [PMID: 37303132 PMCID: PMC10508576 DOI: 10.1002/psp4.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Answering challenging questions in drug development sometimes requires pharmacokinetic (PK) data analysis across different studies, for example, to characterize PKs across diverse regions or populations, or to increase statistical power for subpopulations by combining smaller size trials. Given the growing interest in data sharing and advanced computational methods, knowledge integration based on multiple data sources is increasingly applied in the context of model-informed drug discovery and development. A powerful analysis method is the individual patient data meta-analysis (IPDMA), leveraging systematic review of databases and literature, with the most detailed data type of the individual patient, and quantitative modeling of the PK processes, including capturing heterogeneity of variance between studies. The methodology that should be used in IPDMA in the context of population PK analysis is summarized in this tutorial, highlighting areas of special attention compared to standard PK modeling, including hierarchical nested variability terms for interstudy variability, and handling between-assay differences in limits of quantification within a single analysis. This tutorial is intended for any pharmacological modeler who is interested in performing an integrated analysis of PK data across different studies in a systematic and thorough manner, to answer questions that transcend individual primary studies.
Collapse
Affiliation(s)
- Rob C. van Wijk
- University of California San Francisco Schools of Pharmacy and MedicineSan FranciscoCaliforniaUSA
- UCSF Center for Tuberculosis, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Marjorie Z. Imperial
- University of California San Francisco Schools of Pharmacy and MedicineSan FranciscoCaliforniaUSA
- UCSF Center for Tuberculosis, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Radojka M. Savic
- University of California San Francisco Schools of Pharmacy and MedicineSan FranciscoCaliforniaUSA
- UCSF Center for Tuberculosis, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Belén P. Solans
- University of California San Francisco Schools of Pharmacy and MedicineSan FranciscoCaliforniaUSA
- UCSF Center for Tuberculosis, University of California San FranciscoSan FranciscoCaliforniaUSA
| |
Collapse
|
2
|
Holden MA, Hattle M, Runhaar J, Riley RD, Healey EL, Quicke J, van der Windt DA, Dziedzic K, van Middelkoop M, Burke D, Corp N, Legha A, Bierma-Zeinstra S, Foster NE. Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. THE LANCET. RHEUMATOLOGY 2023; 5:e386-e400. [PMID: 38251550 DOI: 10.1016/s2665-9913(23)00122-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. METHODS We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). FINDINGS Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0-100 scale (with 100 corresponding to worst pain), with a difference of -6·36 points (95% CI -8·45 to -4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, -3·77 points (-5·97 to -1·57, BoS 30·0%, τ2 14·4) in the medium term, and -3·43 points (-5·18 to -1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0-100 scale (with 100 corresponding to worst physical function), with a difference of -4·46 points in the short term (95% CI -5·95 to -2·98, BoS 10·5%, τ2 10·1), -2·71 points in the medium term (-4·63 to -0·78, BoS 33·6%, τ2 11·9), and -3·39 points in the long term (-4·97 to -1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). INTERPRETATION There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. FUNDING Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.
Collapse
Affiliation(s)
- Melanie A Holden
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
| | - Miriam Hattle
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jos Runhaar
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Erasmus MC University, Medical Center, Rotterdam, Netherlands
| | - Richard D Riley
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Chartered Society of Physiotherapy, London, UK
| | | | - Krysia Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Danielle Burke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Nadia Corp
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Amardeep Legha
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Nadine E Foster
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK; Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Herston, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Eleftheriou D, Moraes YC, Purvis C, Pursell M, Morillas MM, Kahn R, Mossberg M, Kucera F, Tulloh R, Standing JF, Swallow V, McCormack R, Herberg J, Levin M, Wan M, Klein N, Connon R, Walker AS, Brogan P. Multi-centre, randomised, open-label, blinded endpoint assessed, trial of corticosteroids plus intravenous immunoglobulin (IVIG) and aspirin, versus IVIG and aspirin for prevention of coronary artery aneurysms (CAA) in Kawasaki disease (KD): the KD CAA prevention (KD-CAAP) trial protocol. Trials 2023; 24:60. [PMID: 36703139 PMCID: PMC9879235 DOI: 10.1186/s13063-022-07051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limiting inflammatory vasculitis affecting predominantly medium-sized arteries, particularly the coronary arteries. A number of recent studies conducted in different European countries have demonstrated alarmingly high coronary complications despite treatment with intravenous immunoglobulin (IVIG). These high complication rates now emphasize the need for an urgent reappraisal of IVIG as the sole primary therapeutic agent for KD. The Kawasaki disease CAA prevention (KD-CAAP) trial will test the hypothesis that immediate adjunctive corticosteroid treatment to standard of care IVIG and aspirin will reduce coronary artery aneurysm (CAA) rates in unselected KD patients across Europe. METHODS KD-CAAP is a multicentre, randomised, controlled, open-label, blinded endpoint assessed trial that will be conducted across Europe supported by the conect4children pan-European clinical trials network. Patients with KD who satisfy the eligibility criteria will be randomised (1:1) to receive either oral prednisolone 2 mg/kg/day plus standard of care therapy IVIG (2 g/kg) and aspirin (40 mg/kg/day); or IVIG and aspirin alone. Further management is dictated by temperature and C-reactive protein (CRP) responses. Co-primary outcomes are as follows: (i) any CAA within the 3 months of trial follow-up; (ii) average estimate of maximum coronary Z-score at weeks 1, 2 and 6 adjusting for rescue treatment. Additional outcomes will be assessed including cost effectiveness, quality of life, corticosteroid toxicity and other safety outcomes. DISCUSSION Several recent studies have indicated that coronary complications associated with KD across Europe are much higher than early trials of IVIG had initially suggested. KD-CAAP directly addresses this issue by exploring the therapeutic benefit of adjunctive corticosteroids in unselected KD cases. If we find that corticosteroids prevent CAA and are safe, this is a cheap and widely available intervention that could be implemented immediately for the benefit of children. TRIAL REGISTRATION ISRCTN71987471- March 31, 2020; Eudract 2019-004433-17.
Collapse
Affiliation(s)
- Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Yolanda Collaco Moraes
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Cara Purvis
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Molly Pursell
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Marta Merida Morillas
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Robin Kahn
- Department of Paediatrics, Lund University, Clinical Sciences, Lund, Sweden
| | - Maria Mossberg
- Department of Paediatrics, Lund University, Clinical Sciences, Lund, Sweden
| | | | | | - Joseph F Standing
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Rachael McCormack
- Societi Foundation CIO, The UK Foundation for Kawasaki Disease, Newark, UK
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Mandy Wan
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roisin Connon
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Ann Sarah Walker
- Medical Research Council (MRC) Clinical Trials Unit (CTU) at University College London (UCL), London, UK
| | - Paul Brogan
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| |
Collapse
|
4
|
Barnhofer T, Dunn BD, Strauss C, Ruths F, Barrett B, Ryan M, Ladwa A, Stafford F, Fichera R, Baber H, McGuinness A, Metcalfe I, Harding D, Walker S, Ganguli P, Rhodes S, Young A, Warren F. A randomised controlled trial to investigate the clinical effectiveness and cost effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol. Trials 2023; 24:43. [PMID: 36658663 PMCID: PMC9851098 DOI: 10.1186/s13063-022-06882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Major depression represents a pressing challenge for health care. In England, Increasing Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies in a stepped-care approach to patients with depression. While introduction of these services has successfully increased access to therapy, estimates suggest that about 50% of depressed patients who have come to the end of the IAPT pathway still show significant levels of symptoms. This study will investigate whether Mindfulness-Based Cognitive Therapy (MBCT), a group intervention combining training in mindfulness meditation and elements from cognitive therapy, can have beneficial effects in depressed patients who have not responded to high-intensity therapy in IAPT. It will seek to establish the effectiveness and cost-effectiveness of MBCT as compared to the treatment these patients would usually receive. METHODS In a 2-arm randomised controlled trial, patients who currently meet the criteria for major depressive disorder and who have not sufficiently responded to at least 12 sessions of IAPT high-intensity therapy will be allocated, at a ratio of 1:1, to receive either MBCT (in addition to treatment as usual [TAU]) or continue with TAU only. Assessments will take place at baseline, 10 weeks and 34 weeks post-randomisation. The primary outcome will be reduction in depression symptomatology 34 weeks post-randomisation as assessed using the Public Health Questionnaire-9 (PHQ-9). Secondary outcomes will include depressive symptomatology at 10 weeks post-randomisation and other clinical outcomes measured at 10-week and 34-week follow-up, along with a series of binarised outcomes to indicate clinically significant and reliable change. Evaluations of cost-effectiveness will be based on assessments of service use costs collected using the Adult Service Use Schedule and health utilities derived from the EQ-5D. DISCUSSION This trial will add to the evidence base for the use of MBCT in depressed treatment non-responders. It will constitute the first trial to test MBCT following non-response to psychological therapy, with results providing a direct estimate of efficacy within the IAPT pathway. As such, its results will offer an important basis for decisions regarding the adoption of MBCT for non-responders within IAPT. TRIAL REGISTRATION ClinicalTrials.gov NCT05236959. Registered on 11 February 2022. ISRCTN 17755571. Registered on 2 February 2021.
Collapse
Affiliation(s)
- Thorsten Barnhofer
- grid.5475.30000 0004 0407 4824School of Psychology, University of Surrey, Guildford, UK
| | - Barnaby D. Dunn
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Clara Strauss
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Florian Ruths
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Barbara Barrett
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, King’s College London, London, UK
| | - Mary Ryan
- grid.4756.00000 0001 2112 2291Department of Health and Social Care Innovation Lab, Southbank University, London, UK
| | - Asha Ladwa
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Frances Stafford
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Roberta Fichera
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Hannah Baber
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ailis McGuinness
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Isabella Metcalfe
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Delilah Harding
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Walker
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Poushali Ganguli
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, King’s College London, London, UK
| | - Shelley Rhodes
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Allan Young
- grid.13097.3c0000 0001 2322 6764Centre for Affective Disorders, King’s College London, London, UK
| | - Fiona Warren
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
5
|
Nejstgaard CH, Boutron I, Chan AW, Chow R, Hopewell S, Masalkhi M, Moher D, Schulz KF, Shlobin NA, Østengaard L, Hróbjartsson A. A scoping review identifies multiple comments suggesting modifications to SPIRIT 2013 and CONSORT 2010. J Clin Epidemiol 2023; 155:48-63. [PMID: 36669708 DOI: 10.1016/j.jclinepi.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To identify, summarize, and analyse comments on the core reporting guidelines for protocols of randomized trials (Standard Protocol Items: Recommendations for Interventional Trials [SPIRIT] 2013) and for completed trials (Consolidated Standards of Reporting Trials [CONSORT] 2010), with special emphasis on suggestions for guideline modifications. METHODS We included documents written in English and published after 2010 that explicitly commented on SPIRIT 2013 or CONSORT 2010. We searched four bibliographic databases (Embase and MEDLINE to June 2022; Web of Science and Google Scholar to April 2022) and other sources (e.g., the EQUATOR Network website, the BMC Blog Network, and the BMJ rapid response section). Two authors independently assessed documents for eligibility and extracted data on basic characteristics and the wording of the main comments. We categorized comments as 'suggestion for modification to the wording of an existing guideline item,' 'suggestion for a new item,' or 'reflections on challenges or strengths.' We provided a summary and examples of the proposed suggestions and categorized comments into those that were directly linked to empirical investigations, were continuations of previous methodological discussions, or reflected new methodological developments. RESULTS We assessed full text of 2,320 potentially eligible documents and included 93 documents with 114 comments. In total, 37 comments suggested modifications to existing guideline items. The participant flow section of CONSORT 2010 received the most comments (eight comments made different suggestions, e.g., one comment suggested to add numbers on nonrandomized screened participants). There were 46 comments suggesting new items. Multiple suggestions were related to trial interventions (eight comments made different suggestions, e.g., one comment suggested to add content on cointerventions), blinding (six comments suggested to add content on risk of unblinding), statistical methods (five comments made different suggestions, e.g., one comment suggested to add content on blinding of statisticians), and participant flow (seven comments made different suggestions, e.g., three comments suggested to add content on missing data). Half (53%) of the suggestions were directly linked to empirical investigations. Six (7%) suggestions were continuations of previous methodological discussions and five (6%) suggestions reflected new methodological developments related to conflicts of interest and funding, data sharing, and patient and public involvement. CONCLUSION The issues raised provide context to authors, peer reviewers, editors, and readers of trials using SPIRIT 2013 and CONSORT 2010 and inform the planned updates of the core guidelines.
Collapse
Affiliation(s)
- Camilla H Nejstgaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Denmark; Open Patient Data Explorative Network (OPEN), Odense University Hospital, Denmark.
| | - Isabelle Boutron
- Université Paris Cité, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, France; Cochrane France, France
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Canada
| | - Ryan Chow
- Faculty of Medicine, University of Ottawa, Canada
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit/Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Kenneth F Schulz
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Denmark; Open Patient Data Explorative Network (OPEN), Odense University Hospital, Denmark; University Library of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Denmark; Open Patient Data Explorative Network (OPEN), Odense University Hospital, Denmark
| |
Collapse
|
6
|
Yoong SL, Turon H, Grady A, Hodder R, Wolfenden L. The benefits of data sharing and ensuring open sources of systematic review data. J Public Health (Oxf) 2022; 44:e582-e587. [PMID: 35285884 PMCID: PMC9715297 DOI: 10.1093/pubmed/fdac031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The benefits of increasing public access to data from clinical trials are widely accepted. Such benefits extend to the sharing of data from high-quality systematic reviews, given the time and cost involved with undertaking reviews. We describe the application of open sources of review data, outline potential challenges and highlight efforts made to address these challenges, with the intent of encouraging publishers, funders and authors to consider sharing review data more broadly. RESULTS We describe the application of systematic review data in: (i) advancing understanding of clinical trials and systematic review methods, (ii) repurposing of data to answer public health policy and practice relevant questions, (iii) identification of research gaps and (iv) accelerating the conduct of rapid reviews to inform decision making. While access, logistical, motivational and legal challenges exist, there has been progress made by systematic review, academic and funding agencies to incentivise data sharing and create infrastructure to support greater access to systematic review data. CONCLUSION There is opportunity to maximize the benefits of research investment in undertaking systematic reviews by ensuring open sources of systematic review data. Efforts to create such systems should draw on learnings and principles outlined for sharing clinical trial data.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, VIC 3122, Australia
- Hunter New England Population Health, Longworth Avenue Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Priority Research Centre in Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Heidi Turon
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Priority Research Centre in Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Alice Grady
- Hunter New England Population Health, Longworth Avenue Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Priority Research Centre in Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rebecca Hodder
- Hunter New England Population Health, Longworth Avenue Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Priority Research Centre in Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Longworth Avenue Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Priority Research Centre in Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| |
Collapse
|
7
|
Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Young T, Rajbhandari S, Sharma S, Rayman G, Gouni R, Alam U, Julious SA, Cooper C, Loban A, Sutherland K, Glover R, Waterhouse S, Turton E, Horspool M, Gandhi R, Maguire D, Jude E, Ahmed SH, Vas P, Hariman C, McDougall C, Devers M, Tsatlidis V, Johnson M, Bouhassira D, Bennett DL, Selvarajah D. Optimal pharmacotherapy pathway in adults with diabetic peripheral neuropathic pain: the OPTION-DM RCT. Health Technol Assess 2022; 26:1-100. [PMID: 36259684 PMCID: PMC9589396 DOI: 10.3310/rxuo6757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The mainstay of treatment for diabetic peripheral neuropathic pain is pharmacotherapy, but the current National Institute for Health and Care Excellence guideline is not based on robust evidence, as the treatments and their combinations have not been directly compared. OBJECTIVES To determine the most clinically beneficial, cost-effective and tolerated treatment pathway for diabetic peripheral neuropathic pain. DESIGN A randomised crossover trial with health economic analysis. SETTING Twenty-one secondary care centres in the UK. PARTICIPANTS Adults with diabetic peripheral neuropathic pain with a 7-day average self-rated pain score of ≥ 4 points (Numeric Rating Scale 0-10). INTERVENTIONS Participants were randomised to three commonly used treatment pathways: (1) amitriptyline supplemented with pregabalin, (2) duloxetine supplemented with pregabalin and (3) pregabalin supplemented with amitriptyline. Participants and research teams were blinded to treatment allocation, using over-encapsulated capsules and matching placebos. Site pharmacists were unblinded. OUTCOMES The primary outcome was the difference in 7-day average 24-hour Numeric Rating Scale score between pathways, measured during the final week of each pathway. Secondary end points included 7-day average daily Numeric Rating Scale pain score at week 6 between monotherapies, quality of life (Short Form questionnaire-36 items), Hospital Anxiety and Depression Scale score, the proportion of patients achieving 30% and 50% pain reduction, Brief Pain Inventory - Modified Short Form items scores, Insomnia Severity Index score, Neuropathic Pain Symptom Inventory score, tolerability (scale 0-10), Patient Global Impression of Change score at week 16 and patients' preferred treatment pathway at week 50. Adverse events and serious adverse events were recorded. A within-trial cost-utility analysis was carried out to compare treatment pathways using incremental costs per quality-adjusted life-years from an NHS and social care perspective. RESULTS A total of 140 participants were randomised from 13 UK centres, 130 of whom were included in the analyses. Pain score at week 16 was similar between the arms, with a mean difference of -0.1 points (98.3% confidence interval -0.5 to 0.3 points) for duloxetine supplemented with pregabalin compared with amitriptyline supplemented with pregabalin, a mean difference of -0.1 points (98.3% confidence interval -0.5 to 0.3 points) for pregabalin supplemented with amitriptyline compared with amitriptyline supplemented with pregabalin and a mean difference of 0.0 points (98.3% confidence interval -0.4 to 0.4 points) for pregabalin supplemented with amitriptyline compared with duloxetine supplemented with pregabalin. Results for tolerability, discontinuation and quality of life were similar. The adverse events were predictable for each drug. Combination therapy (weeks 6-16) was associated with a further reduction in Numeric Rating Scale pain score (mean 1.0 points, 98.3% confidence interval 0.6 to 1.3 points) compared with those who remained on monotherapy (mean 0.2 points, 98.3% confidence interval -0.1 to 0.5 points). The pregabalin supplemented with amitriptyline pathway had the fewest monotherapy discontinuations due to treatment-emergent adverse events and was most commonly preferred (most commonly preferred by participants: amitriptyline supplemented with pregabalin, 24%; duloxetine supplemented with pregabalin, 33%; pregabalin supplemented with amitriptyline, 43%; p = 0.26). No single pathway was superior in cost-effectiveness. The incremental gains in quality-adjusted life-years were small for each pathway comparison [amitriptyline supplemented with pregabalin compared with duloxetine supplemented with pregabalin -0.002 (95% confidence interval -0.011 to 0.007) quality-adjusted life-years, amitriptyline supplemented with pregabalin compared with pregabalin supplemented with amitriptyline -0.006 (95% confidence interval -0.002 to 0.014) quality-adjusted life-years and duloxetine supplemented with pregabalin compared with pregabalin supplemented with amitriptyline 0.007 (95% confidence interval 0.0002 to 0.015) quality-adjusted life-years] and incremental costs over 16 weeks were similar [amitriptyline supplemented with pregabalin compared with duloxetine supplemented with pregabalin -£113 (95% confidence interval -£381 to £90), amitriptyline supplemented with pregabalin compared with pregabalin supplemented with amitriptyline £155 (95% confidence interval -£37 to £625) and duloxetine supplemented with pregabalin compared with pregabalin supplemented with amitriptyline £141 (95% confidence interval -£13 to £398)]. LIMITATIONS Although there was no placebo arm, there is strong evidence for the use of each study medication from randomised placebo-controlled trials. The addition of a placebo arm would have increased the duration of this already long and demanding trial and it was not felt to be ethically justifiable. FUTURE WORK Future research should explore (1) variations in diabetic peripheral neuropathic pain management at the practice level, (2) how OPTION-DM (Optimal Pathway for TreatIng neurOpathic paiN in Diabetes Mellitus) trial findings can be best implemented, (3) why some patients respond to a particular drug and others do not and (4) what options there are for further treatments for those patients on combination treatment with inadequate pain relief. CONCLUSIONS The three treatment pathways appear to give comparable patient outcomes at similar costs, suggesting that the optimal treatment may depend on patients' preference in terms of side effects. TRIAL REGISTRATION The trial is registered as ISRCTN17545443 and EudraCT 2016-003146-89. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme, and will be published in full in Health Technology Assessment; Vol. 26, No. 39. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Solomon Tesfaye
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Human Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Gordon Sloan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - David White
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Tracey Young
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Sanjeev Sharma
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Gerry Rayman
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | - Uazman Alam
- University of Liverpool, Liverpool, UK
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Steven A Julious
- Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Amanda Loban
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Katie Sutherland
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Rachel Glover
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Simon Waterhouse
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Emily Turton
- Clinical Trials Research Unit, University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| | | | - Rajiv Gandhi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Edward Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton under Lyne, UK
- University of Manchester, Manchester, UK
| | - Syed Haris Ahmed
- University of Liverpool, Liverpool, UK
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Prashanth Vas
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, Medical School, University of Sheffield, Sheffield, UK
| |
Collapse
|
8
|
Rodriguez A, Tuck C, Dozier MF, Lewis SC, Eldridge S, Jackson T, Murray A, Weir CJ. Current recommendations/practices for anonymising data from clinical trials in order to make it available for sharing: A scoping review. Clin Trials 2022; 19:452-463. [PMID: 35730910 PMCID: PMC9373195 DOI: 10.1177/17407745221087469] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background/Aims There are increasing pressures for anonymised datasets from clinical trials
to be shared across the scientific community, and differing recommendations
exist on how to perform anonymisation prior to sharing. We aimed to
systematically identify, describe and synthesise existing recommendations
for anonymising clinical trial datasets to prepare for data sharing. Methods We systematically searched MEDLINE®, EMBASE and Web of Science
from inception to 8 February 2021. We also searched other resources to
ensure the comprehensiveness of our search. Any publication reporting
recommendations on anonymisation to enable data sharing from clinical trials
was included. Two reviewers independently screened titles, abstracts and
full text for eligibility. One reviewer extracted data from included papers
using thematic synthesis, which then was sense-checked by a second reviewer.
Results were summarised by narrative analysis. Results Fifty-nine articles (from 43 studies) were eligible for inclusion. Three
distinct themes are emerging: anonymisation, de-identification and
pseudonymisation. The most commonly used anonymisation techniques are:
removal of direct patient identifiers; and careful evaluation and
modification of indirect identifiers to minimise the risk of identification.
Anonymised datasets joined with controlled access was the preferred method
for data sharing. Conclusions There is no single standardised set of recommendations on how to anonymise
clinical trial datasets for sharing. However, this systematic review shows a
developing consensus on techniques used to achieve anonymisation.
Researchers in clinical trials still consider that anonymisation techniques
by themselves are insufficient to protect patient privacy, and they need to
be paired with controlled access.
Collapse
Affiliation(s)
- Aryelly Rodriguez
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Christopher Tuck
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Marshall F Dozier
- Library & University Collections, Information Services, The University of Edinburgh, Edinburgh, UK
| | - Stephanie C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tracy Jackson
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Clayton GL, Elliott D, Higgins JPT, Jones HE. Use of external evidence for design and Bayesian analysis of clinical trials: a qualitative study of trialists' views. Trials 2021; 22:789. [PMID: 34749778 PMCID: PMC8577005 DOI: 10.1186/s13063-021-05759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence from previous studies is often used relatively informally in the design of clinical trials: for example, a systematic review to indicate whether a gap in the current evidence base justifies a new trial. External evidence can be used more formally in both trial design and analysis, by explicitly incorporating a synthesis of it in a Bayesian framework. However, it is unclear how common this is in practice or the extent to which it is considered controversial. In this qualitative study, we explored attitudes towards, and experiences of, trialists in incorporating synthesised external evidence through the Bayesian design or analysis of a trial. METHODS Semi-structured interviews were conducted with 16 trialists: 13 statisticians and three clinicians. Participants were recruited across several universities and trials units in the United Kingdom using snowball and purposeful sampling. Data were analysed using thematic analysis and techniques of constant comparison. RESULTS Trialists used existing evidence in many ways in trial design, for example, to justify a gap in the evidence base and inform parameters in sample size calculations. However, no one in our sample reported using such evidence in a Bayesian framework. Participants tended to equate Bayesian analysis with the incorporation of prior information on the intervention effect and were less aware of the potential to incorporate data on other parameters. When introduced to the concepts, many trialists felt they could be making more use of existing data to inform the design and analysis of a trial in particular scenarios. For example, some felt existing data could be used more formally to inform background adverse event rates, rather than relying on clinical opinion as to whether there are potential safety concerns. However, several barriers to implementing these methods in practice were identified, including concerns about the relevance of external data, acceptability of Bayesian methods, lack of confidence in Bayesian methods and software, and practical issues, such as difficulties accessing relevant data. CONCLUSIONS Despite trialists recognising that more formal use of external evidence could be advantageous over current approaches in some areas and useful as sensitivity analyses, there are still barriers to such use in practice.
Collapse
Affiliation(s)
- Gemma L Clayton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Daisy Elliott
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hayley E Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
10
|
Wildman MJ, O’Cathain A, Hind D, Maguire C, Arden MA, Hutchings M, Bradley J, Walters SJ, Whelan P, Ainsworth J, Tappenden P, Buchan I, Elliott R, Nicholl J, Elborn S, Michie S, Mandefield L, Sutton L, Hoo ZH, Drabble SJ, Lumley E, Beever D, Navega Biz A, Scott A, Waterhouse S, Robinson L, Hernández Alava M, Sasso A. An intervention to support adherence to inhaled medication in adults with cystic fibrosis: the ACtiF research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background
People with cystic fibrosis frequently have low levels of adherence to inhaled medications.
Objectives
The objectives were to develop and evaluate an intervention for adults with cystic fibrosis to improve adherence to their inhaled medication.
Design
We used agile software methods to develop an online platform. We used mixed methods to develop a behaviour change intervention for delivery by an interventionist. These were integrated to become the CFHealthHub intervention. We undertook a feasibility study consisting of a pilot randomised controlled trial and process evaluation in two cystic fibrosis centres. We evaluated the intervention using an open-label, parallel-group randomised controlled trial with usual care as the control. Participants were randomised in a 1 : 1 ratio to intervention or usual care. Usual care consisted of clinic visits every 3 months. We undertook a process evaluation alongside the randomised controlled trial, including a fidelity study, a qualitative interview study and a mediation analysis. We undertook a health economic analysis using both a within-trial and model-based analysis.
Setting
The randomised controlled trial took place in 19 UK cystic fibrosis centres.
Participants
Participants were people aged ≥ 16 years with cystic fibrosis, on the cystic fibrosis registry, not post lung transplant or on the active transplant list, who were able to consent and not using dry-powder inhalers.
Intervention
People with cystic fibrosis used a nebuliser with electronic monitoring capabilities. This transferred data automatically to a digital platform. People with cystic fibrosis and clinicians could monitor adherence using these data, including through a mobile application (app). CFHealthHub displayed graphs of adherence data as well as educational and problem-solving information. A trained interventionist helped people with cystic fibrosis to address their adherence.
Main outcome measures
Randomised controlled trial – adjusted incidence rate ratio of pulmonary exacerbations meeting the modified Fuchs criteria over a 12-month follow-up period (primary outcome); change in percentage adherence; and per cent predicted forced expiratory volume in 1 second (key secondary outcomes). Process evaluation – percentage fidelity to intervention delivery, and participant and interventionist perceptions of the intervention. Economic modelling – incremental cost per quality-adjusted life-year gained.
Results
Randomised controlled trial – 608 participants were randomised to the intervention (n = 305) or usual care (n = 303). To our knowledge, this was the largest randomised controlled trial in cystic fibrosis undertaken in the UK. The adjusted rate of exacerbations per year (primary outcome) was 1.63 in the intervention and 1.77 in the usual-care arm (incidence rate ratio 0.96, 95% confidence interval 0.83 to 1.12; p = 0.638) after adjustment for covariates. The adjusted difference in mean weekly normative adherence was 9.5% (95% confidence interval 8.6% to 10.4%) across 1 year, favouring the intervention. Adjusted mean difference in forced expiratory volume in 1 second (per cent) predicted at 12 months was 1.4% (95% confidence interval –0.2% to 3.0%). No adverse events were related to the intervention. Process evaluation – fidelity of intervention delivery was high, the intervention was acceptable to people with cystic fibrosis, participants engaged with the intervention [287/305 (94%) attended the first intervention visit], expected mechanisms of action were identified and contextual factors varied between randomised controlled trial sites. Qualitative interviews with 22 people with cystic fibrosis and 26 interventionists identified that people with cystic fibrosis welcomed the objective adherence data as proof of actions to self and others, and valued the relationship that they built with the interventionists. Economic modelling – the within-trial analysis suggests that the intervention generated 0.01 additional quality-adjusted life-years at an additional cost of £865.91 per patient, leading to an incremental cost-effectiveness ratio of £71,136 per quality-adjusted life-year gained. This should be interpreted with caution owing to the short time horizon. The health economic model suggests that the intervention is expected to generate 0.17 additional quality-adjusted life-years and cost savings of £1790 over a lifetime (70-year) horizon; hence, the intervention is expected to dominate usual care. Assuming a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained, the probability that the intervention generates more net benefit than usual care is 0.89. The model results are dependent on assumptions regarding the duration over which costs and effects of the intervention apply, the impact of the intervention on forced expiratory volume in 1 second (per cent) predicted and the relationship between increased adherence and drug-prescribing levels.
Limitations
Number of exacerbations is a sensitive and valid measure of clinical change used in many trials. However, data collection of this outcome in this context was challenging and could have been subject to bias. It was not possible to measure baseline adherence accurately. It was not possible to quantify the impact of the intervention on the number of packs of medicines prescribed.
Conclusions
We developed a feasible and acceptable intervention that was delivered to fidelity in the randomised controlled trial. We observed no statistically significant difference in the primary outcome of exacerbation rates over 12 months. We observed an increase in normative adherence levels in a disease where adherence levels are low. The magnitude of the increase in adherence may not have been large enough to affect exacerbations.
Future work
Given the non-significant difference in the primary outcome, further research is required to explore why an increase in objective normative adherence did not reduce exacerbations and to develop interventions that reduce exacerbations.
Trial registration
Work package 3.1: Current Controlled Trials ISRCTN13076797. Work packages 3.2 and 3.3: Current Controlled Trials ISRCTN55504164.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Martin J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Pauline Whelan
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Iain Buchan
- Health eResearch Centre, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Rachel Elliott
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Stuart Elborn
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Laura Mandefield
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Laura Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zhe Hui Hoo
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Aline Navega Biz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anne Scott
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Simon Waterhouse
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Louisa Robinson
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Alessandro Sasso
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
11
|
Bergmame L, Shaw S. Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review. CONTINUITY IN EDUCATION 2021; 2:76-108. [PMID: 38774890 PMCID: PMC11104390 DOI: 10.5334/cie.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/03/2021] [Indexed: 05/24/2024]
Abstract
Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.
Collapse
|
12
|
Medley N, Cuthbert A, Crew R, Stewart L, Smith CT, Alfirevic Z. Developing a topic-based repository of clinical trial individual patient data: experiences and lessons learned from a pilot project. Syst Rev 2021; 10:162. [PMID: 34059123 PMCID: PMC8167976 DOI: 10.1186/s13643-021-01717-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Building a dataset of individual participant data (IPD) for meta-analysis represents considerable research investment as well as collaboration across multiple institutions and researchers. Making arrangements to curate and share the dataset beyond the IPD meta-analysis project for which it was established, for reuse in future research projects, would maximise the value of this investment. METHODS Our aim was to establish the Cochrane repository for individual patient data from clinical trials in pregnancy and childbirth (CRIB) as an example of how an IPD repository could become part of Cochrane infrastructure. We believed that establishing CRIB under Cochrane auspices would engender trust and encourage trial investigators to share data, and at the same time position Cochrane to take steps towards expanding the number of reviews with IPD synthesis. RESULTS CRIB was designed as a web-based platform to receive, host and facilitate onward sharing of de-identified data. Development was not straightforward and we did not fully achieve our aim as intended. We describe the challenges encountered and suggest ways that future repositories might overcome these. In particular, securing the legal agreements required to facilitate data sharing proved to be the main barrier, being time-consuming and more complex than anticipated. CONCLUSIONS We would recommend that researchers conducting IPD meta-analysis should consider discussing the option to transfer the curated IPD datasets to a repository at the end of the initial meta-analysis and this should be recognised within the data sharing agreements made with the original data contributors.
Collapse
Affiliation(s)
- Nancy Medley
- Cochrane Pregnancy and Childbirth, University of Liverpool, Liverpool, UK
| | - Anna Cuthbert
- Cochrane Pregnancy and Childbirth, University of Liverpool, Liverpool, UK
| | - Richard Crew
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Cochrane Pregnancy and Childbirth, University of Liverpool, Liverpool, UK.
| |
Collapse
|
13
|
Wilson P, Huser V. Discoverability of information on clinical trial data-sharing platforms. J Med Libr Assoc 2021; 109:240-247. [PMID: 34285666 PMCID: PMC8270348 DOI: 10.5195/jmla.2021.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was intended to (1) provide clinical trial data-sharing platform designers with insight into users' experiences when attempting to evaluate and access datasets, (2) spark conversations about improving the transparency and discoverability of clinical trial data, and (3) provide a partial view of the current information-sharing landscape for clinical trials. METHODS We evaluated preview information provided for 10 datasets in each of 7 clinical trial data-sharing platforms between February and April 2019. Specifically, we evaluated the platforms in terms of the extent to which we found (1) preview information about the dataset, (2) trial information on ClinicalTrials.gov and other external websites, and (3) evidence of the existence of trial protocols and data dictionaries. RESULTS All seven platforms provided data previews. Three platforms provided information on data file format (e.g., CSV, SAS file). Three allowed batch downloads of datasets (i.e., downloading multiple datasets with a single request), whereas four required separate requests for each dataset. All but one platform linked to ClinicalTrials.gov records, but only one platform had ClinicalTrails.gov records that linked back to the platform. Three platforms consistently linked to external websites and primary publications. Four platforms provided evidence of the presence of a protocol, and six platforms provided evidence of the presence of data dictionaries. CONCLUSIONS More work is needed to improve the discoverability, transparency, and utility of information on clinical trial data-sharing platforms. Increasing the amount of dataset preview information available to users could considerably improve the discoverability and utility of clinical trial data.
Collapse
Affiliation(s)
- Paije Wilson
- , National Library of Medicine Associate Fellow, National Library of Medicine, Bethesda, MD (at time of study). Health Sciences Librarian, University of Wisconsin-Madison, Madison, WI
| | - Vojtech Huser
- , Staff Scientist, National Institutes of Health, Bethesda, MD
| |
Collapse
|
14
|
Wilcock D, Jicha G, Blacker D, Albert MS, D’Orazio LM, Elahi FM, Fornage M, Hinman JD, Knoefel J, Kramer J, Kryscio RJ, Lamar M, Moghekar A, Prestopnik J, Ringman JM, Rosenberg G, Sagare A, Satizabal CL, Schneider J, Seshadri S, Sur S, Tracy RP, Yasar S, Williams V, Singh H, Mazina L, Helmer KG, Corriveau RA, Schwab K, Kivisäkk P, Greenberg SM. MarkVCID cerebral small vessel consortium: I. Enrollment, clinical, fluid protocols. Alzheimers Dement 2021; 17:704-715. [PMID: 33480172 PMCID: PMC8122220 DOI: 10.1002/alz.12215] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
The concept of vascular contributions to cognitive impairment and dementia (VCID) derives from more than two decades of research indicating that (1) most older individuals with cognitive impairment have post mortem evidence of multiple contributing pathologies and (2) along with the preeminent role of Alzheimer's disease (AD) pathology, cerebrovascular disease accounts for a substantial proportion of this contribution. Contributing cerebrovascular processes include both overt strokes caused by etiologies such as large vessel occlusion, cardioembolism, and embolic infarcts of unknown source, and frequently asymptomatic brain injuries caused by diseases of the small cerebral vessels. Cerebral small vessel diseases such as arteriolosclerosis and cerebral amyloid angiopathy, when present at moderate or greater pathologic severity, are independently associated with worse cognitive performance and greater likelihood of dementia, particularly in combination with AD and other neurodegenerative pathologies. Based on this evidence, the US National Alzheimer's Project Act explicitly authorized accelerated research in vascular and mixed dementia along with frontotemporal and Lewy body dementia and AD itself. Biomarker development has been consistently identified as a key step toward translating scientific advances in VCID into effective prevention and treatment strategies. Validated biomarkers can serve a range of purposes in trials of candidate interventions, including (1) identifying individuals at increased VCID risk, (2) diagnosing the presence of cerebral small vessel disease or specific small vessel pathologies, (3) stratifying study participants according to their prognosis for VCID progression or treatment response, (4) demonstrating an intervention's target engagement or pharmacodynamic mechanism of action, and (5) monitoring disease progression during treatment. Effective biomarkers allow academic and industry investigators to advance promising interventions at early stages of development and discard interventions with low success likelihood. The MarkVCID consortium was formed in 2016 with the goal of developing and validating fluid- and imaging-based biomarkers for the cerebral small vessel diseases associated with VCID. MarkVCID consists of seven project sites and a central coordinating center, working with the National Institute of Neurologic Diseases and Stroke and National Institute on Aging under cooperative agreements. Through an internal selection process, MarkVCID has identified a panel of 11 candidate biomarker "kits" (consisting of the biomarker measure and the clinical and cognitive data used to validate it) and established a range of harmonized procedures and protocols for participant enrollment, clinical and cognitive evaluation, collection and handling of fluid samples, acquisition of neuroimaging studies, and biomarker validation. The overarching goal of these protocols is to generate rigorous validating data that could be used by investigators throughout the research community in selecting and applying biomarkers to multi-site VCID trials. Key features of MarkVCID participant enrollment, clinical/cognitive testing, and fluid biomarker procedures are summarized here, with full details in the following text, tables, and supplemental material, and a description of the MarkVCID imaging biomarker procedures in a companion paper, "MarkVCID Cerebral small vessel consortium: II. Neuroimaging protocols." The procedures described here address a range of challenges in MarkVCID's design, notably: (1) acquiring all data under informed consent and enrollment procedures that allow unlimited sharing and open-ended analyses without compromising participant privacy rights; (2) acquiring the data in a sufficiently wide range of study participants to allow assessment of candidate biomarkers across the various patient groups who might ultimately be targeted in VCID clinical trials; (3) defining a common dataset of clinical and cognitive elements that contains all the key outcome markers and covariates for VCID studies and is realistically obtainable during a practical study visit; (4) instituting best fluid-handling practices for minimizing avoidable sources of variability; and (5) establishing rigorous procedures for testing the reliability of candidate fluid-based biomarkers across replicates, assay runs, sites, and time intervals (collectively defined as the biomarker's instrumental validity). Participant Enrollment Project sites enroll diverse study cohorts using site-specific inclusion and exclusion criteria so as to provide generalizable validation data across a range of cognitive statuses, risk factor profiles, small vessel disease severities, and racial/ethnic characteristics representative of the diverse patient groups that might be enrolled in a future VCID trial. MarkVCID project sites include both prospectively enrolling centers and centers providing extant data and samples from preexisting community- and population-based studies. With approval of local institutional review boards, all sites incorporate MarkVCID consensus language into their study documents and informed consent agreements. The consensus language asks prospectively enrolled participants to consent to unrestricted access to their data and samples for research analysis within and outside MarkVCID. The data are transferred and stored as a de-identified dataset as defined by the Health Insurance Portability and Accountability Act Privacy Rule. Similar human subject protection and informed consent language serve as the basis for MarkVCID Research Agreements that act as contracts and data/biospecimen sharing agreements across the consortium. Clinical and Cognitive Data Clinical and cognitive data are collected across prospectively enrolling project sites using common MarkVCID instruments. The clinical data elements are modified from study protocols already in use such as the Alzheimer's Disease Center program Uniform Data Set Version 3 (UDS3), with additional focus on VCID-related items such as prior stroke and cardiovascular disease, vascular risk factors, focal neurologic findings, and blood testing for vascular risk markers and kidney function including hemoglobin A1c, cholesterol subtypes, triglycerides, and creatinine. Cognitive assessments and rating instruments include the Clinical Dementia Rating Scale, Geriatric Depression Scale, and most of the UDS3 neuropsychological battery. The cognitive testing requires ≈60 to 90 minutes. Study staff at the prospectively recruiting sites undergo formalized training in all measures and review of their first three UDS3 administrations by the coordinating center. Collection and Handling of Fluid Samples Fluid sample types collected for MarkVCID biomarker kits are serum, ethylenediaminetetraacetic acid-plasma, platelet-poor plasma, and cerebrospinal fluid (CSF) with additional collection of packed cells to allow future DNA extraction and analyses. MarkVCID fluid guidelines to minimize variability include fasting morning fluid collections, rapid processing, standardized handling and storage, and avoidance of CSF contact with polystyrene. Instrumental Validation for Fluid-Based Biomarkers Instrumental validation of MarkVCID fluid-based biomarkers is operationally defined as determination of intra-plate and inter-plate repeatability, inter-site reproducibility, and test-retest repeatability. MarkVCID study participants both with and without advanced small vessel disease are selected for these determinations to assess instrumental validity across the full biomarker assay range. Intra- and inter-plate repeatability is determined by repeat assays of single split fluid samples performed at individual sites. Inter-site reproducibility is determined by assays of split samples distributed to multiple sites. Test-retest repeatability is determined by assay of three samples acquired from the same individual, collected at least 5 days apart over a 30-day period and assayed on a single plate. The MarkVCID protocols are designed to allow direct translation of the biomarker validation results to multicenter trials. They also provide a template for outside groups to perform analyses using identical methods and therefore allow direct comparison of results across studies and centers. All MarkVCID protocols are available to the biomedical community and intended to be shared. In addition to the instrumental validation procedures described here, each of the MarkVCID kits will undergo biological validation to determine whether the candidate biomarker measures important aspects of VCID such as cognitive function. Analytic methods and results of these validation studies for the 11 MarkVCID biomarker kits will be published separately. The results of this rigorous validation process will ultimately determine each kit's potential usefulness for multicenter interventional trials aimed at preventing or treating small vessel disease related VCID.
Collapse
Affiliation(s)
- Donna Wilcock
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Gregory Jicha
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H Chan School of Public Health and Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lina M. D’Orazio
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Fanny M. Elahi
- Center for Memory and Aging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jason D. Hinman
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Janice Knoefel
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Joel Kramer
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Richard J. Kryscio
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jillian Prestopnik
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - John M. Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Gary Rosenberg
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Abhay Sagare
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Sandeepa Sur
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Victoria Williams
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Herpreet Singh
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lidiya Mazina
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Karl G. Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pia Kivisäkk
- Alzheimer’s Clinical and Translational Research Unit, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | |
Collapse
|
15
|
Coetzee T, Ball MP, Boutin M, Bronson A, Dexter DT, English RA, Furlong P, Goodman AD, Grossman C, Hernandez AF, Hinners JE, Hudson L, Kennedy A, Marchisotto MJ, Myers E, Nowell WB, Nosek BA, Sherer T, Shore C, Sim I, Smolensky L, Williams C, Wood J, Terry SF, Matrisian L. Data Sharing Goals for Nonprofit Funders of Clinical Trials. J Particip Med 2021; 13:e23011. [PMID: 33779573 PMCID: PMC8088851 DOI: 10.2196/23011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 01/25/2023] Open
Abstract
Sharing clinical trial data can provide value to research participants and communities by accelerating the development of new knowledge and therapies as investigators merge data sets to conduct new analyses, reproduce published findings to raise standards for original research, and learn from the work of others to generate new research questions. Nonprofit funders, including disease advocacy and patient-focused organizations, play a pivotal role in the promotion and implementation of data sharing policies. Funders are uniquely positioned to promote and support a culture of data sharing by serving as trusted liaisons between potential research participants and investigators who wish to access these participants' networks for clinical trial recruitment. In short, nonprofit funders can drive policies and influence research culture. The purpose of this paper is to detail a set of aspirational goals and forward thinking, collaborative data sharing solutions for nonprofit funders to fold into existing funding policies. The goals of this paper convey the complexity of the opportunities and challenges facing nonprofit funders and the appropriate prioritization of data sharing within their organizations and may serve as a starting point for a data sharing toolkit for nonprofit funders of clinical trials to provide the clarity of mission and mechanisms to enforce the data sharing practices their communities already expect are happening.
Collapse
Affiliation(s)
- Timothy Coetzee
- National Multiple Sclerosis Society, Cherry Hill, NJ, United States
| | | | | | - Abby Bronson
- Edgewise Therapeutics, Boulder, CO, United States
| | | | - Rebecca A English
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | | | - Andrew D Goodman
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | | | | | | | - Lynn Hudson
- Critical Path Institute, Tucson, AZ, United States
| | - Annie Kennedy
- Parent Project Muscular Dystrophy, Bethesda, MD, United States
| | | | - Elizabeth Myers
- Doris Duke Charitable Foundation, New York, NY, United States
| | | | - Brian A Nosek
- Center for Open Science, Charlottesville, VA, United States
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Carolyn Shore
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Luba Smolensky
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | | | | | | | - Lynn Matrisian
- Pancreatic Cancer Action Network, Washington, DC, United States
| |
Collapse
|
16
|
Cividini S, Sinha I, Donegan S, Maden M, Culeddu G, Rose K, Fulton O, Hughes DA, Turner S, Tudur Smith C. EstablishINg the best STEp-up treatments for children with uncontrolled asthma despite INhaled corticosteroids (EINSTEIN): protocol for a systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data (IPD). BMJ Open 2021; 11:e040528. [PMID: 33550231 PMCID: PMC7925932 DOI: 10.1136/bmjopen-2020-040528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Asthma affects millions of children worldwide-1.1 million children in the UK. Asthma symptoms cannot be cured but can be controlled with low-dose inhaled corticosteroids (ICSs) in the majority of individuals. Treatment with a low-dose ICS, however, fails to control asthma symptoms in around 10%-15% of children and this places the individual at increased risk for an asthma attack. At present, there is no clear preferred treatment option for a child whose asthma is not controlled by low-dose ICS and international guidelines currently recommend at least three treatment options. Herein, we propose a systematic review and individual participant data network meta-analysis (IPD-NMA) aiming to synthesise all available published and unpublished evidence from randomised controlled trials (RCTs) to establish the clinical effectiveness of pharmacological treatments in children and adolescents with uncontrolled asthma on ICS and help to make evidence-informed treatment choices. This will be used to parameterise a Markov-based economic model to assess the cost-effectiveness of alternative treatment options in order to inform decisions in the context of drug formularies and clinical guidelines. METHODS AND ANALYSIS We will search in MEDLINE, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, NICE Technology Appraisals and the National Institute for Health Research (NIHR) Health Technology Assessment series for RCTs of interventions in patients with uncontrolled asthma on ICS. All studies where children and adolescents were eligible for inclusion will be considered, and authors or sponsors will be contacted to request IPD on patients aged <18. The reference lists of existing clinical guidelines, along with included studies and relevant reviews, will be checked to identify further relevant studies. Unpublished studies will be located by searching across a range of clinical trial registries, including internal trial registers for pharmaceutical companies. All studies will be appraised for inclusion against predefined inclusion and exclusion criteria by two independent reviewers with disagreements resolved through discussion with a third reviewer. We will perform an IPD-NMA-eventually supplemented with aggregate data for the RCTs without IPD-to establish both the probability that a treatment is best and the probability that a particular treatment is most likely to be effective for a specific profile of the patient. The IPD-NMA will be performed for each outcome variable within a Bayesian framework, using the WinBUGS software. Also, potential patient-level characteristics that may modify treatment effects will be explored, which represents one of the strengths of this study. ETHICS AND DISSEMINATION The Committee on Research Ethics, University of Liverpool, has confirmed that ethics review is not required. The dissemination plan consists of publishing the results in an open-access medical journal, a plain-language summary available for parents and children, dissemination via local, national and international meetings and conferences and the press offices of our Higher Education Institutions (HEIs). A synopsis of results will be disseminated to NICE and British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN) as highly relevant to future clinical guideline updates. PROSPERO REGISTRATION NUMBER CRD42019127599.
Collapse
Affiliation(s)
- Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ian Sinha
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Katie Rose
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Stephen Turner
- Department of Child Health, University Court of the University of Aberdeen, Aberdeen, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
17
|
Ventresca M, Schünemann HJ, Macbeth F, Clarke M, Thabane L, Griffiths G, Noble S, Garcia D, Marcucci M, Iorio A, Zhou Q, Crowther M, Akl EA, Lyman GH, Gloy V, DiNisio M, Briel M. Obtaining and managing data sets for individual participant data meta-analysis: scoping review and practical guide. BMC Med Res Methodol 2020; 20:113. [PMID: 32398016 PMCID: PMC7218569 DOI: 10.1186/s12874-020-00964-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shifts in data sharing policy have increased researchers' access to individual participant data (IPD) from clinical studies. Simultaneously the number of IPD meta-analyses (IPDMAs) is increasing. However, rates of data retrieval have not improved. Our goal was to describe the challenges of retrieving IPD for an IPDMA and provide practical guidance on obtaining and managing datasets based on a review of the literature and practical examples and observations. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library, until January 2019, to identify publications focused on strategies to obtain IPD. In addition, we searched pharmaceutical websites and contacted industry organizations for supplemental information pertaining to recent advances in industry policy and practice. Finally, we documented setbacks and solutions encountered while completing a comprehensive IPDMA and drew on previous experiences related to seeking and using IPD. RESULTS Our scoping review identified 16 articles directly relevant for the conduct of IPDMAs. We present short descriptions of these articles alongside overviews of IPD sharing policies and procedures of pharmaceutical companies which display certification of Principles for Responsible Clinical Trial Data Sharing via Pharmaceutical Research and Manufacturers of America or European Federation of Pharmaceutical Industries and Associations websites. Advances in data sharing policy and practice affected the way in which data is requested, obtained, stored and analyzed. For our IPDMA it took 6.5 years to collect and analyze relevant IPD and navigate additional administrative barriers. Delays in obtaining data were largely due to challenges in communication with study sponsors, frequent changes in data sharing policies of study sponsors, and the requirement for a diverse skillset related to research, administrative, statistical and legal issues. CONCLUSIONS Knowledge of current data sharing practices and platforms as well as anticipation of necessary tasks and potential obstacles may reduce time and resources required for obtaining and managing data for an IPDMA. Sufficient project funding and timeline flexibility are pre-requisites for successful collection and analysis of IPD. IPDMA researchers must acknowledge the additional and unexpected responsibility they are placing on corresponding study authors or data sharing administrators and should offer assistance in readying data for sharing.
Collapse
Affiliation(s)
- Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Mike Clarke
- Northern Ireland Hub for Trials Methodology Research and Cochrane Individual Participant Data Meta-analysis Methods Group, Queen’s University Belfast, Belfast, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gary H. Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington USA
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marcello DiNisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
18
|
Knowles RL, Ha KP, Mueller J, Rawle F, Parker R. Challenges for funders in monitoring compliance with policies on clinical trials registration and reporting: analysis of funding and registry data in the UK. BMJ Open 2020; 10:e035283. [PMID: 32071191 PMCID: PMC7045207 DOI: 10.1136/bmjopen-2019-035283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 evaluate compliance by researchers with funder requirements on clinical trial transparency, including identifying key areas for improvement; to assess the completeness, accuracy and suitability for annual compliance monitoring of the data routinely collected by a research funding body. DESIGN Descriptive analysis of clinical trials funded between February 2011 and January 2017 against funder policy requirements. SETTING Public medical research funding body in the UK. DATA SOURCES Relevant clinical trials were identified from grant application details, post-award grant monitoring systems and the International Standard Randomised Controlled Trial Number (ISRCTN) registry. MAIN OUTCOME MEASURE The proportion of all Medical Research Council (MRC)-funded clinical trials that were (a) registered in a clinical trial registry and (b) publicly reported summary results within 2 years of completion. RESULTS There were 175 grants awarded that included a clinical trial and all trials were registered in a public trials registry. Of 62 trials completed for over 24 months, 42 (68%) had publicly reported the main findings by 24 months after trial completion; 18 of these achieved this within 12 months of completion. 11 (18%) trials took >24 months to report and 9 (15%) completed trials had not yet reported findings. Five datasets were shared with other researchers. CONCLUSIONS Compliance with the funder policy requirements on trial registration was excellent. Reporting of the main findings was achieved for most trials within 24 months of completion; however, the number of unreported trials remains a concern and should be a focus for future funder policy initiatives. Identifying trials from grant management and grant monitoring systems was challenging therefore funders should ensure investigators reliably provide trial registries with information and regularly update entries with details of trial publications and protocols.
Collapse
Affiliation(s)
| | | | - Julia Mueller
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | | |
Collapse
|
19
|
Biggs K, Hind D, Gossage-Worrall R, Sprange K, White D, Wright J, Chatters R, Berry K, Papaioannou D, Bradburn M, Walters SJ, Cooper C. Challenges in the design, planning and implementation of trials evaluating group interventions. Trials 2020; 21:116. [PMID: 31996259 PMCID: PMC6990578 DOI: 10.1186/s13063-019-3807-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Group interventions are interventions delivered to groups of people rather than to individuals and are used in healthcare for mental health recovery, behaviour change, peer support, self-management and/or health education. Evaluating group interventions in randomised controlled trials (RCTs) presents trialists with a set of practical problems, which are not present in RCTs of one-to-one interventions and which may not be immediately obvious. Methods Case-based approach summarising Sheffield trials unit’s experience in the design and implementation of five group interventions. We reviewed participant recruitment and attrition, facilitator training and attrition, attendance at the group sessions, group size and fidelity aspects across five RCTs. Results Median recruitment across the five trials was 3.2 (range 1.7–21.0) participants per site per month. Group intervention trials involve a delay in starting the intervention for some participants, until sufficient numbers are available to start a group. There was no evidence that the timing of consent, relative to randomisation, affected post-randomisation attrition which was a matter of concern for all trial teams. Group facilitator attrition was common in studies where facilitators were employed by the health system rather than the by the grant holder and led to the early closure of one trial; research sites responded by training ‘back-up’ and new facilitators. Trials specified that participants had to attend a median of 62.5% (range 16.7%–80%) of sessions, in order to receive a ‘therapeutic dose’; a median of 76.7% (range 42.9%–97.8%) received a therapeutic dose. Across the five trials, 75.3% of all sessions went ahead without the pre-specified ideal group size. A variety of methods were used to assess the fidelity of group interventions at a group and individual level across the five trials. Conclusion This is the first paper to provide an empirical basis for planning group intervention trials. Investigators should expect delays/difficulties in recruiting groups of the optimal size, plan for both facilitator and participant attrition, and consider how group attendance and group size affects treatment fidelity. Trial registration ISRCTN17993825 registered on 11/10/2016, ISRCTN28645428 registered on 11/04/2012, ISRCTN61215213 registered on 11/05/2011, ISRCTN67209155 registered on 22/03/2012, ISRCTN19447796 registered on 20/03/2014.
Collapse
Affiliation(s)
- Katie Biggs
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, Nottingham, UK
| | - David White
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Jessica Wright
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Diana Papaioannou
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cindy Cooper
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| |
Collapse
|
20
|
Lavieri L, Koenig C, Teuffel O, Agyeman P, Ammann RA. Temperatures and blood counts in pediatric patients treated with chemotherapy for cancer, NCT01683370. Sci Data 2019; 6:108. [PMID: 31270328 PMCID: PMC6610087 DOI: 10.1038/s41597-019-0112-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/28/2019] [Indexed: 01/10/2023] Open
Abstract
Fever in neutropenia (FN) is the most frequent potentially lethal complication of chemotherapy in patients with cancer. The temperature limit defining fever (TLDF) for FN is based on scarce evidence. This prospective, single center observational study recruited non-selected pediatric patients diagnosed with cancer between ≥1 and ≤17 years in 2012 and 2013. Of 40 patients potentially eligible, 39 participated. Data of 8896 temperature measurements and 1873 complete blood counts (CBCs) were recorded over 289 months (24.1 years) of chemotherapy exposure time. During this time 43 FN episodes were diagnosed. In 32 episodes, FN diagnosis was based on reaching the local (i.e. Bern, Switzerland) standard TLDF of 39.0 °C; another 11 episodes had been captured by clinical judgement (i.e. temperature < 39.0 °C). These data can be used to simulate the effects of various TLDFs on the rate of FN diagnosis. We assume merging these data with other data sets is feasible. Design Type(s) | observation design • cohort study design • disease detection/diagnosis objective | Measurement Type(s) | body temperature • complete blood cell count | Technology Type(s) | thermometry • blood analyzer | Factor Type(s) | Sample Characteristic(s) | Homo sapiens • whole body • Switzerland |
Machine-accessible metadata file describing the reported data (ISA-Tab format)
Collapse
Affiliation(s)
- Luana Lavieri
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa Koenig
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Teuffel
- Division of Oncology, Medical Services of the Statutory Health Insurance Baden-Württemberg, Tübingen, Germany
| | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland A Ammann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
21
|
Kuntz RE, Antman EM, Califf RM, Ingelfinger JR, Krumholz HM, Ommaya A, Peterson ED, Ross JS, Waldstreicher J, Wang SV, Zarin DA, Whicher DM, Siddiqi SM, Lopez MH. Individual Patient-Level Data Sharing for Continuous Learning: A Strategy for Trial Data Sharing. NAM Perspect 2019; 2019:201906b. [PMID: 34532668 DOI: 10.31478/201906b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
22
|
Cox M, O'Connor C, Biggs K, Hind D, Bortolami O, Franklin M, Collins B, Walters S, Wailoo A, Channell J, Albert P, Freeman U, Bourke S, Steiner M, Miles J, O'Brien T, McWilliams D, Schofield T, O'Reilly J, Hughes R. The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation. Health Technol Assess 2019. [PMID: 29516853 DOI: 10.3310/hta22110] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge. OBJECTIVE To assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care. DESIGN Parallel-group, pilot 2 × 2 factorial randomised trial with nested qualitative research and an economic analysis. SETTING Two acute hospital NHS trusts. Recruitment was carried out from September 2015 to April 2016 and follow-up was completed in July 2016. PARTICIPANTS Eligible patients were those aged ≥ 35 years who were admitted with AECOPD, who were non-acidotic and who maintained their blood oxygen saturation level (SpO2) within a prescribed range. Exclusions included the presence of comorbidities that affected the ability to undertake the interventions. INTERVENTIONS (1) Hospital EPR: muscle training delivered at the patient's hospital bed using a cycle ergometer and (2) home EPR: a pulmonary rehabilitation programme delivered in the patient's home. Both interventions were delivered by trained physiotherapists. Participants were allocated on a 1 : 1 : 1 : 1 ratio to (1) hospital EPR (n = 14), (2) home EPR (n = 15), (3) hospital EPR and home EPR (n = 14) and (4) control (n = 15). Outcome assessors were blind to treatment allocation; it was not possible to blind patients. MAIN OUTCOME MEASURES Feasibility of recruiting 76 participants in 7 months at two centres; intervention delivery; views on intervention/research acceptability; clinical outcomes including the 6-minute walk distance (6WMD); and costs. Semistructured interviews with participants (n = 27) and research health professionals (n = 11), optimisation assessments and an economic analysis were also undertaken. RESULTS Over 7 months 449 patients were screened, of whom most were not eligible for the trial or felt too ill/declined entry. In total, 58 participants (76%) of the target 76 participants were recruited to the trial. The primary clinical outcome (6MWD) was difficult to collect (hospital EPR, n = 5; home EPR, n = 6; hospital EPR and home EPR, n = 5; control, n = 5). Hospital EPR was difficult to deliver over 5 days because of patient discharge/staff availability, with 34.1% of the scheduled sessions delivered compared with 78.3% of the home EPR sessions. Serious adverse events were experienced by 26 participants (45%), none of which was related to the interventions. Interviewed participants generally found both interventions to be acceptable. Home EPR had a higher rate of acceptability, mainly because patients felt too unwell when in hospital to undergo hospital EPR. Physiotherapists generally found the interventions to be acceptable and valued them but found delivery difficult because of staffing issues. The health economic analysis results suggest that there would be value in conducting a larger trial to assess the cost-effectiveness of the hospital EPR and hospital EPR plus home EPR trial arms and collect more information to inform the hospital cost and quality-adjusted life-year parameters, which were shown to be key drivers of the model. CONCLUSIONS A full-scale randomised controlled trial using this protocol would not be feasible. Recruitment and delivery of the hospital EPR intervention was difficult. The data obtained can be used to design a full-scale trial of home EPR. Because of the small sample and large confidence intervals, this study should not be used to inform clinical practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN18634494. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Matthew Cox
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Katie Biggs
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Stephen Walters
- Design, Trials and Statistics (DTS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Allan Wailoo
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julie Channell
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Paul Albert
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Ursula Freeman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Bourke
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Jon Miles
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - Tom O'Brien
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David McWilliams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Terry Schofield
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John O'Reilly
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Rodney Hughes
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
23
|
Colombo C, Roberto A, Krleza-Jeric K, Parmelli E, Banzi R. Sharing individual participant data from clinical studies: a cross-sectional online survey among Italian patient and citizen groups. BMJ Open 2019; 9:e024863. [PMID: 30782920 PMCID: PMC6377545 DOI: 10.1136/bmjopen-2018-024863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To gather knowledge on the current debate, opinions and attitudes of Italian patient and citizen groups on individual participant data (IPD) sharing from clinical studies. DESIGN Cross-sectional online survey. SETTING AND PARTICIPANTS A 22-item online questionnaire was sent by email to 2003 contacts of patient and citizen groups in Italy. We received 311 responses, checked for duplicate respondents (16); 295 single groups responded, 280 providing questionnaires eligible for analysis (response rate 15%). Ninety (32.1%) dealt with oncology and palliative care, 175 (46.2%) operated locally or regionally and 136 (48.6%) were involved in clinical research. OUTCOME MEASURE Data on Italian patient and citizen groups' self-reported knowledge, attitudes and opinions on IPD sharing, mechanisms for IPD access, advantages and risks. RESULTS Half the respondents (144 out of 280, 51%) had some knowledge about the IPD sharing debate, and 60 (42%) stated they had an official position (35 in favour, 19 in favour with restrictions, 2 against, 1 neither for nor against, 3 missing). Nineteen discussed the topic encouraged by this survey; 39% approved broad access by researchers and other professions and identified information to participants, data de-identification, secure archives, access agreements and sanctions for misuse as important aspects of IPD sharing models. Respondents highlighted re-identification, privacy and re-use of data for purposes that participants do not agree on, as main risks, advancement of innovation and reducing waste in research as main advantages. Around half believed IPD sharing would not discourage study participation. CONCLUSIONS Half the respondents were aware of the debate. Those who had an official position were mainly in favour of IPD sharing. Many supported broad access, asking for conditions important for building trust in entities that handle IPD sharing.Although limited by the low response rate, these findings reinforce the demand for reliable and transparent processes where accountabilities are clear.
Collapse
Affiliation(s)
- Cinzia Colombo
- Department of Public Health, Laboratory for Medical Research and Consumer Involvement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Anna Roberto
- Department of Public Health, Laboratory for Medical Research and Consumer Involvement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Karmela Krleza-Jeric
- IMPACT Observatory, Visiting Scientist MedILS (Mediterranean Institute for Life Sciences), Split, Croatia
- Cochrane Croatia, Split, Croatia
- Electronic Health Information Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Elena Parmelli
- Department of Epidemiology, Lazio Regional Health Service - ASL Roma 1, Rome, Italy
| | - Rita Banzi
- Center for Regulatory Policies, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
24
|
A data-sharing agreement helps to increase researchers' willingness to share primary data: results from a randomized controlled trial. J Clin Epidemiol 2018; 106:60-69. [PMID: 30342969 DOI: 10.1016/j.jclinepi.2018.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/13/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Sharing individual participant data (IPD) among researchers, on request, is an ethical and responsible practice. Despite numerous calls for this practice to be standard, however, research indicates that primary study authors are often unwilling to share IPD, even for use in a meta-analysis. This study sought to examine researchers' reservations about data sharing and to evaluate the impact of sending a data-sharing agreement on researchers' attitudes toward sharing IPD. METHODS To investigate these questions, we conducted a randomized controlled trial in conjunction with a Web-based survey. We searched for and invited primary study authors of studies included in recent meta-analyses. We emailed more than 1,200 individuals, and 247 participated. The survey asked individuals about their transparent research practices, general concerns about sharing data, attitudes toward sharing data for inclusion in a meta-analysis, and concerns about sharing data in the context of a meta-analysis. We hypothesized that participants who were randomly assigned to receive a data-sharing agreement would be more willing to share their primary study's IPD. RESULTS Results indicated that participants who received a data-sharing agreement were more willing to share their data set, compared with control participants, even after controlling for demographics and pretest values (d = 0.65, 95% CI [0.39, 0.90]). A member of the control group is 24 percent more likely to share her data set should she receive the data-sharing agreement. CONCLUSIONS These findings shed light on data-sharing practices, attitudes, and concerns and can be used to inform future meta-analysis projects seeking to collect IPD, as well as the field at large.
Collapse
|
25
|
Sharing data for future research-engaging participants' views about data governance beyond the original project: a DIRECT Study. Genet Med 2018; 21:1131-1138. [PMID: 30262927 DOI: 10.1038/s41436-018-0299-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Biomedical data governance strategies should ensure that data are collected, stored, and used ethically and lawfully. However, research participants' preferences for how data should be governed is least studied. The Diabetes Research on Patient Stratification (DIRECT) project collected substantial amounts of health and genetic information from patients at risk of, and with type II diabetes. We conducted a survey to understand participants' future data governance preferences. Results will inform the postproject data governance strategy. METHODS A survey was distributed in Denmark, Sweden, The Netherlands, and the United Kingdom. RESULTS In total 855 surveys were returned. Ninety-seven percent were supportive of sharing data postproject, and 90% were happy to share data with universities, and 56% with commercial companies. The top three priorities for data sharing were highly secure database, DIRECT researchers to monitor data used by other researchers, and researchers cannot identify participants. Respondents frequently suggested that a postproject Data Access Committee should involve a DIRECT researcher, diabetes clinician, patient representative, and a DIRECT participant. CONCLUSION Preferences of how data should be governed, and what data could be shared and with whom varied between countries. Researchers are considered as key custodians of participant data. Engaging participants aids in designing governance to support their choices.
Collapse
|
26
|
Li M, Thompson JMD, Cronin RS, Gordon A, Raynes-Greenow C, Heazell AEP, Stacey T, Culling V, Bowring V, Mitchell EA, McCowan LME, Askie L. The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol. BMJ Open 2018; 8:e020323. [PMID: 29643161 PMCID: PMC5898330 DOI: 10.1136/bmjopen-2017-020323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Accumulating evidence has shown an association between maternal supine going-to-sleep position and stillbirth in late pregnancy. Advising women not to go-to-sleep on their back can potentially reduce late stillbirth rate by 9%. However, the association between maternal right-sided going-to-sleep position and stillbirth is inconsistent across studies. Furthermore, individual studies are underpowered to investigate interactions between maternal going-to-sleep position and fetal vulnerability, which is potentially important for producing clear and tailored public health messages on safe going-to-sleep position. We will use individual participant data (IPD) from existing studies to assess whether right-side and supine going-to-sleep positions are independent risk factors for late stillbirth and to test the interaction between going-to-sleep position and fetal vulnerability. METHODS AND ANALYSIS An IPD meta-analysis approach will be used using the Cochrane Collaboration-endorsed methodology. We will identify case-control and prospective cohort studies and randomised trials which collected maternal going-to-sleep position data and pregnancy outcome data that included stillbirth. The primary outcome is stillbirth. A one stage procedure meta-analysis, stratified by study with adjustment of a priori confounders will be carried out. ETHICS AND DISSEMINATION The IPD meta-analysis has obtained central ethics approval from the New Zealand Health and Disability Ethics Committee, ref: NTX/06/05/054/AM06. Individual studies should also have ethical approval from relevant local ethics committees. Interpretation of the results will be discussed with consumer representatives. Results of the study will be published in peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017047703.
Collapse
Affiliation(s)
- Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital Women and Babies, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander E P Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Edwin A Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
27
|
Al-Shahi Salman R, Dennis MS, Murray GD, Innes K, Drever J, Dinsmore L, Williams C, White PM, Whiteley WN, Sandercock PAG, Sudlow CLM, Newby DE, Sprigg N, Werring DJ. The REstart or STop Antithrombotics Randomised Trial (RESTART) after stroke due to intracerebral haemorrhage: study protocol for a randomised controlled trial. Trials 2018; 19:162. [PMID: 29506580 PMCID: PMC5838871 DOI: 10.1186/s13063-018-2542-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/12/2018] [Indexed: 01/08/2023] Open
Abstract
Background For adults surviving stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken an antithrombotic (i.e. anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before the ICH, it is unclear whether starting antiplatelet drugs results in an increase in the risk of recurrent ICH or a beneficial net reduction of all serious vascular events compared to avoiding antiplatelet drugs. Methods/design The REstart or STop Antithrombotics Randomised Trial (RESTART) is an investigator-led, randomised, open, assessor-blind, parallel-group, randomised trial comparing starting versus avoiding antiplatelet drugs for adults surviving antithrombotic-associated ICH at 122 hospital sites in the United Kingdom. RESTART uses a central, web-based randomisation system using a minimisation algorithm, with 1:1 treatment allocation to which central research staff are masked. Central follow-up includes annual postal or telephone questionnaires to participants and their general (family) practitioners, with local provision of information about adverse events and outcome events. The primary outcome is recurrent symptomatic ICH. The secondary outcomes are: symptomatic haemorrhagic events; symptomatic vaso-occlusive events; symptomatic stroke of uncertain type; other fatal events; modified Rankin Scale score; adherence to antiplatelet drug(s). The magnetic resonance imaging (MRI) sub-study involves the conduct of brain MRI according to a standardised imaging protocol before randomisation to investigate heterogeneity of treatment effect according to the presence of brain microbleeds. Recruitment began on 22 May 2013. The target sample size is at least 720 participants in the main trial (at least 550 in the MRI sub-study). Discussion Final results of RESTART will be analysed and disseminated in 2019. Trial registration ISRCTN71907627 (www.isrctn.com/ISRCTN71907627). Prospectively registered on 25 April 2013. Electronic supplementary material The online version of this article (10.1186/s13063-018-2542-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Martin S Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gordon D Murray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Karen Innes
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathan Drever
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Lynn Dinsmore
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Carol Williams
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Philip M White
- Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle-upon-Tyne, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Peter A G Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Cathie L M Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nikola Sprigg
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - David J Werring
- Institute of Neurology, University College London, London, UK
| | | |
Collapse
|
28
|
Hind D, Parkin J, Whitworth V, Rex S, Young T, Hampson L, Sheehan J, Maguire C, Cantrill H, Scott E, Epps H, Main M, Geary M, McMurchie H, Pallant L, Woods D, Freeman J, Lee E, Eagle M, Willis T, Muntoni F, Baxter P. Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation. Health Technol Assess 2018. [PMID: 28627356 DOI: 10.3310/hta21270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING Six paediatric neuromuscular units. PARTICIPANTS Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS The focus on delivery in hospitals limits generalisability. CONCLUSIONS Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN41002956. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Daniel Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - James Parkin
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Victoria Whitworth
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Saleema Rex
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lisa Hampson
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Jennie Sheehan
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Chin Maguire
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Elaine Scott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Marion Main
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Geary
- Children's Therapy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather McMurchie
- Paediatric Physiotherapy, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Lindsey Pallant
- Regional Paediatric Neuromuscular Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jennifer Freeman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Tracey Willis
- The Oswestry Inherited Neuromuscular Service, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Peter Baxter
- Paediatric Neurology, Sheffield Children's Hospital, Sheffield, UK
| |
Collapse
|
29
|
Goldstein A, Venker E, Weng C. Evidence appraisal: a scoping review, conceptual framework, and research agenda. J Am Med Inform Assoc 2018; 24:1192-1203. [PMID: 28541552 DOI: 10.1093/jamia/ocx050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/18/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Critical appraisal of clinical evidence promises to help prevent, detect, and address flaws related to study importance, ethics, validity, applicability, and reporting. These research issues are of growing concern. The purpose of this scoping review is to survey the current literature on evidence appraisal to develop a conceptual framework and an informatics research agenda. Methods We conducted an iterative literature search of Medline for discussion or research on the critical appraisal of clinical evidence. After title and abstract review, 121 articles were included in the analysis. We performed qualitative thematic analysis to describe the evidence appraisal architecture and its issues and opportunities. From this analysis, we derived a conceptual framework and an informatics research agenda. Results We identified 68 themes in 10 categories. This analysis revealed that the practice of evidence appraisal is quite common but is rarely subjected to documentation, organization, validation, integration, or uptake. This is related to underdeveloped tools, scant incentives, and insufficient acquisition of appraisal data and transformation of the data into usable knowledge. Discussion The gaps in acquiring appraisal data, transforming the data into actionable information and knowledge, and ensuring its dissemination and adoption can be addressed with proven informatics approaches. Conclusions Evidence appraisal faces several challenges, but implementing an informatics research agenda would likely help realize the potential of evidence appraisal for improving the rigor and value of clinical evidence.
Collapse
Affiliation(s)
- Andrew Goldstein
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Eric Venker
- Department of Medicine, Columbia University, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| |
Collapse
|
30
|
Naudet F, Sakarovitch C, Janiaud P, Cristea I, Fanelli D, Moher D, Ioannidis JPA. Data sharing and reanalysis of randomized controlled trials in leading biomedical journals with a full data sharing policy: survey of studies published in The BMJ and PLOS Medicine. BMJ 2018; 360:k400. [PMID: 29440066 PMCID: PMC5809812 DOI: 10.1136/bmj.k400] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To explore the effectiveness of data sharing by randomized controlled trials (RCTs) in journals with a full data sharing policy and to describe potential difficulties encountered in the process of performing reanalyses of the primary outcomes. DESIGN Survey of published RCTs. SETTING PubMed/Medline. ELIGIBILITY CRITERIA RCTs that had been submitted and published by The BMJ and PLOS Medicine subsequent to the adoption of data sharing policies by these journals. MAIN OUTCOME MEASURE The primary outcome was data availability, defined as the eventual receipt of complete data with clear labelling. Primary outcomes were reanalyzed to assess to what extent studies were reproduced. Difficulties encountered were described. RESULTS 37 RCTs (21 from The BMJ and 16 from PLOS Medicine) published between 2013 and 2016 met the eligibility criteria. 17/37 (46%, 95% confidence interval 30% to 62%) satisfied the definition of data availability and 14 of the 17 (82%, 59% to 94%) were fully reproduced on all their primary outcomes. Of the remaining RCTs, errors were identified in two but reached similar conclusions and one paper did not provide enough information in the Methods section to reproduce the analyses. Difficulties identified included problems in contacting corresponding authors and lack of resources on their behalf in preparing the datasets. In addition, there was a range of different data sharing practices across study groups. CONCLUSIONS Data availability was not optimal in two journals with a strong policy for data sharing. When investigators shared data, most reanalyses largely reproduced the original results. Data sharing practices need to become more widespread and streamlined to allow meaningful reanalyses and reuse of data. TRIAL REGISTRATION Open Science Framework osf.io/c4zke.
Collapse
Affiliation(s)
- Florian Naudet
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Charlotte Sakarovitch
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Perrine Janiaud
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Ioana Cristea
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Romania
| | - Daniele Fanelli
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Department of Methodology, London School of Economics and Political Science, UK
| | - David Moher
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, California, USA
| |
Collapse
|
31
|
Ohmann C, Canham S, Banzi R, Kuchinke W, Battaglia S. Classification of processes involved in sharing individual participant data from clinical trials. F1000Res 2018; 7:138. [PMID: 29623192 PMCID: PMC5861517 DOI: 10.12688/f1000research.13789.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background: In recent years, a cultural change in the handling of research data has resulted in the promotion of a culture of openness and an increased sharing of data. In the area of clinical trials, sharing of individual participant data involves a complex set of processes and the interaction of many actors and actions. Individual services and tools to support data sharing are becoming available, but what is missing is a detailed, structured and comprehensive list of processes and subprocesses involved and the tools and services needed. Methods: Principles and recommendations from a published consensus document on data sharing were analysed in detail by a small expert group. Processes and subprocesses involved in data sharing were identified and linked to actors and possible supporting services and tools. Definitions adapted from the business process model and notation (BPMN) were applied in the analysis. Results: A detailed and comprehensive tabulation of individual processes and subprocesses involved in data sharing, structured according to 9 main processes, is provided. Possible tools and services to support these processes are identified and grouped according to the major type of support. Conclusions: The identification of the individual processes and subprocesses and supporting tools and services, is a first step towards development of a generic framework or architecture for the sharing of data from clinical trials. Such a framework is needed to provide an overview of how the various actors, research processes and services could interact to form a sustainable system for data sharing.
Collapse
Affiliation(s)
- Christian Ohmann
- European Clinical Research Infrastructure Network (ECRIN), Düsseldorf, 40477, Germany
| | - Steve Canham
- Canham Information Systems, Redhill, Surrey, RH1 6QH, UK
| | - Rita Banzi
- Mario Negri Institute of Pharmacological Research, Milan, 20156, Italy
| | - Wolfgang Kuchinke
- Coordination Centre for Clinical Trials, Heinrich Heine University Dusseldorf, Dusseldorf, 40225, Germany
| | - Serena Battaglia
- European Clinical Research Infrastructure Network (ECRIN), Paris, 75013, France
| |
Collapse
|
32
|
Keerie C, Tuck C, Milne G, Eldridge S, Wright N, Lewis SC. Data sharing in clinical trials - practical guidance on anonymising trial datasets. Trials 2018; 19:25. [PMID: 29321053 PMCID: PMC5763739 DOI: 10.1186/s13063-017-2382-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background There is an increasing demand by non-commercial funders that trialists should provide access to trial data once the primary analysis is completed. This has to take into account concerns about identifying individual trial participants, and the legal and regulatory requirements. Methods Using the good practice guideline laid out by the work funded by the Medical Research Council Hubs for Trials Methodology Research (MRC HTMR), we anonymised a dataset from a recently completed trial. Using this example, we present practical guidance on how to anonymise a dataset, and describe rules that could be used on other trial datasets. We describe how these might differ if the trial was to be made freely available to all, or if the data could only be accessed with specific permission and data usage agreements in place. Results Following the good practice guidelines, we successfully created a controlled access model for trial data sharing. The data were assessed on a case-by-case basis classifying variables as direct, indirect and superfluous identifiers with differing methods of anonymisation assigned depending on the type of identifier. A final dataset was created and checks of the anonymised dataset were applied. Lastly, a procedure for release of the data was implemented to complete the process. Conclusions We have implemented a practical solution to the data anonymisation process resulting in a bespoke anonymised dataset for a recently completed trial. We have gained useful learnings in terms of efficiency of the process going forward, the need to balance anonymity with data utilisation and future work that should be undertaken. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2382-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX, UK.
| | - Christopher Tuck
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Garry Milne
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | | | - Neil Wright
- CTSU - Clinical Trial Service Unit and Epidemiological Studies Unit University of Oxford, Oxford, UK
| | - Steff C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| |
Collapse
|
33
|
Ohmann C, Banzi R, Canham S, Battaglia S, Matei M, Ariyo C, Becnel L, Bierer B, Bowers S, Clivio L, Dias M, Druml C, Faure H, Fenner M, Galvez J, Ghersi D, Gluud C, Groves T, Houston P, Karam G, Kalra D, Knowles RL, Krleža-Jerić K, Kubiak C, Kuchinke W, Kush R, Lukkarinen A, Marques PS, Newbigging A, O'Callaghan J, Ravaud P, Schlünder I, Shanahan D, Sitter H, Spalding D, Tudur-Smith C, van Reusel P, van Veen EB, Visser GR, Wilson J, Demotes-Mainard J. Sharing and reuse of individual participant data from clinical trials: principles and recommendations. BMJ Open 2017; 7:e018647. [PMID: 29247106 PMCID: PMC5736032 DOI: 10.1136/bmjopen-2017-018647] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/31/2017] [Accepted: 10/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We examined major issues associated with sharing of individual clinical trial data and developed a consensus document on providing access to individual participant data from clinical trials, using a broad interdisciplinary approach. DESIGN AND METHODS This was a consensus-building process among the members of a multistakeholder task force, involving a wide range of experts (researchers, patient representatives, methodologists, information technology experts, and representatives from funders, infrastructures and standards development organisations). An independent facilitator supported the process using the nominal group technique. The consensus was reached in a series of three workshops held over 1 year, supported by exchange of documents and teleconferences within focused subgroups when needed. This work was set within the Horizon 2020-funded project CORBEL (Coordinated Research Infrastructures Building Enduring Life-science Services) and coordinated by the European Clinical Research Infrastructure Network. Thus, the focus was on non-commercial trials and the perspective mainly European. OUTCOME We developed principles and practical recommendations on how to share data from clinical trials. RESULTS The task force reached consensus on 10 principles and 50 recommendations, representing the fundamental requirements of any framework used for the sharing of clinical trials data. The document covers the following main areas: making data sharing a reality (eg, cultural change, academic incentives, funding), consent for data sharing, protection of trial participants (eg, de-identification), data standards, rights, types and management of access (eg, data request and access models), data management and repositories, discoverability, and metadata. CONCLUSIONS The adoption of the recommendations in this document would help to promote and support data sharing and reuse among researchers, adequately inform trial participants and protect their rights, and provide effective and efficient systems for preparing, storing and accessing data. The recommendations now need to be implemented and tested in practice. Further work needs to be done to integrate these proposals with those from other geographical areas and other academic domains.
Collapse
Affiliation(s)
- Christian Ohmann
- European Clinical Research Infrastructure Network (ECRIN), Düsseldorf, Germany
| | - Rita Banzi
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri' (IRFMN), Milan, Italy
| | | | - Serena Battaglia
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Mihaela Matei
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | | | - Lauren Becnel
- Clinical Data Interchange Standards Consortium, Austin, Texas, USA
| | - Barbara Bierer
- MRCT Center of BWH and Harvard, Brigham and Women's Hospital and Harvard University, Boston, Massachusetts, USA
| | | | - Luca Clivio
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri' (IRFMN), Milan, Italy
| | | | - Christiane Druml
- Ethics, Collections and History of Medicine of the Medical University of Vienna, Vienna, Austria
| | | | | | - Jose Galvez
- National Institutes of Health/National Cancer Institute, Bethesda, Maryland, USA
| | - Davina Ghersi
- National Health and Medical Research Council, Watson, Australian Capital Territory, Australia
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Trish Groves
- BMJ Editorial, BMJ Editorial BMA House, London, UK
| | - Paul Houston
- Clinical Data Interchange Standards Consortium, Austin, Texas, USA
| | - Ghassan Karam
- World Health Organisation/Organisation mondiale de la santé, Geneva, Switzerland
| | - Dipak Kalra
- The European Institute for Innovation through Health Data, Ghent, Belgium
| | | | | | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Wolfgang Kuchinke
- Coordination Centre for Clinical Trials, Heinrich Heine University, Düsseldorf, Germany
| | - Rebecca Kush
- Catalysis, Austin, Texas, USA
- Formerly Clinical Data Interchange Standards Consortium, Austin, Texas, USA
| | | | | | - Andrew Newbigging
- TrialGrid Limited, London, UK
- Formerly Medidata Solutions, Hammersmith, UK
| | | | | | - Irene Schlünder
- Biobanking and BioMolecular Resources Research Infrastructure (BBMRI), Berlin, Germany
| | | | - Helmut Sitter
- Institute of Theoretical Surgery, Philipps University, Marburg, Germany
| | - Dylan Spalding
- European Molecular Biology Laboratory, European Bioinformatics Institute, EMBL-EBI, Hinxton, UK
| | | | - Peter van Reusel
- Clinical Data Interchange Standards Consortium, Austin, Texas, USA
| | - Evert-Ben van Veen
- MLC Foundation, Den Haag, The Netherlands
- Medlawconsult, The Hague, The Netherlands
| | | | | | | |
Collapse
|
34
|
Tudur Smith C, Nevitt S, Appelbe D, Appleton R, Dixon P, Harrison J, Marson A, Williamson P, Tremain E. Resource implications of preparing individual participant data from a clinical trial to share with external researchers. Trials 2017; 18:319. [PMID: 28712359 PMCID: PMC5512949 DOI: 10.1186/s13063-017-2067-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Demands are increasingly being made for clinical trialists to actively share individual participant data (IPD) collected from clinical trials using responsible methods that protect the confidentiality and privacy of clinical trial participants. Clinical trialists, particularly those receiving public funding, are often concerned about the additional time and money that data-sharing activities will require, but few published empirical data are available to help inform these decisions. We sought to evaluate the activity and resources required to prepare anonymised IPD from a clinical trial in anticipation of a future data-sharing request. METHODS Data from two UK publicly funded clinical trials were used for this exercise: 2437 participants with epilepsy recruited from 90 hospital outpatient clinics in the SANAD trial and 146 children with neuro-developmental problems recruited from 18 hospitals in the MENDS trial. We calculated the time and resources required to prepare each anonymised dataset and assemble a data pack ready for sharing. RESULTS The older SANAD trial (published 2007) required 50 hours of staff time with a total estimated associated cost of £3185 whilst the more recently completed MENDS trial (published 2012) required 39.5 hours of staff time with total estimated associated cost of £2540. CONCLUSIONS Clinical trial researchers, funders and sponsors should consider appropriate resourcing and allow reasonable time for preparing IPD ready for subsequent sharing. This process would be most efficient if prospectively built into the standard operational design and conduct of a clinical trial. Further empirical examples exploring the resource requirements in other settings is recommended. TRIAL REGISTRATION SANAD: International Standard Randomised Controlled Trials Registry: ISRCTN38354748 . Registered on 25 April 2003. MENDS EU Clinical Trials Register Eudract 2006-004025-28 . Registered on 16 May 2007. International Standard Randomised Controlled Trials Registry: ISRCTN05534585 /MREC 07/MRE08/43. Registered on 26 January 2007.
Collapse
Affiliation(s)
- Catrin Tudur Smith
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Duncan Appelbe
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | | | - Pete Dixon
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Janet Harrison
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Paula Williamson
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Elizabeth Tremain
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| |
Collapse
|
35
|
Nevitt SJ, Marson AG, Davie B, Reynolds S, Williams L, Smith CT. Exploring changes over time and characteristics associated with data retrieval across individual participant data meta-analyses: systematic review. BMJ 2017; 357:j1390. [PMID: 28381561 PMCID: PMC5733815 DOI: 10.1136/bmj.j1390] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To investigate whether the success rate of retrieving individual participant data (IPD) for use in IPD meta-analyses has increased over time, and to explore the characteristics associated with IPD retrieval.Design Systematic review of published IPD meta-analyses, supplemented by a reflection of the Cochrane Epilepsy Group's 20 years' experience of requesting IPD.Data sources Medline, CENTRAL, Scopus, Web of Science, CINAHL Plus, and PsycINFO.Eligibility criteria for study selection IPD meta-analyses of studies of all designs and all clinical areas published in English.Results 760 IPD meta-analyses which identified studies by systematic methods that had been published between 1987 and 2015 were included. Only 188 (25%) of these IPD meta-analyses retrieved 100% of the eligible IPD for analysis, with 324 (43%) of these IPD meta-analyses retrieving 80% or more of relevant IPD. There is insufficient evidence to suggest that IPD retrieval rates have improved over time. IPD meta-analyses that included only randomised trials, had an authorship policy, included fewer eligible participants, and were conducted outside of the Cochrane Database of Systematic Reviews were associated with a high or complete IPD retrieval rate. There was no association between the source of funding of the IPD meta-analyses and IPD retrieval rate. The IPD retrieval rate of the Cochrane Epilepsy Group has declined from 83% (up to 2005) to 65% (between 2012 and 2015) and the reported reasons for lack of data availability have changed in recent years.Conclusions IPD meta-analyses are considered to be the "gold standard" for the synthesis of data from clinical research studies; however, only 25% of published IPD meta-analyses have had access to all IPD.
Collapse
Affiliation(s)
- Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Becky Davie
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Sally Reynolds
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Lisa Williams
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| | - Catrin Tudur Smith
- Department of Biostatistics, University of Liverpool, Liverpool L69 3GL, UK
| |
Collapse
|
36
|
Krleža-Jerić K, Gabelica M, Banzi R, Martinić MK, Pulido B, Mahmić-Kaknjo M, Reveiz L, Šimić J, Utrobičić A, Hrgović I. IMPACT Observatory: tracking the evolution of clinical trial data sharing and research integrity. Biochem Med (Zagreb) 2017; 26:308-307. [PMID: 27812300 PMCID: PMC5082220 DOI: 10.11613/bm.2016.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/14/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction The opening of research data is emerging thanks to the increasing possibilities of digital technology. The opening of clinical trial (CT) data is a part of this process, expected to have positive scientific, ethical, health, and economic impacts thus contributing to research integrity. The January 2016 proposal by the International Council of Medical Journal Editors triggered ample discussion about CT data sharing and reconfirmed the need for an ongoing assessment of its dynamics. The IMProving Access to Clinical Trials data (IMPACT) Observatory aims to play such a role, and assess the data sharing culture, policies, and practices of key players, the impact of their interventions on CTs, and contribute to a transformation of research. The objective of this paper is to present the IMPACT Observatory as well as share some of its preliminary findings. Materials and methods Methods include a scoping study of research, surveys, interviews, and an environmental scan of research data repositories. Results Our preliminary findings indicate that although opening of CT data has not yet been achieved, its evolution is encouraging. Initiatives by key players contribute to increasing of CT data sharing, and many barriers are shrinking or disappearing. Conclusions The major barrier is the lack of data sharing standards, from preparing data for public sharing to its curatorship, findability and access. However, experiences accumulated by sharing CT data according to “upon request” or “open” mechanisms could inform the development of such standards. The Vivli, CORBEL-ECRIN and Open Trials projects are currently working in this direction.
Collapse
Affiliation(s)
- Karmela Krleža-Jerić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Mirko Gabelica
- Clinical Department of ENT, Head and Neck Surgery, Split University Hospital Center, Split, Croatia
| | - Rita Banzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Marina Krnić Martinić
- Clinical Department of ENT, Head and Neck Surgery, Split University Hospital Center, Split, Croatia
| | - Bibiana Pulido
- Centre de recherche interuniversitaire sur la mondialisation et le travail (CRIMT), Université de Montréal, Montreal, Canada
| | - Mersiha Mahmić-Kaknjo
- Department of Clinical Pharmacology, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - Ludovic Reveiz
- Knowledge Management, Bioethics and Research Office, Pan American Health Organization, Washington DC, United States of America
| | - Josip Šimić
- Health Sciences Library, Faculty of Health Studies, University of Mostar, Mostar, Bosnia and Hercegovina
| | - Ana Utrobičić
- Central Medical Library, University of Split School of Medicine, Split, Croatia
| | - Irena Hrgović
- School of Pharmacy, University of Split, Split, Croatia
| |
Collapse
|
37
|
Dolling DI, Goodall RL, Chirara M, Hakim J, Nkurunziza P, Munderi P, Eram D, Tumukunde D, Spyer MJ, Gilks CF, Kaleebu P, Dunn DT, Pillay D. The virological durability of first-line ART among HIV-positive adult patients in resource limited settings without virological monitoring: a retrospective analysis of DART trial data. BMC Infect Dis 2017; 17:160. [PMID: 28222702 PMCID: PMC5319022 DOI: 10.1186/s12879-017-2266-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few low-income countries have virological monitoring widely available. We estimated the virological durability of first-line antiretroviral therapy (ART) after five years of follow-up among adult Ugandan and Zimbabwean patients in the DART study, in which virological assays were conducted retrospectively. METHODS DART compared clinically driven monitoring with/without routine CD4 measurement. Annual plasma viral load was measured on 1,762 patients. Analytical weights were calculated based on the inverse probability of sampling. Time to virological failure, defined as the first viral load measurement ≥200 copies/mL after 48 weeks of ART, was analysed using Kaplan-Meier plots and Cox regression models. RESULTS Overall, 65% of DART trial patients were female. Patients initiated first-line ART at a median (interquartile range; IQR) age of 37 (32-42) and with a median CD4 cell count of 86 (32-140). After 240 weeks of ART, patients initiating dual-class nucleoside reverse-transcriptase inhibitor (NRTI) -non-nucleoside reverse-transcriptase (NNRTI) regimens containing nevirapine + zidovudine + lamivudine had a lower incidence of virological failure than patients on triple-NRTI regimens containing tenofovir + zidovudine + lamivudine (21% vs 40%; hazard ratio (HR) =0.48, 95% CI:0.38-0.62; p < 0.0001). In multivariate analyses, female patients (HR = 0.79, 95% CI: 0.65-0.95; p = 0.02), older patients (HR = 0.73 per 10 years, 95% CI: 0.64-0.84; p < 0.0001) and patients with a higher pre-ART CD4 cell count (HR = 0.64 per 100 cells/mm3, 95% CI: 0.54-0.75; p < 0.0001) had a lower incidence of virological failure after adjusting for adherence to ART. No difference in failure rate between the two randomised monitoring strategies was observed (p= 0.25). CONCLUSIONS The long-term durability of virological suppression on dual-class NRTI-NNRTI first-line ART without virological monitoring is remarkable and is enabled by high-quality clinical management and a consistent drug supply. To achieve higher rates of virological suppression viral-load-informed differentiated care may be required. TRIAL REGISTRATION Prospectively registered on 18/10/2000 as ISRCTN13968779 .
Collapse
Affiliation(s)
| | | | | | | | | | | | - David Eram
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | | | - Charles F Gilks
- School of Population Health, University of Queensland, Brisbane, Australia
| | | | | | - Deenan Pillay
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, Durban, South Africa
| | | |
Collapse
|
38
|
Dal-Ré R. The International Committee of Medical Journal Editors trial data sharing requirement and participants' consent. Eur J Clin Invest 2016; 46:971-975. [PMID: 27782296 DOI: 10.1111/eci.12694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 12/18/2022]
Abstract
The International Committee of Medical Journal Editors (ICMJE) has published a draft proposal on de-identified individual clinical trial participant data (IPD) sharing, stating that sharing trial data requires planning to ensure appropriate research ethics committee approval and participants' informed consent. This is why its implementation will be deferred for 1 year after the publication of the final version of the policy. When conducting research with anonymous data, it is not feasible to obtain the informed consent from research participants. De-identified IPD are anonymous to the investigator who is performing the secondary analysis. De-identified IPD meta-analyses have been conducted for decades. Public funders, industry and foundations have recently implemented new IPD sharing procedures; almost all trials used for secondary analyses so far were conducted without participant's consent to de-identified IPD. As stated by the ICMJE, de-identified IPD protects participant's confidentiality. It follows that publishing secondary analyses from completed trials without participant's consent is ethically acceptable. From the ethical perspective, the ICMJE requirement on de-identified IPD sharing should be implemented from the day the policy is published.
Collapse
Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM+CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
39
|
Ross JS, Ritchie JD, Finn E, Desai NR, Lehman RL, Krumholz HM, Gross CP. Data sharing through an NIH central database repository: a cross-sectional survey of BioLINCC users. BMJ Open 2016; 6:e012769. [PMID: 27670522 PMCID: PMC5051517 DOI: 10.1136/bmjopen-2016-012769] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To characterise experiences using clinical research data shared through the National Institutes of Health (NIH)'s Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) clinical research data repository, along with data recipients' perceptions of the value, importance and challenges with using BioLINCC data. DESIGN AND SETTING Cross-sectional web-based survey. PARTICIPANTS All investigators who requested and received access to clinical research data from BioLINCC between 2007 and 2014. MAIN OUTCOME MEASURES Reasons for BioLINCC data request, research project plans, interactions with original study investigators, BioLINCC experience and other project details. RESULTS There were 536 investigators who requested and received access to clinical research data from BioLINCC between 2007 and 2014. Of 441 potential respondents, 195 completed the survey (response rate=44%); 89% (n=174) requested data for an independent study, 17% (n=33) for pilot/preliminary analysis. Commonly cited reasons for requesting data through BioLINCC were feasibility of collecting data of similar size and scope (n=122) and insufficient financial resources for primary data collection (n=76). For 95% of respondents (n=186), a primary research objective was to complete new research, as opposed to replicate prior analyses. Prior to requesting data from BioLINCC, 18% (n=36) of respondents had contacted the original study investigators to obtain data, whereas 24% (n=47) had done so to request collaboration. Nearly all (n=176; 90%) respondents found the data to be suitable for their proposed project; among those who found the data unsuitable (n=19; 10%), cited reasons were data too complicated to use (n=5) and data poorly organised (n=5). Half (n=98) of respondents had completed their proposed projects, of which 67% (n=66) have been published. CONCLUSIONS Investigators were primarily using clinical research data from BioLINCC for independent research, making use of data that would otherwise have not been feasible to collect.
Collapse
Affiliation(s)
- Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jessica D Ritchie
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Emily Finn
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard L Lehman
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- UK Cochrane Center, Oxford, UK
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cary P Gross
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
40
|
Tsai AC, Kohrt BA, Matthews LT, Betancourt TS, Lee JK, Papachristos AV, Weiser SD, Dworkin SL. Promises and pitfalls of data sharing in qualitative research. Soc Sci Med 2016; 169:191-198. [PMID: 27535900 DOI: 10.1016/j.socscimed.2016.08.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 12/20/2022]
Abstract
The movement for research transparency has gained irresistible momentum over the past decade. Although qualitative research is rarely published in the high-impact journals that have adopted, or are most likely to adopt, data sharing policies, qualitative researchers who publish work in these and similar venues will likely encounter questions about data sharing within the next few years. The fundamental ways in which qualitative and quantitative data differ should be considered when assessing the extent to which qualitative and mixed methods researchers should be expected to adhere to data sharing policies developed with quantitative studies in mind. We outline several of the most critical concerns below, while also suggesting possible modifications that may help to reduce the probability of unintended adverse consequences and to ensure that the sharing of qualitative data is consistent with ethical standards in research.
Collapse
Affiliation(s)
- Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA; Harvard Center for Population and Development Studies, Cambridge, USA; Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | - Lynn T Matthews
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Theresa S Betancourt
- Harvard Center for Population and Development Studies, Cambridge, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jooyoung K Lee
- Department of Sociology, University of Toronto, Toronto, Canada
| | | | - Sheri D Weiser
- Department of Medicine, University of California at San Francisco, USA
| | - Shari L Dworkin
- Department of Social and Behavioral Sciences, School of Nursing, University of California at San Francisco, San Francisco, USA
| |
Collapse
|
41
|
Hrynaszkiewicz I, Khodiyar V, Hufton AL, Sansone SA. Publishing descriptions of non-public clinical datasets: proposed guidance for researchers, repositories, editors and funding organisations. Res Integr Peer Rev 2016; 1:6. [PMID: 29451541 PMCID: PMC5793987 DOI: 10.1186/s41073-016-0015-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/22/2016] [Indexed: 12/17/2022] Open
Abstract
Sharing of experimental clinical research data usually happens between individuals or research groups rather than via public repositories, in part due to the need to protect research participant privacy. This approach to data sharing makes it difficult to connect journal articles with their underlying datasets and is often insufficient for ensuring access to data in the long term. Voluntary data sharing services such as the Yale Open Data Access (YODA) and Clinical Study Data Request (CSDR) projects have increased accessibility to clinical datasets for secondary uses while protecting patient privacy and the legitimacy of secondary analyses but these resources are generally disconnected from journal articles-where researchers typically search for reliable information to inform future research. New scholarly journal and article types dedicated to increasing accessibility of research data have emerged in recent years and, in general, journals are developing stronger links with data repositories. There is a need for increased collaboration between journals, data repositories, researchers, funders, and voluntary data sharing services to increase the visibility and reliability of clinical research. Using the journal Scientific Data as a case study, we propose and show examples of changes to the format and peer-review process for journal articles to more robustly link them to data that are only available on request. We also propose additional features for data repositories to better accommodate non-public clinical datasets, including Data Use Agreements (DUAs).
Collapse
Affiliation(s)
- Iain Hrynaszkiewicz
- Springer Nature, The Campus, Trematon Walk, Wharfdale Road, London, N1 9FN UK
| | - Varsha Khodiyar
- Scientific Data, The Campus, Trematon Walk, Wharfdale Road, London, N1 9FN UK
| | - Andrew L. Hufton
- Scientific Data, The Campus, Trematon Walk, Wharfdale Road, London, N1 9FN UK
| | - Susanna-Assunta Sansone
- Scientific Data, The Campus, Trematon Walk, Wharfdale Road, London, N1 9FN UK
- Oxford e-Research Centre, University of Oxford, Oxford, OX1 3QG UK
| |
Collapse
|
42
|
Affiliation(s)
- Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK.
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Richard Lindley
- Sydney Medical School-Westmead Hospital and The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Geoff Cohen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| |
Collapse
|
43
|
Vickers AJ. Sharing raw data from clinical trials: what progress since we first asked "Whose data set is it anyway?". Trials 2016; 17:227. [PMID: 27142986 PMCID: PMC4855346 DOI: 10.1186/s13063-016-1369-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
Ten years ago, one of the first papers published in Trials was a commentary entitled "Whose data set is it anyway?" The commentary pointed out that trialists routinely refused requests for data sharing and argued that this attitude was a community standard that had no rational basis. At the time, there had been few calls for clinical trial data sharing and certainly no institutional support. Today the situation could not be more different. Numerous organizations now recommend or require raw data to be made available, including the International Committee of Medical Journal Editors, which recently proposed that clinical trial data sharing be a "condition of … publication." Furthermore, the literature is replete with papers covering an enormously wide variety of topics on data sharing. But despite a tectonic shift in attitudes, we are yet to see clinical trial data sharing become an unquestioned norm, where a researcher can readily download a data set from a trial almost as easily as they can now download a copy of the published paper. The battle over the next few years is to go beyond changing minds to ensuring that real data sets are routinely made available.
Collapse
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
| |
Collapse
|
44
|
Crook AM, Turkova A, Musiime V, Bwakura-Dangarembizi M, Bakeera-Kitaka S, Nahirya-Ntege P, Thomason M, Mugyenyi P, Musoke P, Kekitiinwa A, Munderi P, Nathoo K, Prendergast AJ, Walker AS, Gibb DM. Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy. BMC Med 2016; 14:50. [PMID: 27004529 PMCID: PMC4804479 DOI: 10.1186/s12916-016-0593-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/08/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There are few data on tuberculosis (TB) incidence in HIV-infected children on antiretroviral therapy (ART). Observational studies suggest co-trimoxazole prophylaxis may prevent TB, but there are no randomized data supporting this. The ARROW trial, which enrolled HIV-infected children initiating ART in Uganda and Zimbabwe and included randomized cessation of co-trimoxazole prophylaxis, provided an opportunity to estimate the incidence of TB over time, to explore potential risk factors for TB, and to evaluate the effect of stopping co-trimoxazole prophylaxis. METHODS Of 1,206 children enrolled in ARROW, there were 969 children with no previous TB history. After 96 weeks on ART, children older than 3 years were randomized to stop or continue co-trimoxazole prophylaxis; 622 were eligible and included in the co-trimoxazole analysis. Endpoints, including TB, were adjudicated blind to randomization by an independent endpoint review committee (ERC). Crude incidence rates of TB were estimated and potential risk factors, including age, sex, center, CD4, weight, height, and initial ART strategy, were explored in multivariable Cox proportional hazards models. RESULTS After a median of 4 years follow-up (3,632 child-years), 69 children had an ERC-confirmed TB diagnosis. The overall TB incidence was 1.9/100 child-years (95% CI, 1.5-2.4), and was highest in the first 12 weeks following ART initiation (8.8/100 child-years (5.2-13.4) versus 1.2/100 child-years (0.8-1.6) after 52 weeks). A higher TB risk was independently associated with younger age (<3 years), female sex, lower pre-ART weight-for-age Z-score, and current CD4 percent; fewer TB diagnoses were observed in children on maintenance triple nucleoside reverse transcriptase inhibitor (NRTI) ART compared to standard non-NRTI + 2NRTI. Over the median 2 years of follow-up, there were 20 ERC-adjudicated TB cases among 622 children in the co-trimoxazole analysis: 5 in the continue arm and 15 in the stop arm (hazard ratio (stop: continue) = 3.0 (95% CI, 1.1-8.3), P = 0.028). TB risk was also independently associated with lower current CD4 percent (P <0.001). CONCLUSIONS TB incidence varies over time following ART initiation, and is particularly high during the first 3 months post-ART, reinforcing the importance of TB screening prior to starting ART and use of isoniazid preventive therapy once active TB is excluded. HIV-infected children continuing co-trimoxazole prophylaxis after 96 weeks of ART were diagnosed with TB less frequently, highlighting a potentially important role of co-trimoxazole in preventing TB.
Collapse
Affiliation(s)
| | | | - Victor Musiime
- />Joint Clinical Research Centre, Kampala, Uganda
- />Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Sabrina Bakeera-Kitaka
- />Makerere University College of Health Sciences, Kampala, Uganda
- />Baylor College of Medicine Children’s Foundation, Kampala, Uganda
| | | | | | | | - Philippa Musoke
- />Makerere University College of Health Sciences, Kampala, Uganda
- />MU-JHU Care Ltd, Kampala, Uganda
| | | | - Paula Munderi
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Kusum Nathoo
- />Department of Paediatrics and Child Health, University of Zimbabwe Medical School, Harare, Zimbabwe
| | | | | | | | - And The ARROW Trial Team
- />MRC Clinical Trials Unit at UCL, London, UK
- />Joint Clinical Research Centre, Kampala, Uganda
- />Makerere University College of Health Sciences, Kampala, Uganda
- />Department of Paediatrics and Child Health, University of Zimbabwe Medical School, Harare, Zimbabwe
- />Baylor College of Medicine Children’s Foundation, Kampala, Uganda
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- />MU-JHU Care Ltd, Kampala, Uganda
- />Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|