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Smith S, Millham F. Agile response to critical need for clinical trial accessibility during the first COVID-19 pandemic wave. Am J Disaster Med 2024; 19:79-82. [PMID: 38597650 DOI: 10.5055/ajdm.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
This article discusses some of the major challenges that the clinical research community faced during the early days of the coronavirus disease 2019 pandemic. A model is offered that may assist other institutions while planning for future pandemics or disasters.
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Affiliation(s)
- Stephanie Smith
- South Shore Hospital, Weymouth; Boston University School of Medicine, Boston, Massachusetts
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2
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Wilmes N, Hendriks CWE, Viets CTA, Cornelissen SJWM, van Mook WNKA, Cox-Brinkman J, Celi LA, Martinez-Martin N, Gichoya JW, Watkins C, Bakhshi-Raiez F, Wynants L, van der Horst ICC, van Bussel BCT. Structural under-reporting of informed consent, data handling and sharing, ethical approval, and application of Open Science principles as proxies for study quality conduct in COVID-19 research: a systematic scoping review. BMJ Glob Health 2023; 8:e012007. [PMID: 37257937 PMCID: PMC10254958 DOI: 10.1136/bmjgh-2023-012007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic required science to provide answers rapidly to combat the outbreak. Hence, the reproducibility and quality of conducting research may have been threatened, particularly regarding privacy and data protection, in varying ways around the globe. The objective was to investigate aspects of reporting informed consent and data handling as proxies for study quality conduct. METHODS A systematic scoping review was performed by searching PubMed and Embase. The search was performed on November 8th, 2020. Studies with hospitalised patients diagnosed with COVID-19 over 18 years old were eligible for inclusion. With a focus on informed consent, data were extracted on the study design, prestudy protocol registration, ethical approval, data anonymisation, data sharing and data transfer as proxies for study quality. For reasons of comparison, data regarding country income level, study location and journal impact factor were also collected. RESULTS 972 studies were included. 21.3% of studies reported informed consent, 42.6% reported waivers of consent, 31.4% did not report consent information and 4.7% mentioned other types of consent. Informed consent reporting was highest in clinical trials (94.6%) and lowest in retrospective cohort studies (15.0%). The reporting of consent versus no consent did not differ significantly by journal impact factor (p=0.159). 16.8% of studies reported a prestudy protocol registration or design. Ethical approval was described in 90.9% of studies. Information on anonymisation was provided in 17.0% of studies. In 257 multicentre studies, 1.2% reported on data sharing agreements, and none reported on Findable, Accessible, Interoperable and Reusable data principles. 1.2% reported on open data. Consent was most often reported in the Middle East (42.4%) and least often in North America (4.7%). Only one report originated from a low-income country. DISCUSSION Informed consent and aspects of data handling and sharing were under-reported in publications concerning COVID-19 and differed between countries, which strains study quality conduct when in dire need of answers.
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Affiliation(s)
- Nick Wilmes
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular research institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Charlotte W E Hendriks
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caspar T A Viets
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Simon J W M Cornelissen
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Josanne Cox-Brinkman
- Department of Health Law, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leo A Celi
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicole Martinez-Martin
- Department of Pediatrics, Stanford Center for Biomedical Ethics, Stanford University, San Jose, California, USA
| | - Judy W Gichoya
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, Atlanta, Florida, USA
| | - Craig Watkins
- School of Journalism and Media, University of Texas, Austin, Texas, USA
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Amsterdam University Medical Centre, Amsterdam and Amsterdam Public Health, Quality of care The Netherlands, Amsterdam, The Netherlands
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular research institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular research institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Burgess T, Rennie S, Moodley K. Key ethical issues encountered during COVID-19 research: a thematic analysis of perspectives from South African research ethics committees. BMC Med Ethics 2023; 24:11. [PMID: 36793067 PMCID: PMC9930063 DOI: 10.1186/s12910-023-00888-y] [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] [Received: 07/07/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa. METHODS We conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60-125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data. RESULTS Five main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme. CONCLUSIONS Numerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues.
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Affiliation(s)
- Theresa Burgess
- Centre for Medical Ethics and Law, WHO Collaborating Centre for Bioethics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, F45 Old Main Building, Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7725 South Africa
| | - Stuart Rennie
- Centre for Medical Ethics and Law, WHO Collaborating Centre for Bioethics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Social Medicine, UNC Bioethics Center, University of North Carolina, Chapel Hill, USA
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, WHO Collaborating Centre for Bioethics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Social Medicine, UNC Bioethics Center, University of North Carolina, Chapel Hill, USA
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Milanese A, Trerotoli P, Vestri A. A Survey on Methodological Issues of Clinical Research Studies Reviewed by Independent Ethic Committees during the COVID-19 Pandemic in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11673. [PMID: 36141946 PMCID: PMC9517254 DOI: 10.3390/ijerph191811673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The struggle for information and the hasty search for answers caused by the COVID-19 pandemic threatened the possibility of lowering study quality, as well as ethical committees' review standards during the outbreak. Our investigation aimed to assess the impact of COVID-19 on the quality of clinical research studies submitted to Italian Ethics Committees in the period between April and July 2020. All 91 Italian ethics committees were contacted via email in order to collect anonymized information on the type and quality of COVID-19-related studies submitted to each committee during the study period. The present study summarizes the characteristics of the 184 study applications collected, pointing out, especially, how the quality of the study population and statistical analysis are crucial variables in determining the study approval. Nevertheless, despite the need for high-quality and open scientific information, especially exacerbated by this particular historical period, only a minority of the ethics committees (20.9%) agreed to share their data; such scarce participation, beyond biasing the representativeness of the results obtained by the present study, more importantly, hinders the broader goal of creating trust between researchers and the general public.
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Affiliation(s)
- Alberto Milanese
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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Kulkarni U, Hamza N. A narrative review of the challenges, ethical frameworks, and guidelines in the setting of COVID-19 healthcare and research. Perspect Clin Res 2022; 13:70-76. [PMID: 35573457 PMCID: PMC9106127 DOI: 10.4103/picr.picr_206_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
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Neira-Fernández KD, Gaitán-Lee L, Gómez-Ramírez OJ. Barreras y facilitadores para la investigación en ciencias de la salud durante la crisis del COVID-19: una revisión de alcance. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2021; 72:377-395. [PMID: 35134285 PMCID: PMC8833242 DOI: 10.18597/rcog.3788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
Objetivo: La pandemia ocasionada por el Covid-19 ha significado un gran desafío para la investigación en salud por la necesidad de dar una respuesta oportuna y efectiva a esta situación de crisis. Es importante proveer una visión panorámica sobre las principales barreras y facilitadores encontrados en la conducción de estudios en ciencias de la salud durante la crisis del Covid-19, así como también de las iniciativas en investigación sugeridas por autoridades en salud de investigación a nivel global, regional o local. Materiales y métodos: Se desarrolló una revisión sistemática de alcance. Se hizo una búsqueda de la literatura en Medline, Cochrane library, Lilacs y Google Scholar. Se incluyeron estudios de investigación originales, artículos de revisión, de opinión y editoriales disponibles en texto completo, publicados entre enero de 2020 y mayo de 2021 en español, inglés o portugués. Se hizo selección de los documentos y extracción de los datos por dos autores de manera independiente. Las barreras y facilitadores identificados fueron descritos y organizados en cuatro categorías a partir de la literatura: socioculturales, administrativos, organizacionales y metodológicos. Asimismo, se incluyeron documentos y comunicados oficiales de autoridades en salud e investigación a nivel global, regional y local. Los resultados se presentan de manera narrativa y en tablas. Resultados: Se seleccionaron 26 documentos para el análisis y síntesis de la información. Las barreras mencionadas más frecuentemente en la literatura incluyen las dificultades en cuanto al acceso a los participantes, a los trámites asociados a los comités de ética; así como el riesgo biológico para los investigadores y la falta de coordinación inter e intrainstitucional. Por su parte, los facilitadores identificados incluyen la adopción de soluciones virtuales, el trabajo cooperativo entre los actores de la investigación y la flexibilidad en el proceso de obtención del consentimiento informado. Frente a las iniciativas difundidas por las autoridades en salud e investigación, se identificaron cuatro estrategias relacionadas con la priorización de preguntas de investigación, el fomento de la cooperación y la inclusión en la investigación, la lucha contra la infodemia y el fortalecimiento de la calidad metodológica de los estudios. Conclusiones: Para la investigación en el contexto de la pandemia representa un desafío continuar con la cooperación e interoperabilidad entre las instituciones, los países y las disciplinas, con el fin de facilitar los procesos investigativos en el futuro; del mismo modo, cobra importancia mantener la ciencia abierta y la financiación de estudios cooperativos cuando surjan otras prioridades. Asimismo, es evidente la necesidad de desarrollar y sostener mecanismos que gestionen la información de manera eficiente para la toma de decisiones. Se requiere evaluar de manera continua los efectos que ha dejado esta pandemia en la práctica de la investigación en ciencias de la salud para comprender de manera integral lo que debemos aprender como sociedad a partir de las crisis.
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Affiliation(s)
| | - Laura Gaitán-Lee
- Investigadora asociada Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá (Colombia)..
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Olivier C, Ganache I, Demers-Payette O, Lochhead L, Pelaez S, de Guise M, Pomey MP. Patient and Citizen Participation in the Identification of Ethical Considerations Aiming to Address Uncertainty in the Evaluation of Promising Interventions in a Pandemic Context. FRONTIERS IN MEDICAL TECHNOLOGY 2021; 3:794003. [PMID: 35047973 PMCID: PMC8757856 DOI: 10.3389/fmedt.2021.794003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, numerous studies have been conducted to identify interventions that could contribute to alleviating the burden it has caused. The Institut national d'excellence en santé et en services sociaux (INESSS) has played a key role in informing the government of Québec regarding the evaluation of specific pandemic-related interventions. This process took place in a context characterized by a sense of urgency to assess and recommend potential interventions that could save lives and reduce the effects of the disease on populations and healthcare systems, which increased the pressure on the regulatory agencies leading these evaluations. While some of the interventions examined were considered promising, results from COVID-19 studies often led to uncertainty regarding their efficacy or safety. Regulatory agencies evaluating the value of promising interventions thus face challenges in deciding whether these should be made available to the population, particularly when assessing their benefit-risk balance. To shed light on these challenges, we identified underlying ethical considerations that can influence such an assessment. A rapid literature review was conducted in February 2021, to identify the main challenges associated with the benefit-risk balance assessment of promising interventions. To reinforce our understanding of the underlying ethical considerations, we initiated a discussion among various social actors involved in critical thinking surrounding the evaluation of promising interventions, including ethicists, clinicians and researchers involved in clinical or public health practice, as well as patients and citizens. This discussion allowed us to create a space for exchange and mutual understanding among these various actors who contributed equally to the identification of ethical considerations. The knowledge and perspectives stemming from the scientific literature and those consulted were integrated in a common reflection on these ethical considerations. This allowed patients and citizens, directly affected by the evaluation of pandemic-related interventions and the resulting social choices, to contribute to the identification of the relevant ethical considerations. It also allowed for reflection on the responsibilities of the various actors involved in the development, evaluation, and distribution of promising interventions in a setting of urgency and uncertainty, such as that brought about by the COVID-19 pandemic.
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Affiliation(s)
- Catherine Olivier
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
- École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Isabelle Ganache
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
- École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Olivier Demers-Payette
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
| | - Louis Lochhead
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
- Centre d'excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
| | - Sandra Pelaez
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
- École de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, QC, Canada
| | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Institut national d'excellence en santé et services sociaux, Bureau - Méthodologies et éthique, Montréal, QC, Canada
- École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre d'excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
- Centre de recherche du Centre Hospitalier, Université de Montréal, Montréal, QC, Canada
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Bhatt A. Consent concerns in clinical trials of investigational therapies for COVID-19: Vulnerability versus voluntariness. Perspect Clin Res 2021; 11:174-177. [PMID: 33489836 PMCID: PMC7819368 DOI: 10.4103/picr.picr_271_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
Obtaining informed consent from vulnerable patients participating in clinical trials of investigational therapies for COVID-19 is a major ethical challenge. Ethical and operational considerations – voluntariness, waiver, timing, time, documentation, and responsibilities of the sponsor, the investigator, and the ethics committee – are discussed briefly.
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Affiliation(s)
- Arun Bhatt
- Consultant - Clinical Research and Drug Development, Mumbai, Maharashtra, India
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Singh V, Garg S, Klimek M, Sinha RR, Dhanwal D. COVID-19 and Clinical Trials: Current Challenges and Future Directions. Rev Recent Clin Trials 2021; 16:258-261. [PMID: 33480349 DOI: 10.2174/1574887116666210122160705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The outbreak of coronavirus disease (COVID-19) has posed a major threat to people's lives across the globe. It has drastically changed the way we perceive this world. A paradigm shift was observed globally as the world's emphasis shifted to testing, diagnosis, treatment, and developing a coronavirus cure. Clinical trials were also not untouched by this. The coronavirus pandemic has abhorrently affected the day-to-day clinical trial activities at sites. METHODS The status of various ongoing clinical trials was assessed through a literature search, which also includes clinical trial portals. Our evaluations were based on these observations. RESULTS Multiple challenges were present in clinical trials as recruitment, retention, the safety of trial subjects, protocol compliance, and this made the world to re-think to incorporate newer strategies and to cope with this untoward situation. CONCLUSION Digitalization of clinical trials as virtual management of adverse events, remote monitoring visits, and web-based consulting with trial subjects are potential directions that can be applied to better manage clinical trials worldwide.
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Affiliation(s)
- Vinay Singh
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Sandeep Garg
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Monika Klimek
- Department of Laboratory Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Rajeev Ranjan Sinha
- Department of Pharmacology, Lord Buddha Koshi Medical College and Hospitals, Saharsa, Bihar, India
| | - Dinesh Dhanwal
- Department of Endocrinology, NMC Speciality Hospitals, Abu Dhabi, United Arab Emirates
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Thangaraju P, Jindal A. Prerequisite of doing clinical trial with drugs in COVID-19 patients: Situational experience. Perspect Clin Res 2020; 11:135. [PMID: 33033705 PMCID: PMC7513783 DOI: 10.4103/picr.picr_184_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Atul Jindal
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Bhatt A. Real-world data in COVID-19 pandemic: An essential unmet health-care need. Perspect Clin Res 2020; 11:103-105. [PMID: 33033697 PMCID: PMC7513788 DOI: 10.4103/picr.picr_168_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arun Bhatt
- Consultant - Clinical Research and Drug Development
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