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Lassman AB, Brogan FL, Shelton RJ, Bentlyewski E, Kelsen MA, Kim H, Ruotolo BL, Rustgi AK, Jurcic JG. Rapidly adapting the clinical research environment at an NCI-designated comprehensive cancer center to the COVID-19 pandemic. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13534 Background: In March 2020, responding to COVID-19, the Columbia University Institutional Review Board (IRB) mandated all research pause in-person activities except studies “offering the potential for direct benefit” to patients. New enrollment was also paused. Columbia University Irving Medical Center concurrently mandated all non-essential employees work remotely, and all feasible patient visits transition to telehealth. The clinical research infrastructure at the Herbert Irving Comprehensive Cancer Center (HICCC) was required to adapt its operations in response. Methods: The HICCC convened an executive committee (EC), consisting of multi-disciplinary leadership, canvassed peer institutions, and engaged the IRB Executive Director (ED), Chief of Infectious Disease, a bioethicist, and others ad hoc. Results: The IRB ED agreed with the EC that all approved interventional therapeutic clinical trials for cancer (n = 554) offered the potential for direct benefit to patients. The EC established an “Emergency Preparedness” standard operating procedure (SOP) with input from the IRB and HICCC Protocol Review & Monitoring and Data & Safety Monitoring Committees. This SOP required assessment of each protocol for risks/benefit, transition to remote processes when possible, and referenced the Code of Federal Regulations allowing changes to a research plan without prospective IRB-approval if “necessary to eliminate apparent immediate hazard”. For new subjects, the EC created a process for enrollment as exceptions to the research pause requiring written justification by the PI that included risk-mitigation strategies and approval by the EC. 116 patients were accrued under this process. All external monitoring and auditing was transitioned to remote. Finally, 25% of research nurses and 10% of coordinators were redeployed to other short-staffed areas of the medical center. After 3 months, the IRB lifted the research pause in tranches, and the EC charged its Disease Based Teams with prioritizing trials to reopen. Accrual nadired at 30% of pre-pandemic levels in June 2020, which fully recovered by March 2021. Conclusions: A centralized research infrastructure working closely with established institutional committees was critical for the unprecedented yet effective and rapid ramp down/up of clinical trials. After 1-year, accrual recovered to pre-pandemic levels, leveraging new processes such as electronic consent, telehealth, and remote work for staff.
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Affiliation(s)
- Andrew B. Lassman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Frances L. Brogan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Ryan J. Shelton
- Hebert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Edward Bentlyewski
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Moshe A. Kelsen
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Helen Kim
- Clinical Trials Office, Columbia University, New York, NY
| | | | - Anil K. Rustgi
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Joseph G. Jurcic
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
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Leng S, Wei A, Assal A, Bhutani D, Baliko G, Gould J, Shelton RJ, Kelly S, Otap D, Mapara MY, Lentzsch S. A phase 1/2 study of carfilzomib, bendamustine, and dexamethasone (CBD) in newly diagnosed multiple myeloma patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Julia Gould
- Columbia University Medical Center, New York, NY
| | | | | | - Daniel Otap
- Columbia University Medical Center, New York, NY
| | - Markus Y Mapara
- Division of Hematology/Oncology, Columbia University, New York, NY
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Shelton RJ, Clark AL, Goode K, Rigby AS, Houghton T, Kaye GC, Cleland JGF. A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart 2009; 95:924-30. [DOI: 10.1136/hrt.2008.158931] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shelton RJ, Rigby AS, Cleland JGF, Clark AL. Effect of a community heart failure clinic on uptake of beta blockers by patients with obstructive airways disease and heart failure. Heart 2005; 92:331-6. [PMID: 15951394 PMCID: PMC1860814 DOI: 10.1136/hrt.2004.059758] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the pattern of beta blocker prescribing over one year in a heart failure clinic with a structured approach towards initiation and dose titration and to give a real life perspective on beta blocker use, compliance, and target dose achievement. METHODS Data were retrospectively analysed on 513 consecutive patients regularly attending a community heart failure clinic over a year. Systolic dysfunction was determined from two dimensional echocardiography (left ventricular ejection fraction < or = 40%) and lung function was assessed by spirometry. All patients were considered for beta blocker initiation and dose up titration. RESULTS Within one year 157 patients died. 143 patients started beta blockers resulting in 315 (88%) patients taking beta blockers at one year; 38% were taking the target dose. 124 had evidence of airways obstruction at baseline, 100 (81%) of whom were taking beta blockers at one year. Forced expiratory volume in one second (1.1 v 1.5 l, p < 0.01) and forced vital capacity (2.3 v 2.5 l/min, p = 0.2) were not reduced in patients with airways obstruction who received beta blockers. Daily doses of beta blockers at one year did not differ statistically between patients with obstructive and patients with non-obstructive spirometry results. 12 patients discontinued beta blockers and 14 required dose reduction due to side effects. CONCLUSION The majority of patients with heart failure and obstructive airways disease can safely tolerate low dose initiation and gradual up titration of beta blockers.
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Affiliation(s)
- R J Shelton
- Department of Academic Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK.
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Kovacs GT, Dennis PM, Shelton RJ, Outch KH, McLean RA, Healy DL, Burger HG. Induction of ovulation with human pituitary gonadotrophin. Twelve years' experience. Med J Aust 1984; 140:575-9. [PMID: 6717330 DOI: 10.5694/j.1326-5377.1989.tb139671.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Twelve years' experience in the therapeutic use of human pituitary gonadotrophins in 74 patients with anovulation is reviewed. Of these 74 patients, 54 conceived on at least one occasion. A new development, the use of radioimmunoassays for oestrone-3-glucuronide and pregnanediol-3-glucuronide to monitor responses, has been shown to be as effective as the more laborious chemical methods which were previously used. The adoption of radioimmunoassay monitoring allows the simultaneous treatment of up to five patients, and will markedly reduce existing waiting lists for this treatment.
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