Trend of drug clinical trials in mainland China from 2009 to 2020

With the development of linnovative regulations on drug clinical trials in mainland China, the quantity and quality of drug clinical trials have gradually improved over the past decade. Based on the information of the clinical trials from the online drug clinical trial registration platform of National Medical Products Administration, we reviewed the data of drug clinical trials in mainland China from 2009 to 2020. A total of 8,593 clinical trials have been conducted during this period. The annual number of clinical trials has been increasing gradually, and peaked in 2017. There were 2,127, 1,051, 1,551, and 156 phases I, II, III, and IV clinical trials respectively. In addition, there were 3,441 bioequivalence studies. Trials for anti-tumor drugs ranked the highest (19.45%), followed by trials of drugs for infections and infestations (12.96%) and those for cardiovascular diseases (9.00%). Meanwhile the number of the clinical trial sites also increased annually. However, there were only 116 and 130 clinical trials of drugs for children and rare diseases respectively. The geographical distribution of the sites was uneven. This mapping review provides an overall look of clinical trials in China, which may be useful for domestic and international sponsors.

Alice through the Looking-glass: Can We Improve Peer Review?

Peer review is an essential component for the evaluation of material submitted to medical and scientific journals. This process usually involves single blind, double blind or open peer review. In the present Editorial, we discuss the advantages and disadvantages of these peer review options. Our comments are influenced by our experience as Editors-in-Chief. We also outline new developments in the field of peer review.

A snapshot of U.S. IRB review of COVID-19 research in the early pandemic

Background/Objective:

Along with the greater research enterprise, Institutional Review Boards (IRBs) had to quickly adapt to the COVID-19 pandemic. IRBs had to review and oversee COVID-related research, while navigating strict public health measures and a workforce largely relegated to working from home. Our objectives were to measure adjustments to standard IRB review processes, IRB turnaround time and document and any novel ethical issues encountered.

Methods:

Structured data requests were sent to members of the Consortium to Advance Effective Research Ethics Oversight directing Human Research Protection Programs (HRPP).

Results:

Fourteen of the 32 HRPP director members responded to a questionnaire about their approach to review and oversight during COVID-19. Eleven of the 14 provided summary data on COVID-19-specific protocols and six of the 11 provided protocol-related documents for our review. All respondents adopted at least one additional COVID-19-specific step to their usual review process. The average turnaround time for convened and expedited IRB reviews was 15 calendar days. In our review of the documents from 194 COVID-19-specific protocols (n = 302 documents), we identified only a single review that raised ethical concerns unique to COVID-19.

Conclusions:

Our data provide a snapshot of how HRPPs approached the review of COVID-19-specific protocols at the start of the pandemic in the USA. While not generalizable to all HRPPs, these data indicate that HRPPs can adapt and respond quickly response to a pandemic and likely need little novel expertise in the review and oversight of COVID-19-specific protocols.

[Risk Analysis and Countermeasures Investigating Based on Medical Device Registration Review Process]

In order to strengthen the supervision and management of medical devices, China implements pre-market registration and approval system for medical device. Technical evaluation is a key point of Chinese medical device registration management system. This study, by process-oriented, systematically sorts out the risks existing in each part of the review process. The countermeasures for risk prevention are proposed, hoping to strengthen the quality control of the whole process of review, improve the quality and efficiency of the review effectively, and ensure the various reform measures of the medical device review and approval system effectively.

Review process of the health scientific journals according to explanation of experts

INTRODUCTION

Reviewing articles are one of the most important methods for maintaining and improving the scientific quality of research outputs, especially in the field of health and medicine, and are often accompanied with various challenges.

AIM

The current study was carried out to Health Promotion in the Review Process of the Health Scientific Journals according to Explanation of Experts.

MATERIALS AND METHODS

This study has a qualitative approach and was carried out using the content analysis method. Data were gathered through semi-structured interviews with experts with direct and related experiences with health scientific journals including editors in chief, internal managers, editorial boards, authors' council and members of national journal commission with at least 2 years of continuous related work experience in journals and review of at least 10 articles. Sampling was carried out using purposeful snowball sampling, and data were analyzed using content analysis method. Lincoln and Guba tests were used to determine the validity and reliability of the analysis based on the following four criteria - credibility, transferability, certainty, and verifiability.

RESULTS

Experts' opinions were categorized based on criteria for reviewer selection with three dimensions of technical expertise, ethical behavior, and orientation and order; reviewer selection methods including emphasis on others and emphasis on self; and review problems in the Iranian Health Science and Research Journals including incentive system, reviewer characteristics, and structural problems.

CONCLUSION

Findings of the current study are usable for all Iranian Health Scientific Journals, editors, editors in chief, and internal managers as well as lawmakers in the area of scientific research.

The Challenges of First-in-Human Stem Cell Clinical Trials: What Does This Mean for Ethics and Institutional Review Boards?

Stem cell-based clinical interventions are increasingly advancing through preclinical testing and approaching clinical trials. The complexity and diversity of these approaches, and the confusion created by unproven and untested stem cell-based “therapies,” create a growing need for a more comprehensive review of these early-stage human trials to ensure they place the patients at minimal risk of adverse events but are also based on solid evidence of preclinical efficacy with a clear scientific rationale for that effect. To address this issue and supplement the independent review process, especially that of the ethics and institutional review boards who may not be experts in stem cell biology, the International Society for Stem Cell Research (ISSCR) has developed a set of practical questions to cover the major issues for which clear evidence-based answers need to be obtained before approving a stem cell-based trial.

Ethical Issues Surrounding the Use of Modern Human Remains for Research in South Africa

Chapter 8 of the South African National Health Act 61 of 2003 (NHA) that deals with the donation of human tissue was promulgated in 2012. The new Act is perceived to impose restrictions on low-risk research involving human remains. This study aimed to identify the issues raised by a research ethics committee (REC) when reviewing protocols where human remains are used as data source. REC minutes from 2009 to 2014 were reviewed, and issues raised by the committee were categorized. In total, 127 protocols submitted to the committee over 6 years involved human remains. Queries relating to science (22.2%) and administration (18.9%) were the most common, whereas queries relating to legal issues constituted only 10.2%. Ethical issues centered on informed consent regarding sensitive topics such as HIV, DNA, and deceased children. The change in legislation did not change the number or type of legal issues identified by the REC.

Improving your journal article using feedback from peer review

While preparation of a journal article for submission may often include informal review by colleagues, an article is not accepted for publication until it has been formally peer reviewed. Peer review is the process whereby journal editors ask expert reviewers to examine the work submitted and prepare a report on its suitability for publication. Two or more revisions of the article may be required following peer review, with the author reworking the article in the light of feedback received on each occasion. This can be challenging for some authors, but used well, it offers a chance to improve the work to the required standard of the journal, and help the author present a more precise and coherent account of the arguments. The extent to which the author responds to the critical commentary of peer reviewers is important, because this may determine whether or not the article is published. This article explores the aims of peer reviewers and recommends ways in which authors can respond to the feedback provided.

Guest reviewers: volume 10

The Editors express their thanks to the persons named below for contributing to the review process in respect of paper submissions received in 2015.

[To what extent do reviewers of multiple-choice questions need to be trained? A comparison between handing out information sheets and brief workshop sessions]

BACKGROUND

A competent review process is crucial to ensure the quality of multiple-choice (MC) questions. However, the acquisition of reviewing skills should not cause any unnecessary additional burden for a medical staff that is already facing heavy workloads.

METHODS

100 MC questions, for which an expert review existed, were presented to 12 novices. In advance, six participants received a specific information sheet covering critical information for high-calibre review; the other six participants attended a 2.5-hour workshop covering the same information. The review results of both groups were analysed with a licensed version of the IBM software SPSS 19.0 (SPSS Inc., Chicago, IL).

RESULTS

The results of the workshop group were distinctly closer to the experts' results (gold standard) than those of the information sheet group. For the quantitatively important category of medium quality MC questions, the results of the workshop group did not significantly differ from the experts' results. In the information sheet group the results were significantly poorer than the experts', regardless of the quality of the questions.

CONCLUSIONS

Distributing specific information sheets to MC question reviewers is not sufficient for ensuring the quality of the review so that - regardless of the increased effort involved - a recommendation to conduct specific workshops must be made.

After an inpatient suicide: the aim and outcome of review mechanisms

OBJECTIVE

To describe the intent and process of reviews undertaken following the death by suicide of an inpatient and suggest possible improvements.

METHOD

The current processes of review undertaken in Victoria following the death by suicide of an inpatient were considered in the context of a review of unnatural, unexpected or violent inpatient deaths undertaken by the Chief Psychiatrist of Victoria in late 2011.

RESULTS

Review processes seeking to elucidate a cause or to find errors in the system that may have contributed to an incident are not always suitable nor sufficient in cases of inpatient suicide, where the patient's actions (as opposed to the actions or inactions of clinicians) led to patient death; therefore, the cause of death is not independent of the patient's condition and the treatment provided.

CONCLUSION

While Root Cause Analysis remains a useful methodology, review of inpatient suicides should go beyond examination of systems issues only, and include consideration of the care and treatment provided: whether it met accepted clinical standards and was delivered by staff with adequate skills to consider the inherent risks of mental illness. Review of aggregate data has a useful role in identifying significant common features associated with inpatient deaths.

An appraisal of the process of protocol review by an ethics review conmmittee in a tertiary institution in Ibadan

It is a well established norm that biomedical research involving human participants must conform to acceptable scientific principles and international codes of research ethics. The University of Ibadan/University College Hospital Health Research Ethics Committee (UI/UCH HREC) is the body that plays an oversight role and performs the function of a third party independent review of research protocols submitted by staff and students of the two institutions. A 6-year (2002-2007) retrospective audit of the protocols submitted to the HREC was performed to determine the profile of the lead investigator, sources of funding for the research and the duration for review using a 25 item questionnaire. A total of 752 protocols were submitted, 618 protocols (82%) were approved while 38 protocols were not approved. The principal investigators were mainly postgraduate students (67.1%) while academic staff constituted 21.3%. The average time from submission to approval was approximately 21 weeks (95% CI: 20-23 weeks). The period from submission to approval is significantly affected by the number of revision required and the funding agent (p < 0.05); it took a shorter time to review internationally funded research.