Accessibility of clinical study reports supporting medicine approvals: a cross-sectional evaluation

OBJECTIVES

Clinical study reports (CSRs) are highly detailed documents that play a pivotal role in medicine approval processes. Though not historically publicly available, in recent years, major entities including the European Medicines Agency (EMA), Health Canada, and the US Food and Drug Administration (FDA) have highlighted the importance of CSR accessibility. The primary objective herein was to determine the proportion of CSRs that support medicine approvals available for public download as well as the proportion eligible for independent researcher request via the study sponsor.

STUDY DESIGN AND SETTING

This cross-sectional study examined the accessibility of CSRs from industry-sponsored clinical trials whose results were reported in the FDA-authorized drug labels of the top 30 highest-revenue medicines of 2021. We determined (1) whether the CSRs were available for download from a public repository, and (2) whether the CSRs were eligible for request by independent researchers based on trial sponsors' data sharing policies.

RESULTS

There were 316 industry-sponsored clinical trials with results presented in the FDA-authorized drug labels of the 30 sampled medicines. Of these trials, CSRs were available for public download from 70 (22%), with 37 available at EMA and 40 at Health Canada repositories. While pharmaceutical company platforms offered no direct downloads of CSRs, sponsors confirmed that CSRs from 183 (58%) of the 316 clinical trials were eligible for independent researcher request via the submission of a research proposal. Overall, 218 (69%) of the sampled clinical trials had CSRs available for public download and/or were eligible for request from the trial sponsor.

CONCLUSION

CSRs were available from 69% of the clinical trials supporting regulatory approval of the 30 medicines sampled. However, only 22% of the CSRs were directly downloadable from regulatory agencies, the remaining required a formal application process to request access to the CSR from the study sponsor.

Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review

Objectives

Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies.

Methods

Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577).

Results

Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking.

Discussion

By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.

Political regime, data transparency, and COVID-19 death cases

The COVID-19-the worst pandemic since the Spanish flu-has dramatically changed the world, with a significant number of people suffering from and dying of the disease. Some scholars argue that democratic governments are disadvantaged in coping with the current pandemic mainly because they cannot intervene in their citizens' lives as aggressively as their authoritarian counterparts. Other scholars, however, suggest that possible data manipulation may account for the apparent advantage of authoritarian countries. Taking such a possibility seriously, this paper analyzes the relationship between political regimes, data transparency, and COVID-19 deaths using cross-national data for over 108 countries, obtained from Worldometer COVID-19 Data, Polity V Project, Variety of Democracy (V-Dem) Project, HRV Transparency Project among other sources. Regression analyses indicate that authoritarian countries do not necessarily tend to have fewer COVID-19 deaths than their democratic counterparts after controlling for other factors, especially data transparency. The transparency variable itself, on the other hand, is positively correlated with the number of death cases more consistently (P <0.05). Overall, the estimation results point to the possible data manipulation, not the nature of regime characteristics itself, as a more significant source for the seemingly low casualty rates in authoritarian countries.

Hospitals' Web Site Lists of Their Interventional Pain Procedures Inadequately Reflect the Diversity of Their Actual Pain Medicine Practices

BACKGROUND

Multidisciplinary chronic pain management includes many types of interventional pain procedures. However, navigating the landscape of providers offering such services is challenging.

OBJECTIVE

We investigated whether stakeholders (e.g., patients, referring physicians, hospital administrators, nurses working for insurance companies, and state officials) could accurately judge the diversity of interventional services actually provided based on information gathered from hospital Web sites.

STUDY DESIGN

This was an observational cohort study.

SETTING

All 119 nonfederal hospitals in Iowa were included in the study.

METHODS

We recorded the publicly available data presented on all hospital Web pages related to interventional pain procedures. We counted the listed types of procedures and numbers of pain medicine physicians portrayed. We compared those results with actual performed interventional pain procedures calculated using contemporaneous data from the Iowa Hospital Association. The diversity of types of procedures performed was quantified using the inverse of the Herfindahl index.

RESULTS

No pain medicine physician was identified on the Web site for 87.4% of hospitals. Such hospitals accounted for 61.4% of the interventional pain procedures performed statewide. The partial Kendall correlation between the count of types of procedures listed on Web sites and the number of pain medicine physicians, controlling for the performed procedures during the year, was too small to be informative: 0.22 (95% Confidence Interval [CI], 0.07 to 0.38; P = .005). The one-sided upper confidence limit that included 0.50 (i.e., moderate) was the 99.98% limit. The partial correlation between the count of types of procedures listed on Web sites and the actual diversity of types of procedures performed, controlling for the performed procedures during the year, was not statistically significant: 0.12 (95% CI, -0.03 to 0.28; P = .12). The partial Kendall correlation between the number of pain medicine physicians listed on the Web sites and the diversity of types of procedures performed was not significant: 0.03 (95% CI, -0.13 to 0.19; P = .73).

LIMITATIONS

This study was limited to the state of Iowa, where we found that 38.6% of interventional pain procedures were performed at hospitals with at least one pain medicine physician. The 38.6% is substantively less than the corresponding estimate of 54.2% for the state of Florida. The estimate of 38.6% exceeds the estimate of 30.4% for critical access hospitals in the United States nationwide. Although the heterogeneity is as expected, it shows that findings are likely to be heterogeneous across regions.

CONCLUSIONS

Stakeholders could not have accurate awareness of the spectrum of services provided by multidisciplinary pain medicine clinics and physicians based on currently reported data, even if they sought it out from publicly available information. Transparency will need to come from pain medicine physicians, at facilities providing the full diversity of services, releasing quantitative data about the services that they provide (e.g., counts by procedure).

High impact nutrition and dietetics journals' use of publication procedures to increase research transparency

BACKGROUND

The rigor and integrity of the published research in nutrition studies has come into serious question in recent years. Concerns focus on the use of flexible data analysis practices and selective reporting and the failure of peer review journals to identify and correct these practices. In response, it has been proposed that journals employ editorial procedures designed to improve the transparency of published research.

OBJECTIVE

The present study examines the adoption of editorial procedures designed to improve the reporting of empirical studies in the field of nutrition and dietetics research.

DESIGN

The instructions for authors of 43 journals included in Quartiles 1 and 2 of the Clarivate Analytics' 2018 Journal Citation Report category Nutrition and Dietetics were reviewed. For journals that published original research, conflict of interest disclosure, recommendation of reporting guidelines, registration of clinical trials, registration of other types of studies, encouraging data sharing, and use of the Registered Reports were assessed. For journals that only published reviews, all of the procedures except clinical trial registration were assessed.

RESULTS

Thirty-three journals published original research and 10 published only reviews. Conflict of interest disclosure was required by all 33 original research journals. Use of guidelines, trial registration and encouragement of data sharing were mentioned by 30, 27 and 25 journals, respectively. Registration of other studies was required by eight and none offered Registered Reports as a publication option at the time of the review. All 10 review journals required conflict of interest disclosure, four recommended data sharing and three the use of guidelines. None mentioned the other two procedures.

CONCLUSIONS

While nutrition journals have adopted a number of procedures designed to improve the reporting of research findings, their limited effects likely result from the mechanisms through which they influence analytic flexibility and selective reporting and the extent to which they are properly implemented and enforced by journals.

ViSiElse: an innovative R-package to visualize raw behavioral data over time

The scientific community encourages the use of raw data graphs to improve the reliability and transparency of the results presented in articles. However, the current methods used to visualize raw data are limited to one or two numerical variables per graph and/or small sample sizes. In the behavioral sciences, numerous variables must be plotted together in order to gain insight into the behavior in question. In this article, we present ViSiElse, an R-package offering a new approach in the visualization of raw data. ViSiElse was developed with the open-source software R to visualize behavioral observations over time based on raw time data extracted from visually recorded sessions of experimental observations. ViSiElse gives a global overview of a process by creating a visualization of the timestamps for multiple actions and all participants into a single graph; individual or group behavior can then be easily assessed. Additional features allow users to further inspect their data by including summary statistics and time constraints.

Information and organization in public health institutes: an ontology-based modeling of the entities in the reception-analysis-report phases

BACKGROUND

Ontologies are widely used both in the life sciences and in the management of public and private companies. Typically, the different offices in an organization develop their own models and related ontologies to capture specific tasks and goals. Although there might be an overall coordination, the use of distinct ontologies can jeopardize the integration of data across the organization since data sharing and reusability are sensitive to modeling choices.

RESULTS

The paper provides a study of the entities that are typically found at the reception, analysis and report phases in public institutes in the life science domain. Ontological considerations and techniques are introduced and their implementation exemplified by studying the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), a public veterinarian institute with different geographical locations and several laboratories. Different modeling issues are discussed like the identification and characterization of the main entities in these phases; the classification of the (types of) data; the clarification of the contexts and the roles of the involved entities. The study is based on a foundational ontology and shows how it can be extended to a comprehensive and coherent framework comprising the different institute's roles, processes and data. In particular, it shows how to use notions lying at the borderline between ontology and applications, like that of knowledge object. The paper aims to help the modeler to understand the core viewpoint of the organization and to improve data transparency.

CONCLUSIONS

The study shows that the entities at play can be analyzed within a single ontological perspective allowing us to isolate a single ontological framework for the whole organization. This facilitates the development of coherent representations of the entities and related data, and fosters the use of integrated software for data management and reasoning across the company.

EFSPI/PSI working group on data sharing: accessing and working with pharmaceutical clinical trial patient level datasets - a primer for academic researchers

BACKGROUND

Access to patient level datasets from clinical trial sponsors continues to be an important topic for the Pharmaceutical Industry as well as academic institutions and researchers. How to make access to patient level data actually happen raises many questions from the perspective of the researcher.

METHODS

Patient level data access models of all major pharmaceutical companies were surveyed and recommendations made to guide academic researchers in the most efficient way through the process of requesting and accessing patient level data.

RESULTS

The key considerations for researchers covered here are finding information; writing a research proposal to request data access; the review process; how data are shared; and the expectations of the data holder. A lot of clinical trial information is available on public registries and so these are great sources of information. Depending on the research proposal the required information may be available in Clinical Study Reports and therefore patient level data may not need to be requested. Many data sharing systems have an electronic form or template but in cases where these are not available the proposal needs to be created as a stand-alone document outlining the purpose, statistical analysis plan, identifying the studies for which data are required, the research team members involved, any conflicts of interest and the funding for the research. There are three main review processes - namely having an internal review board, external review board selected by the data holder or an external review board selected by a third party. Data can be shared through Open access i.e. on a public website, direct sharing between the data holder and the researcher, controlled access or the data holder identifies a contract organization to access the data and perform the analyses on behalf of the researcher. The data that are shared will have accompanying documentation to assist the researcher in understanding the original clinical trial and data collection methods. The data holder will require a legally binding data sharing agreement to be set up with the researcher. Additionally the data holder may be available to provide some support to the researcher if questions arise.

CONCLUSION

Whilst the benefits and value of patient level data sharing have yet to be fully realised, we hope that the information outlined in this article will encourage researchers to consider accessing and re-using clinical trial data to support their research questions.

Data inconsistencies from states with unconventional oil and gas activity

The quality and availability of unconventional oil and gas (O&G) data in the United States have never been compared methodically state-to-state. By conducting such an assessment, this study seeks to better understand private and publicly sourced data variability and to identify data availability gaps. We developed an exploratory data-grading tool - Data Accessibility and Usability Index (DAUI) - to guide the review of O&G data quality. Between July and October 2013, we requested, collected, and assessed 5 categories of unconventional O&G data (wells drilled, violations, production, waste, and Class II disposal wells) from 10 states with active drilling activity. We based our assessment on eight data quality parameters (accessibility, usability, point location, completeness, metadata, agency responsiveness, accuracy, and cost). Using the DAUI, two authors graded the 10 states and then averaged their scores. The average score received across all states, data categories, and parameters was 67.1 out of 100, largely insufficient for proper data transparency. By state, Pennsylvania received the highest average ( = 93.5) and ranked first in all but one data category. The lowest scoring state was Texas ( = 44) largely due to its policy of charging for certain data. This article discusses the various reasons for scores received, as well as methodological limitations of the assessment metrics. We argue that the significant variability of unconventional O&G data-and its availability to the public-is a barrier to regulatory and industry transparency. The lack of transparency also impacts public education and broader participation in industry governance. This study supports the need to develop a set of data best management practices (BMPs) for state regulatory agencies and the O&G industry, and suggests potential BMPs for this purpose.