Computer-aided information management systems in clinical trials. A physician's perspective

Information Needs in a Clinical Trials Unit

The aim of the study was to analyse the information needs of the Clinical Trials Unit (CTU) at Velindre Hospital, a specialist cancer centre, and the Wales Cancer Trials Network (WCTN). The purpose was to determine the trial information needs that may be collected via the Velindre hospital information system, and the data structure required to store that information. A case study approach was adopted with semi-structured interviews (17 face-to-face interviews with staff based at Velindre Hospital and three telephone interviews with staff at other trial centres in Wales) complemented by document analysis, and an analysis of trial activity databases either in use or under development. A core information set, common to all trials, was identified and this can be collected in ISCO. The document-based trial-specific information is best made available in HTML format. Entity-relationship model diagrams were developed to show the data structure. The study concluded that trial activity information needs can be satisfied as a byproduct of collecting patient trial information in a hospital information system. Patient care should be improved by the greater availability of trials information, and accrual may be increased through identification of potential trial candidates.

Web-based decision support for clinical trial eligibility determination in an international clinical trials network

Matching individuals to multisite cooperative clinical trials can be a complex and nonintuitive decision process that expends considerable time and may be prone to errors. We developed and tested a web-based decision support tool to aid investigators in matching patients to open clinical trials for children with rhabdomyosarcoma in the context of an international cooperative cancer clinical trials network. A decision tree for trial eligibility based on eight clinical variables representing major disease characteristics was translated into a web-based format. In a blinded fashion, we assessed the accuracy of the tool in assigning 100 randomly selected cases to the proper clinical trial. The web-based tool assigned patients to the proper clinical trial in all 100 randomly selected cases. The time needed to enter data and receive results using this tool is about 1 minute per patient entered. It is feasible to develop a web-based tool to help investigators in matching patients to clinical trials. When such decisions are complex and nonintuitive, such tools have the potential to improve the accuracy of clinical trial assignment and save time.

Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study

While previous prospective multicenter studies have conducted cardiovascular disease surveillance, few have detailed the techniques relating to the ascertainment of and data collection for events. The Cardiovascular Health Study (CHS) is a population-based study of coronary heart disease and stroke in older adults. This article summarizes the CHS events protocol and describes the methods of surveillance and ascertainment of hospitalized and nonhospitalized events, the use of medical records and other support documents, organizational issues at the field center level, and the classification of events through an adjudication process. We present data on incidence and mortality, the classification of adjudicated events, and the agreement between classification by the Events Subcommittee and the medical records diagnostic codes. The CHS techniques are a successful model for complete ascertainment, investigation, and documentation of events in an older cohort.

The use of microcomputers for data management in a large epidemiological survey

A data management system designed around microcomputers and commercial software packages was employed for a large epidemiological study. Management involved the tracking of subjects through several stages of the study and the generation of subject listings, personalized letters of invitation, daily worklists for the field teams, and a checklist for the laboratories. These processes were controlled using a continually updated subject data base which in final form provided the core of the management system for the collected data. Data management presented major problems because of the volume of data which were received from several sources over a period of months. A key feature to emerge was the importance of an accurate serial number on all items for which a check digit was employed. The system had a short development time and was found to be inexpensive and flexible and to cope easily with the demands made of it.