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Desai P, Nasa P, Soo J, Jia C, Berbaum ML, Fischer JH, Johnson TP. Effects of Regulatory Support Services on Institutional Review Board Turnaround Times. J Empir Res Hum Res Ethics 2017; 12:131-139. [PMID: 28412874 PMCID: PMC5546085 DOI: 10.1177/1556264617704294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated how regulatory support services provided by University of Illinois at Chicago's Center for Clinical and Translational Science may reduce Institutional Review Board (IRB) turnaround times. IRB applications were categorized by receipt of any regulatory support and amount of support received. Turnaround time included total turnaround time, time for IRB review, and time for investigators to modify protocols. There were no differences in any turnaround times for supported versus nonsupported applications. However, for supported applications, those receiving more intensive support had total turnaround times 16.0 days ( SE 7.62, p < .05) faster than those receiving less intensive support. Receiving higher regulatory support may be associated with faster approval of IRB submissions.
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Affiliation(s)
- Pankaja Desai
- Alliance of Chicago Community Health Services, L3C (USA)
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Meier-Girard D, Tibi A, Abdoul H, Prot-Labarthe S, Brion F, Bourdon O, Alberti C. Academic pediatric clinical research: factors associated with study implementation duration. BMC Med Res Methodol 2016; 16:36. [PMID: 27025840 PMCID: PMC4812626 DOI: 10.1186/s12874-016-0138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ethical, methodological, and technical aspects of pediatric research, often results in complications and delays in implementation. Our objective was to identify factors associated with the implementation duration of hospital-based pediatric studies. METHODS All hospital-based pediatric studies sponsored by AP-HP between 2002 and 2008 were retrospectively identified. Association of the funding mechanism and methodological factors with the implementation duration was assessed using a multivariable mixed linear model. Pharmaceutical factors were explored as part of a subgroup analysis restricted to the studies involving drug therapy. Given that we took an exploratory approach, factors associated with implementation duration with p < 0.10 were kept in the final models. RESULTS A total of 139 studies were evaluated. The median implementation duration was 17.1 months (range: 0.9-55.3 months), and tended to increase over time (from 14.9 [25(th) percentile-75(th) percentile: 11.5-19.9] months in 2002 to 23.7 [15.2-31.0] months in 2008, p = 0.01). External (coefficient [95 % confidence interval]: -7.7 [-11.9;-3.5] months, p < 0.001) and internal funding (-5.3 95 % CI [-9.8;-0.8], p = 0.02) compared to governmental funding and number of centers (-0.1 95 % CI[-0.2;0.02] months for 1 center increase, p = 0.07) were associated with reduced duration, whereas interventional study (either involving drug therapy (6.0 95 % CI[0.7;11.3] months, p = 0.03 or not (3.5 95 % CI[-0.3;7.3] months, p = 0.06) was associated with increased duration compared to observational study. Regarding the 35 studies involving drug therapy, external funding decreased duration (-6.7 95 % CI[-13.2;-0.2] months, p = 0.05), whereas studies involving solely a pediatric population (7.8 95 % CI[1.1;14.5] months, p = 0.01) (compared to mixed adult-pediatric population), a placebo-controlled design (6.6 95 % CI[0.9;12.3] months, p = 0.01), and inappropriate drug formulation for at least one drug used in the study (6.9 95 % CI[-0.2;14.0] months, p = 0.06) were associated with increased duration. CONCLUSION Implementation of hospital-based pediatric studies primarily faced delays when they were interventional and, in particular, when they involved drug therapy. Regarding the latter, difficulties that resulted in delayed studies arose with respect to the supply of drugs and placebo in age-appropriate dosages and route of administration. Therefore, difficulties related to the use of pharmaceuticals need to be anticipated earlier in order to avoid implementation delays.
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Affiliation(s)
- Delphine Meier-Girard
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
- />University of Basel, University Children’s Hospital (UKBB), Basel, Switzerland
- />Department of Paediatric Pulmonology, University Children`s Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
| | - Annick Tibi
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />Département d’Essais Cliniques, AP-HP, Agence Générale des Equipements et Produits de Santé, F-75013 Paris, France
| | - Hendy Abdoul
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
| | - Sonia Prot-Labarthe
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Françoise Brion
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Olivier Bourdon
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Corinne Alberti
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
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How to improve the implementation of academic clinical pediatric trials involving drug therapy? A qualitative study of multiple stakeholders. PLoS One 2013; 8:e64516. [PMID: 23724056 PMCID: PMC3665797 DOI: 10.1371/journal.pone.0064516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/15/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The need for encouraging pediatric drug research is widely recognized. However, hospital-based clinical trials of drug treatments are extremely time-consuming, and delays in trial implementation are common. The objective of this qualitative study was to collect information on the perceptions and experience of health professionals involved in hospital-based pediatric drug trials. METHODS Two independent researchers conducted in-depth semi-structured interviews with principal investigators (n = 17), pharmacists (n = 7), sponsor representatives (n = 4), and drug regulatory agency representatives (n = 3) who participated in institutionally sponsored clinical trials of experimental drugs in pediatric patients between 2002 and 2008. RESULTS Dissatisfaction was reported by 67% (16/24) of principal investigators and pharmacists: all 7 pharmacists felt they were involved too late in the trial implementation process, whereas 11 (65%) principal investigators complained of an excessive regulatory burden and felt they were insufficiently involved in the basic research questions. Both groups perceived clinical trial implementation as burdensome and time-consuming. The sponsor and regulatory agency representatives reported a number of difficulties but were not dissatisfied. CONCLUSIONS The heavy burden related to regulatory requirements, and suboptimal communication across disciplines involved, seem to be the main reasons for the major delays in pediatric drug trial implementation. The pharmaceutical aspects are intrinsically tied to trial methodology and implementation and must therefore be examined, in particular by involving Clinical Research Pharmacists at early stages of study conception.
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Bethelmie-Bryan B, Lord K, Holloway S, Safavi F, Shepard M, Rogers S, Harvey RD, Rodger K, Waller EK, El-Rayes B, Arellano M, Khoury HJ. Tools to optimize the functionality of a leukemia clinical trial team. Leuk Lymphoma 2013; 54:110-6. [DOI: 10.3109/10428194.2012.708929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Silberman G, Kahn KL. Burdens on research imposed by institutional review boards: the state of the evidence and its implications for regulatory reform. Milbank Q 2011; 89:599-627. [PMID: 22188349 PMCID: PMC3250635 DOI: 10.1111/j.1468-0009.2011.00644.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Federal regulations mandate independent review and approval by an "institutional review board" (IRB) before studies that involve human research subjects may begin. Although many researchers strongly support the need for IRB review, they also contend that it is burdensome when it imposes costs that do not add to the protections afforded to research participants and that this burden threatens the viability of research. The U.S. Department of Health and Human Services recently announced its intention to reform the regulations governing IRB review. METHODS We used a search of the PubMed database, supplemented by a bibliographic review, to identify all existing primary data on the costs of IRB review. "Costs" were broadly defined to include both expenditures of time or money and constraints imposed on the scope of the research. Burdensome costs were limited to those that did not contribute to greater protections for the participants. FINDINGS Evidence from a total of fifty-two studies shows that IRBs operate at different levels of efficiency; that waiting to obtain IRB approval has, in some instances, delayed project initiation; that IRBs presented with identical protocols sometimes asked for different and even competing revisions; and that some decisions made (and positions held) by IRBs are not in accord with federal policy guidance. CONCLUSIONS While the evidence is sufficient to conclude that there is burden associated with IRB review, it is too limited to allow for valid estimates of its magnitude or to serve as the basis for formulating policies on IRB reform. The single exception is multicenter research, for which we found that review by several local IRBs is likely to be burdensome. No mechanism currently exists at the national level to gather systematic evidence on the intersection between research and IRB review. This gap is of concern in light of the changing nature of research and the increasingly important role that research is envisioned to play in improving the overall quality of health care.
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Affiliation(s)
- George Silberman
- RAND Corporation, Cancer Policy Group, LLC, Santa Monica, CA 90407, USA.
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