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Johnson AL, Torgerson T, Adewumi MT, Kee M, Farahani C, Wehrmann DJ, Francis CL, Vassar M. Discontinuation and nonpublication of pediatric otolaryngology clinical trials. Int J Pediatr Otorhinolaryngol 2021; 151:110972. [PMID: 34773883 DOI: 10.1016/j.ijporl.2021.110972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear. STUDY DESIGN Cross-sectional analysis. METHODS Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email. RESULTS After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion. CONCLUSIONS Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | | | - Micah Kee
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Clay Farahani
- Oklahoma State University Medical Center, Department of Otolaryngology, Tulsa, OK, USA
| | - Daniel J Wehrmann
- University of Nebraska Medical Center, Department of Otolaryngology, Omaha, NE, USA
| | - Carrie L Francis
- University of Kansas Medical Center, Department of Otolaryngology, Kansas City, KS, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Clayton P, Connelly J, Ellington M, Rojas V, Lorenzo Y, Trak-Fellermeier MA, Palacios C. Facilitators and barriers of children's participation in nutrition, physical activity, and obesity interventions: A systematic review. Obes Rev 2021; 22:e13335. [PMID: 34472191 PMCID: PMC9113612 DOI: 10.1111/obr.13335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Recruitment of children into clinical trials is challenging. Most systematic reviews exploring facilitators and barriers of child recruitment in clinical trials are related to drugs or experimental treatments for various health conditions. This may differ in nutrition, physical activity, and obesity interventions. The objective was to conduct a systematic review of facilitators and barriers for children's participation in nutrition, physical activity, and obesity interventions from the perspective of parents, children, and researchers. Studies were identified from five databases and restricted to children 2-18 years and the English language. Studies without results on facilitators and barriers of recruitment were excluded. Four hundred twenty-three records were identified; 94 duplicates and 269 unrelated records were initially excluded; 60 records were reviewed for full-text, and subsequently 34 were excluded, for a total of 26 included studies. The top barriers for recruiting children into clinical trials were time constraints, understanding of clinical trial information or complexity of consent/trial info, and transportation/lack of childcare. The most common facilitators were benefits to others and self, compensation/incentives, physician recommendations/referrals, and support. These barriers and facilitators should be addressed in future studies to assist in the successful recruitment of children into nutrition, physical activity, and obesity interventions.
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Affiliation(s)
- Priscilla Clayton
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Jeneene Connelly
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Malik Ellington
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Vicky Rojas
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Yaisli Lorenzo
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - María Angélica Trak-Fellermeier
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Cristina Palacios
- Dietetics and Nutrition Department, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Nomura O, Kobayashi T, Nagata C, Kuriyama T, Sako M, Saito K, Ishiguro A. Needs Assessment for Supports to Promote Pediatric Clinical Research Using an Online Survey of the Japanese Children's Hospitals Association. JMA J 2020; 3:131-137. [PMID: 33150245 PMCID: PMC7590392 DOI: 10.31662/jmaj.2019-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Infrastructure and the capacity to conduct clinical research in pediatrics have not been fully established in Japan. To elucidate the physicians' perspectives on clinical research, level of experience, existing barriers, and requests for support, we conducted a survey at 34 children's hospitals in Japan. METHODS In January 2016, an online survey with 13 questions was sent to approximately 2000 physicians working in 34 pediatric hospitals belonging to the Japanese Association of Children's Hospitals and Related Institutions. RESULTS Of the 360 respondents, 318 (88.3%) had presentations at academic conferences, and 261 (72.5%) had publications in academic journals, in the previous year. The most common study designs of clinical research conducted were case reports and case series. The most requested supports were for statistical analysis, followed by study design, grant application, and English-language editing. Younger physicians were more likely to prefer educational lectures (p < 0.001), whereas experienced physicians were more likely to request support for conducting statistical analysis (p = 0.002). Whereas physicians who had ever led a clinical trial requested support for the development of study protocol (p = .013), those without this experience preferred support for literature review (p = .002) and consultation services for study design (p = .027). CONCLUSIONS The requests for supports were different, depending on the physicians' years after graduation and experience level in clinical research. In order to enhance clinical research in pediatrics, it is essential to provide appropriate types and levels of educational and support programs.
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Affiliation(s)
- Osamu Nomura
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Kobayashi
- Department of Management and Strategy, National Center for Child Health and Development, Tokyo, Japan
| | - Chie Nagata
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Kuriyama
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuyuki Saito
- Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
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Martin-Kerry JM, Knapp P, Atkin K, Bower P, Watt I, Stones C, Higgins S, Sheridan R, Preston J, Horton Taylor D, Baines P, Young B. Supporting children and young people when making decisions about joining clinical trials: qualitative study to inform multimedia website development. BMJ Open 2019; 9:e023984. [PMID: 30782720 PMCID: PMC6340013 DOI: 10.1136/bmjopen-2018-023984] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand stakeholders' views regarding the content and design of paediatric clinical trial multimedia websites. To describe how this knowledge informed the development of the multimedia websites. DESIGN Qualitative study comprising two rounds of interviews or focus groups, with thematic analysis of interview transcripts. PARTICIPANTS Sixty-two people (21 children and young people with long-term health conditions, 24 parents and 17 professionals). SETTING One UK children's hospital and one UK Young Persons' Advisory Group. RESULTS When asked what was important in deciding whether to join a trial, children, young people and parents prioritised information about what participation would involve, what the trial was testing, potential benefits and risks of participation and knowing they could leave the trial if they later changed their minds. Young people and parents trusted trial teams to follow regulatory and quality requirements and therefore did not think such information was a priority for the websites, although logos of trusted organisations could lend credibility. Professionals largely concurred with these views. Children and young people advised on the importance of designing the multimedia website to ensure its appearance, tone and wording suited the intended audience and on using animated characters to facilitate children's engagement. CONCLUSIONS Our study provides insights into the information that families value when deciding about healthcare trial participation. It provides guidance on the design of information resources to appeal to children and young people, while also being acceptable to parents and professionals who are often gatekeepers of children's access to information. Our findings will be of use to others developing similar multimedia websites. We report specific information needs and new visual preferences that are not usually addressed in printed trial information. Our work illustrates what qualitative research and participatory design practices can contribute to the development of information resources more generally. TRIAL REGISTRATION NUMBER ISRCTN73136092; Pre-results.
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Affiliation(s)
| | - Peter Knapp
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ian Watt
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
| | | | | | - Jenny Preston
- University of Liverpool, Liverpool, UK
- Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Paul Baines
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Chong LSH, Sautenet B, Tong A, Hanson CS, Samuel S, Zappitelli M, Dart A, Furth S, Eddy AA, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Raman G, Craig JC. Range and Heterogeneity of Outcomes in Randomized Trials of Pediatric Chronic Kidney Disease. J Pediatr 2017; 186:110-117.e11. [PMID: 28449820 DOI: 10.1016/j.jpeds.2017.03.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/07/2017] [Accepted: 03/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated. RESULTS From 205 trials included, 6158 different measurements of 100 different outcome domains were reported, with a median of 22 domains per trial (IQR 13-41). Overall, 52 domains (52%) were surrogate, 38 (38%) were clinical, and 10 (10%) were patient-reported. The 5 most commonly reported domains were blood pressure (76 [37%] trials), relapse/remission (70 [34%]), kidney function (66 [32%]), infection (61 [30%]), and height/pubertal development (51 [25%]). Mortality (14%), cardiovascular disease (4%), and quality of life (1%) were reported infrequently. The 2 most frequently reported outcomes, blood pressure and relapse/remission, had 56 and 81 different outcome measures, respectively. CONCLUSIONS The outcomes reported in clinical trials involving children with CKD are extremely heterogeneous and are most often surrogate outcomes, rather than clinical and patient-centered outcomes such as cardiovascular disease and quality of life. Efforts to ensure consistent reporting of outcomes that are important to patients and clinicians will improve the value of trials to guide clinical decision-making. In our study, non-English articles were excluded.
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Affiliation(s)
- Lauren S H Chong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM (U1153), Paris, France
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia and the British Columbia Children's Hospital, Vancouver, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Pediatric Nephrology and National Institute for Health Research/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- University College London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gayathri Raman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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Ishiguro A, Sasaki H, Yahagi N, Kato H, Kure S, Mori R. Needs assessment for collaborative network in pediatric clinical research and education. Pediatr Int 2017; 59:74-79. [PMID: 27273620 DOI: 10.1111/ped.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A collaborative network for pediatric research has not been fully established in Japan. To identify the network infrastructure, we conducted a survey on the support and education for clinical research currently available in children's hospitals. METHODS In November 2014, a 27-question survey was distributed to 31 hospitals belonging to the Japanese Association of Children's Hospitals and Related Institutions (JACHRI) to assess clinical research support, research education, research achievements, and their expectations. RESULTS All the hospitals responded to the survey. Overall, 74.2% of hospitals had clinical research support divisions. Although all hospitals had ethics committees, <30% of the hospitals had a data manager, intellectual property management unit, biostatistician, and English-language editor. Seven hospitals had education programs for clinical research. The number of seminars and workshops for clinical research had significant correlations with the number of physicians (r = 0.927), pediatricians (r = 0.922), and clinical trial management physicians (r = 0.962). There was a significant difference in the number of clinical trials initiated by physicians between hospitals with research education programs and those without (P < 0.01). The number of education programs was significantly correlated with the number of original articles and case reports in English (r = 0.788), and the number of publications in Japanese (r = 0.648). All hospitals recognized the need for a leader to establish a collaborative network for clinical research. CONCLUSIONS Important factors for creating a collaborative system for pediatric research in Japan were identified. Human resources to support clinical research are a key factor to improve clinical research education and research achievements.
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Affiliation(s)
- Akira Ishiguro
- Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Joseph PD, Craig JC, Caldwell PHY. Clinical trials in children. Br J Clin Pharmacol 2015; 79:357-69. [PMID: 24325152 PMCID: PMC4345947 DOI: 10.1111/bcp.12305] [Citation(s) in RCA: 261] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/28/2013] [Indexed: 12/31/2022] Open
Abstract
Safety and efficacy data on many medicines used in children are surprisingly scarce. As a result children are sometimes given ineffective medicines or medicines with unknown harmful side effects. Better and more relevant clinical trials in children are needed to increase our knowledge of the effects of medicines and to prevent the delayed or non-use of beneficial therapies. Clinical trials provide reliable evidence of treatment effects by rigorous controlled testing of interventions on human subjects. Paediatric trials are more challenging to conduct than trials in adults because of the paucity of funding, uniqueness of children and particular ethical concerns. Although current regulations and initiatives are improving the scope, quantity and quality of trials in children, there are still deficiencies that need to be addressed to accelerate radically equitable access to evidence-based therapies in children.
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Affiliation(s)
- Pathma D Joseph
- The Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, The University of SydneyWestmead, NSW, Australia
| | - Jonathan C Craig
- School of Public Health, The Children's Hospital at Westmead, The University of SydneyWestmead, NSW, Australia
| | - Patrina HY Caldwell
- The Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, The University of SydneyWestmead, NSW, Australia
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Woolfall K, Shilling V, Hickey H, Smyth RL, Sowden E, Williamson PR, Young B. Parents' agendas in paediatric clinical trial recruitment are different from researchers' and often remain unvoiced: a qualitative study. PLoS One 2013; 8:e67352. [PMID: 23844006 PMCID: PMC3701006 DOI: 10.1371/journal.pone.0067352] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/17/2013] [Indexed: 11/19/2022] Open
Abstract
Ensuring parents make an informed decision about their child's participation in a clinical trial is a challenge for practitioners as a parent's comprehension of a trial may differ from that intended by the practitioners responsible for recruitment. We explored what issues parents consider important when making a decision about participation in a paediatric clinical trial and their comprehension of these issues to inform future recruitment practice. This qualitative interview and observational study examined recruitment in four placebo-controlled, double-blind randomised clinical trials of medicines for children. Audio-recorded trial recruitment discussions between practitioners and parents (N = 41) were matched with semi-structured interviews with parents (N = 41). When making a decision about trial entry parents considered clinical benefit, child safety, practicalities of participation, research for the common good, access to medication and randomisation. Within these prioritised issues parents had specific misunderstandings, which had the potential to influence their decisions. While parents had many questions and concerns about trial participation which influenced their decision-making, they rarely voiced these during discussions about the trials with practitioners. Those involved in the recruitment of children to clinical trials need to be aware of parents' priorities and the sorts of misunderstandings that can arise with parents. Providing trial information that is tailored to what parents consider important in making a decision about a clinical trial may improve recruitment practice and ultimately benefit evidence-based paediatric medicine.
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Affiliation(s)
- Kerry Woolfall
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
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Nor Aripin KNB, Choonara I, Sammons HM. Systematic review of safety in paediatric drug trials published in 2007. Eur J Clin Pharmacol 2011; 68:189-94. [PMID: 21858432 PMCID: PMC3256313 DOI: 10.1007/s00228-011-1112-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/27/2011] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is now greater involvement of children in drug trials to ensure that paediatric medicines are supported by sound scientific evidence. The safety of the participating children is of paramount importance. Previous research shows that these children can suffer moderate and severe adverse drug reactions (ADRs) in clinical trials, yet very few of the trials designated a data safety monitoring board (DSMB) to oversee the trial. METHODS Safety data from a systematic review of paediatric drug randomised controlled trials (RCTs) published in 2007 were analysed. All reported adverse events (AEs) were classified and assessed to determine whether an ADR had been experienced. ADRs were then categorised according to severity. Each trial report was examined as to whether an independent DSMB was in place. RESULTS Of the 582 paediatric drug RCTs analysed, 210 (36%) reported that a serious AE had occurred, and in 15% mortality was reported. ADRs were detected in more than half of the RCTs (305); 66 (11%) were severe, and 79 (14%) were moderate. Severe ADRs involved a wide range of organ systems and were frequently associated with cytotoxic drugs, antiparasitics, anticonvulsants and psychotropic drugs. Two RCTs reported significantly higher mortality rates in the treatment group. Only 69 (12%) of the RCTs stated there was a DSMB. DSMBs terminated five RCTs and changed the protocol in one. CONCLUSIONS Children participating in drug RCTs experience a significant amount and a wide range of ADRs. DSMBs are needed to ensure the safety of paediatric participants in clinical drug trials.
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Shilling V, Williamson PR, Hickey H, Sowden E, Beresford MW, Smyth RL, Young B. Communication about children's clinical trials as observed and experienced: qualitative study of parents and practitioners. PLoS One 2011; 6:e21604. [PMID: 21765898 PMCID: PMC3134466 DOI: 10.1371/journal.pone.0021604] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 06/06/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recruiting children to clinical trials is perceived to be challenging. To identify ways to optimise recruitment and its conduct, we compared how parents and practitioners described their experiences of recruitment to clinical trials. METHODS AND FINDINGS This qualitative study ran alongside four children's clinical trials in 11 UK research sites. It compared analyses of semi-structured interviews with analyses of audio-recordings of practitioner-family dialogue during trial recruitment discussions. Parents from 59 families were interviewed; 41 had participated in audio-recorded recruitment discussions. 31 practitioners were interviewed. Parents said little in the recruitment discussions contributing a median 16% of the total dialogue and asking a median of one question. Despite this, parents reported a positive experience of the trial approach describing a sense of comfort and safety. Even if they declined or if the discussion took place at a difficult time, parents understood the need to approach them and spoke of the value of research. Some parents viewed participation as an 'exciting' opportunity. By contrast, practitioners often worried that approaching families about research burdened families. Some practitioners implied that recruiting to clinical trials was something which they found aversive. Many were also concerned about the amount of information they had to provide and believed this overwhelmed families. Whilst some practitioners thought the trial information leaflets were of little use to families, parents reported that they used and valued the leaflets. However, both parties agreed that the leaflets were too long and wanted them to be more reader-friendly. CONCLUSIONS Parents were more positive about being approached to enter their child into a clinical trial than practitioners anticipated. The concerns of some practitioners, that parents would be overburdened, were unfounded. Educating practitioners about how families perceive clinical trials and providing them with 'moral' support in approaching families may benefit paediatric research and, ultimately, patients.
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Affiliation(s)
- Valerie Shilling
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Paula R. Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Helen Hickey
- Medicines for Children Research Network Clinical Trials Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Emma Sowden
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Michael W. Beresford
- Department of Women's and Children's Medicine, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Rosalind L. Smyth
- University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Bridget Young
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Hickey HR, Jones AP, Lenney W, Williamson PR, Smyth RL. Feasibility study to inform the design of a randomised controlled trial to eradicate Pseudomonas aeruginosa infection in individuals with cystic fibrosis. Trials 2010; 11:11. [PMID: 20137079 PMCID: PMC2832639 DOI: 10.1186/1745-6215-11-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 02/05/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are controversies about the most effective treatment to eradicate first growth of Pseudomonas aeruginosa (P aeruginosa) from the lower airways of patients with cystic fibrosis (CF). UK guidelines recommend oral treatment, but some advocate intravenous (IV) treatment. The objective of this study was to assess the feasibility of conducting a randomised controlled trial comparing two treatment strategies to eradicate P aeruginosa in CF patients. METHODS/PRINCIPAL FINDINGS Two surveys were conducted. Survey [1] included clinicians who were responsible for the treatment of individuals with CF, to assess their clinical practice, opinions and numbers of potentially eligible patients. Survey [2] included adults and young people aged 13 years or more with CF and parents of children with CF aged less than 13 years, identified at six UK CF centres, who fulfilled eligibility criteria for the proposed clinical trial, to assess their views about the interventions and their willingness to participate in the trial. Generally clinicians treat first or new growth of P aeruginosa with oral antibiotics, but 90% reported that they would consider IV treatment of first isolation of P aeruginosa. 74% of clinicians would consider recruiting their patients and 45% of consumers would consider entry for themselves or their children into a trial comparing oral with intravenous antibiotics. The median rate per annum for first or new growths of P aeruginosa in adults was 3% (range 1% to 9%) and in children was 10% (range 3% to 23%). If the trial was conducted across the UK, with a consent rate of 45%, then the number of eligible patients per annum who would be willing to take part in a study would be approximately 41 adults and 203 children. CONCLUSIONS This work demonstrates the importance of feasibility studies in preparation for multicentre clinical trials. It confirmed the uncertainty amongst clinicians and patients about the clinical question, enabled assessment of the number of potentially eligible patients, the proportion of patients and clinicians prepared to participate and aspects of trial design which might encourage this. It showed that a clinical trial was feasible, but only if patients were recruited from across United Kingdom.
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Affiliation(s)
- Helen R Hickey
- Medicines for Children Research Network Clinical Trials Unit, University of Liverpool, UK
| | - Ashley P Jones
- Medicines for Children Research Network Clinical Trials Unit, University of Liverpool, UK
| | - Warren Lenney
- University Hospital of North Staffordshire, Staffordshire, UK
| | - Paula R Williamson
- Medicines for Children Research Network Clinical Trials Unit, University of Liverpool, UK
| | - Rosalind L Smyth
- Division of Child Health, School of Reproductive and Developmental Medicine, University of Liverpool, Alder Hey Children's Foundation Trust, Liverpool, L12 2AP, UK
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12
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Klassen TP, Hartling L, Hamm M, van der Lee JH, Ursum J, Offringa M. StaR Child Health: an initiative for RCTs in children. Lancet 2009; 374:1310-2. [PMID: 19837237 DOI: 10.1016/s0140-6736(09)61803-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Terry P Klassen
- Alberta Research Center for Health Evidence, Women's and Children's Health Research Institute, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
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Thornton JG. Drug development and obstetrics: Where are we right now? J Matern Fetal Neonatal Med 2009; 22 Suppl 2:46-9. [DOI: 10.1080/14767050902860377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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