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Amos A, Guerra C, Reid C, Toro E, Calia C. Exploring ethical practice in NGOS on mental health research in Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003001. [PMID: 38603700 PMCID: PMC11008845 DOI: 10.1371/journal.pgph.0003001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/10/2024] [Indexed: 04/13/2024]
Abstract
In recent years, an increasing trend in mental health research has been to collaborate with non-governmental organizations [NGOs] and their constituents. However, ethical difficulties can arise as a result of such partnerships. Understanding the ethics-related practices of NGOs engaged in mental health research is therefore critical. This study addressed these questions in a Malawian context. The goal of this study was to investigate NGO's ethical practices in relation to mental health research by identifying characteristics that influence ethical practices and investigating staff conceptualization of ethics and mental health. Twenty individuals who work for different local NGOs took part in one-on-one interviews or a workshop about their engagement in diverse research initiatives. They pinpointed the areas that needed improvement, as well as the challenges and chances to create partnerships and increase research capability. The diversity in conceptualizing mental health was a key influence on research practices, with heterogeneity in definitions reflected in the use of cultural, spiritual, behavioural, or medical terms. Notably, there was also a greater emphasis on procedural ethics than ethics-in-practice. Collaboration dynamics and limited staffing capacity were cited as major ethical practice considerations. Each of these elements have an impact on NGOs' ethical behaviour when conducting mental health research. Participants in the study saw engagement with notions of both ethics and mental health as lacking or rudimentary in their institutions and felt that they needed to be improved through capacity building and stronger research involvement.
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Affiliation(s)
- Action Amos
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Epilepsy Movers, Blantyre, Malawi
- Pan African Network for persons with Psychosocial Disabilities, Blantyre, Malawi
| | - Cristobal Guerra
- Escuela de Psicología, Facultad de Ciencias Sociales y Comunicaciones, Universidad Santo Tomás, Santiago, Chile
| | - Corinne Reid
- Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom
| | - Edgardo Toro
- Escuela de Psicología, Facultad de Ciencias Sociales y Comunicaciones, Universidad Santo Tomás, Santiago, Chile
| | - Clara Calia
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Mekonnen D, Munshea A, Nibret E, Derbie A, Wubetu M, Taye M, Zeru T, Bezabih B, Azage M, Bobosha K, Aseffa A. Rapid Bioethical Assessment for Mycobacterium tuberculosis and Host Genetic Study in Amhara Regional State, Ethiopia: Towards a Context-Specific Ethical Approach. Ethiop J Health Sci 2023; 33:413-422. [PMID: 37576164 PMCID: PMC10416330 DOI: 10.4314/ejhs.v33i3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Rapid Ethical Assessment (REA) is a rapid qualitative study anticipated to understand the ethical sphere of the research setting prior to recruiting study subjects. This study assessed the communities' knowledge about tuberculosis (TB) and research, understand the social arrangements advisable for recruiting research participant and appraised the information provision and consent process. Methods The study was conducted in Amhara region, Ethiopia from 5th-30th January 2021. Google-based survey, face-to-face in-depth interview and focus group discussion were carried out to collect the data from researchers, data collectors, health professionals, TB program officers. A structured questionnaire was administered to assess the knowledge of TB patients and healthy controls about TB, research, gene, (co)evolution and consent process. Results Over 71% of researchers were not satisfied with the current consent process, and 82.7% of researchers agreed that the best interest of the research participants was not adequately addressed in the current research practices in ANRS. TB patients and healthy controls misunderstood research and its goals. Participants advised the researchers to approach the community with the assistance of health extension workers (HEW) or religious/local leaders. Combined use of verbal and written based information provision at individual participant level is the preferred way for information provision. Conclusions The adherence of researchers to standard information provision and consent process was very low. Healthy controls and TB patients have low level of knowledge and awareness about research, ethics and genomic research-related common terms. Hence, public education is required to strengthen the research ethics in the region.
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Affiliation(s)
- Daniel Mekonnen
- Department of Medical Laboratory Sciences, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
| | - Abaineh Munshea
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Biology, Bahir Dar University, Ethiopia
| | - Endalkachew Nibret
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Biology, Bahir Dar University, Ethiopia
| | - Awoke Derbie
- Department of Medical Laboratory Sciences, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- The Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Mastewal Wubetu
- Department of Ethiopia Langue(s) and Literature-Amharic, Faculty of Humanities, Bahir Dar University, Ethiopia
| | - Mengistie Taye
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Animal Science, College of Agriculture and Environmental Sciences, Bahir Dar University, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Ethiopia
| | | | - Muluken Azage
- Department of Environmental Health, School of public health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
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3
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Singh JA. Governance of adaptive platform trials. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.19058.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Adaptive Clinical Trials (ACT) differ from conventional clinical trials because they permit continual modifications to key components of trial design during the trial. ACTs have grown in prevalence in recent years, with Adaptive Platform Trials (APTs), in particular, having demonstrated their significant scientific, clinical, and public health utility in relation to the COVID-19 pandemic. There has been a steady increase in the number of regulations and guidelines aimed at guiding the conduct of clinical trials. However, despite the potential of APTs to expedite the testing of new interventions in emergency situations, there is a relative dearth of published literature on why and how such trials should be governed. This work attempts to address this knowledge gap.
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Saxena A, Lasher E, Somerville C, Heidari S. Considerations of sex and gender dimensions by research ethics committees: a scoping review. Int Health 2022; 14:554-561. [PMID: 35043198 PMCID: PMC9623496 DOI: 10.1093/inthealth/ihab093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
Despite a growing consensus on the importance of integrating sex and gender in health research, research across disciplines continues to be conducted and reported without a gender focus. Research ethics committees (RECs) can play a particularly powerful role in identifying the gender gaps at an early stage of the development of research protocols. Their role is missing in the dialogue related to improving gender awareness and analysis in health research. A scoping review was conducted to examine the extent to which RECs discuss and consider the inclusion and analysis of sex and gender in health research and to examine the literature regarding the gender balance of RECs. The limited literature around gender and research ethics reveals the power and potential of RECs to ensure that gender dimensions are thoughtfully included in health research, and sheds light on the gaps that exist. These include an under-representation of women on RECs, a lack of awareness of the importance of gender-related aspects in health research and a paucity of gender-related training to RECs. Guidelines such as the Sex and Gender Equity in Research guidelines are required for RECs to strengthen the ways in which health research is gendered from conception of a research protocol to its publication.
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Affiliation(s)
- Abha Saxena
- Independent Bioethics Advisor, 35 Chemin de Valerie, Chambesy 1292, Geneva, Switzerland
| | | | - Claire Somerville
- Lecturer, International Affairs, Executive Director of the Gender Centre, GraduateInstitute of International and Development Studies, Case postale 1672, 1211 Geneva, Switzerland
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Vingan NR, Kenkel JM. The Institutional Review Board: A Discussion of the Importance of Ethical, Evidence-Based Research in Plastic Surgery. Aesthet Surg J 2022; 42:224-229. [PMID: 34633036 DOI: 10.1093/asj/sjab363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicole R Vingan
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M Kenkel
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kateb L, El-Jayousi S, Al-Hussaini M. An Overview of King Hussein Cancer Center Institutional Review Board Over 12 Years (2009-2020), Successes and Challenges, Including Those Imposed by the COVID-19 Pandemic. J Empir Res Hum Res Ethics 2021; 17:94-101. [PMID: 34806921 DOI: 10.1177/15562646211053234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The problem: Running an efficient institutional review board (IRB) can be challenging. The research subjects: To ensure an efficient committee, our IRB adopted several operational metrics. Methods: Analysis of retrospective data from the IRB records, database, and annual reports over 12 years. Results: The IRB roster comprises 11 members. The average medical to nonmedical member ratio is 5:6, and the male to female ratio is 4:7, which has not been consistent over the years. One thousand three hundred and twenty-four proposals were reviewed including 1077 exempt (81.3%), 126 expedited (9.5%), and 121 full board (9.2%) with a median turnaround time to approval of 4.0, 35.0, and 68.0 days, respectively. Training of the IRB members was conducted to enhance their knowledge and skills. IRB at King Hussein Cancer Center has managed to stay abreast and efficient during the COVID-19 pandemic, by working remotely. Conclusion: Running an efficient IRB mandates implementing a number of operational metrics.
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Affiliation(s)
- Linda Kateb
- Human Research Protection Program, 37559King Hussein Cancer Center, Amman, Jordan
| | - Sawsan El-Jayousi
- Human Research Protection Program, 37559King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Human Research Protection Program, 37559King Hussein Cancer Center, Amman, Jordan.,Department of Pathology and Laboratory Medicine, 37559King Hussein Cancer Center, Amman, Jordan
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Liu X, Wu Y, Yang M, Li Y, Hahne J, Khoshnood K, Coleman L, Wang X. Cross-cultural validation of the IRB Researcher Assessment Tool: Chinese Version. BMC Med Ethics 2021; 22:133. [PMID: 34583718 PMCID: PMC8479956 DOI: 10.1186/s12910-021-00699-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Using an effective method for evaluating Institutional Review Board (IRB) performance is essential for ensuring an IRB's effectiveness, efficiency, and compliance with applicable human research standards and organizational policies. Currently, no empirical research has yet been published in China evaluating IRB performance measures by the use of a standardized tool. This study was therefore conducted to develop a Chinese version of the IRB Researcher Assessment Tool (IRB-RAT), assess the psychometric properties of the Chinese version (IRB-RAT-CV), and validate the tool for use in China. METHODS In this cultural adaptation, cross-sectional validation study, the IRB-RAT-CV was developed through a back-translation process and then distributed to 587 IRB staff members and researchers in medical institutions and schools in Hunan Province that review biomedical and social-behavioral research. Data from the 470 valid questionnaires collected from participants was used to evaluate the reliability, content validity, and construct validity of the IRB-RAT-CV. RESULTS Participants' ratings of their ideal and actual IRB as measured by the IRB-RAT-CV achieved Cronbach's alpha 0.989 and 0.992, Spearman-Brown coefficient 0.964 and 0.968, and item-total correlation values ranging from 0.631 to 0.886 and 0.743 to 0.910, respectively. CONCLUSION The IRB-RAT-CV is a linguistically and culturally applicable tool for assessing the quality of IRBs in China.
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Affiliation(s)
- Xing Liu
- Medical Ethics Committee, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Ying Wu
- School of Public Administration, Central South University, Changsha, 410075, Hunan, China
| | - Min Yang
- Xiangya School of Nursing, Central South University, Changsha, 410013, Hunan, China
| | - Yang Li
- School of Public Administration, Central South University, Changsha, 410075, Hunan, China
| | - Jessica Hahne
- Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
| | - Linda Coleman
- Human Research Protection Program, Yale University, 150 Munson Street, New Haven, CT, 06511, USA
| | - Xiaomin Wang
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China.
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Salhia B, Olaiya V. Historical Perspectives on Ethical and Regulatory Aspects of Human Participants Research: Implications for Oncology Clinical Trials in Africa. JCO Glob Oncol 2021; 6:959-965. [PMID: 32614729 PMCID: PMC7392783 DOI: 10.1200/jgo.19.00196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical trials research involving human participants has led to numerous medical advances. Historically, however, clinical trials research was the source of major concerns for the safety and welfare of the human participants taking part in these studies. The ethical principles of autonomy, beneficence, and justice came about in response to medical atrocities, and regulations were ultimately put in place to protect the rights and welfare of human participants and to maintain the public trust in the research enterprise. Today, clinical trials are one of the most heavily regulated practices in the world, and yet still not all people are provided the same oversights and protections, with improprieties disproportionately affecting poor-resource nations and vulnerable populations. As Africa approaches the post-communicable disease era, cancer is set to take the lead as the most burdensome disease, making the need for oncology clinical trials in Africa greater than ever before. Africa represents a heterogeneous market with 55 countries, most with their own National Regulatory Agency (NRA) and each with varying levels of regulatory maturity. This diversity creates a highly complex regulatory environment and causes challenges when bringing drugs to market. There is a large need for harmonization and increased collaboration between the African nations' NRAs. In addition, many African countries need to be better equipped to handle research ethics committees and/or learn how to rely on neighboring countries with more established ethics committees. Well-run clinical trials offer solutions to national health care problems, and all people deserve equal access to their benefits.
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Affiliation(s)
- Bodour Salhia
- Department of Translational Research, University of Southern California, Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
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Perceptions of Challenges Affecting Research Ethics Committees’ Members at Medical and Health Science Colleges in Omani and Jordanian Universities. JOURNAL OF ACADEMIC ETHICS 2021. [DOI: 10.1007/s10805-021-09410-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractIn recent years there has been an increase in research conducted in the Middle East, with a corresponding increase in the challenges faced by members of the Research Ethics Committees (RECs). This study compares the structures of Omani and Jordanian RECs and investigates the perceptions of the challenges affecting the work of the REC members in Oman and Jordan. A convenience sample of 34 Omani and 66 Jordanian participants from 21 universities was recruited in this cross-sectional study. Almost 70% disagreed that the members of RECs are unqualified, providing comments without justification; half believed that members have limited experience in research, and almost three-quarters that they have different opinions regarding some ethical issues. No significant differences were found between Omani and Jordanian REC members regarding their perception of the challenges, except for the perception that reviewing proposals is a time-consuming task (p = 0.048) and that multi-REC centres are less available (p = 0.026). The regression model showed that there were significantly more male members of Jordanian RECs, and that Jordanian members were less likely to receive formal training. In conclusion, the current structure of RECs and the challenges faced by members need to be re-evaluated by decision makers to improve the overall quality of research activities, and to ensure that current REC members’ practices adhere to international standards.
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Assessment of research ethics education offerings of pharmacy master programs in an Arab nation relative to top programs worldwide: A qualitative content analysis. PLoS One 2021; 16:e0238755. [PMID: 33606694 PMCID: PMC7895361 DOI: 10.1371/journal.pone.0238755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
The importance of research ethics (RE) training has led academic and funding institutions to require that students, trainees, and faculty obtain such training at various stages of their careers. Despite the increasing awareness of the value RE education offers, this training requirement is absent in Jordan. We aimed to assess RE education offerings of pharmacy master programs in Jordan and compare with the top-ranked pharmacy graduate programs globally. Therefore, a list of universities that offer research-based pharmacy master programs was created. Each program was evaluated for the inclusion of RE education. A qualitative content analysis approach based on inductive reasoning and latent analysis was followed to analyze the data. Results of the study showed a lack of appropriate RE education for graduate-level pharmacy programs in Jordan with only 40% of the programs partially discuss selected topics related to RE. Regarding pharmacy graduate programs globally, 10% offer a standalone RE course, 40% offer some discussions related to RE, another 10% do not offer RE education in any form, and the remaining 40% of the programs were difficult to assess due to lack of sufficient information available online. Based on the findings of this study, training in RE is tends to be lacking in pharmacy graduate programs in Jordan and globally, with a greater lack in Jordan than globally. There is a need to incorporate formal RE education into programs that do not offer this type of instruction. Programs that formally touch on some aspects of RE need to expand the scope of topics to include more RE-related themes. Integrating a standalone RE course into pharmacy graduate programs is highly encouraged.
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Labude MK, Shen L, Zhu Y, Schaefer GO, Ong C, Xafis V. Perspectives of Singaporean biomedical researchers and research support staff on actual and ideal IRB review functions and characteristics: A quantitative analysis. PLoS One 2020; 15:e0241783. [PMID: 33382683 PMCID: PMC7774925 DOI: 10.1371/journal.pone.0241783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Biomedical research is overseen by numerous Institutional Review Boards (IRBs) in Singapore but there has been no research that examines how the research review process is perceived by the local research community nor is there any systematic data on perceptions regarding the review process or other research ethics processes and IRB characteristics. The aim of this study was to ascertain general views regarding the overall perceived value of ethics review processes; to measure perceptions about local IRB functions and characteristics; to identify IRB functions and characteristics viewed as important; and to compare these views with those of other international studies. Methods An online survey was used with the main component being the IRB-Researcher Assessment Tool (IRB-RAT), a validated tool, to evaluate perceptions of ideal and actual IRB functions and characteristics held by Singaporean researchers and research support staff. Data were analysed descriptively first, with mean and SD of each item of IRB-RAT questionnaire reported, excluding the respondents whose answers were unknown or not applicable. The Wilcoxon Sign Rank test was used to compare the ideal and actual ratings of each IRB-RAT item, while the Mann-Whitney U test was used to compare the ratings of each IRB-RAT item between respondents with different characteristics. The Z-test was used to compare the mean ratings of our cohort with the mean ratings reported in the literature. The correlation between our mean ideal scores and those of two international studies also employing the IRB-RAT was examined. Results Seventy-one respondents completed the survey. This cohort generally held positive views of the impact of the ethics review process on: the quality of research; establishing and maintaining public trust in research; the protection of research participants; and on the scientific validity of research. The most important ideal IRB characteristics were timeliness, upholding participants’ rights while also facilitating research, working with investigators to find solutions when there are disagreements, and not allowing biases to affect reviews. For almost all 45 IRB-RAT statements, the rating of the importance of the characteristic was higher than the rating of how much that characteristic was descriptive of IRBs the respondents were familiar with. There was a significant strong correlation between our study’s scores on the ideal IRB characteristics and those of the first and largest published study that employed the IRB-RAT, the US National Validation (USNV) sample in Keith-Spiegel et al. [19]. Conclusions An understanding of the perceptions held by Singaporean researchers and research support staff on the value that the ethics review process adds, their perceptions of actual IRB functions and characteristics as well as what they view as central to high functioning IRBs is the first step to considering the aspects of the review process that might benefit from improvements. This study provides insight into how our cohort compares to others internationally and highlights strengths and areas for improvement of Singapore IRBs as perceived by a small sample of the local research community. Such insights provide a springboard for additional research and may assist in further enhancing good relations so that both are working towards the same end.
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Affiliation(s)
- Markus K. Labude
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (MKL); (VX)
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yujia Zhu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - G. Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Catherine Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (MKL); (VX)
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Peña-Fernández A, Anjum U, Wadoum REG, Koroma S, Berghs M. Competing ethics in a pilot strategy to implement parasitology training and research in post-Ebola Sierra Leone. Int Health 2020; 12:509-514. [PMID: 33165547 PMCID: PMC7650977 DOI: 10.1093/inthealth/ihaa065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
Much of the focus of public health research post-Ebola in Sierra Leone has been on rebuilding the healthcare system. However, very little attention has focused on capacity building in knowledge necessary for (bio)medical research, specifically around emerging opportunistic human pathogens that contribute to the high morbidity and mortality rates in Sierra Leone. In collaboration with academic staff from the University of Makeni, we engaged in a small-scale pilot intervention to strengthen medical parasitology teaching and research. The cultural competencies and ethical expertise provided by Sierra Leonean academics was critical to work in local communities and ensuring consent to undertake research. Yet, at the end of a day of collecting samples, in small pieces of conversation, the staff also explained ethical constraints they experienced taking part in research collaborations. They illustrate that, while on the surface all may seem well with a project, there can be harmful effects in terms of accessibility, ownership, cultural responsiveness and accountability, which should be taken into consideration when establishing networks and collaborations with universities from low-income countries.
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Affiliation(s)
- Antonio Peña-Fernández
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Umar Anjum
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Raoul Emeric Guetiya Wadoum
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
- Department of Public Health, University of Makeni, Makeni, Sierra Leone
| | - Sylvester Koroma
- Department of Public Health, University of Makeni, Makeni, Sierra Leone
| | - Maria Berghs
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
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Swedan S, Khabour OF, Alzoubi KH, Aljabali AAA. Graduate students reported practices regarding the issue of informed consent and maintaining of data confidentiality in a developing country. Heliyon 2020; 6:e04940. [PMID: 32995624 PMCID: PMC7505757 DOI: 10.1016/j.heliyon.2020.e04940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/21/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
Research involving human subjects requires strict adherence to ethical principles, including informed consent and assuring data confidentiality. Herein, a questionnaire was utilized to assess compliance of graduate students who conduct research involving human subjects in Jordan with proper practices related to informed consent and maintaining of data confidentiality. Among the 251 respondents, 55.4% were from health-related fields, 61.4% undertook research involving humans, and 48.6% did research requiring institutional review board approval. Only 37.1% of respondents reported exposure to research ethics education during their graduate study. Satisfactory adherence to informed consent practices was reported at rates of 56.0%-67.5%. Satisfactory adherence to practices related to data confidentiality and study participants' anonymity was reported at rates of 67.3%-74.7%. Sharing of data or samples with others was reported at a rate of 24.3%. The rates of adherence to proper informed consent practices and practices that maintain data confidentiality were less than ideal. Significant policy changes need to be implemented to address these issues.
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Affiliation(s)
- Samer Swedan
- Faculty of Applied Medical Sciences, Dept. of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Omar F Khabour
- Faculty of Applied Medical Sciences, Dept. of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Faculty of Pharmacy, Dept. of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Alaa A A Aljabali
- Faculty of Pharmacy, Dept. of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid 21163, Jordan
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The introduction of research ethics review procedures at a university in South Africa: review outcomes of a social science research ethics committee. RESEARCH ETHICS REVIEW 2020. [DOI: 10.1177/1747016119898408] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The research ethics committee (REC) is a key element of university administration and has gained increasing importance as a review mechanism for those institutions that wish to conduct responsible research, along with safeguarding research ethics standards, scientific merit and human rights of participants. Given the critical role of the university REC, it is argued that there is a need to assesses and understand the work of RECs to identify areas for improvement and thus focus on capacity building to respond to the escalating volume, type and complexity of research. This paper reports on the research ethics outcomes of a social science REC in a Business Faculty at a South African university during its seminal period of operation (2010–2015). Content methodology and a standardised questionnaire were used to assess the REC. The results show the increasing workload of the REC with favourable scores for submission/review processes and minute-taking. However, lower scores were seen for ethics education/training and tracking previously approved research. These shortcomings appear to be related to inadequate funding and resource support for research ethics education/training and administrative structures. Factors contributing to proposal rejections included weak research questions or hypotheses, poor questionnaires/interview schedule design and inadequate research ethics consideration in the proposal. It is argued that the complexity and escalation of research submissions to South African RECs necessitates that they are appropriately developed and capacitated to enhance their utility and thereby support the research mandate of universities.
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Tang M, Joensuu H, Simes RJ, Price TJ, Yip S, Hague W, Sjoquist KM, Zalcberg J. Challenges of international oncology trial collaboration-a call to action. Br J Cancer 2019; 121:515-521. [PMID: 31378784 PMCID: PMC6889481 DOI: 10.1038/s41416-019-0532-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
International collaboration in oncology trials has the potential to enhance clinical trial activity by expediting the recruitment of large patient populations, testing treatments in diverse populations and facilitating the study of rare tumours or specific molecular subtypes. However, a number of challenges continue to hinder the efficient and productive conduct of both commercial and non-commercial international clinical trials. These challenges include complex and burdensome regulatory requirements, the high cost of conducting trials, and logistical challenges associated with ethics review, drug supply and biospecimen collection and management. We propose solutions to promote oncology trial collaboration, such as regulatory reform, harmonisation of trial initiation and management processes and greater recognition and funding of academic (non-commercial) clinical trials. It is only through coordinated effort and leadership from researchers, regulators and those responsible for health systems that the full potential of international trial collaboration can be realised.
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Affiliation(s)
- Monica Tang
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Robert J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy J Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - John Zalcberg
- Alfred Health and the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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16
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See HY, Mohamed MS, Mohd Noor SN, Low WY. Addressing procedural challenges of ethical review system: Towards a better ethical quality of clinical trials review in Malaysia. Account Res 2018; 26:49-64. [DOI: 10.1080/08989621.2018.1556646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hooi Yan See
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Salim Mohamed
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nurani Mohd Noor
- Department of Biomedical Science, Faculty of Science, Lincoln University College, Selangor, Malaysia
| | - Wah Yun Low
- Dean’s Office, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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17
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Oo ZZ, Oo YTN, Than MM, Oo KZ, Wun M, Htun KS, Silverman H. Current Status of Research Ethics Capacity in Myanmar. Asian Bioeth Rev 2018; 10:123-132. [PMID: 32322311 DOI: 10.1007/s41649-018-0054-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Myanmar has recently surfaced from total military rule and efforts at conducting research to enhance the health of the population has increased during the recent democratization process, both from the military and civil sectors as well as support from international agencies. International guidelines mandate that such research requires prior ethics review in accordance with international standards. Previous commentators have expressed concerns, however, regarding the degree of adequate training in research ethics for investigators, the optimal functioning of Research Ethics Committees (RECs), and the extent of responsible conduct in research in low and middle-income countries. Such concerns might also be applicable to Myanmar, especially since it has recently emerged from a long period of military rule where there has been lack of basic freedoms and human rights abuses. We herein review the current gaps in research ethics capacity in Myanmar, the status of the existing RECs and the current efforts to establish training programs to enhance capacity in research ethics.
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Affiliation(s)
- Zaw-Zaw Oo
- University of Medicine 2, Yangon, Yangon, Myanmar
| | - Yin-Thet-Nu Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Mo-Mo Than
- Defence Services Medical Academy, Yangon, Myanmar
| | - Khine Zaw Oo
- Defence Services Medical Research Center, Ministry of Defence, Naypyidaw, Myanmar
| | - Min Wun
- Department of Food and Drug Administration, Naypyidaw, Myanmar
| | - Kyaw-Soe Htun
- Defence Services Medical Research Center, Ministry of Defence, Naypyidaw, Myanmar
| | - Henry Silverman
- University of Maryland School of Medicine, 110 S. Paca Street, Baltimore, MD 21201, USA
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18
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Qiao H. A brief introduction to institutional review boards in the United States. Pediatr Investig 2018; 2:46-51. [PMID: 32851230 PMCID: PMC7331443 DOI: 10.1002/ped4.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 11/25/2022] Open
Abstract
China has become one of the main fields for international drug and device trials in the last twenty years. Although China has greatly strengthened the protection of human research participants over this time, there is still room for improvement. In order for Chinese investigators to participate in international clinical trials, compliance with internationally recognized ethical regulations is essential. In the United States (U.S.), research involving human subjects is reviewed by an ethics committee called the Institutional Review Board (IRB). In this article, we briefly introduce the background, composition, and function of the IRB in the U.S. to our Chinese investigators.
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Affiliation(s)
- Haiping Qiao
- Jacobs School of Medicine and Biomedical SciencesJohn R. Oishei Children's HospitalBuffaloNYUSA
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19
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Joshi R, Faruqui N, Nagarajan SR, Rampatige R, Martiniuk A, Gouda H. Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review. Int J Epidemiol 2018; 47:255-279. [PMID: 29092034 DOI: 10.1093/ije/dyx216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
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Affiliation(s)
- Rohina Joshi
- George Institute for Global Health
- University of New South Wales
- University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alex Martiniuk
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | - Hebe Gouda
- School of Public Health
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD, Australia
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20
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Tasker L, Getty SF, Briggs JR, Benka VA. Exploring the Gaps in Practical Ethical Guidance for Animal Welfare Considerations of Field Interventions and Innovations Targeting Dogs and Cats. Animals (Basel) 2018; 8:ani8020019. [PMID: 29382052 PMCID: PMC5836027 DOI: 10.3390/ani8020019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Large populations of domestic dogs and cats are found living, or in close association with humans. They are often targeted by field interventions or innovations to enhance their welfare or to reduce conflict with communities or wildlife. Ethical review is a cornerstone of responsible engagement that aims to promote animal and human wellbeing. For the review process to be robust, identifying and understanding the ethical dilemmas that may be encountered when working with dogs and cats in field contexts, together with their human communities and in multi-stakeholder partnerships would be advantageous. We explored existing guidance from other disciplines (regulated animal research, veterinary and human clinical trials, and research conducted on wildlife) and identified gaps in ethical frameworks that do not adequately address the specific and practical needs of nongovernmental or intergovernmental organizations, government agencies or independent researchers working with dogs and cats in field contexts. Navigating practical ethical concerns in complex, highly variable field contexts necessitates the development of additional resources that can better inform reliable ethical review processes, and subsequently enhance the humaneness and effectiveness of future interventions and innovations. Abstract Domestic dogs (Canis lupus familiaris) and cats (Felis silvestris catus) are common species targeted by nongovernmental or intergovernmental organizations, veterinarians and government agencies worldwide, for field interventions (e.g., population management, rabies vaccination programs) or innovations (e.g., development of technologies or pharmaceuticals to improve animal welfare). We have a moral responsibility to ensure that the conduct of this work is humane for dogs or cats, and to consider the human communities in which the animals live. Ethical review is widely accepted as being integral to responsible practice, and it is fundamental to good science that underpins innovation. Despite the necessity of field interventions or innovations to advance the welfare of individuals or populations of animals, we found a lack of specific guidance and review processes to help navigate ethical dilemmas surrounding the conduct of such work. This can be detrimental to the wellbeing of animals and their human communities. Here we identify the gaps in existing ethical frameworks (specifically application of Reduction and Refinement principles, challenges of obtaining meaningful informed consent with variations in the quality of human-animal relationships, and limited resources regarding considerations of local stakeholders), and outline the need for additional tools to promote ethical conduct in the field.
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Affiliation(s)
- Louisa Tasker
- Independent Consultant, Hillcrest, Stanton-by-Dale, Derbyshire DE7 4QQ, UK
- Correspondence: ; Tel.: +44-(0)-758-087-3353
| | - Susan F. Getty
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
| | - Joyce R. Briggs
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
| | - Valerie A.W. Benka
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
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21
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Tedesco D, Farid-Kapadia M, Offringa M, Bhutta ZA, Maldonado Y, Ioannidis JPA, Contopoulos-Ioannidis DG. Comparative evidence on harms in pediatric randomized clinical trials from less developed versus more developed countries is limited. J Clin Epidemiol 2017; 95:63-72. [PMID: 29191447 DOI: 10.1016/j.jclinepi.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Evaluate comparative harm rates from medical interventions in pediatric randomized clinical trials (RCTs) from more developed (MDCs) and less developed countries (LDCs). STUDY DESIGN AND SETTING Meta-epidemiologic empirical evaluation of Cochrane Database of Systematic Reviews (June 2014) meta-analyses reporting clinically important harm-outcomes (severe adverse events [AEs], discontinuations due to AEs, any AE, and mortality) that included at least one pediatric RCT from MDCs and at least one from LDCs. We estimated relative odds ratios (RORs) for each harm, within each meta-analysis, between RCTs from MDCs and LDCs and calculated random-effects-summary-RORs (sRORs) for each harm across multiple meta-analyses. RESULTS Only 1% (26/2,363) of meta-analyses with clinically important harm-outcomes in the entire Cochrane Database of Systematic Reviews included pediatric RCTs both from MDCs and LDCs. We analyzed 26 meta-analyses with 244 data sets from pediatric RCTs, 116 from MDCs and 128 from LDCs (64 and 66 unique RCTs respectively). The summary ROR was 0.92 (95% confidence intervals: 0.78-1.08) for severe AEs; 1.13 (0.54-2.34) for discontinuations due to AEs; 1.10 (0.77-1.59) for any AE; and 0.99 (0.61-1.61) for mortality and for the all-harms-combined-end point 0.96 (0.83-1.10). Differences of ROR-point-estimates ≥2-fold between MDCs and LDCs were identified in 35% of meta-analyses. CONCLUSION We found no major systematic differences in harm rates in pediatric trials between MDCs and LDCs, but data on harms in children were overall very limited.
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Affiliation(s)
- Dario Tedesco
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Mufiza Farid-Kapadia
- Department of Pediatrics, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children University of Toronto, 555 University Avenue, Toronto, Ontario M5G-1X8, Canada
| | - Martin Offringa
- Department of Pediatrics, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children University of Toronto, 555 University Avenue, Toronto, Ontario M5G-1X8, Canada
| | - Zulfiqar A Bhutta
- Department of Pediatrics, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children University of Toronto, 555 University Avenue, Toronto, Ontario M5G-1X8, Canada; Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Suite 11.9805, Toronto, ON, M5G-0A4, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Yvonne Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room G312, Stanford, CA 94305, USA; Department of Health Research and Policy, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305, USA; Senior Associate Dean for Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - John P A Ioannidis
- Department of Health Research and Policy, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305, USA; Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA; Meta Research Innovation Center at Stanford (METRICS), 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Despina G Contopoulos-Ioannidis
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room G312, Stanford, CA 94305, USA; Meta Research Innovation Center at Stanford (METRICS), 1070 Arastradero Road, Palo Alto, CA 94304, USA.
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22
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Shaw S, Boynton PM, Greenhalgh T. Research Governance: Where did it Come From, What Does it Mean? J R Soc Med 2017; 98:496-502. [PMID: 16260798 PMCID: PMC1275997 DOI: 10.1177/014107680509801110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For a variety of historical and social reasons, research has become increasingly formalized and regulated. This change has potential benefits (reduction in fraud and misconduct, protection of vulnerable groups, financial probity) but also disadvantages (increased paperwork, time delays, constraints on research freedom). The terms ‘research’ and ‘governance’ mean different things in different contexts. Even with explicit guidance, ambiguities must be resolved by human judgement. Variation in the nature and outcome of approval decisions is therefore a fact of life. The type of approval needed for a research study depends on the official remit of the approval body, the question to be addressed; the methods to be used; the context in which the work will take place; the level of analysis and interpretation; and the plans for how the findings will be presented and used.
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Affiliation(s)
- Sara Shaw
- Open Learning Unit, Department of Primary Care and Population Sciences, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, UK.
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23
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Hifnawy T, Kobrosly S, Edwards H, Anwar M, Zahran D, Silverman H. Patients' attitudes and perceptions regarding research and their rights: a pilot survey study from the Middle East. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2017; 23:461-468. [PMID: 28853129 PMCID: PMC5944347 DOI: 10.26719/2017.23.7.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/16/2016] [Indexed: 11/09/2022]
Abstract
Ethical and regulatory oversight of research may be suboptimal in low- and middle-income countries. To determine patients' attitudes and perceptions toward research participation and perceptions of their rights, we recruited 202 participants from hospitals in Egypt, Lebanon, Saudi Arabia and Sudan and asked them to complete a questionnaire assessing attitudes and perceptions. Around 20% believed that doctors sometimes perform research on patients without their knowledge and 35% believed that if participants withdrew from the research they would not receive good medical care. Over 85% believed that they should have rights regarding confidentiality of data, free medical care if injured during the research and asking questions. Almost half believed they have a right to withdraw without penalty and around 75% believed they could make complaints without fear of harm. Those who were illiterate or unemployed were less likely to appreciate their rights compared with their counterparts.
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Affiliation(s)
- Tamer Hifnawy
- Department of Public Health and Community Medicine, College of Dentistry, Taibah University, Saudi Arabia
- Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | - Hillary Edwards
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Manal Anwar
- Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dalia Zahran
- Department of Public Health and Community Medicine, College of Dentistry, Taibah University, Saudi Arabia
- Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Henry Silverman
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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24
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Geller SE, Patel A, Niak VA, Goudar SS, Edlavitch SA, Kodkany BS, Derman RJ. Conducting International Collaborative Research in Developing Nations. Int J Gynaecol Obstet 2017; 87:267-71. [PMID: 15548406 DOI: 10.1016/j.ijgo.2004.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 08/24/2004] [Accepted: 08/24/2004] [Indexed: 11/23/2022]
Abstract
International research partnerships bring together some of the best and the brightest in an effort to tackle global health problems. Such collaborations also pose complex challenges, such as maintaining ethical principles in the conduct of research in developing nations. In implementing a randomized clinical trial to reduce postpartum hemorrhage (PPH) during childbirth in rural India, U.S. and Indian collaborators addressed three such issues: the appropriateness of an ethical randomized controlled trial in the developing world, the inclusion of a placebo arm, and the relevance of informed consent in a semiliterate rural population.
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Affiliation(s)
- S E Geller
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL 60612, USA.
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25
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Ralefala D, Ali J, Kass N, Hyder A. A case study of researchers’ knowledge and opinions about the ethical review process for research in Botswana. RESEARCH ETHICS 2016. [DOI: 10.1177/1747016116677250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most countries, including Botswana, have established Institutional Review Boards (IRBs) to provide oversight of research involving human beings. Although much has been published on the structure and function of IRBs around the world, there is less literature that empirically describes the perspectives of stakeholders in low- and middle-income country (LMIC) settings regarding IRB processes. In this study, we employed primarily quantitative methods to examine the perceptions of researchers at the University of Botswana (UB) about the review of research protocols by local IRBs. Data were collected using a web-based survey (SurveyMonkey1). This was a preliminary effort to document some of the emerging experiences of researchers with ethics review in a context where both research and research oversight are relatively new. Findings from 85 researchers indicate that researchers recognized the need for an IRB to review all human research protocols, expressed the need for research ethics training, experienced high rates of approval at government ministries and UB, and generally believed that ethics review processes can help researchers themselves better understand and appreciate research ethics in general. Though only about one-quarter of respondents reported a more positive view of research ethics after interacting with the UB IRB, 56.5 percent reported no change. In contexts where IRBs have recently been established, it can be particularly important to document the perspectives of researchers in order to align expectations with capabilities, and identify areas where IRBs can improve operations. Future efforts to advance research ethics and ethical review in Botswana should include establishing research ethics training requirements and courses for researchers, increasing investment in IRBs and their training, further developing institutional and national research ethics policies, and formalizing agreements between IRBs and others involved in research oversight in the country to support coordinated review.
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Affiliation(s)
- Dimpho Ralefala
- Office of Research and Development, University of Botswana, Botswana
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, USA
| | - Nancy Kass
- Berman Institute of Bioethics; Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Adnan Hyder
- Berman Institute of Bioethics; Bloomberg School of Public Health, Johns Hopkins University, USA
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26
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Linkov F, Adambekov S, Goughnour S, Welburn SC, Padilla-Raygoza N, Kana M, Shubnikov E, Mustapha MM, Sheikh A, LaPorte R. Scientific Banana Republics: Do They Exist? Cent Asian J Glob Health 2016; 5:249. [PMID: 29138733 PMCID: PMC5661190 DOI: 10.5195/cajgh.2016.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Faina Linkov
- Department of Ob/Gyn, University of Pittsburgh School of Medicine, Pittsburgh, PA,USA
| | - Shalkar Adambekov
- Department of Ob/Gyn, University of Pittsburgh School of Medicine, Pittsburgh, PA,USA
| | - Sharon Goughnour
- Department of Ob/Gyn, University of Pittsburgh School of Medicine, Pittsburgh, PA,USA
| | - Sharon C Welburn
- Department of Epidemioloy, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicolas Padilla-Raygoza
- Department of Nursing and Obstetrics, Division of Health Sciences and Engineering, University of Guanajuato, Mexico
| | - Musa Kana
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Department of Community Medicine, Faculty of Medicine, Kaduna State University, Kaduna, Nigeria
| | | | - Mustapha M Mustapha
- Center for Innovative Antimicrobial Therapy School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ronald LaPorte
- Department of Epidemioloy, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Ogunrin OA, Daniel F, Ansa V. Knowledge of the Nigerian Code of Health Research Ethics Among Biomedical Researchers in Southern Nigeria. J Empir Res Hum Res Ethics 2016; 11:397-407. [PMID: 27241870 DOI: 10.1177/1556264616650072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Responsibility for protection of research participants from harm and exploitation rests on Research Ethics Committees and principal investigators. The Nigerian National Code of Health Research Ethics defines responsibilities of stakeholders in research so its knowledge among researchers will likely aid ethical conduct of research. The levels of awareness and knowledge of the Code among biomedical researchers in southern Nigerian research institutions was assessed. Four institutions were selected using a stratified random sampling technique. Research participants were selected by purposive sampling and completed a pre-tested structured questionnaire. A total of 102 biomedical researchers completed the questionnaires. Thirty percent of the participants were aware of the National Code though 64% had attended at least one training seminar in research ethics. Twenty-five percent had a fairly acceptable knowledge (scores 50%-74%) and 10% had excellent knowledge of the code (score ≥75%). Ninety-five percent expressed intentions to learn more about the National Code and agreed that it is highly relevant to the ethical conduct of research. Awareness and knowledge of the Code were found to be very limited among biomedical researchers in southern Nigeria. There is need to improve awareness and knowledge through ethics seminars and training. Use of existing Nigeria-specific online training resources is also encouraged.
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28
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Ng LC, Hanlon C, Yimer G, Henderson DC, Fekadu A. Ethics in global health research: the need for balance. LANCET GLOBAL HEALTH 2016; 3:e516-7. [PMID: 26275322 PMCID: PMC4562379 DOI: 10.1016/s2214-109x(15)00095-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Lauren C Ng
- Chester M Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Getnet Yimer
- Department of Pharmacology and Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - David C Henderson
- Chester M Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA; Harvard School of Public Health, Boston, MA, USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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29
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Contopoulos-Ioannidis D, Tseretopoulou X, Ancker M, Walterspiel JN, Panagiotou OA, Maldonado Y, Ioannidis JPA. Comparative rates of harms in randomized trials from more developed versus less developed countries may be different. J Clin Epidemiol 2016; 78:10-21. [PMID: 27063207 DOI: 10.1016/j.jclinepi.2016.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 01/04/2016] [Accepted: 02/04/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We set up to evaluate the relative risk of harms in trials performed in less developed vs. more developed countries. STUDY DESIGN AND SETTING Meta-epidemiologic evaluation using the Cochrane Database of Systematic Reviews. We considered meta-analyses with at least one randomized clinical trial (RCT) in a less developed country and one RCT in a more developed country. We targeted severe adverse events (AEs), discontinuations due to AEs, any AE, organ system-specific AEs, individual AEs, and all discontinuations due to any reason. We estimated the relative odds ratio (ROR) of harms between more and less developed countries for each topic and the summary ROR (sROR) across topics under each category of harms. RESULTS We identified 42 systematic reviews (128 meta-analyses, 521 independent RCTs). Summary sRORs did not differ significantly from 1.00 for any harm category. Nominally significant RORs were found in only 6/128 meta-analyses. However, in 27% (35/128) of meta-analyses the ROR point estimates indicated relative differences between country settings >2-fold. Considering also ROR 95% confidence intervals, in 92% (118/128) of meta-analyses one could not exclude a 2-fold difference in both directions. CONCLUSIONS We identified limited comparative evidence on harms in trials from these two country settings. Substantial differences in the risk point estimates were common; the potential for modest differences could rarely be excluded with confidence.
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Affiliation(s)
- Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5107, USA; Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Room 2A027B, Palo Alto, CA, 94301, USA; Meta-Research Innovation Center at Stanford (METRICS), 1070 Arastradero Road, Palo Alto, CA, 94304, USA.
| | | | - Megan Ancker
- Medecins San Frontieres, 8 Rue Saint-Sabin, Paris 75011, France
| | - Juan N Walterspiel
- Mendocino Coast District Hospital, 700 River Dr, Fort Bragg, CA 95437, USA
| | - Orestis A Panagiotou
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institute of Health, 9609 Medical Center Dr., Room 7E136, Bethesda, MD 20892, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5107, USA; Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building T152, 150 Governor's Lane, Stanford, CA 94305-5405, USA; Faculty Development and Diversity, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), 1070 Arastradero Road, Palo Alto, CA, 94304, USA; Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building T152, 150 Governor's Lane, Stanford, CA 94305-5405, USA; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, Stanford, CA 94305, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Sequoia Hall, 390 Serra Mall, Stanford, CA 94305-4065, USA
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Morris N. Providing ethical guidance for collaborative research in developing countries. RESEARCH ETHICS REVIEW 2015; 11:211-235. [PMID: 26640509 PMCID: PMC4647303 DOI: 10.1177/1747016115586759] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Experience has shown that the application of ethical guidelines developed for research in developed countries to research in developing countries can be, and often is, impractical and raises a number of contentious issues. Various attempts have been made to provide guidelines more appropriate to the developing world context; however, to date these efforts have been dominated by the fields of bioscience, medical research and nutrition. There is very little advice available for those seeking to undertake collaborative social science or natural science research in developing countries and what is there tends to be held within disparate sources. Charting the development of a set of ethics documentation for future use by the Ecosystem Services for Poverty Alleviation (ESPA) programme research community, this paper outlines past and present attitudes towards ethics procedures amongst this community and suggests ways in which ethics procedures might be made more relevant and user-friendly to researchers working in this area.
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Building Networks for Global Clinical Research: The Basics. J Orthop Trauma 2015; 29 Suppl 12:S15-8. [PMID: 26584260 DOI: 10.1097/bot.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last several decades, interest in global health across all fields of medicine, including orthopaedic surgery, has grown markedly. Cross-national collaborations are an effective means of conducting high-quality clinical research and offer many advantages over single-center investigations. Successful collaboration requires a well-designed research protocol, development of an effective team structure, and the funding to ensure the project is sustained to completion. Equally important, investigators must consider the social, linguistic, and cultural context in which the study is being undertaken. Although randomized clinical trials are the highest level of evidence, study designs may have to be adapted to accommodate available resources, expertise, and local contextual factors. With appropriate planning, these collaborative endeavors can generate changes in clinical practice and positively impact health policy.
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Gallagher B, Berman AH, Bieganski J, Jones AD, Foca L, Raikes B, Schiratzki J, Urban M, Ullman S. National Human Research Ethics: A Preliminary Comparative Case Study of Germany, Great Britain, Romania, and Sweden. ETHICS & BEHAVIOR 2015; 26:586-606. [PMID: 27746664 PMCID: PMC5044765 DOI: 10.1080/10508422.2015.1096207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics” (NHREs), that is, national ethical guidelines (NEGs), Institutional Review Boards (IRBs), and research stakeholder’ ethical attitudes and behaviors (EABs). We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity.
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Affiliation(s)
| | - Anne H Berman
- Department of Clinical Neurosciences, Karolinska Institutet
| | | | - Adele D Jones
- School of Human and Health Sciences, University of Huddersfield
| | - Liliana Foca
- Department of Psychology, Asociația Alternative Sociale
| | - Ben Raikes
- Division of Social Work, University of Huddersfield
| | | | - Mirjam Urban
- Department of Medicine, Technische Universitaet Dresden
| | - Sara Ullman
- Department of Investigation, The Swedish Police
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Macdonald H, Spiegel AD. ‘Distraction from the real difficulties’: ethical deliberations in international health research. ANTHROPOLOGY SOUTHERN AFRICA 2015. [DOI: 10.1080/23323256.2013.11500055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van Teijlingen E, Simkhada P. Failure to Apply for Ethical Approval for Health Studies in Low-Income Countries. Nepal J Epidemiol 2015; 5:511-5. [PMID: 26913212 PMCID: PMC4762509 DOI: 10.3126/nje.v5i3.13609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022] Open
Abstract
On too many occasions researchers conduct public health and/or epidemiological studies in low-income countries without the appropriate in-country ethical approval. This article reflects on some of the underlying reasons for not applying for ethical approval. The piece concludes that we need to start by educating our (junior) researchers and research students about the importance of research ethics. We conclude with a number of recommendations for researchers, scientific journal editors and reviewers and ethical committees in high-income countries to bring the message home to researchers that ethical approval should be sought in low-income countries if and when required!
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Affiliation(s)
- Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK.
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Johnson WMS, Archana R, Prathibha KM, Johnson P. Anatomy research under the knife of medical ethics. J Pharm Bioallied Sci 2015; 7:S46-8. [PMID: 26015746 PMCID: PMC4439706 DOI: 10.4103/0975-7406.155792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 10/31/2014] [Accepted: 11/09/2014] [Indexed: 11/04/2022] Open
Abstract
There is increased awareness and anxiety in conducting research for publication and at the same time ignorance about getting Ethical Committee clearance at least in Anatomy Departments among Basic Medical Sciences. While people are actively presenting papers, collect data, Indian Council for Medical Research guidelines does not cover aspects pertaining to Anatomy oriented research activities. This review article is an eye opener for fraternity in the medical field, especially in anatomy.
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Affiliation(s)
- W M S Johnson
- Department of Anatomy, Sree Balaji Medical College, Bharath University, Chennai, Tamil Nadu, India
| | - R Archana
- Department of Anatomy, Sree Balaji Medical College, Bharath University, Chennai, Tamil Nadu, India
| | - K M Prathibha
- Department of Physiology, Saveetha Medical College, Thandalam, Chennai, Tamil Nadu, India
| | - Priscilla Johnson
- Department of Physiology, Sri Ramachandra Medical College, SRU, Porur, Chennai, Tamil Nadu, India
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Corluka A, Hyder AA, Segura E, Winch P, McLean RKD. Survey of Argentine health researchers on the use of evidence in policymaking. PLoS One 2015; 10:e0125711. [PMID: 25928292 PMCID: PMC4415923 DOI: 10.1371/journal.pone.0125711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 03/18/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE In this study, Argentine health researchers were surveyed regarding their perceptions of facilitators and barriers to evidence-based policymaking in Argentina, as well as their publication activities, and research environment satisfaction. METHODS A self-administered online survey was sent to health researchers in Argentina. The survey questions were based on a preceding qualitative study of Argentine health researchers, as well as the scientific literature. RESULTS Of the 647 researchers that were reached, 226 accessed the survey, for a response rate of 34.9%. Over 80% of researchers surveyed had never been involved in or contributed to decision-making, while over 90% of researchers indicated they would like to be involved in the decision-making process. Decision-maker self-interest was perceived to be the driving factor in the development of health and healthcare policies. Research conducted by a research leader was seen to be the most influential factor in influencing health policy, followed by policy relevance of the research. With respect to their occupational environment, researchers rated highest and most favourably the opportunities available to present, discuss and publish research results and their ability to further their education and training. Argentine researchers surveyed demonstrated a strong interest and willingness to contribute their work and expertise to inform Argentine health policy development. CONCLUSION Despite Argentina's long scientific tradition, there are relatively few institutionalized linkages between health research results and health policymaking. Based on the results of this study, the disconnect between political decision-making and the health research system, coupled with fewer opportunities for formalized or informal researcher/decision-maker interaction, contribute to the challenges in evidence informing health policymaking in Argentina. Improving personal contact and the building of relationships between researchers and policymakers in Argentina will require taking into account researcher perceptions of policymakers, as highlighted in this study.
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Affiliation(s)
- Adrijana Corluka
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Adnan A. Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elsa Segura
- National Institute of Parasitology “Dr. M. Fatala Chaben”, Ministry of Health, Buenos Aires, Argentina
| | - Peter Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert K. D. McLean
- Policy, Strategy, and Evaluation Division, International Development Research Centre, Ottawa, Canada
- Evaluation Unit, Canadian Institutes of Health Research, Ottawa, Canada
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Silverman H, Sleem H, Moodley K, Kumar N, Naidoo S, Subramanian T, Jaafar R, Moni M. Results of a self-assessment tool to assess the operational characteristics of research ethics committees in low- and middle-income countries. JOURNAL OF MEDICAL ETHICS 2015; 41:332-337. [PMID: 24748650 DOI: 10.1136/medethics-2013-101587] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Many research ethics committees (RECs) have been established in low- and middle-income countries (LMICs) in response to increased research in these countries. How well these RECs are functioning remains largely unknown. Our objective was to assess the usefulness of a self-assessment tool in obtaining benchmarking data on the extent to which RECs are in compliance with recognised international standards. METHODS REC chairs from several LMICs (Egypt, South Africa and India) were asked to complete an online self-assessment tool for RECs with a maximum score of 200. Individual responses were collected anonymously. RESULTS The aggregate mean score was 137.4±35.8 (∼70% of maximum score); mean scores were significantly associated with the presence of a budget (p<0.001), but not with duration of existence, frequency of meetings, or the presence of national guidelines. As a group, RECs achieved more than 80% of the maximum score for the following domains: submission processes and documents received, recording of meeting minutes, criteria for ethical review and criteria for informed consent. RECs achieved less than 80% of the maximum score for the following domains: institutional commitment, policies and procedures of the REC, membership composition and training, policies and procedures for protocol review, elements of a decision letter and criteria for continuing review. CONCLUSIONS This study highlights areas where RECs from LMICs can improve to be in compliance with recommended international standards for RECs. The self-assessment tool provides valuable benchmarking data for RECs and can serve as a quality improvement method to help RECs enhance their operations.
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Affiliation(s)
- Henry Silverman
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hany Sleem
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | | | | | | | | | - Malini Moni
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Silaigwana B, Wassenaar D. Biomedical Research Ethics Committees in sub-Saharan Africa: a collective review of their structure, functioning, and outcomes. J Empir Res Hum Res Ethics 2015; 10:169-84. [PMID: 25819759 DOI: 10.1177/1556264615575511] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research Ethics Committees (RECs) are mandated to protect human participants by conducting ethical reviews of biomedical research. To date, there is a dearth of information on the structure, functioning, and outcomes of RECs in Africa. This article reviews empirical studies investigating African RECs, with the aim of providing an overview of what is known and identifying gaps in our knowledge. We conducted a literature search of the EBSCO, PubMed, and Google Scholar electronic databases. Twenty-three empirical studies reporting on the structure, functions, and outcomes of African RECs were included in our analysis. The review yielded limited systematic data on RECs in Africa. Available empirical evidence suggests that challenges hampering the effective functioning of RECs included lack of membership diversity, scarcity of resources, insufficient training of members, inadequate capacity to review and monitor studies, and lack of national ethics guidelines and accreditation. Relatively little data on the review outcomes of African RECs were described. There is an ongoing need for concerted efforts from various stakeholders to support capacity development and enhancement of African RECs.
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Okpechi IG, Swanepoel CR, Venter F. Access to medications and conducting clinical trials in LMICs. Nat Rev Nephrol 2015; 11:189-94. [DOI: 10.1038/nrneph.2015.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Quigley D. Promoting human subjects training for place-based communities and cultural groups in environmental research: curriculum approaches for graduate student/faculty training. SCIENCE AND ENGINEERING ETHICS 2015; 21:209-226. [PMID: 24430427 DOI: 10.1007/s11948-013-9508-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/27/2013] [Indexed: 06/03/2023]
Abstract
A collaborative team of environmental sociologists, community psychologists, religious studies scholars, environmental studies/science researchers and engineers has been working together to design and implement new training in research ethics, culture and community-based approaches for place-based communities and cultural groups. The training is designed for short and semester-long graduate courses at several universities in the northeastern US. The team received a 3 year grant from the US National Science Foundation's Ethics Education in Science and Engineering in 2010. This manuscript details the curriculum topics developed that incorporate ethical principles, particularly for group protections/benefits within the field practices of environmental/engineering researchers.
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Affiliation(s)
- Dianne Quigley
- Northeast Ethics Education Partnership, Center for Environmental Studies, Brown University, 135 Angell St., PO Box 1943, Providence, RI, 02912, USA,
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Hunter PR, Abdelrahman SH, Antwi-Agyei P, Awuah E, Cairncross S, Chappell E, Dalsgaard A, Ensink JHJ, Potgieter N, Mokgobu I, Muchiri EW, Mulogo E, van der Es M, Odai SN. Needs assessment to strengthen capacity in water and sanitation research in Africa: experiences of the African SNOWS consortium. Health Res Policy Syst 2014; 12:68. [PMID: 25510403 PMCID: PMC4274706 DOI: 10.1186/1478-4505-12-68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project. Methods We reviewed the reports of two needs assessments. The first was a detailed needs assessment led by one northern partner, with follow-up visits which included reciprocal representation from the African universities. The second assessment, led by another northern partner, focused primarily on training needs. The reports from both needs assessments were read and stated needs were extracted and summarised. Results Key common issues identified in both assessments were supervisory skills, applications for external research funding, research management, and writing for publication in the peer-reviewed scientific literature. The bureaucratisation of university processes and inconsistencies through administration processes also caused problems. The lack of specialist laboratory equipment presented difficulties, particularly of inaccessibility through a lack of skilled staff for operation and maintenance, and of a budget provision for repairs and running costs. The lack of taught PhD modules and of research training methods also caused problems. Institutionally, there were often no mechanisms for identifying funding opportunities. On the other hand, grantees were often unable to understand or comply with the funders’ financial and reporting requirements and were not supported by their institution. Skills in staff recruitment, retention, and performance were poor, as were performance in proposal and paper writing. The requirements for ethical clearance were often not known and governance issues not understood, particularly those required by funders. Conclusions SNOWS believes that working with African universities to develop networks that support African-led research driven by the local context is an effective approach to develop and retain research skills needed to change policy and practice in water, sanitation, and hygiene in Africa. Electronic supplementary material The online version of this article (doi:10.1186/1478-4505-12-68) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul R Hunter
- The Norwich Medical School, University of East Anglia, Norwich NR 4 7TJ, UK.
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Adams P, Kaewkungwal J, Limphattharacharoen C, Prakobtham S, Pengsaa K, Khusmith S. Is your ethics committee efficient? Using "IRB Metrics" as a self-assessment tool for continuous improvement at the Faculty of Tropical Medicine, Mahidol University, Thailand. PLoS One 2014; 9:e113356. [PMID: 25406085 PMCID: PMC4236196 DOI: 10.1371/journal.pone.0113356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 10/27/2014] [Indexed: 11/23/2022] Open
Abstract
Tensions between researchers and ethics committees have been reported in several institutions. Some reports suggest researchers lack confidence in the quality of institutional review board (IRB) reviews, and that emphasis on strict procedural compliance and ethical issues raised by the IRB might unintentionally lead to delays in correspondence between researchers and ethics committees, and/or even encourage prevarication/equivocation, if researchers perceive committee concerns and criticisms unjust. This study systematically analyzed the efficiency of different IRB functions, and the relationship between efficiency and perceived quality of the decision-making process. The major purposes of this study were thus (1) to use the IRB Metrics developed by the Faculty of Tropical Medicine, Mahidol University, Thailand (FTM-EC) to assess the operational efficiency and perceived effectiveness of its ethics committees, and (2) to determine ethical issues that may cause the duration of approval process to be above the target limit of 60 days. Based on a literature review of definitions and methods used and proposed for use, in assessing aspects of IRB quality, an “IRB Metrics” was developed to assess IRB processes using a structure-process-outcome measurement model. To observe trends in the indicators evaluated, data related to all protocols submitted to the two panels of the FTM-EC (clinical and non-clinical), between January 2010–September 2013, were extracted and analyzed. Quantitative information based on IRB Metrics structure-process-outcome illuminates different areas for internal-process improvement. Ethical issues raised with researchers by the IRB, which were associated with the duration of the approval process in protocol review, could be considered root causes of tensions between the parties. The assessment of IRB structure-process-outcome thus provides a valuable opportunity to strengthen relationships and reduce conflicts between IRBs and researchers, with positive outcomes for all parties involved in the conduct of human-subject research.
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Affiliation(s)
- Pornpimon Adams
- Office of Research Services, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
| | | | - Sukanya Prakobtham
- Office of Research Services, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Krisana Pengsaa
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Srisin Khusmith
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Sexton P, Hui K, Hanrahan D, Barnes M, Sugarman J, London AJ, Klitzman R. Reviewing HIV-Related Research in Emerging Economies: The Role of Government Reviewing Agencies. Dev World Bioeth 2014; 16:4-14. [PMID: 25388003 DOI: 10.1111/dewb.12072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Little research has explored the possible effects of government institutions in emerging economies on ethical reviews of multinational research. We conducted semi-structured, in-depth telephone interviews with 15 researchers, Research Ethics Committees (RECs) personnel, and a government agency member involved in multinational HIV Prevention Trials Network (HPTN) research in emerging economies. Ministries of Health (MOH) or other government agencies often play pivotal roles as facilitators or barriers in the research ethics approval process. Government agency RECs reviewing protocols may face particular challenges, as they can lack resources, be poorly organized, have inconsistent review processes and limited expertise, and use differing definitions of national interests, including upholding national reputation and avoiding potential exploitation and stigma of the country's population. The MOH/governmental review body may be affected by power dynamics and politics in study reviews; may consider issues both related and unrelated to research ethics as understood elsewhere; and may prioritize particular diseases, treatments, or interventions over other topics/types of research. Poor communication and deeply-rooted tensions may exist between sponsor and host countries, impeding optimal interactions and reviews. Investigators must understand and plan for the potential effects of governmental agencies on multinational collaborative research, including preserving adequate time for agency review, and contacting these agencies beforehand to address issues that may arise. Better understanding of these issues can aid and advance appropriate global scientific collaboration.
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Makhoul J, El-Alti L, Qutteina Y, Nasrallah C, Sakr C, Nakkash R, Alali K. "Protecting" or "Policing": Academic Researchers' View of IRBs in an Arab Context. J Empir Res Hum Res Ethics 2014; 9:25-35. [PMID: 25747688 DOI: 10.1177/1556264614553170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A recent surge of research universities and human subjects research funding in the Arab world raises concerns about applied research ethics and oversight. In-depth interviews conducted with 52 researchers in Lebanon and Qatar about their research conduct and the problems they face while conducting it indicate that although researchers admit to the added value of institutional review board (IRB) functions, the researchers have several complaints, such as rigid and contextually insensitive requirements, delays, and inadequate resources at IRBs, and a lack of outreach and effective communication with researchers. The study discusses these challenges pointing to the need for socioculturally adaptive regulations and forms and strengthening outreach and communication between IRBs and their users to improve ethical practices. Implications for future research are also presented.
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Silverman H, Strosberg M, Luna F, Philpott S, Hemmerle CA. An analysis of online courses in research ethics in the Fogarty-sponsored bioethics training programs. J Empir Res Hum Res Ethics 2014; 8:59-74. [PMID: 24384517 DOI: 10.1525/jer.2013.8.5.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several training programs sponsored by the NIH/Fogarty International Center's International Research Ethics Education and Curriculum Development Program offer online graduate-level courses in research ethics to participants in lowand middle-income countries. This paper describes the evaluation of four of these online courses and recommendations for improvements to achieve the highest-quality design and delivery. We used an evaluation matrix consisting of 95 criteria based on recommended best practices in eLearning. Our results showed that these courses are developing or meeting nearly 73% of the criteria, while they are not meeting approximately 21% of the criteria. Together, one or more of the courses are developing or meeting 89 of the 95 criteria. These results suggest that the necessary skills and expertise exist in these programs to bring all of the eLearning courses close to 100% proficiency by sharing a common set of best practices. This paper is part of a collection of articles analyzing the Fogarty International Center's International Research Ethics Education and Curriculum Development Program.
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Moorhouse R, Slack C, Quayle M, Essack Z, Lindegger G. Stakeholder views of ethical guidance regarding prevention and care in HIV vaccine trials. BMC Med Ethics 2014; 15:51. [PMID: 24981027 PMCID: PMC4104735 DOI: 10.1186/1472-6939-15-51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/20/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders' perspectives on ethical guidance related to prevention and care in HIV vaccine trials. METHODS Site staff, Community Advisory Board members and Research Ethics Committee members involved with current HIV vaccine trials in South Africa were invited to participate in an exploration of their views. A questionnaire listed 10 care and 10 prevention recommendations drawn from two widely available sets of ethical guidelines for biomedical HIV prevention trials. Respondents (n = 98) rated each recommendation on five dimensions: "Familiarity with", "Ease of Understanding", "Ease of Implementing", "Perceived Protection", and "Agreement with" each ethical recommendation. The ratings were used to describe stakeholder perspectives on dimensions for each recommendation. Dimension ratings were averaged across the five dimensions and used as an indication of overall merit for each recommendation. Differences were explored across dimensions, between care-oriented and prevention-oriented recommendations, and between stakeholder groups. RESULTS Both care and prevention recommendations were rated highly overall, with median ratings well above the scale midpoint. In general, informed consent recommendations were most positively rated. Care-related recommendations were rated significantly more positively than prevention-related recommendations, with the five lowest-rated recommendations being prevention-related. The most problematic dimension across all recommendations was "Ease of Implementing," and the least problematic was "Agreement with," suggesting the most pressing stakeholder concerns are practical rather than theoretical; that is, respondents agree with but see barriers to the attainment of these recommendations. CONCLUSIONS We propose that prevention recommendations be prioritized for refinement, especially those assigned bottom-ranking scores for "Ease of Implementing", and/ or "Ease of Understanding" in order to assist vaccine stakeholders to better comprehend and implement these recommendations. Further qualitative research could also assist to better understand nuances in stakeholder reservations about implementing such recommendations.
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Affiliation(s)
- Rika Moorhouse
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, South Africa
| | - Michael Quayle
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, South Africa
| | - Zaynab Essack
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, South Africa
| | - Graham Lindegger
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, South Africa
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Zielinski C, Kebede D, Mbondji PE, Sanou I, Kouvividila W, Lusamba-Dikassa PS. Research ethics policies and practices in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey. J R Soc Med 2014; 107:70-76. [PMID: 24643663 DOI: 10.1177/0141076813517679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the state of research ethics policies and practices in health research institutions in sub-Saharan African countries. DESIGN A structured questionnaire was used to solicit information on research ethics from health research institutions. SETTING Forty-two sub-Saharan African countries. PARTICIPANTS Key informants from the health research institutions. MAIN OUTCOME MEASURES Existence of institutional ethics review policies and mechanisms. RESULTS About half (51%) of respondent institutions reported having policies on research ethics and 58% had written policies requiring that researchers obtain informed consent of research participants. About one-third of respondent institutions (34%) had established ethics review committees, 42% required that studies went through ethics review committees and 46% had linkages with national or regional ethics organisations. Regarding operating procedures for ethics review committees, 53% had adopted standard operating procedures. Less than one-quarter of respondent institutions reported having policies in place to monitor ongoing research. Of the institutions that monitored ongoing research, 34% did an annual ethical review and 74% required a periodic written report. Only 36% provided any type of ethics training for staff, including those conducting health research and those who were not members of the ethics review committee. CONCLUSIONS There are substantial gaps in the capacity of health research institutions in the WHO African Region to undertake ethical review of studies before, during and after studies conducted. There is a need to strengthen such capacity in order to ensure the wellbeing of individuals enrolled in studies and that of communities that host these studies.
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Affiliation(s)
- Chris Zielinski
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo
| | - Derege Kebede
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo
| | - Peter Ebongue Mbondji
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo
| | - Issa Sanou
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo
| | - Wenceslas Kouvividila
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Republic of Congo
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Abstract
This article discusses implications of participant withdrawal for inductive research. I describe and analyze how a third of my participants withdrew from a grounded theory study. I position my example, ensuing issues, and potential solutions as reflective of inductive methodologies as a whole. The crux of the problem is the disruption inflicted by withdrawal on inductive processes of generating knowledge. I examine the subsequent methodological and ethical issues in trying to determine the best course of action following withdrawal. I suggest three potential options for researchers: Continuing the study with partial data, continuing the study with all data, and discontinuing the study. Motivated by my experience, and wider theoretical considerations, I present several suggestions and questions, with the aim of supporting researchers in determining the best course of action for their individual field circumstances.
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Barchi F, Kasimatis Singleton M, Merz JF. Fostering IRB collaboration for review of international research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:3-8. [PMID: 24766110 PMCID: PMC4012328 DOI: 10.1080/15265161.2014.892168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article presents a review of the literature, summarizes current initiatives, and provides a heuristic for assessing the effectiveness of a range of institutional review board (IRB) collaborative strategies that can reduce the regulatory burden of ethics review while ensuring protection of human subjects, with a particular focus on international research. Broad adoption of IRB collaborative strategies will reduce regulatory burdens posed by overlapping oversight mechanisms and has the potential to enhance human subjects protections.
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Edginton ME, Ornstein T, Denholm J, El Sony A, Kim SJ, Narain A, O'Brien R. Research ethics in The Union: an 8-year review of the Ethics Advisory Group. Public Health Action 2013; 3:346-50. [PMID: 26393060 PMCID: PMC4463154 DOI: 10.5588/pha.13.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING The Ethics Advisory Group (EAG) of the International Union Against Tuberculosis and Lung Disease (The Union) was established in 2004 to provide ethical guidance and promote ethical standards within The Union, including reviews of proposed research projects associated with The Union. OBJECTIVES To describe research proposal reviews conducted by the EAG in the period 2005-2012 in terms of 1) annual numbers, 2) the Union departments in which the proposals originated, 3) study designs, 4) regions and countries where studies were to be conducted, 5) study topics, 6) problems encountered by the EAG, and 7) review outcomes. DESIGN Descriptive study of application records of the EAG. RESULTS A total of 292 applications were reviewed; 79% were proposals for operational research; 85% were from Africa and Asia, with 64% from India, South Africa, Malawi, Kenya and Zimbabwe. Tuberculosis was the topic in 68%; only three studies in the 8 years were on other lung diseases. Several problems encountered are highlighted. All applications were approved except six, either immediately or after modification. CONCLUSION The proposal review process of the EAG serves to maintain ethical standards of research within The Union. Ideas for expanding the scope of the EAG are discussed.
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Affiliation(s)
- M E Edginton
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - T Ornstein
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Denholm
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A El Sony
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S J Kim
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Narain
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R O'Brien
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
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