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Dasari H, Smyrnova A, Leng J, Ducharme FM. Feasibility, acceptability, and safety of a novel device for self-collecting capillary blood samples in clinical trials in the context of the pandemic and beyond. PLoS One 2024; 19:e0304155. [PMID: 38809872 PMCID: PMC11135758 DOI: 10.1371/journal.pone.0304155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Home blood self-collection devices can enable remote monitoring, but their implementation requires validation. Our objectives were to explore (i) the impact of sampling sites and topical analgesia on capillary blood volume and pain perception and (ii) the safety, acceptability, and failure of capillary self-collection among adults and children using the Tasso-SST device. METHODS We conducted a two-phase study. The investigational phase consisted of two on-site cross-sectional studies in healthy adult participants (≥ 12 years) and children (1-17 years) with their accompanying parent. Adults received 4 capillary samplings, where puncture sites and topical analgesia were randomized in a factorial design, and a venipuncture; children (and one parent) had one capillary sampling. The two co-primary outcomes were blood volume and pain. The implementation phase was conducted in two multicentre trials in participants choosing remote visits; blood volume, collection failure, adverse events, and satisfaction were documented. RESULTS In the investigational phase, 90 participants and 9 children with 7 parents were enrolled; 15 adults and 2 preschoolers participated in the implementation phase. In the adult investigational study, the device collected a median (25%, 75%) of 450 (250, 550) μl of blood with no significant difference between the puncture site, topical analgesia, and its interaction. Using topical analgesia reduced pain perception by 0.61 (95% CI: 0.97, 0.24; P <0.01) points on the 11-point scale; the pain reduction varied by puncture site, with the lower back showing the most significant decrease. Overall, combining all studies and phases, the median volume collected was 425 (250, 500) μl, and the device failure rate was 4.4%; minor adverse effects were reported in 8.9% of the participants, all were willing to use the device again. CONCLUSION Capillary blood self-collection, yielding slightly less than 500 μl, proves to be a safe and relatively painless method for adults and children, with high satisfaction and low failure rates. The puncture site and topical analgesia do not affect blood volume, but topical analgesia on the lower back could reduce pain.
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Affiliation(s)
- Harika Dasari
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Anna Smyrnova
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jing Leng
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Francine M. Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, University of Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Québec, Canada
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Löfgren L, von Euler Chelpin M, Bhat M, Althage M, Hober A, Edfors F, Ruckh T, Challis B, Davidsson P, Miliotis T. Patient-Centric Quantitative Microsampling for Accurate Determination of Urine Albumin to Creatinine Ratio (UACR) in a Clinical Setting. J Appl Lab Med 2024; 9:329-341. [PMID: 38113397 DOI: 10.1093/jalm/jfad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Developing and implementing new patient-centric strategies for drug trials lowers the barrier to participation for some patients by reducing the need to travel to research sites. In early chronic kidney disease (CKD) trials, albuminuria is the key measure for determining treatment effect prior to pivotal kidney outcome trials. METHODS To facilitate albuminuria sample collection outside of a clinical research site, we developed 2 quantitative microsampling methods to determine the urinary albumin to creatinine ratio (UACR). Readout was performed by LC-MS/MS. RESULTS For the Mitra device the within-batch precision (CV%) was 2.8% to 4.6% and the between-batch precision was 5.3% to 6.1%. Corresponding data for the Capitainer device were 4.0% to 8.6% and 6.7% to 9.0%, respectively. The storage stability at room temperature for 3 weeks was 98% to 103% for both devices. The recovery for the Mitra and Capitainer devices was 104% (SD 7.0%) and 95 (SD 7.4%), respectively. The inter-assay comparison of UACR assessment generated results that were indistinguishable regardless of microsampling technique. The accuracy based on LC-MS/MS vs analysis of neat urine using a clinical chemistry analyzer was assessed in a clinical setting, resulting in 102 ± 8.0% for the Mitra device and 95 ± 10.0% for the Capitainer device. CONCLUSIONS Both UACR microsampling measurements exhibit excellent accuracy and precision compared to a clinical chemistry analyzer using neat urine. We applied our patient-centric sampling strategy to subjects with heart failure in a clinical setting. Precise UACR measurements using quantitative microsampling at home would be beneficial in clinical drug development for kidney therapies.
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Affiliation(s)
- Lars Löfgren
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Marianne von Euler Chelpin
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Maria Bhat
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Magnus Althage
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Andreas Hober
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
- Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
- Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm.Sweden
| | - Fredrik Edfors
- Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
- Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm.Sweden
| | - Tim Ruckh
- R&D Digital Health, AstraZeneca, Gothenburg, Sweden
| | - Benjamin Challis
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Pia Davidsson
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Tasso Miliotis
- Translational Science and Experimental Medicine, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
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Sinha SD, Chary Sriramadasu S, Raphael R, Roy S. Decentralisation in Clinical Trials and Patient Centricity: Benefits and Challenges. Pharmaceut Med 2024; 38:109-120. [PMID: 38453755 DOI: 10.1007/s40290-024-00518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Decentralised clinical trials (DCTs) encompass various terms such as virtual, home-based, remote and siteless trials. The objectives of DCTs are to enhance the ease of participation for patients in clinical trials by minimising or removing the necessity for trial subjects to travel to the trial sites. This approach has been shown to reduce drop-out rates, increase study effectiveness and ultimately get life-altering drugs to market faster-saving sponsors billions. At the outset, DCTs deploy a wide range of digital technologies to collect safety and efficacy data from study participants, providing study treatments and performing investigations from the comfort of the patient's own home. The aim of decentralised trials includes patient centricity, enhanced efficacy in clinical trial conduct and generating real-world data. This is done by not only making it convenient for the patient to participate in the trial execution, but also involving them from the planning stage and taking their inputs during designing of trials and consenting documentation, understanding their treatment requirements and designing the studies accordingly. Various regulatory authorities have published guidelines governing DCT principles, especially after the coronavirus disease 2019 (COVID-19) experience of undertaking multicentric clinical trials. Both United States Food and Drug Administration (USFDA) and European Medicines Agency (EMA) have newer, recently updated guidelines to capture this growing reality to undertake clinical trials using patient technology or patient-centric technologies. Other regulatory agencies are accepting data generated using decentralised and patient-centric technologies and making an effort to include elements of decentralised trials in their regulatory guidelines. Decentralised trials follow a hybrid approach to have a balanced mix of remote and in-person data collection and trial procedures. Decentralised and patient-centric approaches are the future of any organisation for the conduct of clinical trials. Globally, all sponsor pharmaceutical companies must start undertaking drug development and clinical trials using a decentralised approach while keeping patient centricity in mind.
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Affiliation(s)
- Shubhadeep D Sinha
- Department of Clinical Development and Medical Affairs, Hetero Labs Limited, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Telangana, 500018, India.
| | - Sreenivasa Chary Sriramadasu
- Department of Clinical Development and Medical Affairs, Hetero Labs Limited, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Telangana, 500018, India
| | - Ruby Raphael
- Department of Clinical Development and Medical Affairs, Hetero Labs Limited, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Telangana, 500018, India
| | - Sudeshna Roy
- Department of Clinical Development and Medical Affairs, Hetero Labs Limited, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Telangana, 500018, India
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Nomali M, Mehrdad N, Heidari ME, Ayati A, Yadegar A, Payab M, Olyaeemanesh A, Larijani B. Challenges and solutions in clinical research during the COVID-19 pandemic: A narrative review. Health Sci Rep 2023; 6:e1482. [PMID: 37554954 PMCID: PMC10404843 DOI: 10.1002/hsr2.1482] [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: 03/13/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic has presented significant challenges to clinical research, necessitating the adoption of innovative and remote methods to conduct studies. This study aimed to investigate these challenges and propose solutions for conducting clinical research during the pandemic. METHODS A narrative review was conducted (approval ID: IR.AMS.REC.1401.029), utilizing keyword searches in PubMed and Web of Science (WOS) citation index expanded (SCI-EXPANDED) from January 2020 to January 2023. Keywords included COVID-19, clinical research, barriers, obstacles, facilitators and enablers. RESULTS Out of 2508 records retrieved, 43 studies were reviewed, providing valuable insights into the challenges and corresponding solutions for conducting clinical research during the COVID-19 pandemic. The identified challenges were categorized into four main groups: issues related to researchers or investigators, issues related to participants and ethical concerns, administrative issues, and issues related to research implementation. To address these challenges, multiple strategies were proposed, including remote monitoring through phone or video visits, online data collection and interviews to minimize in-person contact, development of virtual platforms for participant interaction and questionnaire completion, consideration of financial incentives, adherence to essential criteria such as inclusion and exclusion parameters, participant compensation, and risk assessment for vulnerable patients. CONCLUSION The COVID-19 pandemic has significantly impacted clinical research, requiring the adaptation and enhancement of existing research structures. Although remote methods and electronic equipment have limitations, they hold promise as effective solutions during this challenging period.
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Affiliation(s)
- Mahin Nomali
- Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Neda Mehrdad
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
- Nursing and Midwifery Care Research Center, Health Management Research InstituteIran University of Medical SciencesTehranIran
| | - Mohammad Eghbal Heidari
- Students' Scientific Research Center, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), Vali‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Moloud Payab
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Alireza Olyaeemanesh
- National Institute of Health ResearchTehran University of Medical SciencesTehranIran
- Health Equity Research Center (HERC)Tehran University of Medical Sciences (TUMS)TehranIran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
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Johnson E, Marsh L. Clinical research nurse utilisation and role in the conduct of decentralised clinical trials: a literature review. J Res Nurs 2023; 28:214-226. [PMID: 37332317 PMCID: PMC10272696 DOI: 10.1177/17449871231162497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background The decentralised clinical trial (DCT) model has been popularised given its remote or virtual design, permitting expanded participant enrolment into community settings. Clinical research nurses (CRNs) are specially trained in the management of clinical trials; however, the utilisation of the research nurse role relating to decentralised trial conduct is not well-established. Aims A literature review was conducted to describe the role of the research nurse in the conduct of DCTs and the current utilisation of this nurse specialty for decentralised trial management. Methods Use of keywords 'DCT' or 'virtual trial' and 'nursing' were used to identify full-text, peer-reviewed literature in the English language and published within the last 10 years that described the clinical research nursing role. Results Of the 102 pre-screened articles identified across five databases, 11 articles were eligible for full-text analysis. Thematic groupings of common discussion elements included Variance in Decentralised Clinical Trial Model Implementation, CRN Involvement in Decentralised Trial Conduct and Reporting and Shared Challenges of Decentralised Trial Implementation Affecting the CRN Role. Conclusions Implications of this literature review include expanded trial sponsor awareness of the support requirements to facilitate research nurse utilisation and optimal decentralised trial conduct.
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Affiliation(s)
- Elizabeth Johnson
- Assistant Professor, Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA
| | - Lisa Marsh
- Adjunct Faculty, Buntain College of Nursing, Northwest University, Kirkland, WA, USA
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Derobertmasure A, Kably B, Justin J, De Sousa Carvalho C, Billaud EM, Boutouyrie P. Dried Urine Spot Analysis for assessing cardiovascular drugs exposure applicable in spaceflight conditions. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1219:123539. [PMID: 36867996 DOI: 10.1016/j.jchromb.2022.123539] [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: 09/01/2022] [Revised: 10/24/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
Cardiovascular pharmacological countermeasures will be required as a preventive measure of cardiovascular deconditioning and early vascular ageing for long term space travelers. Physiological changes during spaceflight could have severe implications on drug pharmacokinetics and pharmacodynamics (PK/PD). However, limitations exist for the implementation of drug studies due to the requirements and constraints of this extreme environment. Therefore, we developed an easy sampling method on dried urine spot (DUS), for the simultaneous quantification of 5 antihypertensive drugs in human urine: irbesartan, valsartan, olmesartan, metoprolol and furosemide analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), considering spaceflight parameters. This assay was validated in terms of linearity, accuracy, and precision with satisfactory results. There were no relevant carry-over, matrix interferences. The targeted drugs were stable in urine collected by DUS until 6 months at +21 °C, +4°C, -20 °C (with or without desiccants) and at 30 °C during 48 h. Irbesartan, valsartan and olmesartan were not stable at 50 °C during 48 h. This method was found to be eligible for space pharmacology studies in terms of practicality, safety, robustness and energy costs. It has been successfully implemented in space tests programs led in 2022.
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Affiliation(s)
- Audrey Derobertmasure
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France; INSERM PARCC UMRS970, Paris, France
| | - Benjamin Kably
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France; INSERM PARCC UMRS970, Paris, France
| | - Junior Justin
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France
| | - Christelle De Sousa Carvalho
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France
| | - Eliane M Billaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France; Université de Paris, Paris, France
| | - Pierre Boutouyrie
- Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU BIOPHYGEN, Paris, France; INSERM PARCC UMRS970, Paris, France; Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Pharmacology Unit and DMU CARTE, Paris, France; Université de Paris, Paris, France.
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Conducting CNS trials during a public health emergency – Lessons learned from the COVID-19 pandemic: A joint ISCTM/ECNP working group consensus paper. NEUROSCIENCE APPLIED 2023; 2:101129. [PMCID: PMC10275769 DOI: 10.1016/j.nsa.2023.101129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 12/11/2023]
Abstract
A joint working group between the International Society of CNS Clinical Trials and Methodology (ISCTM) and the European College of Neuropsychopharmacology (ECNP) was formed in the latter part of 2020 to explore possible ways to mitigate the impact of Coronavirus disease-19 (COVID-19) in clinical trials while attempting to advance approaches and capabilities to bring new therapeutics to patients. The working group was tasked with developing guidelines for trial design modifications to assist sponsor companies in minimizing risks to data integrity, with a focus on regulatory, technological, operational, and methodological issues related to COVID-19. To facilitate focused and transferable recommendations, three disease categories were selected as examples to demonstrate the breadth of solutions implemented across CNS clinical trials, as well as ongoing challenges. The categories studied reflected the interests and expertise of the working group, and included neurodegenerative diseases and dementia, mental health disorders, and rare/pediatric diseases. Herein, we describe interim recommendations from the working group as well as priorities for future public health emergencies, to inform permanent adoption in CNS clinical trial development and conduct.
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Zahradka N, Pugmire J, Lever Taylor J, Wolfberg A, Wilkes M. Deployment of an End-to-End Remote, Digitalized Clinical Study Protocol in COVID-19: Process Evaluation. JMIR Form Res 2022; 6:e37832. [PMID: 35852933 PMCID: PMC9345299 DOI: 10.2196/37832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/24/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The SARS-CoV-2 (COVID-19) pandemic may accelerate the adoption of digital, decentralized clinical trials. Conceptual recommendations for digitalized and remote clinical studies and technology are available to enable digitalization. Fully remote studies may break down some of the participation barriers in traditional trials. However, they add logistical complexity and offer fewer opportunities to intervene following a technical failure or adverse event. Objective Our group designed an end-to-end digitalized clinical study protocol, using the Food and Drug Administration (FDA)–cleared Current Health (CH) remote monitoring platform to collect symptoms and continuous physiological data of individuals recently infected with COVID-19 in the community. The purpose of this work is to provide a detailed example of an end-to-end digitalized protocol implementation based on conceptual recommendations by describing the study setup in detail, evaluating its performance, and identifying points of success and failure. Methods Primary recruitment was via social media and word of mouth. Informed consent was obtained during a virtual appointment, and the CH-monitoring kit was shipped directly to the participants. The wearable continuously recorded pulse rate (PR), respiratory rate (RR), oxygen saturation (SpO2), skin temperature, and step count, while a tablet administered symptom surveys. Data were transmitted in real time to the CH cloud-based platform and displayed in the web-based dashboard, with alerts to the study team if the wearable was not charged or worn. The study duration was up to 30 days. The time to recruit, screen, consent, set up equipment, and collect data was quantified, and advertising engagement was tracked with a web analytics service. Results Of 13 different study advertisements, 5 (38.5%) were live on social media at any one time. In total, 38 eligibility forms were completed, and 19 (50%) respondents met the eligibility criteria. Of these, 9 (47.4%) were contactable and 8 (88.9%) provided informed consent. Deployment times ranged from 22 to 110 hours, and participants set up the equipment and started transmitting vital signs within 7.6 (IQR 6.3-10) hours of delivery. The mean wearable adherence was 70% (SD 19%), and the mean daily survey adherence was 88% (SD 21%) for the 8 participants. Vital signs were in normal ranges during study participation, and symptoms decreased over time. Conclusions Evaluation of clinical study implementation is important to capture what works and what might need to be modified. A well-calibrated approach to online advertising and enrollment can remove barriers to recruitment and lower costs but remains the most challenging part of research. Equipment was effectively and promptly shipped to participants and removed the risk of illness transmission associated with in-person encounters during a pandemic. Wearable technology incorporating continuous, clinical-grade monitoring offered an unprecedented level of detail and ecological validity. However, study planning, relationship building, and troubleshooting are more complex in the remote setting. The relevance of a study to potential participants remains key to its success.
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Affiliation(s)
| | | | | | | | - Matt Wilkes
- Current Health Ltd, Edinburgh, United Kingdom
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Ethics review of decentralized clinical trials (DCTs): Results of a mock ethics review. Drug Discov Today 2022; 27:103326. [PMID: 35870693 DOI: 10.1016/j.drudis.2022.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
Decentralized clinical trials (DCTs) can be a valuable addition to the clinical trial landscape. However, the practice of DCTs is dependent on a regulatory system designed for conventional (site-based) trials. This study provides insight into the ethics review of DCTs. A 'mock ethics review' was performed in which members of European ethics committees (ECs) and national competent authorities (NCAs) discussed and reviewed a DCT protocol. Respondents expressed hesitancy toward DCTs and focused on potential risks and burdens. We advise to address these aspects explicitly when submitting a DCT protocol. We propose that both the benefits and risks of DCTs should be carefully monitored to advance the review and practice of this innovative approach to ethically optimize drug development.
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Alguacil Ojeda J. [Biomedical research and innovation and COVID-19 syndemic. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S87-S92. [PMID: 35781155 PMCID: PMC9244786 DOI: 10.1016/j.gaceta.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/23/2022]
Abstract
Objetivo Describir críticamente la respuesta en investigación e innovación (I + I) contra la sindemia por COVID-19 en el ámbito nacional, contextualizada internacionalmente. Método Revisión narrativa dirigida. Resultados En la sindemia por COVID-19 se ha pasado la presión a la comunidad científica en general, e innovadora biomédica en particular, para aportar soluciones sobre todo de productos biotecnológicos. La mayoría de las recomendaciones de paneles expertos no van orientadas a una respuesta biotecnológica (que también debe existir), sino de gobernanza, organizativa, socioeconómica y de apoyo a las infraestructuras de salud pública. Existe un déficit importante en la inclusión de la perspectiva de género en la I + I por COVID-19. La sindemia ha ofrecido una oportunidad (desaprovechada) para potenciar la I + I desde la perspectiva epidemiológica contra brotes infecciosos con potencial de provocar crisis en salud pública reivindicando el liderazgo desde la epidemiología. Hace falta evaluar si la gran inversión en I + I biomédica orientada a la medicina personalizada puede integrarse eficientemente en los proveedores públicos de salud ante crisis sanitarias. Conclusiones Es urgente diseñar una estrategia de I + I en España en línea con los fondos disponibles internacionalmente y que se beneficie de ellos, pero que provea al país del máximo de independencia de cara a afrontar situaciones críticas para la salud pública.
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Affiliation(s)
- Juan Alguacil Ojeda
- Centro de Investigación en Recursos Naturales, Medio Ambiente y Salud (RENSMA), Facultad de Ciencias Experimentales, Universidad de Huelva, Huelva, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
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Le Prell CG, Brewer CC, Campbell KCM. The audiogram: Detection of pure-tone stimuli in ototoxicity monitoring and assessments of investigational medicines for the inner ear. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:470. [PMID: 35931504 PMCID: PMC9288270 DOI: 10.1121/10.0011739] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Pure-tone thresholds have long served as a gold standard for evaluating hearing sensitivity and documenting hearing changes related to medical treatments, toxic or otherwise hazardous exposures, ear disease, genetic disorders involving the ear, and deficits that develop during aging. Although the use of pure-tone audiometry is basic and standard, interpretation of thresholds obtained at multiple frequencies in both ears over multiple visits can be complex. Significant additional complexity is introduced when audiometric tests are performed within ototoxicity monitoring programs to determine if hearing loss occurs as an adverse reaction to an investigational medication and during the design and conduct of clinical trials for new otoprotective agents for noise and drug-induced hearing loss. Clinical trials using gene therapy or stem cell therapy approaches are emerging as well with audiometric outcome selection further complicated by safety issues associated with biological therapies. This review addresses factors that must be considered, including test-retest variability, significant threshold change definitions, use of ototoxicity grading scales, interpretation of early warning signals, measurement of notching in noise-induced hearing loss, and application of age-based normative data to interpretation of pure-tone thresholds. Specific guidance for clinical trial protocols that will assure rigorous methodological approaches and interpretable audiometric data are provided.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas 75080, USA
| | - Carmen C Brewer
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Washington D.C. 20892, USA
| | - Kathleen C M Campbell
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois 62702, USA
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Special Focus Issue - COVID-19: bioanalytical considerations, contributions and lessons - part 1. Bioanalysis 2021; 13:1157-1159. [PMID: 34404225 DOI: 10.4155/bio-2021-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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