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Varma R, Staab JP, Matey ET, Wright JA, Deb B, Lazaridis KN, Szarka LA, Bailey KR, Bharucha AE. Most patients with disorders of gut-brain interaction receive pharmacotherapy with major or moderate drug-gene interactions. Neurogastroenterol Motil 2024; 36:e14722. [PMID: 38072827 DOI: 10.1111/nmo.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND How variations predicted by pharmacogenomic testing to alter drug metabolism and therapeutic response affect outcomes for patients with disorders of gut- brain interaction is unclear. AIMS To assess the prevalence of pharmacogenomics-predicted drug-gene interactions and symptom outcomes for patients with disorders of gut-brain interaction. METHODS Patients who were treated in our clinical practice for functional dyspepsia/bowel disorder underwent pharmacogenomic testing. The change in symptoms from baseline to 6 months was compared for patients with variations in CYP2D6 and CYP2C19, which metabolize neuromodulators, and SLC6A4, which encodes the sodium- dependent serotonin transporter. RESULTS At baseline, 79 of 94 participants (84%) had at least one predicted major drug- gene interaction, and all 94 (100%) had at least one predicted moderate interaction. For the 44 participants who completed a survey of their symptoms at 6 months, the mean (SD) irritable bowel syndrome-symptom severity score decreased from 284 (71) at baseline to 231 (95) at 6 months (p < 0.001). Among patients taking selective serotonin reuptake inhibitors, the decrease in symptom severity (p = 0.03) and pain (p = 0.002) scores from baseline to 6 months was greater for patients with a homozygous SLC6A4 long/long genotype (n = 30) (ie, increased serotonin transporter activity) than for patients with homozygous short/short or heterozygous long/short genotypes (n = 64). Symptom outcomes were not affected by CYP2D6 or CYP2C19 variations. CONCLUSIONS The homozygous SLC6A4 long/long genotype confers better symptom resolution for patients with disorders of gut-brain interaction who take selective serotonin reuptake inhibitors than do the homozygous short/short or heterozygous long/short genotypes.
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Affiliation(s)
- Revati Varma
- Research Fellow in the Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric T Matey
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brototo Deb
- Research Fellow in the Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Lawrence A Szarka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Ravi KE, Cronley C, Lawler A, Held ML. Presenting Methodological Resilience for Conducting Research with Vulnerable Populations During Current and Future Pandemics: A Case Study with IPV Shelters and Survivors in the United States. J Fam Violence 2023:1-8. [PMID: 36743688 PMCID: PMC9885919 DOI: 10.1007/s10896-023-00499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Purpose In this brief report, we highlight the challenges that we experienced while attempting to conduct primary data collection with intimate partner violence (IPV) survivors living in an IPV emergency shelter throughout the prolonged COVID-19 pandemic and our strategies to overcome them. Method In the summer of 2021, we began collecting data on a study investigating maternal-child bonding while living in IPV emergency shelters. We proposed a 14-day electronic daily diary methodology with follow-up semi-structured interview. The purpose of the study was to understand what factors affect maternal-child bonding to support survivors' relationships with their children while living in an emergency shelter. Results We encountered two global obstacles to study implementation: the Institutional Review Board (IRB) pausing in-person data collection and low IPV shelter utilization. In what we term methodological resilience, we engaged in innovative and flexible team work to overcome these barriers. Specific strategies centered on creating an entirely remote data collection process and expanding our geographic area and participant eligibility criteria. Conclusions Implications for researchers include greater communication with IRB offices, planning for multi-state recruitment, triangulated recruitment methods, reminder texts for participants and incremental incentives to ensure continued engagement with the study.
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Affiliation(s)
- Kristen E. Ravi
- The University of Tennessee-Knoxville College of Social Work, 1618 Cumberland Ave, Knoxville, TN 37996 USA
| | - Courtney Cronley
- The University of Tennessee-Knoxville College of Social Work, 1618 Cumberland Ave, Knoxville, TN 37996 USA
| | - Ashlee Lawler
- The University of Tennessee-Knoxville College of Social Work, 1618 Cumberland Ave, Knoxville, TN 37996 USA
| | - Mary L. Held
- The University of Tennessee-Knoxville College of Social Work, 1618 Cumberland Ave, Knoxville, TN 37996 USA
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Lerman Ginzburg S, Vazquez-Dodero T, Mason C, Hudda N, Meunier L, Sprague Martínez L, Eliasziw M, Brugge D. Adapting an In-Home Randomized Intervention Trial Protocol for COVID-19 Precautions. Int J Environ Res Public Health 2023; 20:1987. [PMID: 36767354 PMCID: PMC9915540 DOI: 10.3390/ijerph20031987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the status of clinical trials in the United States, requiring researchers to reconsider their approach to research studies. In light of this, we discuss the changes we made to the protocol of the Home Air Filtration for Traffic-Related Air Pollution (HAFTRAP) study, a randomized crossover trial of air filtration in homes next to a major highway. The senior authors designed the trial prior to the pandemic and included in-person data collection in participants' homes. Because of the pandemic, we delayed the start of our trial in order to revise our study protocol to ensure the health and well-being of participants and staff during home visits. To our knowledge, there have been few reports of attempts to continue in-home research during the pandemic. METHODS When pandemic-related protective measures were imposed in March 2020, we were close to launching our trial. Instead, we postponed recruitment, set a new goal of starting in September 2020, and spent the summer of 2020 revising our protocol by developing increased safety precautions. We reviewed alternative approaches to installing portable air filtration units in study participants' homes, in order to reduce or eliminate entry into homes. We also developed a COVID-19 safety plan that covered precautionary measures taken to protect both field team staff and study participants. RESULTS Our primary approach was to minimize contact with participants when collecting the following measures in their homes: (1) placing portable air filtration units; (2) conducting indoor air quality monitoring; (3) obtaining blood samples and blood pressure measurements; and (4) administering screening, consent, and follow-up questionnaires that coincided with collection of biological measures. Adapting our public health trial resulted in delays, but also helped ensure ethical and safe research practices. Perceived risk of COVID-19 infection appeared to have been the primary factor for an individual in deciding whether or not to participate in our trial, particularly at the beginning of the pandemic, when less was known about COVID-19. CONCLUSIONS We needed to be flexible, creative, and calm when collaborating with community members, the IRB, and the universities, while repeatedly adjusting to changing guidelines as we determined what worked and what did not for in-home data collection. We learned that high-quality air monitoring data could be collected with minimal in-person contact and without compromising the integrity of the trial. Furthermore, we were able to collect blood pressure and phlebotomy data with minimal risk to the participant.
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Affiliation(s)
- Shir Lerman Ginzburg
- Department of Public Health, School of Arts and Sciences, MCPHS University, Boston, MA 02115, USA
| | - Teresa Vazquez-Dodero
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Chermaine Mason
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Neelakshi Hudda
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02476, USA
| | - Leigh Meunier
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
| | | | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA
| | - Doug Brugge
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
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Zuckerman S, Barlavie Y, Niv Y, Arad D, Lev S. Accessing unproven interventions in the COVID-19 pandemic: discussion on the ethics of 'compassionate therapies' in times of catastrophic pandemics. J Med Ethics 2022; 48:1000-1005. [PMID: 34645620 PMCID: PMC8520601 DOI: 10.1136/medethics-2020-106783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
Since the onset of the SARS-CoV-2 pandemic, an array of off-label interventions has been used to treat patients, either provided as compassionate care or tested in clinical trials. There is a challenge in determining the justification for conducting randomised controlled trials over providing compassionate use in an emergency setting. A rapid and more accurate evaluation tool is needed to assess the effect of these treatments. Given the similarity to the Ebola Virus Disease (EVD) pandemic in Africa in 2014, we suggest using a tool designed by the WHO committee in the aftermath of the EVD pandemic: Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI). Considering the uncertainty around SARS-CoV-2, we propose using an improved MEURI including the Plan-Do-Study-Act tool. This combined tool may facilitate dynamic monitoring, analysing, re-evaluating and re-authorising emergency use of unproven treatments and repeat it in cycles. It will enable adjustment and application of outcomes to clinical practice according to changing circumstances and increase the production of valuable data to promote the best standard of care and high-quality research-even during a pandemic.
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Affiliation(s)
- Shlomit Zuckerman
- Department of Disaster Medicine & Center for Bioethics and Law, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Barlavie
- Division of Intensive Care, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yaron Niv
- Quality and Safety Program, Ministry of Health, Jerusalem, Israel
- Department of Internal Medicine, Ariel University, Ariel, Israel
| | - Dana Arad
- Division of Patient Safety, Ministry of Health, Jerusalem, Israel
- Department of Health System Managment, Bar Ilan University, Ramat Gan, Israel
| | - Shaul Lev
- Unit of General Intensive Care, Hasharon Hospital, Petah Tikva, Israel
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5
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Rubbo P, Lievore C, Biynkievycz Dos Santos C, Picinin CT, Pilatti LA, Pedroso B. “Research exceptionalism” in the COVID-19 pandemic: an analysis of scientific retractions in Scopus. Ethics & Behavior 2022. [DOI: 10.1080/10508422.2022.2080067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Priscila Rubbo
- Department of Accounting Sciences, Federal University of Technology – Paraná (UTFPR)
| | - Caroline Lievore
- Department of Accounting Sciences, Federal University of Technology – Paraná (UTFPR)
| | | | - Claudia Tania Picinin
- Postgraduate Program in Production Engineering, Federal University of Technology – Paraná (UTFPR)
| | - Luiz Alberto Pilatti
- Postgraduate Program in Science and Technology Teaching and Production Engineering and Postgraduate Program in Production Engineering, Federal University of Technology – Paraná (UTFPR)
| | - Bruno Pedroso
- Postgraduate Program in Health Sciences and Postgraduate Program in Inclusive Education, State University of Ponta Grossa (UEPG)
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Bauer A, Eskat A, Ntekim A, Wong C, Eberle D, Hedayati E, Tay F, Yau H, Stockley L, de Medina Redondo M, Şen S, Egert-Schwender S, Üresin Y, Grossmann R. How COVID-19 changed clinical research strategies: a global survey. J Int Med Res 2022; 50:3000605221093179. [PMID: 35469473 PMCID: PMC9087250 DOI: 10.1177/03000605221093179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical research has faced new challenges during the COVID-19 pandemic, leading to excessive operational demands affecting all stakeholders. We evaluated the impact of COVID-19 on clinical research strategies and compared different adaptations by regulatory bodies and academic research institutions in a global context, exploring what can be learned for possible future pandemics. METHODS We conducted a cross-sectional online survey and identified and assessed different COVID-19-specific adaptation strategies used by academic research institutions and regulatory bodies. RESULTS All 19 participating academic research institutions developed and followed similar strategies, including preventive measures, manpower recruitment, and prioritisation of COVID-19 projects. In contrast, measures for centralised management or coordination of COVID-19 projects, project preselection, and funding were handled differently amongst institutions. Regulatory bodies responded similarly to the pandemic by implementing fast-track authorisation procedures for COVID-19 projects and developing guidance documents. Quality and consistency of the information and advice provided was rated differently amongst institutions. CONCLUSION Both academic research institutions and regulatory bodies worldwide were able to cope with challenges during the COVID-19 pandemic by developing similar strategies. We identified some unique approaches to ensure fast and efficient responses to a pandemic. Ethical concerns should be addressed in any new decision-making process.
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Affiliation(s)
- Annina Bauer
- Annina Bauer Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Anja Eskat
- Anja Eskat Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Atara Ntekim
- Atara Ntekim University of Ibadan/University College Hospital
Ibadan, Ibadan, Nigeria
| | - Creany Wong
- Creany Wong Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Deborah Eberle
- Deborah Eberle Clinical Trials Center Zürich, University
Hospital Zurich, Zurich, Switzerland
| | - Elham Hedayati
- Elham Hedayat Department of Oncology-Pathology, Cancer Center
Karolinska, Karolinska Institute, Stockholm, Sweden
| | - Fabian Tay
- Fabian Tay Clinical Trials Center Zürich, University Hospital
Zurich, Zurich, Switzerland
| | - Henry Yau
- Henry Yau Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Louise Stockley
- Louise Stockley Cambridge Clinical Trials Unit, Cambridge
University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Selçuk Şen
- Henry Yau Clinical Trials Centre, The University of Hong Kong,
Hong Kong
| | - Silvia Egert-Schwender
- Louise Stockley Cambridge Clinical Trials Unit, Cambridge
University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Yağız Üresin
- María de Medina Redondo Clinical Trials Center Zürich,
University Hospital Zurich, Zurich, Switzerland
| | - Regina Grossmann
- Selçuk Şen Center of Excellence for Clinical Research,
University of Istanbul, Istanbul, Turkey
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Abstract
ABSTRACT ED nurses are at high risk for developing moral distress during the COVID-19 pandemic. Predisposing factors include limited resources, inadequate staffing, PPE shortages, and caring for vulnerable populations. This article explores personal and organizational strategies to help nurses cope with moral distress.
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Affiliation(s)
- Salima Bano Virani
- Salima Bano Virani is an ED nurse at St. Michaels Hospital in Toronto, Canada, and a sessional faculty member in the School of Community and Health Studies at Centennial College in Ontario
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8
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Bharucha AE, Rhodes CT, Boos CM, Keller DA, Dispenzieri A, Oldenburg RP. Increased Utilization of Virtual Visits and Electronic Approaches in Clinical Research During the COVID-19 Pandemic and Thereafter. Mayo Clin Proc 2021; 96:2332-2341. [PMID: 34481597 PMCID: PMC8255101 DOI: 10.1016/j.mayocp.2021.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on clinical research and the use of electronic approaches to mitigate this impact. METHODS We compared the utilization of electronic consenting, remote visits, and remote monitoring by study monitors in all research studies conducted at Mayo Clinic sites (Arizona, Florida, and Minnesota) before and during the COVID-19 pandemic (ie, between May 1, 2019 and December 31, 2020). Participants are consented through a participant-tracking system linked to the electronic health record. RESULTS Between May 2019, and December 2020, there were 130,800 new consents across every modality (electronic and paper) to participate in a non-trial (107,176 [82%]) or a clinical trial (23,624 [18%]). New consents declined from 5741 in February 2020 to 913 in April 2020 but increased to 11,864 in November 2020. The mean (standard deviation [SD]) proportion of electronic consent increased from 22 (2%) before to 45 (20%) during the pandemic (P=.001). Mean (SD) remote electronic consenting increased from 0.3 (0.5%) to 29 (21%) (P<.001). The mean (SD) number of patients with virtual visits increased from 3.5 (2.4%) to 172 (135%) (P=.003) per month between pre-COVID (July 2019 to February 2020) and post-COVID (March to December 2020) periods. Virtual visits used telemedicine (68%) or video (32%). Requests for remote monitor access to complete visits increased from 44 (17%) per month between May 2019 and February 2020 to 111 (74%) per month between March and December 2020 (P=.10). CONCLUSION After a sharp early decline, the enrollment of new participants and ongoing study visits recovered during the COVID-19 pandemic. This recovery was accompanied by the increased use of electronic tools.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
| | - Cathi T Rhodes
- Research Systems Operations, Mayo Clinic, Scottsdale, AZ
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Bharucha AE, Gantz MG, Rao SS, Lowry AC, Chua H, Karunaratne T, Wu J, Hamilton FA, Whitehead WE. Comparative effectiveness of biofeedback and injectable bulking agents for treatment of fecal incontinence: Design and methods. Contemp Clin Trials 2021; 107:106464. [PMID: 34139357 PMCID: PMC8429255 DOI: 10.1016/j.cct.2021.106464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022]
Abstract
Fecal incontinence (FI), the involuntary passage of stool, is common and can markedly impair the quality of life. Among patients who fail initial options (pads or protective devices, bowel modifying agents, and pelvic floor exercises), the options are pelvic floor biofeedback (BIO), perianal injection with bulking agents (INJ), and sacral nerve electrical stimulation (SNS), which have not been subjected to head-to-head comparisons. This study will compare the safety and efficacy of BIO and INJ for managing FI. The impact of these approaches on quality-of-life and psychological distress, cost effectiveness, and predictors of response to therapy will also be evaluated. Six centers in the United States will enroll approximately 285 patients with moderate to severe FI. Patients who have 4 or more FI episodes over 2 weeks proceed to a 4-week trial of enhanced medical management (EMM) (ie, education, bowel management, and pelvic floor exercises). Thereafter, 194 non-responders as defined by a less than 75% reduction in the frequency of FI will be randomized to BIO or INJ. Three months later, the efficacy, safety, and cost of therapy will be assessed; non-responders will be invited to choose to add the other treatment or SNS for the remainder of the study. Early EMM responders will be re-evaluated 3 months later and non-responders randomized to BIO or INJ. Standardized, and where appropriate validated approaches will be used for study procedures, which will be performed by trained personnel. Prospectively collected data on care costs and resource utilization will be used for cost effectiveness analyses.
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Affiliation(s)
- Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
| | - Marie G. Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC
| | - Satish S. Rao
- Division of Gastroenterology, Augusta University, Augusta, Ga
| | - Ann C. Lowry
- Colon and Rectal Surgery Associates, Minneapolis, Mn
| | - Heidi Chua
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
| | | | - Jennifer Wu
- Division of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Frank A. Hamilton
- National Institute of Digestive Diseases, Kidney, and Diabetes, Bethesda, MD
| | - William E. Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
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Orkin AM, Gill PJ, Ghersi D, Campbell L, Sugarman J, Emsley R, Steg PG, Weijer C, Simes J, Rombey T, Williams HC, Wittes J, Moher D, Richards DP, Kasamon Y, Getz K, Hopewell S, Dickersin K, Wu T, Ayala AP, Schulz KF, Calleja S, Boutron I, Ross JS, Golub RM, Khan KM, Mulrow C, Siegfried N, Heber J, Lee N, Kearney PR, Wanyenze RK, Hróbjartsson A, Williams R, Bhandari N, Jüni P, Chan AW. Guidelines for Reporting Trial Protocols and Completed Trials Modified Due to the COVID-19 Pandemic and Other Extenuating Circumstances: The CONSERVE 2021 Statement. JAMA 2021; 326:257-265. [PMID: 34152382 DOI: 10.1001/jama.2021.9941] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Extenuating circumstances can trigger unplanned changes to randomized trials and introduce methodological, ethical, feasibility, and analytical challenges that can potentially compromise the validity of findings. Numerous randomized trials have required changes in response to the COVID-19 pandemic, but guidance for reporting such modifications is incomplete. OBJECTIVE As a joint extension for the CONSORT and SPIRIT reporting guidelines, CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstances) aims to improve reporting of trial protocols and completed trials that undergo important modifications in response to extenuating circumstances. EVIDENCE A panel of 37 international trial investigators, patient representatives, methodologists and statisticians, ethicists, funders, regulators, and journal editors convened to develop the guideline. The panel developed CONSERVE following an accelerated, iterative process between June 2020 and February 2021 involving (1) a rapid literature review of multiple databases (OVID Medline, OVID EMBASE, and EBSCO CINAHL) and gray literature sources from 2003 to March 2021; (2) consensus-based panelist meetings using a modified Delphi process and surveys; and (3) a global survey of trial stakeholders. FINDINGS The rapid review yielded 41 673 citations, of which 38 titles were relevant, including emerging guidance from regulatory and funding agencies for managing the effects of the COVID-19 pandemic on trials. However, no generalizable guidance for all circumstances in which trials and trial protocols might face unanticipated modifications were identified. The CONSERVE panel used these findings to develop a consensus reporting guidelines following 4 rounds of meetings and surveys. Responses were received from 198 professionals from 34 countries, of whom 90% (n = 178) indicated that they understood the concept definitions and 85.4% (n = 169) indicated that they understood and could use the implementation tool. Feedback from survey respondents was used to finalize the guideline and confirm that the guideline's core concepts were applicable and had utility for the trial community. CONSERVE incorporates an implementation tool and checklists tailored to trial reports and trial protocols for which extenuating circumstances have resulted in important modifications to the intended study procedures. The checklists include 4 sections capturing extenuating circumstances, important modifications, responsible parties, and interim data analyses. CONCLUSIONS AND RELEVANCE CONSERVE offers an extension to CONSORT and SPIRIT that could improve the transparency, quality, and completeness of reporting important modifications to trials in extenuating circumstances such as COVID-19.
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Affiliation(s)
- Aaron M Orkin
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australia
| | - Lisa Campbell
- Clinical Trials Unit, Medicines and Healthcare Products Regulatory Agency, London, England
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England
| | | | - Charles Weijer
- Departments of Medicine, Epidemiology and Biostatistics, and Philosophy, Western University, London, Ontario, Canada
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Hywel C Williams
- University of Nottingham, Nottingham, England
- National Institute for Health Research, Nottingham, England
| | | | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Yvette Kasamon
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Kenneth Getz
- Tufts Center for the Study of Drug Development, Boston, Massachusetts
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, University of Oxford, Oxford, England
| | - Kay Dickersin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Taixiang Wu
- Chinese Clinical Trial Registry, Sichuan University, Chengdu, China
| | - Ana Patricia Ayala
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth F Schulz
- FHI 360, Durham, North Carolina
- School of Medicine, University of North Carolina at Chapel Hill
| | - Sabine Calleja
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Boutron
- Centre of Research in Epidemiology and Statistics, Université de Paris, Inserm, Paris, France
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- The BMJ , London, England
| | - Robert M Golub
- Deputy Editor, JAMA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karim M Khan
- Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis, Ottawa, Ontario, Canada
| | - Cindy Mulrow
- University of Texas Health Science Center, San Antonio
| | - Nandi Siegfried
- Alcohol, Tobacco, and Other Drugs Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Joerg Heber
- Lawrence Berkeley National Laboratory, Berkeley, California
| | | | - Pamela Reed Kearney
- Office of Extramural Research, Division of Human Subjects Research, National Institutes of Health, Bethesda, Maryland
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
| | - Rebecca Williams
- ClinicalTrials.gov, National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Peter Jüni
- Applied Health Research Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Banack HR, Lesko CR, Whitcomb BC, Kobayashi LC. Teaching Epidemiology Online (Pandemic Edition). Am J Epidemiol 2021; 190:1183-1189. [PMID: 33354713 PMCID: PMC7799241 DOI: 10.1093/aje/kwaa285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
In response to the threat posed by the coronavirus disease 2019 (COVID-19) pandemic, many universities are encouraging or requiring online instruction. Teaching an epidemiology course online is different in many respects from teaching in person. In this article, we review specific approaches and strategies related to teaching epidemiology online during the pandemic and beyond, including a discussion of options for course format, grading and assessment approaches, pandemic-related contingencies, and the use of technology. Throughout this article we present practical, epidemiology-specific teaching examples. Moreover, we also examine 1) how the lessons learned about the practice of epidemiology during the pandemic can be integrated into the didactic content of epidemiology training programs and 2) whether epidemiologic pedagogy and teaching strategies should change in the long term, beyond the COVID-19 pandemic. The pandemic has served to heighten our awareness of concerns related to student health and safety, as well as issues of accessibility, equity, and inclusion. Our goal is to present a practical overview connecting pandemic-era online teaching with thoughts about the future of epidemiologic instruction.
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Affiliation(s)
- Hailey R Banack
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
- Correspondence to Dr. Hailey Banack, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, 14214 ph: 716-829-5358
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian C Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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12
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Perillat L, Baigrie BS. COVID-19 and the generation of novel scientific knowledge: Research questions and study designs. J Eval Clin Pract 2021; 27:694-707. [PMID: 33590660 PMCID: PMC8014661 DOI: 10.1111/jep.13550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARS-CoV-2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper is the first part of a series of two papers that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific knowledge during the COVID-19 pandemic. METHODS During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers, and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. RESULTS This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimising biases and increasing objectivity, were, instead, the subject of fruitless oppositions. The duplication of research works, combined with poor-quality research, has greatly contributed to slowing down the creation of novel scientific knowledge. CONCLUSIONS The COVID-19 pandemic presented challenges in terms of (1) finding and prioritising relevant research questions and (2) choosing study designs that are appropriate for a time of emergency.
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Affiliation(s)
- Lucie Perillat
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Brian S Baigrie
- Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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13
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Gill SV, Shin D, Ayoub M, Keegan L, Desrochers PC, Helfrich CA. Pivoting in Context: Using the Forging Alliances in Interdisciplinary Rehabilitation Research Model to Collaborate During COVID-19. Am J Phys Med Rehabil 2021; 100:519-525. [PMID: 33782276 PMCID: PMC8131232 DOI: 10.1097/phm.0000000000001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT With the onset of the COVID-19 pandemic, researchers have been faced with challenges in maintaining interdisciplinary research collaborations. The purpose of this article is to apply and expand a previously introduced model to sustaining new interdisciplinary research collaborations: Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR). FAIRR is a logic model that can be used as a guide to create interdisciplinary rehabilitation research teams. In this article, the authors propose expanding FAIRR by including strategies for sustaining interdisciplinary rehabilitation research collaborations: modifying inputs (resources needed to assemble a team and to conduct research activities), shifting activities (steps taken to move the interdisciplinary collaboration forward), and examining what impacts the fit between inputs and activities. Two examples are used to highlight the application of the FAIRR model to interdisciplinary collaborations during COVID-19.
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Affiliation(s)
- Simone V. Gill
- College of Health and Rehabilitation Science: Sargent College, 677 Beacon Street, Boston University, Boston, MA 02215, USA
| | - Danny Shin
- College of Health and Rehabilitation Science: Sargent College, 677 Beacon Street, Boston University, Boston, MA 02215, USA
| | - Maria Ayoub
- College of Health and Rehabilitation Science: Sargent College, 677 Beacon Street, Boston University, Boston, MA 02215, USA
| | - Laura Keegan
- College of Health and Rehabilitation Science: Sargent College, 677 Beacon Street, Boston University, Boston, MA 02215, USA
| | - Phillip C. Desrochers
- College of Health and Rehabilitation Science: Sargent College, 677 Beacon Street, Boston University, Boston, MA 02215, USA
| | - Christine A. Helfrich
- American International College, Division of Occupational Therapy, 1000 State Street, Springfield, MA 01109
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14
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Abstract
Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.
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15
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Gould JF, Best K, Netting MJ, Gibson RA, Makrides M. New Methodologies for Conducting Maternal, Infant, and Child Nutrition Research in the Era of COVID-19. Nutrients 2021; 13:941. [PMID: 33803970 DOI: 10.3390/nu13030941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) outbreak rapidly became a worldwide pandemic in early 2020. In Australia, government-mandated restrictions on non-essential face-to-face contact in the healthcare setting have been crucial for limiting opportunities for COVID-19 transmission, but they have severely limited, and even halted, many research activities. Our institute's research practices in the vulnerable populations of pregnant women and young infants needed to adapt in order to continue without exposing participants, or staff, to an increased risk of exposure to COVID-19. Here, we discuss our pre-and-post COVID-19 methods for conducting research regarding nutrition during pregnancy, infancy, and early childhood. We discuss modifications to study methods implemented to avoid face-to-face contact when identifying and recruiting potential participants, gaining informed consent, conducting appointments, and collecting outcome data, and the implications of these changes. The COVID-19 pandemic has required numerous changes to the conduct of research activities, but many of those modifications will be useful in post-COVID-19 research settings.
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16
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Muñoz de Nova JL, Ortega-Gómez M, Abad-Santos F. Research during the SARS-CoV-2 pandemic. ACTA ACUST UNITED AC 2021; 156:39-40. [PMID: 33294623 PMCID: PMC7713575 DOI: 10.1016/j.medcle.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- José Luis Muñoz de Nova
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.,Facultad de Medicina. Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Mara Ortega-Gómez
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.,Biobanco, Hospital Universitario de La Princesa, Madrid, Spain
| | - Francisco Abad-Santos
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.,Facultad de Medicina. Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Servicio de Farmacología Clínica, Hospital Universitario de La Princesa, Madrid, Spain
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17
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Hashem H, Abufaraj M, Tbakhi A, Sultan I. Obstacles and Considerations Related to Clinical Trial Research During the COVID-19 Pandemic. Front Med (Lausanne) 2020; 7:598038. [PMID: 33425945 PMCID: PMC7785796 DOI: 10.3389/fmed.2020.598038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
The response to the COVID-19 pandemic from the research and science community has been vigorous, with information being released faster than that of any other event in human history. Articles related to the virus were being rapidly published by January 2020. A small fraction of these publications comprised reports of prospective clinical trials (0.25%), and many of these trials have imparted conflicting conclusions, leading to confusion among the public and the scientific community. Additionally, the pandemic has raised many serious scientific and ethical concerns related to clinical research. In this review, we divided the conduct of clinical research trials into three steps and critically reviewed each step, along with the challenges and obstacles arising amid the ongoing crisis. The clinical research steps we reviewed include (1) clinical trial design factors such as social and scientific value, feasibility, single vs. multicenter trials, randomization, control groups, endpoints, off-label and compassionate use of medications, data analysis, and verifying the integrity of data; (2) ethical issues such as committee approvals, efficiency, virtual visits and remote monitoring, informed consent, shipping investigational products, and external monitoring and audits; and (3) publication and sharing of preprints, press releases, social media, and misinformation. The COVID-19 pandemic is adversely affecting existing clinical trials for other ailments and diseases, including cancer, with most trials being delayed or deferred. Although urgency is needed to communicate effective treatment and prevention strategies for COVID-19, research efforts should maintain the same high-quality core ethical principles that governed human subject research before the pandemic. Despite the catastrophic devastation caused by the pandemic, the adoption of more flexible, cost-effective methods of conducting clinical trials (without compromising ethical conduct, safety, or data integrity, while maintaining research efficiency) represents a potential silver lining. Streamlining clinical research will help to congruently address other important health issues, despite the ongoing COVID-19 crisis.
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Affiliation(s)
- Hasan Hashem
- Division of Pediatric Hematology Oncology, Department of Pediatrics, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, Amman, Jordan
| | - Abdelghani Tbakhi
- Department of Cellular Therapy and Applied Genomics, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Iyad Sultan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, King Hussein Cancer Center (KHCC), Amman, Jordan
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18
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Yazdizadeh B, Majdzadeh R, Ahmadi A, Mesgarpour B. Health research system resilience: lesson learned from the COVID-19 crisis. Health Res Policy Syst 2020; 18:136. [PMID: 33339524 PMCID: PMC7747187 DOI: 10.1186/s12961-020-00667-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/06/2020] [Indexed: 12/28/2022] Open
Abstract
Producing evidence in epidemics is crucial to control the current epidemic and prevent its recurrence in the future. Data must be collected and analyzed rapidly to recognize the most efficient and feasible methods with proper timelines. However, there are many challenges a research system may encounter during a crisis. This article has presented lessons learned from the COVID-19 pandemic for health research system (HRS) to deal with current and future crises. Therefore, a HRS needs to produce and use evidence in such a situation. The components Knowledge Translation Self-Assessment Tool for Research Institutes (SATORI) framework was used to review the actions required and respond to the COVID-19 pandemic in a national HRS. This framework consists of four categories of defining the research question, conducting research, translating the research results, and promoting the use of evidence. The work is proposed actions in response to the COVID-19 crisis and improving a HRS's resilience. While COVID-19 has serious harm to the health and broader socio-economic consequences, this threat should be accounted for as an opportunity to make research systems more accountable and responsible in the timely production and utilization of knowledge. It is time to seriously think about how HRS can build a better back to be resilient to potential shock and prepare for unforeseen emerging conditions.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-based Participatory Research Center, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD), Tehran, Iran
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19
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Muñoz de Nova JL, Ortega-Gómez M, Abad-Santos F. [Research during the SARS-CoV-2 pandemic]. Med Clin (Barc) 2020; 156:39-40. [PMID: 33268132 PMCID: PMC7518177 DOI: 10.1016/j.medcli.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022]
Affiliation(s)
- José Luis Muñoz de Nova
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, España; Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid (UAM), Madrid, España.
| | - Mara Ortega-Gómez
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, España; Biobanco, Hospital Universitario de La Princesa, Madrid, España
| | - Francisco Abad-Santos
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid (UAM), Madrid, España; Servicio de Farmacología Clínica, Hospital Universitario de La Princesa, Madrid, España
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20
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Affiliation(s)
- Kenji Matsui
- Division of Bioethics and Healthcare Law, the National Cancer Center Japan
| | - Keiichiro Yamamoto
- Department of Biomedical Ethics, University of Tokyo Graduate School of Medicine.,Clinical Research Center, the National Center for Global Health and Medicine
| | - Yusuke Inoue
- Department of Public Policy, University of Tokyo Institute of Medical Science
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21
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Calina D, Hartung T, Docea AO, Spandidos DA, Egorov AM, Shtilman MI, Carvalho F, Tsatsakis A. COVID-19 vaccines: ethical framework concerning human challenge studies. ACTA ACUST UNITED AC 2020; 28:807-12. [PMID: 32851596 DOI: 10.1007/s40199-020-00371-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
Background The pandemic associated with the new SARS-CoV-2 coronavirus continues to spread worldwide. The most favorable epidemic control scenario, which provides long-term protection against COVID-19 outbreak, is the development and distribution of an effective and safe vaccine. The need to develop a new COVID-19 vaccine is pressing; however, it is likely to take a long time, possibly several years. This is due to the time required to demonstrate the safety and efficacy of the proposed vaccine. and the time required to manufacture and distribute millions of doses. Objectives To accelerate this development and associated safety testing, the deliberate infection of healthy volunteers has been suggested. The purpose of this short communication is to describe the ethical aspects of this type of testing, Results Deliberate infection of volunteers with a dangerous virus such as SARS-CoV-2 was initially considered unethical by researchers; but the current pandemic is so different from previous ones that these studies are considered ethical if certain criteria are met. Participants in human challenge studies must be relatively young, in good health and must receive the highest quality medical care, with frequent monitoring. Tests should also be performed with great caution and specialized medical supervision. Besides, the fact that obtaining vaccines faster through deliberate infection studies of healthy people has greater benefits than risks, has been demonstrated by obtaining other vaccines in other historical pandemics such as: smallpox, influenza, malaria, typhoid fever, Dengue fever and Zika. Conclusions One possibility to shorten the time required for the development of COVID-19 vaccines is to reduce clinical phases II and III by using human challenge studies through eliberate infection of healthy volunteers with SARS-CoV-2 after administration of the candidate vaccine. Accelerating the development of a COVID-19 vaccine even for a few weeks or months would have a great beneficial impact on public health by saving many lives. Graphical abstract ![]()
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22
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Calia C, Reid C, Guerra C, Oshodi AG, Marley C, Amos A, Barrera P, Grant L. Ethical challenges in the COVID-19 research context: a toolkit for supporting analysis and resolution. Ethics & Behavior 2020. [DOI: 10.1080/10508422.2020.1800469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Clara Calia
- School of Health in Social Sciences, The University of Edinburgh, UK
| | | | - Cristóbal Guerra
- School of Health in Social Sciences, The University of Edinburgh, UK
- Universidad Santo Tomás, Chile
| | | | - Charles Marley
- School of Health in Social Sciences, The University of Edinburgh, UK
| | | | | | - Liz Grant
- Global Health Academy, The University of Edinburgh, UK
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23
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Abstract
As of May 2020, nursing home residents account for a staggering one-third of the more than 80,000 deaths due to COVID-19 in the U.S. This pandemic has resulted in unprecedented threats to achieving and sustaining care quality even in the best nursing homes, requiring active engagement of nursing home leaders in developing solutions responsive to the unprecedented threats to quality standards of care delivery during the pandemic. This perspective offers a framework, designed with the input of nursing home leaders, to facilitate internal and external decision-making and collective action to address these threats. Policy options focus on assuring a shared understanding among nursing home leaders and government agencies of changes in the operational status of nursing homes throughout the crisis, improving access to additional essential resources needed to mitigate the crisis' impact, and promoting shared accountability for consistently achieving accepted standards in core quality domains.
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Affiliation(s)
- Liza L Behrens
- Postdoctoral Research Fellow, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania, USA
| | - Mary D Naylor
- Marian S. Ware Professor in Gerontology, Director of the NewCourtland Center for Transitions and Health, University of Pennsylvania , Philadelphia, Pennsylvania, USA
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