Towards a common European ethical and legal framework for conducting clinical research: the GATEKEEPER experience

This paper examines the ethical and legal challenges encountered during the GATEKEEPER Project and how these challenges informed the development of a comprehensive framework for future Large-Scale Pilot (LSP) projects. GATEKEEPER is a LSP Project with 48 partners conducting 30 implementation studies across Europe with 50,000 target participants grouped into 9 Reference Use Cases. The project underscored the complexity of obtaining ethical approval across various jurisdictions with divergent regulations and procedures. Through a detailed analysis of the issues faced and the strategies employed to navigate these challenges, this study proposes an ethical and legal framework. This framework, derived from a comparative analysis of ethical application forms and regulations, aims to streamline the ethical approval process for future LSP research projects. By addressing the hurdles encountered in GATEKEEPER, the proposed framework offers a roadmap for more efficient and effective project management, ensuring smoother implementation of similar projects in the future.

Comparative study of use of Diastat versus standard wall PTFE grafts in upper arm hemodialysis access

The objective of this study was to review our experience with using brachioaxillary Diastat vascular grafts (Diastat) compared to standard wall brachioaxillary PTFE grafts (sPTFE) in two similar groups of hemodialysis patients. We conducted a retrospective study comparing complications and graft survival in two similar groups (in terms of age, diabetes mellitus, surgical technique, and previous vascular access) of hemodialysis patients during the period 1994-1997 who had received Diastat (n = 40) or (sPTFE) (n = 40) grafts. We found that the Diastat graft for upper arm hemodialysis access has lower patency and higher complication rates than sPTFE grafts.