Monitoring and auditing protocol adherence, data integrity and ethical conduct of a randomized clinical trial: A case study

PURPOSE

To categorize, quantify and interpret findings documented in feedback letters of monitoring or auditing visits for an investigator-initiated, peer-review funded multicenter randomized trial testing probiotics for critically ill patients.

MATERIALS & METHODS

In 37 Canadian centers, monitoring and auditing visits were performed by 3 trained individuals; findings were reported in feedback letters. At trial termination, we performed duplicate content analysis on letters, categorizing observations first into unique findings, followed by 10 pre-determined trial quality management domains. We further classified each observation into a) missing operational records, b) errors in process, and potential threats to c) data integrity, d) patient privacy or e) safety.

RESULTS

Across 37 monitoring or auditing visits, 75 unique findings were categorized into 10 domains. Most frequently, observations were in domains of training documentation (180/566 [32%]) and the informed consent process (133/566 [23%]). Most observations were missing operational records (438/566 [77%]) rather than errors in process (128/566 [23%]). Of 75 findings, 13 (62/566 observations [11%]) posed a potential threat to data integrity, 1 (1/566 observation [0.18%]) to patient privacy, and 9 (49/566 observations [8.7%]) to patient safety.

CONCLUSIONS

Monitoring and auditing findings predominantly concerned missing documentation with minimal threats to data integrity, patient privacy or safety.

TRIAL REGISTRATION

PROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial): NCT02462590.

Longitudinal weight growth patterns in the highland fringes of West Sepik Province, Papua New Guinea: a comparison of three groups

Longitudinal weight growth data from three groups in West Sepik Province, Papua New Guinea, are compared. A form of analysis based on the four-parameter Jenss curve is adopted, to allow intelligible comparisons of parameter means despite irregular weighing schedules for individual children. Although many weighing records include notes of a child's ill-health (e.g. malaria), omission of these weighings does not have a large effect on the results. Some significant sex differences were found, but do not appear to be importantly confounded with group differences. Of the three groups compared, the East Mianmin live at moderate altitude, the Imnai live at low altitude, and the West Mianmin are a migrant group from moderate to low altitude. In principle the analysis could have shown the groups to be differentiated by altitude of current residence (suggesting the influence of environmental factors), by altitude of ancestral residence (suggesting the influence of genetic and/or cultural factors) or by some interaction of causal factors. Findings on most parameters suggest interaction. Neither moderate nor low-altitude conditions appear consistently more favourable to rapid growth; it is suggested that the advantage of a more favourable disease environment at moderate altitude may be at least partially offset by a nutritional disadvantage. The effect of environmental conditions may also be non-uniform, especially for young infants, since infants of the migrant group, the West Mianmin, are born heaviest but grow more slowly in the early months than infants of either non-migrant group.