Development of a Safety Surveillance Plan for the Academic Medicine Sponsor Performing First-in-Human Cellular Therapy Clinical Trials: A Report from the Consortium for Pediatric Cellular Immunotherapy

Pharmacovigilance (PV), also known as drug safety, is the science of risk management involving the detection, assessment, understanding, and prevention of adverse effects related to a medication. This discipline has traditionally focused on the postmarketing period, with less attention to early-phase clinical trials. However, during the immunotherapy and cellular therapy investigational stage, regulatory agencies are increasingly emphasizing the need to identify and characterize safety signals earlier in clinical development as part of a comprehensive safety surveillance plan. Compliance with PV and safety regulations are further heightened as cell and gene therapy (CGT) trials grow in complexity and scope owing to ever-changing and increasingly rigorous regulatory mandates. Based on this changing landscape, a critical aspect of early-phase trials of cellular products where significant safety events are anticipated is to ensure that every effort is made to protect clinical trial participants by maximizing attention to the risk-versus-benefit profile. This includes the development of robust plans for safety surveillance that provide a continual assessment of safety signals to enable safety reporting to regulatory bodies and the Food and Drug Administration, a regular analysis of aggregate safety data, and a plan to communicate safety findings. This report focuses on PV in early-phase clinical trials of first-in-human investigational products sponsored by academic centers in which the availability of PV resources and subject matter experts is limited. To more fully understand the challenges of CGT PV oversight within pediatric academic medical centers conducting early-phase clinical trials, a working group from institutions participating in the Consortium for Pediatric Cellular Immunotherapy composed of faculty and regulatory professionals was convened to compare experiences, identify best practices, and review published literature to identify commonalities and opportunities for alignment. Here we present guidelines on PV planning in early-phase CGT clinical trials occurring in academic medical centers and offer strategies to mitigate risk to trial participants. Standards to address regulatory requirements and governance for safety signal identification and risk assessment are discussed.

Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study

BACKGROUND

Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative.

METHODS

This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains.

RESULTS

Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals.

CONCLUSIONS

This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.

Program evaluation of a student-led peer support service at a Canadian university

Background

University students often experience numerous financial, social and emotional stressors that can affect their mental health. The Peer Support Centre (PSC) is a pilot project that was established to provide peer support to students in these stressful conditions. We wanted to investigate whether peer support is a viable form of support that would benefit university students. The objective of this study is to determine whether the organization was indeed providing a beneficial service to students and if it was fulfilling the needs of the students that visited the service.

Methods

After a support session, students and peer support providers completed an anonymous questionnaire regarding their self-reported mental wellbeing using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) metrics, and Outcome Rating Scale (ORS). They were also asked about their experience with previous professional mental health services as well as their experience at the PSC. With the data collected from 1043 students and 797 volunteers from September 2016–March 2020, a program evaluation was conducted for quality improvement purposes.

Results

The PSC is used by students of different sexes, genders, and ethnicities. Students reported having a low ORS score, moderate anxiety as per the GAD-7 and moderate depression according to the PHQ-9. They find it easy to use and rely on it as an alternative form of support when they approach barriers that prevent them from accessing professional services. Lastly, the peer support providers feel very validated in their role and overall quite prepared and helpful when helping their fellow peers.

Conclusions

The establishment of a student service that provides peer support would be beneficial to the members of a university/college campus.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-021-00479-7.

Applying health, safety, and environmental risk assessment at academic settings

Background

Students, staff, and faculties are involved in activities that exposed them to a range of minor to severe or even fatal accidents in academic settings. Managing work environment risks is crucial to any safety and health prevention program. This study developed a risk assessment using combinations of hazards and risk factors to establish a scale of measures in a risk reduction action plan.

Methods

This cross-sectional study was conducted in an Iranian medical sciences university in 2018. A structured method of risk assessment was developed, applying a three-step procedure to identify hazards, consequences, and risk evaluation. Data were collected through detailed health, safety, and environment checklist in 38 different sites. Finally, the risks quantified, prioritized, and control measures proposed accordingly. Chi-square and correlation tests assessed how environmental factors were associated with hazard consequences. The analysis results were evaluated at the significance level of 0.05.

Results

The frequencies of moderate and high-risk levels were 22.7 and 2.9%, respectively. Thus, corrective measures should be considered as soon as possible and immediately for these risk groups. Facilities and functions within laboratories, library, and powerhouse were more vulnerable to serious risks. The type of hazard had associated with the sites and total risk score at the significance level of 0.05 (P-value = 0.017). Similarly, risk severity was significantly related to the sites (P-value = 0.003). Safety hazards had a statistically higher contribution to the total risk score when compared to health and environmental hazards.

Conclusion

The study revealed complex risks and hazardous circumstances with significant variances in academic sites and activities. Universities should provide training in risk reduction programs to increase the awareness of students, staff, and faculties, which can improve life safety in a university environment.

Chinese research into ulcerative colitis from 1978 to 2017: A bibliometric analysis

BACKGROUND

Over the last 40 years, with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis (UC) in China, the number of studies on UC has been rapidly increasing. But it still lacks a comprehensive meta-analysis of publications regarding UC for the last four decades in China. Thus, a bibliometric analysis of UC is warranted to investigate the trend and distribution of the publications on UC in China in recent years. And it is supposed that the number of the papers related to UC increased by year.

AIM

To investigate the current status of research output from Chinese studies related to UC during the period of 1978 to 2017, with special attention paid to the distribution of publication dates, journals, regions, and research organizations.

METHODS

Publications on UC were searched in the Chinese periodical database SinoMed from January 1978 to December 2017. The search term used for retrieval was “ulcerative colitis”. The language of the publications was restricted to English or Chinese. The studies have to be performed in China. Then, a bibliometric analysis was performed on the distribution of publication dates, journals, regions, and research organizations with EndNote, Excel, MySQL, and GraphPad Prism.

RESULTS

A total of 16257 papers matched the search criteria, which included 7561 papers published in core journals, 4641 evidence-based articles, and 4177 publications of randomized controlled trials. These papers were mainly published in Chinese Journal of Coloproctology, World Chinese Journal of Digestology, Chinese Journal of Digestion, Chinese Journal of Integrated Traditional and Western Medicine on Digestion, and Modern Journal of Integrated Traditional Chinese and Western Medicine. In particular, the majority of these organizations were located in Jiangsu, Henan, Shandong, and Guangdong Provinces which are rich areas or have the largest population per province. Most of these studies were conducted by academic institutions.

CONCLUSION

Over the past four decades, the output of research into UC in China has increased significantly, with academic institutions playing a central role in the academic field, but the number and quality of these researches vary substantially among different regions.

Establishing and Maintaining Research Integrity at Academic Institutions: Challenges and Opportunities

Integrity and trust are essential attributes of medical researchers. Research misconduct represents clear and present dangers to academic institutions and their faculty, residents, students, and staff. To achieve and maintain public trust, medical researchers must achieve and maintain research integrity. To do so requires synchronicity and collaboration between and within academic institutions. Substantial failures to maintain research integrity by institutional leadership will lead to increasing demands to do so from the funding organizations and the general public. This, in turn, will lead to avoidable consequences of substantial penalties, financial and otherwise, adverse publicity, and reputational damage. Researchers must self-regulate to avoid pitfalls, including those created by changes in the medical care delivery system that have decreased the influence of health care providers and increased the influence of outside legal and business interests. Our common goal should be to return public trust in our research enterprise that has done so much good for so many, but requires the establishment and maintenance of vigilance to establish and maintain research integrity.

Institutional Conflicts of Interest in Academic Research

Financial relationships in academic research can create institutional conflicts of interest (COIs) because the financial interests of the institution or institutional officials may inappropriately influence decision-making. Strategies for dealing with institutional COIs include establishing institutional COI committees that involve the board of trustees in conflict review and management, developing policies that shield institutional decisions from inappropriate influences, and establishing private foundations that are independent of the institution to own stock and intellectual property and to provide capital to start-up companies.

Uterotonic drug usage in Canada: a snapshot of the practice in obstetric units of university-affiliated hospitals

OBJECTIVE

The objective of this study was to determine the pattern of uterotonic drug usage in obstetric units of university-affiliated hospitals in Canada.

METHODS

This was a prospective observational study conducted in the form of an electronic survey. The target group consisted of chiefs or directors of Obstetrics and Anaesthesia at university-affiliated hospitals across Canada. The survey was sent out between November 2016 and January 2017, using the program 'SurveyMonkey'. Data on institutional obstetric practices and usage of uterotonic agents were collected.

RESULTS

The survey was sent to 92 obstetricians and anesthesiologists from 46 institutions, of which 33 clinicians from 24 institutions responded. About 65% of clinicians were unaware of the rate of postpartum hemorrhage in their institution. The first-line agent for vaginal deliveries was reported as oxytocin by 94% and carbetocin by 6% of physicians. For women at low-risk for postpartum hemorrhage when undergoing cesarean deliveries (CD), 66% reported oxytocin as the first-line uterotonic, while 34% reported carbetocin. For CDs at high-risk of postpartum hemorrhage, 60% of physicians reported oxytocin and 40% reported using carbetocin initially. The use of second-line uterotonics was also variable. The choice of uterotonic was mainly based on perceived efficacy and Society of Obstetricians and Gynaecologists of Canada guidelines.

CONCLUSION

There is a lack of a unified approach to the use of uterotonic drugs for postpartum hemorrhage management in Canada. To improve the management of postpartum hemorrhage due to uterine atony, an evidence-based approach to usage and consensus between obstetricians and anesthesiologists is warranted.

Mode of delivery in pregnancies with gastroschisis according to delivery institution

Purpose: We aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center. Material and methods: Chart review from 2008 to 2015 was performed. Cesarean delivery rate (CDR), attempted vaginal delivery rate (AVR), planned cesarean rate (PCR) and adverse neonatal outcomes were compared among pregnancies with gastroschisis delivered in nonacademic hospitals with those delivered in an academic institution. Parametric and nonparametric statistical analysis was performed when appropriate. A multivariable logistic regression mode was utilized to control for confounders. A p value < .05 was considered significant. Results: Mode of delivery was documented in 94 cases (88%). CDR (76.7 versus 41.2%; odds ratios (OR), 4.7; 95%CI, 1.9-11.6) and PCR (55 versus 6.4%; OR 17.9; 95%CI, 4.8-67.4) were higher in those delivered in nonacademic centers. AVR was lower in the nonacademic group (45 versus 93.6%; OR 0.02; 95%CI, 0.01-0.2). Neonatal intensive care length of stay (56 days [IQR, 34-102 days] versus 36 days [IQR, 26-60 days; p = .018]) was longer in the nonacademic group. Other neonatal adverse outcomes studied were not statistically different between groups. Conclusions: In our population, delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition. Rationale: In our study we aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center. Our results suggest, that delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition.

7. Administrative structures

The basic systems of any society rarely can operate independently. Instead, they are dependent and often interdependent upon other entities. Such entities control the resources within their respective systems. Thus, coordination and control agencies require contracts or memoranda of understanding with these entities in order to assure access to the resources required during a crisis. These administrative structures include: (1) governmental institutions and agencies, including the military; (2) intergovernmental organisations; (3) nongovernmental organisations; (4) commercial private sector organisations; and (5) academic institutions. These dependencies create potential barriers to the provision of coordination and control including: (1) the complexity of the administrative structures with which coordination and control must interact; (2) the location of resources; (3) finding responsible person(s); (4) the competence and compatibility; (5) methods of access; (6) payment; (7) contracts and memoranda of understanding; (8) inventories of accessible resources; (9) competition for the mandate, power, and resources; and (10) jealousy. The need for potential interactions between administrative structures requires that agreements for the sharing of resources during crises be reached as part of planning and preparedness. Gaining an understanding of these relationships is an important area for research.