Comitês de monitoramento para a proteção de participantes de pesquisa / Monitoring committees for research participant protection / Comités de seguimiento para la protección de los participantes en investigación

Resumo O tema segurança tem sido intensamente discutido, mostrando-se cada vez mais relevante na saúde pública e em projetos de pesquisa envolvendo seres humanos. Participantes de estudos clínicos estão sujeitos a riscos, físicos ou não, que impactam em sua integridade, direitos ou autonomia. Este trabalho apresenta e discute a atuação do Comitê de Monitoramento de Dados e de Segurança para a proteção do participante de pesquisa e minimização de riscos em pesquisa clínica. A metodologia consiste em revisão integrativa da literatura, realizada com o propósito de identificar as funções dos comitês e seu papel na proteção dos participantes. Identificou-se que grande parte das publicações analisadas confirmam que os comitês de monitoramento têm como responsabilidade principal a proteção do participante de pesquisa, além da garantia de integridade e credibilidade da pesquisa.

Abstract Of increasingly relevance in public health and research projects involving human beings, the topic of safety has been intensely discussed. Participants in clinical trials are subject to risks, physical or otherwise, that impact their integrity, rights, or autonomy. This study outlines and discusses the performance of the Data and Safety Monitoring Committee for research participant protection and risk minimization in clinical research. An integrative literature review was conducted to identify the committees' duties and role in protecting participants. Most of the analyzed articles confirm that the monitoring committees are mainly responsible for protecting research participants, as well as ensuring research integrity and credibility.

Resumen La seguridad ha sido un tema muy discutido, por lo que muestra su relevancia para la salud pública y los proyectos de investigación que involucran a seres humanos. Los participantes en estudios clínicos están sujetos a riesgos físicos o de otro tipo, que impactarán su integridad, derechos o autonomía. Este texto realiza un debate sobre el desempeño del Comité de Seguimiento de Datos y Seguridad destinado a la protección de los participantes de investigación y la mitigación de los riesgos en investigación clínica. Se realizó una revisión integradora de la literatura, con el propósito de identificar las funciones de los comités y su rol en la protección de los participantes. La mayoría de las publicaciones analizadas confirman que los comités de seguimiento tienen como principal responsabilidad la protección del participante de la investigación, además de garantizar la integridad y credibilidad de la investigación.

Health workers with good self-perceived competency have lower actual competency levels on HIS in Eastern Ethiopia: A cross-sectional study

Introduction: Utilization of health information is critical to meeting service performance goals and for making informed decisions. However, in resource limited countries, health data is rarely used in decisions around program improvements. This study aimed to assess the determinants of competency levels for health workers who utilized data from health information systems in Eastern Ethiopia. Methods:A cross-sectional study was carried out from April -May 2021 at selected public health facilities in the Dire Dawacityand Harar regions. A total of 129 health professionals were included in the study and simple random sampling techniques were used to select health facilities. Data was collected using face-to-face interviews and competency levels were measured using a tool adapted from the Performance of Routine Information Systems Management (PRISM) framework. STATA version 16 was used for data analysis. A linear regression model was applied to determine the linear relationship between self-perceived competency and the actual competency levels of the healthcare workers.Adjusted beta (ß) along with a 95% confidence interval (CI) was used to measure the strength of the association with a p-value < 0.05. Results:The overall mean for the actual competency levels of health workers who utilized data was 20.45 [95% CI: 16.71, 24.19]. Being head of a hospital/health center (ß: 19.24, 95% CI: 4.42, 34.06), perusing HIS training (ß: 14.38, 95% CI: 6.10, 22.67) and good perceived competency to perform RHIS tasks (ß: -12.96, 95% CI: -25.49, -0.43) were significantly associated with actual competency levels.Conclusion:The Health workers with high perceivedcompetency levels were found to have actual competency levels that were low. Health information systemfocused trainings were found to be positively associated with actual competency levels and being a hospital or health center head was found to be associated negatively to the actual competency levels of health workers. This research has found that providing health information system training for health workers could prove to be beneficial. There is also a need for initiatives aimed at enhancing competency in order to improve the health information systems related competency levels and data use.[Ethiop. J. Health Dev. 2022;36(SI-1)]

Aproximación al estado del arte de los comités de monitoreo de datos en ensayos clínicos / Approach to the state of the art of data monitoring committees in clinical trials

Introducción: En 1967 se estableció, por primera vez, un comité de monitoreo de datos, en un estudio de mortalidad cardiovascular; desde entonces su uso se ha incrementado debido a su valor para garantizar la seguridad de los sujetos participantes en ensayos clínicos y la validez e integridad de los datos. Se realizó una exploración documental de los últimos 20 años, sobre aspectos relacionados con los requisitos de creación y funcionamiento de los comités de monitoreo de datos a nivel mundial, con los objetivos de mostrar el desarrollo alcanzado en el establecimiento de los comités de monitoreo de datos e identificar sus características fundamentales. Desarrollo: Existe un incremento en la producción documental sobre los comités de monitoreo de datos, liderado por angloparlantes de países desarrollados, con franco aumento de publicaciones sobre el tema en el último quinquenio, superior en 50 por ciento a los 15 años anteriores. Este fenómeno lo provoca el auge de la industria farmacéutica y biotecnológica, los altos costos de investigación y desarrollo de medicamentos, la necesidad de introducir nuevos fármacos y el incremento de las exigencias regulatorias. Se describen las características estructurales, requisitos clínicos y metodológicos para el establecimiento de los comités. Conclusiones: Existe alto desarrollo de los comités de monitoreo de datos en los ensayos clínicos, con tendencia al incremento de su uso en los últimos años. Los comités de monitoreo de datos se caracterizan por requerimientos clínicos y metodológicos para su establecimiento(AU)

Introduction: For the first time, in 1967, a data monitoring committee was established in a study of cardiovascular mortality. Since then its use has increased, due to its value to guarantee the safety of subjects participating in clinical trials, the validity and integrity of the data. A documentary exploration of the last 20 years was carried out, on aspects related to the requirements for the creation and operation of data monitoring committees worldwide, with the aim of showing the development achieved in the establishment of data monitoring committees and identify its fundamental characteristics. Development: There is an increase in documentary production on data monitoring committees, led by English speakers from developed countries, with a clear increase in publications on the subject, in the last five-year period, 50% higher than in the previous 15 years. This phenomenon is caused by the rise of the pharmaceutical and biotechnology industry, the high costs of drug research and development, the need to introduce new drugs and the increase in regulatory requirements. The structural characteristics, clinical and methodological requirements for the establishment of the committees are described. Conclusions: There is a high development of data monitoring committees in clinical trials, with a tendency to increase their use in recent years. Data monitoring committees are characterized by clinical and methodological requirements for their establishment(AU)

Análisis interino en ensayos clínicos: un estudio meta-epidemiológico / Interim analysis in clinical trials: A meta-epidemiological study / Análise interino em ensaios clínicos: um estudo meta-epidemiológico

Objetivo: la responsabilidad ética del investigador obliga al monitoreo de la seguridad de los participantes a través del estudio y, por ende, se requiere de un comité de monitoreo de datos, cuya tarea principal es el análisis interino que se refiere a la supervisión de variables como beneficios dramáticos, efectos adversos, mortalidad y futilidad, que lleven a la terminación temprana del estudio. El objetivo de esta investigación es determinar los métodos estadísticos más utilizados en el análisis interino en los ensayos clínicos aleatorizados y publicados en 2016 en una revista médica general de alto factor de impacto. Metodología: se realizó un estudio meta-epidemiológico descriptivo, constituido por ensayos clínicos aleatorizados publicados en el The New England Journal of Medicine, desde el 7 de enero hasta el 10 de noviembre de 2016. Resultados: se analizaron 104 artículos con una muestra promedio de 5 531 ± 762 pacientes y un tiempo de seguimiento promedio de 31 ± 45 meses. De los estudios evaluados se encontró que 88 (84.61%) realizaron análisis interino y 16 (15.38%) no lo realizaron. Los métodos estadísticos utilizados en los artículos fueron O'Brien-Fleming en 30 (34.09%), Haybittle-Peto en 13 (14.77%); otros métodos en dos (2.27%) y no especificado en 43 (48.86%) de ellos. Conclusiones: la mayoría de los ensayos clínicos aleatorizados realizó análisis interino y lo describen en su protocolo. Aproximadamente la mitad de los estudios no especificó el método estadístico; sin embargo, el método descrito más utilizado fue O'Brien-Fleming y, en segundo lugar, Haybittle-Peto y en ningún estudio se especificó el método de Pocock.

Objective: The ethical responsibility of the researcher requires that the safety of participants be monitored throughout the study. Thus, a data monitoring committee is required, whose main function is the interim analysis, which monitors variables such as dramatic benefits, adverse effects, mortality and futility that lead to the early termination of a study. The objective of this study is to determine the most frequently used statistical methods in interim analysis in randomized clinical trials published during 2016 in a high impact factor medical journal. Methodology: Meta-epidemiological descriptive study, consisting of randomized clinical trials published in The New England Journal of Medicine from January 7 to November 10 of 2016. Results: 104 articles were analyzed, where the mean sample was 5,531 ± 762 patients and and average follow-up time was 31 ± 45 months. Of the studies evaluated, 88 (84.61%) performed interim analysis, while 16 (15.38%) did not. Regarding statistical methods used, O'Brien-Fleming was used in 30 (34.09%) studies, Haybittle-Peto in 13 (14.77%), other methods in two (2.27%), and the method was not specified in 43 (48.86%). Conclusions: most of the randomized clinical trials reviewed had interim analysis and described it in their protocol. Approximately half of the studies did not specify the statistical method; however, the most commonly described method was O'Brien-Fleming, followed by Haybittle-Peto; no study used the Pocock method.

Objetivo: a responsabilidade ética do investigador obriga à monitoração da segurança dos participantes através do estudo e, por consequência, se requere de um comitê de monitoração de dados, cuja a tarefa principal é a análise interino que se refere à supervisão de variáveis como benefícios dramáticos, efeitos adversos, mortalidade e futilidade, que levem à terminação precoce do estudo. O objetivo desta investigação é determinar os métodos estatísticos mais utilizados na análise interino nos ensaios clínicos aleatorizados e publicados em 2016 em uma revista médica geral de alto fator de impacto. Metodologia: se realizou um estudo meta-epidemiológico descritivo, constituído por ensaios clínicos aleatorizados publicados no The New England Journal of Medicine, desde o dia 7 de Janeiro até o dia 10 de novembro de 2016. Resultados: se analisaram 104 artigos com uma amostra média de 5 531 ± 762 pacientes e um tempo de seguimento médio de 31 ± 45 meses. Dos estudos avaliados se encontrou que 88 (84.61%) realizaram análise interino e 16 (15.38%) não o realizaram. Os métodos estatísticos utilizados nos artigos foram O'Brien-Fleming em 30 (34.09%), Haybittle-Peto em 13 (14.77%); outros métodos em dois (2.27%) e não especificado em 43 (48.86%) deles. Conclusões: a maioria dos ensaios clínicos aleatorizados realizou análise interino e o descrevem no seu protocolo. Aproximadamente a metade dos estudos não especificou o método estatístico; mas, o método descrito mais utilizado foi O'Brien-Fleming e, em segundo lugar, Haybittle-Peto e em nenhum estudo se especificou o método de Pocock.

Independent Data Monitoring Committees: Review of Current Guidelines

BACKGROUND: There has been on increasing emphasis on the importance of monitoring the safety of participants in a clinical trial to protect patients and maintain the integrity of the trial. The independent data monitoring committee (IDMC) has become common component of randomized clinical trials in recent years. METHODS: It is important to consider the implications of different approaches that are being used in various countries. IDMC guidelines in Korea, US, and Europe were reviewed and compared to provide the objective, composition and operation of IDMC in detail. RESULTS: IDMC is a group of experts in related subject are as who perform interim data monitoring to make a recommendation to the sponsor or organizer regarding appropriateness of trial continuation and the need for modifications of the trial. Independence of IDMC is preferred in order to minimize influence of factors unrelated to scientific, medical and ethical considerations that should underlie decision-making. CONCLUSION: IDMC has become an increasingly important component of clinical trials in recent years. Practical operating procedures need to be developed considering the future regulatory status of data monitoring committees.

Estudios clinicos controlados aleatoreos, en la pediatria de Latino America ( 1996-2005) / Randomized controlled trials in pediatric Latin America (1996-2005)

Los estudios controlados aleatoreos (ECR) están entre los métodos más adecuados para evaluar la efectividadde intervenciones en Salud, pero hay grandes dificultades para efectuar este tipo de investigaciones en Latino América. Objetivo: Analizar la producción de ECR en países de Latino América en niños o adolescentes, en el período 1996-2005.

Monitoria em estudos clínicos / Monitoring visits in clinical research

A realização de um estudo clínico engloba múltiplas facetas, envolvendo sujeitos de pesquisa, investigadores clínicos e patrocinadores, no intuito de consolidar de forma objetiva e fidedigna a execução do protocolo de estudo e conseqüente geração de sólidas e robustas conclusões. A monitoria de um estudo clínico tem por objetivos garantir a segurança do sujeito de pesquisa e do pesquisador, avaliar a rastreabilidade dos dados e sua efetiva presença em documentos-fontes, avaliar a adequada adesão às normas de boas práticas clínicas (Good Clinical Pratices – GCPs)e às resoluções vigentes no País e, por fim, assegurar qualidade e idoneidade de dados. Este artigo descreve os objetivos da monitoria, as responsabilidades do monitor e alguns aspectos importantes sobre a visita de monitoria em um centro de pesquisa clínica.

Quality monitoring in multi-central large sample acupuncture clinical trials / 中国针灸

<p><b>OBJECTIVE</b>To ensure and enhance the quality of multi-central large sample clinical trials of acupunc ture and moxibustion.</p><p><b>METHODS</b>Take the multi-central clinical trials supported by National Key Technology R &- D Program of "the 11th Five-year Plan" as an example to introduce the duty of monitors and simply describe the formulation of the monitoring plan, the monitoring procedure and contents of the monitoring plan and treatment of the commonly-seen problems.</p><p><b>CONCLUSION</b>Quality monitoring work in multi-central large sample clinical trials of acupuncture and moxibustion is equally serious and scientific with clinical medical trials and it is an important way to guarantee the credible results.</p>

Monitoramento e avaliação de eventos adversos: a experiência do Hospital de Clínicas de Porto Alegre / Monitoring and evaluation of adverse events: the experience at Hospital de Clínicas de Porto Alegre

A proteção dos participantes nas pesquisas que envolvem seres humanos é uma das atribuições fundamentais dos Comitês de Ética em Pesquisa (CEPs), estando regulamentada em âmbito nacional e internacional. Segundo esses documentos, cabe aos CEPs não só revisar todos os protocolos de pesquisa submetidos a ele, mas também monitorar a ocorrência dos eventos adversos (EA) encaminhados pelo pesquisador no transcorrer da pesquisa. Esse monitoramento deve ser ágil e crítico, orientando sua ação em observância à relação dano/benefício de cada estudo, com o objetivo de proteger os participantes de pesquisa. O Grupo de Pesquisa e Pós-Graduação do Hospital de Clínicas de Porto Alegre (HCPA) implantou, em 2001, o Programa de Monitoramento de Riscos e Eventos Adversos, que atualmente é desenvolvido pelo Laboratório de Pesquisa em Bioética e Ética na Ciência

Based on national and international regulations, one of the the Research Ethics Committees (REC) have the attribution to protect human beings involved in research. According to these documents, REC should not only review all the research protocols, but also monitor adverse events (AE) reported by the investigator. This monitoring activities must be agile and critical, guiding its actions by evaluation of risk/benefit associated to each study. The Grupo de Pesquisa e Pós-Graduação of the Hospital de Clínicas de Porto Alegre (HCPA) introduced, in 2001, the Program of Monitoring of Risks and Adverse Events, developed by the Laboratório de Pesquisa em Bioética e Ética na Ciência

A Sequential Test Procedure for Monitoring a Singular Safety and Efficacy Outcome

"In this note we describe a modification of the sequential probability ratio test (SPRT) developed for the purpose of ""flagging"" a significant increase in the mortality rate of a treatment relative to a control while ensuring that double-blinding and the Type I error for the primary test of efficacy; also based on mortality rates; is not compromised."