Indicadores de Qualidade na condução de estudos clínicos / Quality indicators in the conduct of clinical studies

Introdução: A geração, análise e difusão de indicadores pertinentes é uma das estratégias fundamentais do processo de gestão de qualidade. Indicadores são mensurações que avaliam direta ou indiretamente os processos e desfechos da assistência ao participante de pesquisa. Padrões rigorosos de qualidade garantirão a validade dos dados obtidos nos estudos clínicos. Métodos: Estudo transversal descritivo e analítico, com dados coletados no Centro de Pesquisa Clínica de um Hospital Universitário, durante Novembro/2016 a Fevereiro/2019 quanto ao tempo de inclusão de dados no electronic case report form (IID), tempo de comunicação de desvios de protocolo ao Comitê de Ética em Pesquisa (ICD), tempo de resposta aos feasibilities recebidos (IRF) e tempo de resposta às pendências de monitoria (IRP). Resultados: Variações substanciais foram encontradas entre os escores de qualidade ao longo de 27 meses. O desempenho geral da equipe do Escritório de Projetos em Pesquisa alcançou a classificação excelente ou satisfatória em 61,40% das observações: 50,87% e 10,52% respectivamente. Entre 38,59% de observações críticas, 17,54% foram expressas pelo IRP, seguido de 12,28% por ICD e 7% atribuído ao IID que não atingiram a meta proposta. Conclusão: O Escritório de Projetos em Pesquisa elencou dois indicadores de qualidade, IID e IRP, que podem melhorar o tempo e a eficácia das entregas propostas da equipe. (AU)

Introduction: The generation, analysis and dissemination of relevant indicators is a fundamental strategy in the quality management process. Indicators are measurements that directly or indirectly evaluate the processes and outcomes of the care provided to research participants. Rigorous quality standards will guarantee the validity of the data obtained in clinical studies. Methods: This descriptive, analytical cross-sectional study collected data at the Clinical Research Center of a University Hospital, covering the period from November 2016 to February 2019, regarding the time of data inclusion in the electronic case report form (IID), communication of protocol deviations to the Research Ethics Committee (ICD), response time to received feasibilities (IRF) and response time to monitoring pending issues (IRP). Results: Substantial variations were found between quality scores in a period of 27 months. The overall performance of the Research Project Office team was excellent or satisfactory in 61.40% of the observations (50.87% and 10.52% respectively). Among critical observations (38.59%), 17.54% were expressed by IRP, 12.28% by ICD and 7% by IID, indicating those that did not reach the proposed target. Conclusions: The Research Project Office has listed two quality indicators, IID and IRP, which can improve the time and effectiveness of team deliveries.(AU)

Cd modifies hepatic Zn deposition and modulates δ-ALA-D activity and MT levels by distinct mechanisms.

Cadmium (Cd) is a pollutant that is harmful to human and animals. The liver is a target for Cd accumulation and it can disrupt Zn homeostasis. Here we examined the interaction of Zn and Cd to determine how these two metals could affect δ-aminolevulinate-dehydratase (δ-ALA-D) and metallothionein (MT), two potential molecular endpoints for Cd hepatotoxicity. Cd exposure (0.25 and 1 mg kg1 body weight, i.p., for 10 days) caused a marked increase in hepatic Zn deposition, which was not modified by treatment with Zn (2 mg kg1 , i.p.). Cd caused a dose-dependent increase in hepatic Cd content that was not modified by Zn. Zn and/or Cd treatment increased hepatic δ-ALA-D activity, although the increase caused by Cd was less marked. Reactivation index of δ-ALA-D by DTT was decreased by Zn and Cd exposure, which indicates that Zn protects enzyme from oxidation. Hepatic MT was increased only after exposure to 1 mg kg(-1) Cd and Zn reduced the stimulation of MT synthesis. The results presented here indicate that Cd can redistribute Zn from non-hepatic tissues to liver and the increase in hepatic Zn deposition can account for the increase in hepatic δ-ALA-D activity after Cd exposure. However, Zn blocked the increase in hepatic MT levels caused by Cd. Thus, the modulation of the two molecular endpoints of Cd toxicity used here was distinct, which indicates that the mechanism(s) involved in Zn and Cd distribution, δ-ALA-D and MT regulation are not coincident.