The NIH Collaboratory’s Biostatistics and Study Design Core has just published a new guidance document by Andrea Cook, PhD, of the Group Health Research Institute, on using small-sample robust variance correction for generalized estimating equations (GEE) for use in cluster-randomized trials. The document, which includes guidance on methods available in the SAS and Stata statistical analysis packages, is available directly from the NIH Collaboratory Knowledge Repository here (opens as PDF), or via the Biostatistical Guidance Documents page in the Living Textbook.
This guidance document is one in a series of research tools focused on detailed aspects of statistical design for conducting pragmatic clinical trials. Each document in this series provides a synthesis of current developments, discusses possible future directions, and, where appropriate, makes recommendations for application to pragmatic clinical research.
The NIH Collaboratory Biostatistics/Study Design Core has released a new guidance document concerning the use of frailty models in the setting of cluster-randomized trials (CRTs). This guidance, the fifth in a series from the Core, outlines considerations affecting power calculations in frailty models, as well as issues raised by the use of logistic regression models for time-to-event versus dichotomous outcomes in CRTs .
The guidance document can be found under Biostatistical Guidance Documents on the Tools for Research page on the Living Textbook, or accessed directly here (PDF).
On March 9, 2015, the U.S. Food and Drug Administration (FDA) issued draft guidance on the Use of Electronic Informed Consent in Clinical Investigations (document opens as a PDF). In a question-and-answer format, the guidance provides recommendations for investigators, sponsors, and institutional review boards (IRBs) on the use of electronic media and processes to obtain informed consent for FDA-regulated clinical investigations of medical products, including human drug and biological products, and medical devices, and combinations thereof.
Electronic informed consent, or eIC, refers to the use of electronic systems and processes to convey information related to the study and to obtain and document informed consent. Electronic media formats may include text, graphics, audio, video, podcasts, and interactive websites, biological recognition devices, and card readers. Use of electronic systems may allow for rapid notification to study participants of any amendments pertaining to the informed consent, promote timely entry of eIC data into the study database, and allow for timely collection of the informed consent data from remote locations.
The guidance provides answers to these questions:
- How should the information in the eIC be presented to the subject?
- How and where may the eIC process be conducted?
- How and when should questions from subjects be answered?
- What steps may be taken to facilitate the subject’s understanding of the information being presented?
- What steps may be taken to ensure that new or additional information is conveyed to the subject during the course of the clinical investigation?
- Does FDA allow the use of electronic signatures to document eIC?
- What special considerations should be given to the use of eIC for pediatric studies?
- Should subjects receive a copy of their eIC and have easy access to the material and information presented to them in their eIC?
- What steps can be taken to help ensure confidentiality of the information once eIC is obtained?
- Can HIPAA authorizations for research, which are frequently combined with informed consent documents, be obtained electronically?
- What are the IRB’s responsibilities in the eIC process?
- What eIC documentation does FDA require for submission with applications?
- What steps can be taken to ensure the system archives the documents appropriately?
- What materials or documents will FDA require during an inspection?
The comment period ends May 7, 2015. Users can submit electronic comments using the docket number HHS-OPHS-2015-0002 at the Federal eRulemaking Portal: http://www.regulations.gov.
On December 3, 2014, the National Institutes of Health (NIH) issued a draft policy promoting the use of a single institutional review board (IRB) for multisite studies. IRBs play a critical role in assuring the ethical conduct of research, and studies must be reviewed and approved by an IRB before they can begin. Yet over time, the clinical research landscape has become increasingly complex, expanding from studies formerly conducted at single institutions to large, diverse studies across networks and multiple sites. This situation challenges the practicality of using local IRBs to conduct initial and ongoing reviews for such studies.
The goal of permitting use of a single IRB—also called a central IRB or IRB of record—is to enhance and streamline the process of IRB review for multisite studies so that research can proceed efficiently without compromising ethical principles and protections. While both the FDA and Office for Human Research Protections support the use of a single IRB, too few institutions involved in multisite studies are taking advantage of the option.
Read the NIH draft policy here.
“By using single IRBs in multi-site studies, we reduce duplication of effort, speed the initiation of important research, and save time and taxpayer funds.”
Francis S. Collins, MD, PhD, NIH Director
Among the current NIH programs incorporating the use of a single IRB are:
- National Cancer Institute’s Central Institutional Review Board (CIRB)
- National Institute of Neurological Disorders and Stroke’s Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT)
- Network for Stroke Research (NIH StrokeNet)
Dr. Sally Rockney, NIH deputy director for extramural research, explains the NIH perspective in her blog. Public comment on the draft policy extends for 60 days, through January 29, 2015. When finalized, the policy will apply to all NIH-funded multisite studies carried out in the United States, whether supported through grants, contracts, or the NIH intramural program.
“Writing for the Clinical Research Setting, “A 4-part webinar series sponsored by the National Patient-Centered Clinical Research Network (PCORnet) is now available on Rethinking Clinical Trials. Originally given in the fall of 2014 as part of the PCORnet “Office Hours” series, the recorded sessions are presented by Living Textbook managing editor Jonathan McCall, MS, and can be accessed as streaming video under the Tools for Research tab, or directly here.
The series provides a basic introduction to various facets of writing for the clinical research environment. Individual sessions, each roughly 1 hour in length, include the following topics:
- Writing Peer-Reviewed Research Articles
- Organizing and Writing Your White Paper
- Writing Guidance Documents
- Managing the Process of Writing and Publication
In June 2014, the NIH held a joint workshop with the Nature Publishing Group and Science on the issue of reproducibility and rigor of research findings. The workshop’s goal was to strengthen approaches to support biomedical research that is reproducible, robust, and transparent. An editorial appears in the November 5, 2014, online edition of Nature.
Workshop participants included journal editors representing more than 30 basic/preclinical science journals in which NIH-funded investigators have most often published. Attendees reached consensus on a set of principles and guidelines to facilitate the interpretation and repetition of experiments as they have been conducted in published studies. Principles endorsed by the group cover five areas, recommended to be delineated in each journal’s Information for Authors section or other public place:
- Rigorous statistical analysis: Outline the journal’s policy for statistical analysis and have a method of checking the statistical accuracy of submissions
- Transparency in reporting: Provide a checklist of reporting standards (replicates, statistics, randomization, blinding, sample-size estimation, inclusion/exclusion criteria) and require authors to state where this information is located in the manuscript
- Data and material sharing: Stipulate that all datasets on which the conclusions of the paper rely must be made available upon request, where appropriate, during manuscript review and upon publication
- Consideration of refutations: Include the journal’s policy for considering refutations of the paper, subject to its usual standards of quality
- Best practices guidelines: Establish methods for dealing with image-based data and biological material (antibodies, cell lines, animals)
The existence of these guidelines does not preclude the need for replication or independent verification of research results, but should make it easier to perform such replication. Journals endorsing the proposed principles and guidelines are listed here.
The NIH Collaboratory’s Phenotypes, Data Standards, and Data Quality Core has released a new white paper on data quality assessment in the setting of pragmatic research. The white paper, titled Assessing Data Quality for Healthcare Systems Data Used in Clinical Research (V1.0) provides guidance, based on the best available evidence and practice, for assessing data quality in pragmatic clinical trials (PCTs) conducted through the Collaboratory. Topics covered include an overview of data quality issues in clinical research settings, data quality assessment dimensions (completeness, accuracy, and consistency), and a series of recommendations for assessing data quality. Also included as appendices are a set of data quality definitions and review criteria, as well as a data quality assessment plan inventory.
The full text of the document can be accessed through the “Tools for Research” tab on the Living Textbook or can be downloaded directly here (PDF).
The NIH Collaboratory’s Biostatistics and Study Design Core has released the first in a series of guidance documents focusing on statistical design issues for pragmatic clinical trials. Each of the four guidance documents are intended to help researchers by providing a synthesis of current developments in the field, discuss possible future directions, and, where appropriate, make recommendations for application to pragmatic clinical research.
The guidance documents are available through the Living Textbook and can be accessed on the “Tools for Research” tab or directly here.