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A data-capture system for post-marketing surveillance of drugs that integrates with hospital electronic health records 用于药品上市后监测的数据采集系统,该系统与医院电子健康记录相结合
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2011-04-29 DOI: 10.2147/OAJCT.S19579
Keiichi Yamamoto, S. Matsumoto, K. Yanagihara, S. Teramukai, M. Fukushima
Keiichi Yamamoto1 shigemi Matsumoto2 Kazuhiro Yanagihara2 satoshi Teramukai1 Masanori Fukushima1,2,3 1Department of Clinical Trial Design and Management, Translational research Center, Kyoto University hospital, Kyoto, Japan; 2Outpatient Oncology Unit, Kyoto University hospital, Kyoto, Japan; 3Translational research informatics Center, Foundation for Biomedical research and innovation, Kobe, Japan
日本京都大学附属医院转化研究中心临床试验设计与管理教研室,日本京都;2京都大学医院肿瘤科门诊,日本京都;3日本生物医学研究与创新基金会转化研究信息学中心,神户
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引用次数: 3
Data retention after a patient withdraws consent in clinical trials. 临床试验中患者撤回同意后的数据保留。
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2011-04-01 DOI: 10.2147/OAJCT.S13960
André P Gabriel, Charles P Mercado

Patient retention is critically important in the conduct of a successful clinical trial. The power in numbers in multicenter trials is dependent on the completion of follow-up for every patient randomized. If at the end of a clinical trial, a significant number of randomized patients are missing outcome data, there will not be enough pool for data analyses to conclude a study based on its primary and secondary objectives. When patients who are either lost to follow-up or who withdraw consent during the clinical trial are eliminated from the data pool, they subsequently affect the power and the validity of conclusions derived from the clinical study. This paper aims to present current guidance on data retention for patients who have withdrawn consent from clinical trials.

患者滞留对成功进行临床试验至关重要。在多中心试验中,数量上的优势取决于随机分配的每位患者的随访完成情况。如果在临床试验结束时,大量随机患者缺少结局数据,则没有足够的数据分析池来根据其主要和次要目标得出研究结论。当失去随访或在临床试验期间撤回同意的患者从数据池中排除时,他们随后会影响临床研究得出的结论的效力和有效性。本文旨在为撤回临床试验同意的患者提供当前关于数据保留的指导。
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引用次数: 10
Phase II trial of second-line erlotinib and digoxin for nonsmall cell lung cancer (NSCLC) 二线厄洛替尼和地高辛治疗非小细胞肺癌(NSCLC)的II期试验
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2011-02-06 DOI: 10.2147/OAJCT.S16347
F. Kayali, M. Janjua, D. Laber, Donald M Miller, G. Kloecker
Correspondence: goetz h Kloecker University of Louisville, 529 s. Jackson street, Louisville, KY 40202, UsA Tel +1 502 562 4358 Fax +1 502 562 6811 email ghkloe01@louisville.edu; goetzkloecker@yahoo.com Background: In vitro digoxin sensitizes cancer cells to the induction of apoptosis by c hemotherapy. Inhibition of the Na/K-ATPase enzyme by ouabain disturbs the intracellular ion composition of cancer cells, altering cellular homeostasis. This suggests that inhibition of the Na/K pump results in cellular sensitization of malignant but not benign cells to the induction of apoptosis. Epidemiologic studies have also shown beneficial effects of digitalis in breast cancer incidence. At ASCO (American Society of Clinical Oncology) 2007 our group presented a Phase II study showing encouraging results by adding digoxin to biochemotherapy for melanoma. Erlotinib is one of the standard second-line treatments for nonsmall cell lung cancer (NSCLC), with a response rate (RR) of 10%. This study’s hypothesis was that adding digoxin to erlotinib will improve the RR and time to progression (TTP) in NSCLC. Methods: Patients with progressive disease (PD) after chemotherapy were enrolled if they had an ECOG (Eastern Cooperative Oncology Group) score from 0 to 2 and good organ f unction. Daily erlotinib 150 mg and digoxin 0.25 mg were taken by mouth. The digoxin dose was adjusted to keep levels between 1 and 2 ng/mL. Computed tomography scans were done every 6 weeks. Treatment continued until PD or significant toxicity occurred. Results: Patient accrual lasted from March 2006 until August 2008 and was stopped early at the time of interim analysis. Twenty-eight patients were enrolled, and 24 who completed at least 6 weeks of therapy are presented here. All patients had unresectable NSCLC stage III/IV at diagnosis. Median age was 61 (34–78), 14 were female, 17 had prior radiation (not involving the target lesions), 23 had one prior chemotherapy, and one subject had two. Only one patient was a never-smoker. Histologies were 50% adenocarcinoma, 30% squamous, and 20% u nspecified. One patient had a partial response, nine had stable disease, and 14 had progressive disease. The median TTP was 61 days (9–366) and median survival 157 days (9–844). Side effects were similar to erlotinib single agent with no treatment-related mortality. There were no unexpected or increased adverse events related to digoxin. Conclusions: Digoxin did not increase the response rate of erlotinib in the treatment of p rogressive NSCLC. The TTP and survival seen in this study were similar to the published results with erlotinib alone. This combination does not warrant further clinical studies in NSCLC.
通信:路易斯维尔的goetz Kloecker大学,529s。美国肯塔基州路易斯维尔杰克逊街40202电话+1 502 562 4358传真+1 502 562 6811邮箱ghkloe01@louisville.edu;goetzkloecker@yahoo.com背景:在体外,地高辛使癌细胞对c血液疗法诱导的凋亡敏感。乌阿巴因对Na/ k - atp酶的抑制会扰乱癌细胞的细胞内离子组成,改变细胞稳态。这表明抑制Na/K泵导致恶性细胞而非良性细胞对诱导凋亡的细胞敏化。流行病学研究也表明洋地黄对乳腺癌发病率有有益作用。在2007年ASCO(美国临床肿瘤学会)上,我们的小组提交了一项II期研究,显示了将地高辛加入黑色素瘤生物化疗的令人鼓舞的结果。厄洛替尼是非小细胞肺癌(NSCLC)的标准二线治疗之一,缓解率(RR)为10%。本研究假设地高辛联合厄洛替尼可改善NSCLC的RR和进展时间(TTP)。方法:纳入化疗后进展性疾病(PD)患者,ECOG (Eastern Cooperative Oncology Group)评分为0 ~ 2分,脏器功能良好。每日口服厄洛替尼150 mg,地高辛0.25 mg。调整地高辛剂量,使其保持在1 - 2ng /mL之间。每6周进行一次计算机断层扫描。治疗持续至PD或出现明显毒性。结果:患者病程从2006年3月持续到2008年8月,在中期分析时提前停止。28例患者入组,其中24例完成了至少6周的治疗。所有患者在诊断时均为不可切除的NSCLC III/IV期。中位年龄61岁(34-78岁),14名女性,17名既往放疗(不涉及目标病变),23名既往化疗一次,1名既往化疗两次。只有一名患者从不吸烟。组织学为50%腺癌,30%鳞状,20%不明。1例患者有部分反应,9例病情稳定,14例病情进展。中位TTP为61天(9-366),中位生存期为157天(9-844)。副作用与厄洛替尼单药相似,无治疗相关死亡率。与地高辛相关的不良事件没有意外或增加。结论:地高辛并没有提高厄洛替尼治疗进展性NSCLC的有效率。本研究中TTP和生存率与已发表的单独使用厄洛替尼的结果相似。这种组合不值得在NSCLC中进行进一步的临床研究。
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引用次数: 5
Prospective evidence that HIV lipoatrophy and visceral adiposity are partially independent processes 前瞻性证据表明,HIV脂肪萎缩和内脏肥胖是部分独立的过程
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2011-01-24 DOI: 10.2147/OAJCT.S14359
H. Wand, D. Carey, A. Calmy, M. Law, D. Cooper, S. Emery, A. Carr
Correspondence: Handan Wand national Centre in HiV Epidemiology and Clinical research, University of new South Wales, Sydney, nSW 2052, Australia Tel +61 2 9385 0900 Fax +61 2 9385 0910 Email hwand@nchecr.unsw.edu.au Purpose: To investigate the patterns of change in objectively assessed body composition parameters and to determine to what extent the observed patterns correlate with modifiable variables and potential risk factors for lipodystrophy in human immunodeficiency virus (HIV)-infected lipoatrophic adults. Method: Changes from baseline in limb fat and visceral adipose tissue (VAT), and their associations with antiretroviral therapy, body composition, and metabolic variables were investigated using linear and logistic regression models. Results: Increases in limb fat were significantly associated with higher baseline limb fat (P , 0.0001), VAT (P = 0.023), and change from baseline to week 72 in VAT (P , 0.0001). On-study use of zidovudine or stavudine was negatively associated with a limb fat increase (P = 0.017). High baseline limb fat mass and VAT had negative effects on subsequent VAT increases at week 72 (P = 0.016 and P = 0.001, respectively). Conclusions: This large, prospective study in HIV-infected adults with moderate or severe lipoatrophy at baseline showed positive associations between changes in limb fat and VAT over 72 weeks. Risk factors for these two lipodystrophic features were different. Our findings suggest that lipoatrophy and fat accumulation are at least partially independent processes.
通讯:澳大利亚新南威尔士州悉尼新南威尔士州2052新南威尔士大学Handan Wand国家艾滋病流行病学和临床研究中心电话+61 2 9385 0900传真+61 2 9385 0910邮箱hwand@nchecr.unsw.edu.au目的:研究客观评估的身体成分参数的变化模式,并确定观察到的模式与人类免疫缺陷病毒(HIV)感染的脂肪萎缩成人脂肪营养不良的可修改变量和潜在危险因素的关联程度。方法:使用线性和逻辑回归模型研究肢体脂肪和内脏脂肪组织(VAT)从基线的变化及其与抗逆转录病毒治疗、身体组成和代谢变量的关系。结果:肢体脂肪的增加与较高的基线肢体脂肪(P, 0.0001)、VAT (P = 0.023)以及从基线到第72周的VAT变化(P, 0.0001)显著相关。研究中使用齐多夫定或司他夫定与肢体脂肪增加呈负相关(P = 0.017)。高基线肢体脂肪量和VAT在第72周对随后的VAT增加有负面影响(P = 0.016和P = 0.001)。结论:这项大型前瞻性研究在基线时患有中度或重度脂肪萎缩的hiv感染成人中显示,72周内肢体脂肪变化与VAT呈正相关。这两种脂肪营养不良的危险因素是不同的。我们的研究结果表明,脂肪萎缩和脂肪积累至少是部分独立的过程。
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引用次数: 0
Retrospective analysis of a South African cardiovascular trial site’s patient retention rates 回顾性分析南非心血管试验点的患者保留率
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-11-26 DOI: 10.2147/OAJCT.S13896
L. Burgess, N. Sulzer
Correspondence: Lesley J Burgess TreAD research/Cardiology Unit, Department of internal Medicine, Tygerberg hospital and Stellenbosch University, Parow, South Africa Tel +27 21 931 7825 Fax +27 21 933 3597 email lesley@treadresearch.com Introduction: Patient dropouts negatively affect study cost and validity of study results. Objectives: To investigate the attrition rate and reasons for patient discontinuations at a cardiovascular trial site in South Africa. Methods: Studies conducted over the past 10 years were randomly selected and retrospectively examined for attrition rates and reasons for patient discontinuation. Results: A total of 50 studies with a duration ranging from 3 to 45 months were examined. A total of 1386 patients were randomized. Of these, 88.9% completed all scheduled study visits, resulting in a mean 11.1% (n = 154) attrition rate. Reasons for discontinuation included death (39.6%), withdrawal of consent (33.1%), adverse events (22.7%), and relocation (4.5%). There were no patients lost to follow-up. Conclusion: The low attrition rate and absence of any patients lost to follow-up are the result of a dedicated retention plan in which each site staff member has a crucial role to play in keeping patients motivated and interested in participating in a clinical trial.
通讯:Lesley J Burgess TreAD研究/心脏病科,内科,Tygerberg医院和Stellenbosch大学,Parow,南非电话+27 21 931 7825传真+27 21 933 3597电子邮件lesley@treadresearch.com介绍:患者退出对研究成本和研究结果的有效性产生负面影响。目的:调查南非一个心血管试验地点患者的流失率和停药原因。方法:随机选择过去10年进行的研究,回顾性检查患者的损耗率和停药原因。结果:共检查了50项研究,持续时间从3到45个月不等。共有1386名患者被随机分组。其中,88.9%完成了所有预定的研究访问,平均损失率为11.1% (n = 154)。终止治疗的原因包括死亡(39.6%)、撤回同意(33.1%)、不良事件(22.7%)和重新安置(4.5%)。无患者失访。结论:低流失率和没有任何患者失去随访是一个专门的保留计划的结果,在这个计划中,每个站点的工作人员都在保持患者参与临床试验的积极性和兴趣方面发挥着关键作用。
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引用次数: 4
Examining the readability of patient-informed consent forms 检查患者知情同意书的可读性
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-10-19 DOI: 10.2147/OAJCT.S13608
Marli Terblanche, L. Burgess
Correspondence: Marli Terblanche Room 41, Department of Cardiology, 8th Floor, Tygerberg Hospital, Parow 7500, South Africa Tel +27 21 931 7825 Fax + 27 21 933 3597 Email marli@treadresearch.com Primary objective: To investigate the readability of informed consent forms (ICF) used at TREAD Research, a private clinical trial research unit located in Tygerberg Hospital. Secondary objective: To assess if there is a difference in readability between therapeutic areas, as well as a difference in readability over two time periods. Methods: The readability of 84 ICFs given to patients at TREAD Research between the years 2000 and 2009 was quantitatively assessed by means of the Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, and Gunning-Fog index. Results: The mean ± standard deviation (SD) Flesch–Kincaid Reading Ease score for the 84 ICFs was 46.60 ± 5.62 (range 33.2–65.6). The mean ± SD grade level was 12.13 ± 1.8 (range 8.3–14.9) using the Flesch–Kincaid formula and 13.96 ± 1.22 (range 10.3–16.6) using the Gunning-Fog index. Readability at grade level 8 was only found in 1.2% of all the ICFs assessed. No differences were found in readability between therapeutic areas or over the two time periods. Conclusions: The main finding is that these forms are too complex to be understood by average study participants and their families.
通讯:Marli Terblanche,南非Parow 7500, Tygerberg医院8楼心脏病科41室电话+27 21 931 7825传真+27 21 933 3597电子邮件marli@treadresearch.com主要目的:调查知情同意书(ICF)在位于Tygerberg医院的私人临床试验研究单位TREAD Research中使用的可读性。次要目的:评估治疗区域之间的可读性是否存在差异,以及两个时间段的可读性差异。方法:采用Flesch-Kincaid Reading Ease、Flesch-Kincaid Grade Level和Gunning-Fog指数对2000 - 2009年在TREAD Research中给予患者的84份ICFs的可读性进行定量评价。结果:84例ICFs的Flesch-Kincaid Reading Ease评分均值±标准差(SD)为46.60±5.62(范围33.2 ~ 65.6)。使用Flesch-Kincaid公式的平均±SD等级水平为12.13±1.8(范围8.3-14.9),使用Gunning-Fog指数的平均±SD等级水平为13.96±1.22(范围10.3-16.6)。在所有被评估的ICFs中,只有1.2%的人具有8级的可读性。在治疗区域之间或在两个时间段内,没有发现可读性的差异。结论:主要发现是这些表格太复杂,一般的研究参与者和他们的家人无法理解。
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引用次数: 41
Sodium nitroprusside-associated cyanide toxicity in adult patients – fact or fiction? A critical review of the evidence and clinical relevance 成人硝普钠相关氰化物中毒——事实还是虚构?对证据和临床相关性的批判性回顾
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-09-02 DOI: 10.2147/OAJCT.S7573
P. Abraham
Correspondence: Prasad Abraham Department of Pharmacy and Drug information, Box 2061, Grady Health System, 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303, USA Tel +1 404-616-3246 Fax +1 404-616-2228 email pabraham@gmh.edu Abstract: Since its US Food and Drug Administration (FDA) approval in 1974, sodium nitroprusside (SNP) has been fraught with controversy in regards to its safety. Over the years, a growing concern related to SNPs propensity to cause cyanide (CN) toxicity culminated into a series of case reports that led the FDA to develop a black-box warning with dose limitations of ,2 μg/kg/min. These recommendations stemmed also from the reality of the difficulty of obtaining CN levels in a timely manner, as well as the presumed poor correlation of metabolic markers (lactate levels and pH) as it related to the severity of CN toxicity. All these issues have driven practitioners to the use of alternative agents. In this paper, we critically review the cases and the data that led to the development of these restrictive dosing recommendations and reveal several limitations of the data and assumptions that led to these recommendations. We conclude that SNP is still a reasonable agent to use in the management of patients with hypertension today and can safely be used beyond doses of 2 μg/kg/min. Furthermore, in lieu of CN levels, monitoring of lactic acid levels is also a reasonable measure to ensure safety.
通讯:Prasad Abraham Pharmacy and Drug information Department, Box 2061, Grady Health System, 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303, USA Tel +1 404-616-3246 Fax +1 404-616-2228 email pabraham@gmh.edu摘要:自1974年美国食品和药物管理局(FDA)批准硝普钠(SNP)以来,其安全性一直充满争议。多年来,人们对snp引起氰化物(CN)毒性的倾向日益关注,最终形成了一系列病例报告,导致FDA制定了剂量限制为2 μg/kg/min的黑框警告。这些建议还源于难以及时获得CN水平的现实,以及代谢标志物(乳酸水平和pH)与CN毒性严重程度的推定相关性较差。所有这些问题都促使从业者使用替代药物。在本文中,我们批判性地回顾了导致这些限制性剂量建议发展的病例和数据,并揭示了导致这些建议的数据和假设的一些局限性。我们得出的结论是,SNP仍然是一种合理的用于高血压患者管理的药物,并且可以安全地使用超过2 μg/kg/min的剂量。此外,监测乳酸水平代替CN水平也是确保安全的合理措施。
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引用次数: 21
Time will tell: community acceptability of HIV vaccine research before and after the "Step Study" vaccine discontinuation. 时间会告诉我们:在停止“步进研究”疫苗之前和之后,社区对艾滋病毒疫苗的接受程度。
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-09-01 DOI: 10.2147/OAJCT.S11915
Paula M Frew, Mark J Mulligan, Su-I Hou, Kayshin Chan, Carlos del Rio

OBJECTIVE: This study examines whether men-who-have-sex-with-men (MSM) and transgender (TG) persons' attitudes, beliefs, and risk perceptions toward human immunodeficiency virus (HIV) vaccine research have been altered as a result of the negative findings from a phase 2B HIV vaccine study. DESIGN: We conducted a cross-sectional survey among MSM and TG persons (N = 176) recruited from community settings in Atlanta from 2007 to 2008. The first group was recruited during an active phase 2B HIV vaccine trial in which a candidate vaccine was being evaluated (the "Step Study"), and the second group was recruited after product futility was widely reported in the media. METHODS: Descriptive statistics, t tests, and chi-square tests were conducted to ascertain differences between the groups, and ordinal logistic regressions examined the influences of the above-mentioned factors on a critical outcome, future HIV vaccine study participation. The ordinal regression outcomes evaluated the influences on disinclination, neutrality, and inclination to study participation. RESULTS: Behavioral outcomes such as future recruitment, event attendance, study promotion, and community mobilization did not reveal any differences in participants' intentions between the groups. However, we observed greater interest in HIV vaccine study screening (t = 1.07, P < 0.05) and enrollment (t = 1.15, P < 0.05) following negative vaccine findings. Means on perceptions, attitudes, and beliefs did not differ between the groups. Before this development, only beliefs exhibited a strong relationship on the enrollment intention (β = 2.166, P = 0.002). However, the effect disappeared following negative trial results, with the positive assessment of the study-site perceptions being the only significant contributing factor on enrollment intentions (β = 1.369, P = 0.011). CONCLUSION: Findings show greater enrollment intention among this population in the wake of negative efficacy findings from the Step Study. The resolve of this community to find an HIV vaccine is evident. Moreover, any exposure to information disseminated in the public arena did not appear to negatively influence the potential for future participation in HIV vaccine studies among this population. The results suggest that subsequent studies testing candidate vaccines could be conducted in this population.

目的:本研究探讨男男性行为者(MSM)和变性人(TG)对人类免疫缺陷病毒(HIV)疫苗研究的态度、信念和风险认知是否因2B期HIV疫苗研究的阴性结果而改变。设计:我们对2007年至2008年在亚特兰大社区招募的MSM和TG人群(N = 176)进行了横断面调查。第一组是在一项正在评估候选疫苗的2B期HIV疫苗试验期间招募的(“Step研究”),第二组是在媒体广泛报道产品无效后招募的。方法:采用描述性统计、t检验和卡方检验来确定组间差异,并采用有序logistic回归检验上述因素对关键结局——未来HIV疫苗研究参与情况的影响。序数回归结果评估了不倾向、中立和倾向于研究参与的影响。结果:行为结果,如未来招聘、活动出席、学习促进和社区动员,没有显示组间参与者意图的任何差异。然而,我们观察到,在疫苗结果阴性后,HIV疫苗研究筛选(t = 1.07, P < 0.05)和入组(t = 1.15, P < 0.05)的兴趣更大。在感知、态度和信仰方面,各组之间没有差异。在此之前,只有信念对入组意向有较强的影响(β = 2.166, P = 0.002)。然而,在试验结果为阴性后,这种影响就消失了,对研究地点认知的积极评价是影响入组意向的唯一显著因素(β = 1.369, P = 0.011)。结论:研究结果显示,在Step研究的负面疗效结果之后,该人群的入组意向更大。这个社区寻找艾滋病毒疫苗的决心是显而易见的。此外,接触在公共场所传播的信息似乎不会对这一人群今后参与艾滋病毒疫苗研究的可能性产生负面影响。结果表明,可以在这一人群中进行测试候选疫苗的后续研究。
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引用次数: 9
HeartSmart ® for routine optimization of blood flow and facilitation of early goal-directed therapy HeartSmart®用于常规血流优化和促进早期目标导向治疗
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-08-05 DOI: 10.2147/OAJCT.S9843
K. Warring-Davies, Martin J. Bland
The empirical physiological formulae of the new continuous cardiac dynamic monitoring HeartSmart ® technology, which involves the use of a new inverse square rule of the heart, were investigated with pulmonary artery catheter (PAC) thermodilution in the estimation of CI in diverse patients. Clinical trial data collected from 268 adult surgery or intensive care patients requiring PAC placement were obtained from 7 NHS Trust hospitals, providing 2720 paired sets of CI estimations for comparison between HeartSmart ® and PAC thermodilution. For 95% of pairs of measurements, HeartSmart ® values were between 57% and 164% of PAC measure- ments; additionally, the larger limit of agreement between HeartSmart ® and PAC thermodilution (1.26 L min -1 ·m -2 ) suggests that HeartSmart ® agrees with PAC thermodilution as closely as PAC thermodilution agrees with itself. HeartSmart ® can also estimate CI in the extreme circumstances of shock/sepsis, as indicated by PAC thermodilution CI values that were hypo- or hyperdynamic based on systemic inflammatory response syndrome criteria. In CI measurements for hypo- or hyperdynamic values that were matched between HeartSmart ® and PAC thermodilution, the difference in total volumes and average CI measurements between the two methods was less than 5%. For unmatched hypo- or hyperdynamic values, the difference between total volumes and average CI measurements was less than 33% - an acceptable percentage of difference or error even for normal values of CI. HeartSmart ® tracked PAC thermodilution CI hypodynamic values 98.2% of the time and hyperdynamic values 97.6% of the time. These findings show that CI estimations provided by the HeartSmart ® empirical physiological formulae are comparable to those obtained using PAC thermodilution. HeartSmart ® removes many of the technical barriers that prevent the routine adoption and practice of early goal-directed therapy, and represents a simple, reliable method of estimating CI and other hemodynamic variables at the bedside or in departments other than the Intensive Care Unit.
新的连续心脏动态监测HeartSmart®技术的经验生理学公式,涉及到使用新的心脏平方反比法则,用肺动脉导管(PAC)热稀释来估计不同患者的CI。从7家NHS信托医院收集了268名需要放置PAC的成人手术或重症监护患者的临床试验数据,提供了2720组配对的CI估计,用于比较HeartSmart®和PAC热稀释。对于95%的测量对,HeartSmart®的值在57%到164%的PAC测量值之间;此外,HeartSmart®和PAC热修正之间的最大一致限度(1.26 L min -1·m -2)表明HeartSmart®与PAC热修正的一致程度与PAC热修正本身的一致程度一样高。HeartSmart®还可以估计休克/败血症极端情况下的CI,根据全身炎症反应综合征标准,PAC热稀释CI值为低动态或高动态。在HeartSmart®和PAC热调节相匹配的低动力或高动力值CI测量中,两种方法之间的总体积和平均CI测量差异小于5%。对于不匹配的低动力或高动力值,总体积和平均CI测量值之间的差异小于33%——即使对于正常CI值,差异或误差的百分比也是可以接受的。HeartSmart®跟踪PAC热稀释CI低动力值98.2%的时间和高动力值97.6%的时间。这些发现表明,由HeartSmart®经验生理公式提供的CI估计值与使用PAC热稀释获得的估计值相当。HeartSmart®消除了许多阻碍早期目标导向治疗常规采用和实践的技术障碍,并代表了一种简单、可靠的方法来估计床边或重症监护病房以外科室的CI和其他血液动力学变量。
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引用次数: 5
Conducting ethical clinical trials for L. donovani in the Bihar region of India 在印度比哈尔邦地区进行多诺瓦杆菌的伦理临床试验
IF 1.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2010-08-04 DOI: 10.2147/OAJCT.S10967
T. Crawford, B. Vesely
Visceral leishmaniasis is a severe disease that disproportionally afflicts the Bihar state in India with 40% of the worldwide disease burden. Drug resistance, poor adherence, extreme poverty, malnutrition and certain living conditions have made control and treatment of the disease difficult. There is a great need for new drugs and control programs to reduce the disease burden of this debilitating and potentially fatal disease. Drug discovery research on leishmaniasis is being conducted in the USA and this raises issues concerning the ethical conduct of international clinical trials. Ethical principles dictate that the Bihari who need these drugs should be included in clinical trials. Additional safeguards for the ethical conduct of clinical trials on developing countries by developed countries have been formulated elsewhere. These include collaborative partnership, social value, scientific validity, fair selection of study population, favorable risk-benefit ratio, independent review, informed consent, and respect for recruited participants and study communities. These principles are applied to the Bihari context, and issues of ancillary care and post-trial access are also addressed. The socio-cultural context of the region is discussed in order to give researchers the tools to obtain meaningful informed consent. A description of the Bihari context and relevant ethical considerations should facilitate the design and conduct of ethical clinical trials for L. donovani.
内脏利什曼病是一种严重疾病,严重影响印度比哈尔邦,占世界疾病负担的40%。耐药性、依从性差、赤贫、营养不良和某些生活条件使控制和治疗这种疾病变得困难。我们迫切需要新的药物和控制计划来减轻这种使人衰弱和可能致命的疾病的疾病负担。关于利什曼病的药物发现研究正在美国进行,这引发了有关国际临床试验伦理行为的问题。伦理原则规定,需要这些药物的比哈里人应该被纳入临床试验。对发达国家在发展中国家进行临床试验的道德行为,其他地方也制定了额外的保障措施。这些因素包括合作伙伴关系、社会价值、科学有效性、研究人群的公平选择、有利的风险收益比、独立审查、知情同意以及对被招募参与者和研究群体的尊重。这些原则适用于比哈里的情况,辅助护理和审判后获取的问题也得到了解决。讨论了该地区的社会文化背景,以便为研究人员提供获得有意义的知情同意的工具。对比哈里背景和相关伦理考虑的描述应有助于设计和开展多诺瓦氏乳杆菌的伦理临床试验。
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Open Access Journal of Clinical Trials
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