Data management system is a major factor affecting the quality of clinical trial. Development of data management system include a steering group and data safety and monitoring board, data collection, database, performance of the data safety and monitoring, as well as locking of database. This article provides key issues of the five parts so as to help researchers understand the clinical trial data management system.
The two factors that affect enrollment of participants and the process of intervention in randomizedcontrolled pragmatic trials are similar to the situation of clinical practice, thus its effects are similar to the situation ofclinical practice. Therefore, when one estimates an intervention’s effect on a patient, it will be more similar to a real clinicalsituation than results taken from an explanatory trial. Due to the introduction of interventions and process variables usedin a pragmatic trial that conform to traditional Chinese medicine and acupuncture practices, more and more interest isgrowing among researchers in the traditional Chinese medicine field. This article introduces the principles and conceptsof the pragmatic trial, and the key points of design via some samples.
With the encouragement of national policy on drug and medical device innovation, multi-center clinical trials and multi-regional clinical trials are facing an unprecedented opportunity in China. Trials with a multi-center design are far more common at present than before. However, it should be recognized there still exists shortcomings in current multi-center trials. In this paper, we summarize the problems and challenges and provide corresponding resolutions with the aim to reduce heterogeneity between study centers and avoid excessive center effects in treatment. It is urgent to develop design, implementation and reporting guidelines to improve the overall quality of multi-center clinical trials.
The concept of clinical trial transparency has been promoted for more than 40 years. The act of clinical trial registration, report guidelines development, and data sharing has has been strongly pushed forward and become a common practice. The clinical trial process being the key procedure of trial operation and quality control, determines the accuracy of the results. However, the process report of clinical trials is insufficient. In this article, we summarize the importance of clinical trial process report and provide corresponding suggestions. We propose that medical journals, reporting guidelines developers and clinical trial registration platforms should work together to strengthen the process report of clinical trials and promote full transparency of clinical trials.
若在已发表的报告中干预措施描述不完整，临床工作者和患者就无法可靠地实施有效的干预措施，其他研究人员也无法在此研究基础上重复或进一步开展研究。然而，已发表文章中干预措施的报告质量非常差。为提高报告的完整性并最终提高干预措施的可重复性，一个国际专家组和利益相关方共同制订了描述干预措施的清单和报告规范（Template for Intervention Description and Replication，TIDieR）。制订过程包括：相关清单和研究的文献综述，针对国际专家小组的德尔菲调查以指导选择清单条目及召开面对面的小组会议。最终确定的 12 条 TIDieR 清单条目（包括：干预措施简称、实施理由、实施资料、实施过程、干预措施实施者、实施方法、实施地点、实施时间及强度、个性化方案、方案更改、预期效果和实际效果）是对 CONSORT（The Consolidated Standards of Reporting Trials）2010 声明中条目 5 和 SPIRIT（Standard Protocol Items: Recommendations for Interventional Trials）2013 声明中条目 11 的扩展。虽然该清单强调的是试验中干预措施描述，但该指导仍适用于所有评价性研究设计。本文对 TIDieR 清单的每个条目进行了解释和说明并呈现了高质量报告的实例。TIDieR 清单和报告规范可提高干预措施的报告质量，并且使得作者对干预措施的描述、审稿人和编辑对有关干预措施描述的评估、读者对干预措施的使用更加容易。
Clinical trial transparency, include clinical trial registration, unbiased reporting results and sharing individual participant data (IPD), is one of the most important revolutionary concepts following clinical epidemiology and evidence-based medicine in the medical field. Sharing IPD is a medical ethics issue reflected a new sense of worth and constructing new rules of clinical trials. Our viewpoint is that from the essential purpose of clinical research, IPD is a social public property. Sharing IPD is a one of the best ways for respecting the contributions of the participants, and one of the keys for changing face of clinical trials.
背景 随机对照试验（randomized controlled trials，RCTs）常用于评估社会和心理干预措施的效果，这些结果亦常被用于制定决策。有关社会及心理干预措施试验结果的准确、完整和透明的报告，对了解针对这些干预措施的临床试验设计、实施、结果及这些结果的应用至关重要。然而，关于社会和心理干预措施的 RCT 报告质量仍不理想。CONSORT（consolidated standards of reporting trials）声明改善了生物医学领域 RCT 的报告质量，同样，行为和社会科学方面也需要类似的高质量报告规范。我们的目标是基于 RCT 报告规范 2010 年声明（Consolidated Standards of Reporting Trials 2010 Statement，CONSORT 2010）的官方扩展版，制定适用于社会和心理干预措施（social and psychological interventions，SPI）的 RCT 报告规范（CONSORT-SPI 2018）。 方法 我们遵循最佳方案制定报告规范的扩展版。首先，我们对现有报告规范进行了系统评价。随后，我们进行了有 384 位国际参与者参加的德尔菲在线调查。2014 年 3 月，我们举行了为期 3 天的共识会议，由 31 位专家参与，确定针对社会和心理干预措施的 RCT 报告的检查清单内容。专家们仔细讨论了先前与社会和心理干预措施 RCT 相关的研究和方法学问题。然后，投票决定对 CONSORT 2010 条目的修改或扩展。 结果 CONSORT-SPI 2018 检查清单扩展了 CONSORT 2010 的 25 个条目中的 9 个，包括：背景和目标、试验设计、受试者、干预措施、统计方法、受试者流程、基线数据、结果和估计及资助来源。此外，与会者还添加了一个与利益相关方参与度有关的新条目，此外，也修改了与受试者招募和及其后续维持相关的流程图。 结论 作者应使用 CONSORT-SPI 2018 来改善社会和心理干预相关的 RCT 的报告质量。期刊应修改编辑政策和程序，要求作者使用报告规范准备相关稿件，要求同行评议者使用报告规范评审相关稿件，以使读者能够评估研究的质量，评价研究结果的推广性，并重复有效的干预措施。
Evidence produced by clinical trial is the main basis for health care decision-making at all levels. In recent years, some problems been revealed in the national data audit of new drug clinical trials have sounded the alarm for the quality of clinical research in China. In addition to strengthening the implementation of clinical trial process management and supervision, we call attention to the coherence and consistency of trial design and implementation, including the promotion of clinical trial design in the agenda of improving the quality of the trials and putting forward reasonable suggestions. We hope that our work could make research ideas clear from the source of a clinical trial, with a view to avoid violating protocol behavior and provide standardized recommendations for improving the quality of clinical trials in China.