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04.Parker_team-procedure-monitor-sponsor.ppt
1. Joint Research & Enterprise Office Training
Joint Research & Enterprise Office Training
The team, the procedures, the monitor
and the Sponsor
Lucy H H Parker
Clinical Research Governance Manager
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Joint Research & Enterprise Office Training
CI and PIs
Monitor
Regulatory Assurance Manager
Stats.
?RN/CTA/DM
Research Pharmacy
Archivist
Finance
Support Departments
IT - eCRF
The Team
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Lots of meetings!
Site selection
Risk Assessment (26 point risk assessment)
Major issues identified and minimised
Monitoring plan – agreed with all parties even if external monitor
Standard RG processes – initiation, routine, close out
Safety reporting
How are the studies set up?
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Sponsor
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Sponsor
• Sponsor takes on overall responsibility for initiation, management
and/or financing of study
• All clinical trials must have a designated sponsor
– Must be named in the protocol
• Not necessarily the funder
– Typically CI employer
• Can delegate responsibilities to investigators
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• Quality Assurance (audits)
• Quality Control (monitoring)
• Contracts & Agreements
• Medical Expertise
• Trial Design
• Trial Management, Data Handling, and Record
Keeping
• Investigator Selection
• Allocation of Responsibilities
• Compensation to Subjects and Investigators
• Financing
• Submission to Regulatory Authorities
• Confirmation of Review by REC
• Information on IMP
• Manufacturing, Packaging, Labelling, and
Coding of IMP
• Supplying and Handling of IMP
• Record Access
• Safety Information
• Safety Reporting
• Non-compliance
• Premature Termination or Suspension of a
Trial
• Clinical Trial/Study Reports
• Multi-centre Trials
ICH GCP Section 5
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Sponsor Responsibilities
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Quality Assurance (QA) versus Quality Control (QC)
• QC = Quality Control = monitoring
– Member of trial team
– Ongoing
• QA = Quality Assurance = auditing
– Independent
– Planned and systematic
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Monitoring
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What is monitoring?
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“The act of overseeing the progress of a clinical trial, and of ensuring that it is
conducted, recorded, and reported in accordance with the protocol, SOPs, GCP, and
any regulatory requirements”
ICH GCP Section 5.18
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Purpose of Monitoring?
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• Protection of rights and wellbeing of human participants
– Ensure consent in place for record access
• Trial data are accurate, complete and verifiable from source documents
• Conduct of trial is in compliance with the currently approved protocol, GCP,
and all applicable regulatory requirements
ICH GCP Section 5.18.1
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Qualities of a Good Monitor?
• Appropriately trained
• Adequate scientific and/or clinical knowledge
– Documented with training logs and CVs
• Thoroughly familiar with:
– IMP
– Protocol
– Consent form
– Sponsor & trial SOPs
– GCP
• Knowledge of local laws, regulations, customs & local language
ICH GCP Section 5.18.2
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Extent and Nature of monitoring
• Monitoring should be proportionate to:
– Objective
– Purpose
– Design
– Blinding
– Size and complexity
– Outcome measures
– Risks
ICH GCP Section 5.18.3
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Types Of Monitoring (1)
• Coordinating centre / day-to-day monitoring
– Data collected are consistent with protocol
– CRFs are being completed by authorised staff
– No key data is missing
– Data appears to be valid
– Review of recruitment rate, withdrawals and losses to f/up
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Types Of Monitoring (2)
• Central monitoring
– Determination of key eligibility criteria through collection of:
• Consent forms (with agreement by participant)
• Scans
• Pathology reports
– Statistics
• Unusual patterns of data
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Types Of Monitoring (3)
• On-site monitoring
– Staff training
– Access to necessary documents
– Confirm pharmacy and lab resources in place
• Count study drugs
– Adherence to protocol and GCP
– Check medical records
• Consent forms
• Eligibility
• SAEs, SADRs, SUSARs etc
– Source Data Verification (SDV)
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CRF Completion Data Entry
Data cleaning &
Validation
Data entry
checks
Double data
entry
Post entry
checks
Monitoring visits
& SDV
Training Investigators
OCR
Data Management & Processing
EDC system
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Joint Research & Enterprise Office Training
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Common queries and checks
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• Most common checks to identify discrepancies:
– Missing values
– Range checks, including lab values and normals
– Logical date sequence
– Header information consistent
– Missing visits or pages
– Visits in compliance with protocol
– Inclusion/exclusion criteria met
– Procedures performed in proper order
– Fraud
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Post
1. Data manager cleans &
validates database
2. Problems such as missing values or
inconsistencies
3.Queries addressed to the PI via paper
query forms
4. PI resolves
queries
5. Query resolutions put on
query form
6. Monitor checks query
resolutions
7. Query forms with resolution
sent back to data manager
8. Corrections entered in
database
Data validated
No
Yes
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Post Entry Checks
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Plan
Do
Check
Revie
MONITORING
& AUDITS
Ensuring the Quality of the Data
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Joint Research & Enterprise Office Training