This document discusses monitoring response variables in clinical studies. It defines response variables as the outcomes used to answer the study's primary and secondary questions. Ideal response variables are well-defined, stable, reproducible, unbiased, and can be ascertained in all participants. Surrogate response variables can be used but require validation as they may not fully capture the effect of an intervention on the true clinical outcome. Data and safety monitoring boards provide independent oversight of clinical studies to ensure participant safety and appropriate study conduct.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Le 27 octobre 2016, Benoît de Juvigny, secrétaire général de l'AMF, Yves Perrier, président de l'AFG, et Didier Le Menestrel, président de la commission compétitivité de l'AFG, ont présenté le rapport FROG pour une plus grande visibilité et distribution des fonds français à l’international
Vinay Prassad, hematólogo-oncólogo y profesor de Medicina en la Oregon Health and Sciences University. Ponencia presentada en el marco de la jornada Cómo revertir prácticas clínicas de escaso valor organizada por la Societat Catalana de Gestió Sanitària el 18 de mayo de 2018.
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
Designing Causal Inference Studies Using Real-World DataInsideScientific
In this webinar, experts provide an overview of causal inference, along with step-by-step guidance to designing these studies using real-world healthcare data.
Causal inference is used to answer cause and effect research questions and yield estimates of effect. Causal study design considerations and statistical methods address the effects of confounding variables and other potential biases and allow researchers to answer questions such as, “Does treatment A produce better patient outcomes compared to Treatment B?”
Causal study interpretations have traditionally been restricted to randomized controlled trials; however, causal inference applied to observational healthcare data is growing in importance, driven by the need for generalizable and rapidly delivered real-world evidence to inform regulatory, payer, and patient/provider decision making. The application of causal inference methods leads to stronger and more powerful evidence. When these techniques are applied to observational data, the results generated are both from and for the real world.
Presenters walk through several real-world case studies including the PCORI-funded BESTMED study and a collaborative study with a prominent pharmacy payer.
A Lecture for 5th year MDCU medical students
by Associate Professor Dr.Thira Woratanarat
Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University
สไลด์บรรยาย "Health literacy for NCDs prevention and control" ของป๊าในงาน Prince Mahidol Award Conference (PMAC) 30 มกราคม 2562 ที่โรงแรม Central World
Primary Health Care Systems (PRIMASYS): Case Study from Thailand, Abridged ve...Thira Woratanarat
Primary health care systems (PRIMASYS): case study from Thailand, abridged version. WHO 2017.
By Thira Woratanarat, Patarawan Woratanarat, Charupa Lekthip
Effectiveness of Nutrition Information Provision on Food Consumption Behavior among Undergraduate Students in Urban Areas
โดย
นพพล วิทย์วรพงศ์
สันต์ สัมปัตตะวนิช
ธนะพงษ์ โพธิปิติ
ธานี ชัยวัฒน์
พัชรสุทธิ์ สุจริตตานนท์
ธีระ วรธนารัตน์
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
3. What’s The Question?
•
•
•
•
•
•
What’s the outcome?
What’s the intervention?
When and for how long?
For whom?
How many participants are needed?
How can we optimize potential benefit (and what
we learn) while minimizing potential harm?
4. Answering the Question
• Response variable selection and
measurement
• Defining the intervention
• Study design
• Eligibility criteria
• Sample size estimate
• Patient management procedures
• Monitoring for safety and benefit
• Data analysis approaches
8. What’s the Response Variable?
• Used to answer primary/secondary questions
• Characteristics for primary/secondary outcomes
1. Well defined & stable
2.
Ascertained in all subjects
3.
Unbiased
4.
Reproducible
5.
Specificity to question
9. Response Variable (1)
• Examples
1. MILIS
Infarct size measurement?
- Enzymes (area under curve or peaks)
- Radionuclide imaging
- EKG
Issues of definition, ascertainment, reproducible
2. NOTT
Quality of Life?
- POMS (Profile of Mood)
- SIP (Sickness Impact Profile)
- Pulmonary Function
- Survival
11. Surrogate Response Variables
• Used as alternative to desired or ideal clinical response
• Examples
– Suppression of arrhythmia (sudden death)
– T4 cell counts (AIDS or ARC)
• Used often - therapeutic exploratory
(Phase I, Phase II)
• Use with caution - therapeutic confirmatory
(Phase III)
12. Surrogate Response Variables (2)
• Frequent Criticism of Clinical Trials
– Too long
– Too large
– Too expensive
• Advantages
– Perhaps smaller sample size
– Detect earlier effect → shorter trial
– Easier
13. Examples of FDA Approval of Drugs Using
Surrogates (1)
• Lower cholesterol without evidence of survival
benefit
• Lower blood pressure without evidence of
benefit for stroke, MI, congestive heart failure,
or survival
• Increase bone density without evidence of
decreased fractures in osteoporosis
14. Examples of FDA Approval of Drugs Using
Surrogates (2)
• Increase cardiac function in congestive heart
failure without evidence of survival benefit
• Decrease rate of arrhythmias (VPBs) without
evidence of survival benefit
• Lower blood glucose and glycosylated
hemoglobin without evidence about diabetic
complications or survival benefit
15. Surrogate Response Variables (3)
• Requirements (Prentice, 1989)
T = True clinical endpoint
S = Surrogate
Z = Treatment
• H0: P(T|Z) = P(T) ⇔ P(S|Z) = P(S)
• Sufficient Conditions
1.
2.
S is informative about T (predictive)
P(T|S) ≠ P(T)
S fully captures effect of Z on T
P(T|S,Z) = P(T|S)
16. Concerns About Surrogates
1. Relationship between surrogate and true
endpoint may not be causal, but coincidental
to a third factor
2. Other unfavorable effects of the drug
3. Effect on surrogate may correlate with one
clinical endpoint, but not others
18. Time
Reasons for failure of
surrogate end points.
A. The surrogate is not
in the causal pathway
of the disease process.
B. Of several causal
pathways of disease,
the intervention
affects only the
pathway mediated
through the surrogate.
C. The surrogate is not
in the pathway of the
intervention’s effect or
is insensitive to its
effect.
D. The intervention
has mechanisms for
action independent of
the disease process.
Dotted lines =
mechanisms of action
that might exist.
A
Disease
Surrogate
End Point
True Clinical
Outcome
Intervention
B
Disease
Surrogate
End Point
True Clinical
Outcome
Intervention
C
Disease
Surrogate
End Point
True Clinical
Outcome
Intervention
D
Disease
Surrogate
End Point
True Clinical
Outcome
20. Nocturnal Oxygen Therapy Trial
(NOTT)
• Hypothesis
– Is continuous oxygen therapy better than nocturnal oxygen therapy in
chronic obstructive lung disease patients?
• Possible Surrogates
• Quality of Life
• Survival
• Design
–
–
–
–
–
203 patients
Two-sided 0.05 Type I error
Randomized
Multicenter
Sequential data monitoring
21. Possible NOTT Surrogates
PaO2
• Mean Pulmonary
Artery Pressure
Hematocrit
FEV1 % Predicted • Cardiac Index
FVC % Predicted • Pulmonary
Vascular
Maximum
Resistance
Workload
• Heart Rate
•
•
•
•
•
22. Concluding Remarks on Surrogates
• Surrogates play an important role in the development of
Phase I, II, and pilot Phase III studies
• Treatments may affect more than one mechanism
• “Surrogates” do not reliably predict treatment on clinical
outcome
• Continued success in a given field is not even guaranteed
• Reliance on “surrogates” should be minimized
23. Composite Outcomes
• Defined as having occurred if any one of several
components is observed
– e.g. death, MI, stroke, change in severity,…..
•
•
•
•
Should be clinically relevant
Each component ascertainable without bias
Must be sensitive to intervention
Made up of fatal & nonfatal events
24. Composite Endpoint Rationale
• May reduce Sample Size by increasing event
rates
– Assumes each component sensitive to
intervention
– Otherwise, power can be lost
• Avoids competing risk problem
– Death is a competing risk to all other morbid
events, probably not independent
25. Problems with
Composite Outcomes
• Interpretability if individual components go in different
directions
– e.g. WHI global index–
• Death: similar
• Fractures: positive
• DVTs, PEs: negative
• Relevance of a mixed set of components
– Adding softer outcomes
• Could have a loss of power
• Failure to ascertain components
26. Data and Safety Monitoring Boards
Why?
• Participant Safety
• Policy Review
27. Data and Safety Monitoring Boards
New Treatment for Lung Cancer
• Totally New Compound
• Possible Liver Toxicity in Animals
28. Data and Safety Monitoring Boards
New Treatment for Lung Cancer
Ten Patients Enrolled – 6 Months FU
• Placebo Group
Two Dead from Lung Cancer
• Treated Group
None Dead from Lung Cancer
Two Dead from Liver Failure
29. Data and Safety Monitoring Boards
Who?
• Independent of Sponsor/Investigators
• Appointed by Sponsor
• Members Without Conflict of Interest
• Different Areas of Expertise
30. Data and Safety Monitoring Boards
What? – Study Monitoring
• Review Protocols and Procedures
• Review Study Design
• Monitor Ongoing Quality
• Monitor Patient Accrual and Drop-out
• Monitor Clinic and Patient Compliance
31. Data and Safety Monitoring Boards
What? – Data Monitoring
• Identify Major Response Variables
• Identify Possible Adverse Outcomes
• Develop Stopping Guidelines
32. Sequential Study Monitoring
O’Brian - Flemming
5
4
3
2
1
Test
0
Statistic
-1
-2
-3
-4
-5
Reject Null Hypothesis
Continue Study
Accept
Null
Hypothesis
Continue Study
Reject Null Hypothesis
0
20
40
60
Number of Events
80
33. Data and Safety Monitoring Boards
Study Outcomes
• Planned Termination
• Harm – Early Termination
• Early Benefit – Early Termination
• Futility – Early Termination
• Study Extension with Changes