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The Role Of Clinical Research Associates In Good Clinical Practice

By Jose Meyer


The term "Good Clinical Practice" is an international quality standard that is applied to interventional trials. In an interventional study, subjects are assigned to a group of people to receive a treatment, usually either a drug or a medical device, or to a control group receiving existing treatment or no treatment. Clinical research associates, also known as trial monitors, play a pivotal role in maintaining the integrity of the trial data and the safety of the patients who are participating.

Trial monitors get involved in every aspect of the operational aspects of trials from feasibility to study closeout. Before a single patient is recruited, monitors help with study center selection. The names of the investigators, who are usually key opinion holders in their fields, will have been narrowed down by the study management team. The monitors are responsible for visiting each investigator's clinic to begin the process of study center selection.

The study management team will usually have produced a pro forma that the monitor can work from to see if the site has the right personnel and facilities to successfully complete their part of the study. This means the monitor must know the study protocol from start to finish and back again.

The main reason for failure of a drug trial is because the study did not manage to recruit the prescribed number of patients. Each investigator must have a suitable pool of patients who will meet all of the inclusion criteria and none of the exclusion criteria specified in the protocol. For example, you would not expect a urologist to recruit many patients with Alzheimer's Disease.

Once a patient is enrolled into the trial and has signed their consent form, everything from that point on must be accurately written down in the trial documentation. These days, most trial documentation is done online on computerized forms. There used to be a time when the monitor had to look at the medical records and compare them to the handwritten forms to make sure the info was completely accurate.

One of the main tasks of a study monitor is to verify the recorded data. They go through patient records and make sure all of the requisite tests have been performed as detailed in the study protocol and that they have been faithfully documented in the trial literature. They have to make sure that the subject's name or other personally identifying information will be invisible to the study team.

Every compound has a range of temperatures at which it is stable. The temperature of the clinical trial supplies has to be validated at every step of the trial. Competent authorities (the FDA in the United States) can invalidate an entire trial if it is not conclusively recorded that the study drug did not veer outside the specified temperature range.

One of the main qualities of a successful research study monitor is a keen eye for details. Every piece of data has to be recorded correctly and nothing must be missing. It can get very interesting when the study team implements protocol amendments. The monitor has to keep track of the dates these amendments have been approved by both the regulatory authorities and the ethics committees.




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