The Value of Centralized Monitoring

group of clinical researchers

Joanne Malia
Associate Director, Clinical Documentation Management
 Regeneron Pharmaceuticals

Abstract: Regulatory agencies are advocating for sponsors to take risk-based approaches in various clinical trial-related activities, especially in the area of monitoring. Sponsors are looking at and beginning to use centralized monitoring. This article describes centralized monitoring, regulatory and industry expectations and initiatives related to centralized monitoring, the value of centralized monitoring in enhancing data quality in clinical trials, and use and documentation of centralized monitoring,

Disclaimer: The views and opinions expressed in this article are those of the author and should not be attributed to the Society of Clinical Research Associates or Regeneron Pharmaceuticals.

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The Changing Landscape of Human Subjects Research

Amy Waltz, JD, CIP
Associate Director – Regulatory Affairs, Reliance, Outreach
Indiana University

Abstract: Understanding context is key to understanding the regulations and complying with regulatory requirements. This article explores the historical context and events that shaped the current human subjects protection regulations and how changes in human subjects research and public perception have impacted the proposed revisions to the human subjects protection regulations. The 2017 revisions to the Common Rule (45CFR46) and the impact of these revisions on government funded research are also addressed.

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Building a Quality Assurance Program for Investigator-initiated Trials

Abby Statler, MPH, MA, CCRP
Research Regulatory Quality Assurance Coordinator
Cleveland Clinic Cancer Institute

Two clinical researchers analyzing information on a computer

Abstract: In 2008, The Cleveland Clinic Cancer Institute established a quality assurance (QA) program for investigator-initiated trials (IITs). Over the past nine years, the program has become an integral part of the Institute’s research department, supporting the growth of IITs while improving the proficiency of regulatory operations. This article describes the program’s objectives and discusses the operational strategies employed to achieve these goals. Other clinical research sites are encouraged to consider how components of the Cleveland Clinic Cancer Institute’s QA program may be adapted to meet the needs of their organizations.


The research sponsored by Cleveland Clinic investigators supports the Foundation’s innovation initiatives, making it a top priority for the Institute’s leadership team. Thus, the development and implementation of the Cleveland Clinic Taussig Cancer Institute’s QA program was motivated by the organization’s commitment to effectively oversee the conduct of IITs. Launched in 2008, the Cancer Institute’s QA program was the first of its kind, specifically focusing on providing operational support for investigator-initiated trials.

Before the department was implemented, investigator-initiated trials had few operational resources, protocols required multiple revisions, Investigational New Drug Applications were submitted inconsistently to the U.S. Food and Drug Administration (FDA), and processes for effective essential regulatory documentation management had not been established. To date, the QA program has grown from one to five members, which has enabled the department to cohesively support the IIT profile while also improve the operations of industry-sponsored and cooperative group trials. In this article, I will outline the essential components of a QA program, discuss the challenges that our department faced during the program’s development, and highlight how the Institute’s commitment to quality has enhanced the Cancer Center’s conduct and initiation of clinical trials.

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Reducing Over-reporting to INDs and Increasing Efficiencies at Clinical Research Sites

Sarah Attwood, BSc
Director of Client Services
IntegReview IRB

Abstract: Institutional review boards (IRBs) continue to be overburdened with reports not required by federal regulations. It is important to understand the difference between what the regulations require and what has become an industry standard. Additionally, clinical research sites are often confused about reporting requirements and err on the side of conservatism by over-reporting. By clearly identifying regulatory requirements, the clinical research industry may become more efficient and eliminate unnecessary work for sites as well as IRBs.

Clinical researcher at computer


Study sites are over-reporting adverse events (AEs) and serious adverse events (SAEs) for studies conducted under Investigational New Drug (IND) applications. IRBs are required by the U.S. Food and Drug Administration (FDA) and the Office of Human Research Protections (OHRP) within the Department of Health and Human Services to review “unanticipated problems involving risks to participants or others.”  

IntegReview IRB is a central IRB that reviews many protocols each year, just as institutional IRBs do. In 2016, IntegReview IRB saw an increase in the number of IND safety reports and a slight decrease in SAE reports. The reason for these changes is unknown. IntegReview IRB is seeing about a four-fold increase in IND safety reports, which is far above the increase in business.

IRBs receive many IND safety reports that are not related to the current protocol at the clinical researchsite. The reports could be about something that is happening in Asia or Europe, a different use of the drug, or a different research project. These reports must be processed, even though they are not under the jurisdiction of the IRB for the current study, creating information overload.

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Research with Respect: Advocacy in Pediatric Clinical Trials

A pediatric clinical researcher meeting with a mother and child

Lauren Bird, RN, BSN, CCRC
Clinical Research Nurse

Mallory Rowell, MS, CCRC
Clinical Research Coordinator

The Research Institute at Nationwide Children’s Hospital

Abstract: Maintaining respect for the autonomy of families enrolled in pediatric clinical trials is a vital aspect in achieving the best outcomes. This article highlights ethical considerations in working with families enrolled in pediatric clinical trials, with a focus on appreciating the difficulty that families face in deciding whether to participate in a clinical trial as well as the importance of advocating for the special needs of family units. The significance of providing valuable resources to families and how this can positively affect recruitment and retention rates is also covered, along with the need to incorporate an ethical mindset into daily practice.

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Adding it up to Create the Perfect Balance: Advanced Site Management Tools

Christina Talley, MS, RAC, CCRP, CCRC

Houston Methodist Research Institute, Office of Strategic Research Initiatives

a clinical research working on a tablet

Abstract: Detailed protocol analysis and feasibility objectively translated into a protocol grade or quantitative score is an effective way to manage overall workload distribution, personnel resource allocation, and financial management before the clinical trial is implemented. This article provides an overview of protocol areas for evaluation, scoring, and current effort tracking models used in clinical research. One model, the Protocol Acuity Rating Scale (PARS), is described in detail with examples of its application to different types of clinical research studies

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BULLSEYE: What is Targeted Monitoring All About?

Jane Ferguson, RN, MN, CCRP
Senior CRA, Westat

Abstract: Targeted monitoring is the on-site component of risk-based monitoring and focuses on the aspects of clinical research that have the most potential to impact participant safety and the credibility of the study’s results. This article provides an overview of targeted monitoring, including the need for targeted monitoring and its role in risk-based monitoring. The basics of conducting a targeted monitoring visit are covered

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Quality by Design for Clinical Trials

Vatché Bartekian
President, Vantage BioTrials, Inc.

Abstract: Quality by design for clinical trials comprises an independent entity responsible for quality standards and an integrated system where each person is accountable for quality. This article explores myths about quality and provides a general overview of the principles and philosophy of quality by design. Quality issues normally encountered at clinical research sites and contract research organizations as well as practical ways to build quality into a research program in order to prevent issues are highlighted. The Plan-Do-Check-Act cycle and its tie-in with risk-based monitoring are described.

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The Trainer’s Toolkit: How to Design Successful Blended Learning

artistic representation of blended learning

Anatoly Gorkun MD, PhD, Chartered MCIPD
Senior Manager, MedImmune

Abstract: Blended learning is a training program in which the audience learns the content through a combination of different learning methods with some element of self-control over time, place, and pace. This article provides an overview of audience learning preferences and styles, blended learning, and how to choose the most appropriate learning methods for a specific training program. Examples of and tools for learning methods are provided.

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Virtual Project Management

Radhika Sivaramakrishna, PhD, PMP, CSSBB, CCRP
Senior Director, Project
Covance, Inc.

Abstract: Clinical research project management is increasingly conducted globally across multiple time zones and cultures. In order to be successful, certain adaptations must be made to routine practices. This article describes key terms and basic concepts of virtual project management, considerations for effective communication and collaboration tools, and ways in which the Project Management Institute knowledge areas can be applied to a virtual framework. Situational examples are provided. While this has been written in the context of clinical trials performed by a biotech or pharmaceutical sponsor engaging a CRO, the same concepts could easily be extended to any geographically dispersed project team.

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