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COMMON TERMS IN
CR AND CDM
POOJA BANSAL
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CLINICAL RESEARCH AND CLINICAL TRIAL
• CLINICAL RESEARCH : Clinical research is a branch of healthcare science that determines the safety and
effectiveness (efficacy) of medications, devices, diagnostic products and treatment regimens intended for
human use. These may be used for prevention, treatment, diagnosis or for relieving symptoms of a disease.
• Clinical research involves methodological and systemic study of drugs, devices or biological vaccines used
for the diagnosis, prevention or treatment of diseases. Main objective of CR is to determine the safety and
efficacy or to determine the Pharmacokinetics and Pharmacodynamic properties and its potential effects in
human subjects.
• CLINICAL TRIAL : A clinical trial is a research program conducted with patients to evaluate a new medical
treatment, drug, or device. The purpose of clinical trials is to find new and improved methods of treating,
preventing, screening for, and diagnosing different diseases.
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REGULATORY BODIES/AGENCIES
• REGULATORY BODY: A regulatory body is a public organization or government agency that is set up to
exercise a regulatory function. This involves imposing requirements, conditions or restrictions, setting
the standard for activities, and enforcing in these areas or obtaining compliance.
• FOOD AND DRUG ADMINISTRATION (FDA): The Food & Drug Administration (FDA) is
responsible for the oversight of drugs, medical devices, vaccines, blood products and biologics,
establishing rules for testing, clinical trials and approval of new products. The FDA monitors safety,
medical errors and adverse reactions to treatment, alerting the health care industry of risks associated
with treatments. The FDA also monitors food products to ensure safety of your food supply.
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DIFFERENT REGULATORY BODIES
• US – Food and Drug Administration (FDA)
• UK – Medicine and Health Care Product Regulatory Agency (MHRA)
• Australia - Therapeutic Goods Administration (TGA)
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TYPES OF
• Prevention Research looks for better ways to prevent
RESEARCH
disorders from developing or returning. Different kinds of
STUDIES prevention research may study medicines, vitamins,
vaccines, minerals, or lifestyle changes.
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CONTD …
• BIOAVAILABILITY - The proportion of a drug or other substance which enters the circulation when
introduced into the body and so is able to have an active effect.
• EFFICACY - Efficacy is the capacity for beneficial change (or therapeutic effect) of a given
intervention (for example a drug, medical device, surgical procedure, or a public health intervention).
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PHARMACOKINETICS PHARMACODYNAMICS
• Pharmacokinetics is the study of drug • Pharmacodynamics is the study of
absorption, distribution, and the biochemical and physiological
elimination (metabolisms and effect of a drug and their
excretion). mechanisms of action.
• Pharmacokinetics is “what the body • Pharmacodynamics is “what the drug
does to the drug”. does to the body”.
• Pharmacokinetics is the body’s action • Pharmacodynamics is the drug action
on the drug or alteration of a drug by on the body.
the body.
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SEVERTITY Refers to the intensity of the event and can be used with any
event
• Grade 1: Asymptomatic or mild symptoms
clinical or diagnostic observations only; no intervention indicated
• Grade 2: Moderate
minimal or noninvasive intervention indicated; limiting age-
appropriate instrumental ADL
• Grade 3: Severe
medically significant but not immediately life threatening;
hospitalization or prolongation of hospitalization indicated;
disabling
• Grade 4: Life-threatening
urgent intervention indicated
• Grade 5: Death related to an AE
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INCLUSION EXCLUSION
• Inclusion criteria is a list of • Exclusion criteria is a list of
characteristics that qualify a person characteristics that disqualify a
from participating in a clinical trial. person from participating in a clinical
trial.
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INCLUSIUON
AND
EXCLUSION
CRITERIA
• CASE REPORT FORM - A case report form (or CRF) is a paper or electronic
questionnaire specifically used in clinical trial research. The case report
form is the tool used by the sponsor of the clinical trial to collect data from
each participating patient.
CRF AND ICF usually documented by means of a written, signed, and dated informed
consent form, which has been approved by an IRB/IEC.
✓ A document that describes the rights of the study participants, and includes
details about the study, such as its purpose, duration, required procedures,
and key contacts. The main source of information to subjects considering
taking part in clinical trials is the Informed Consent Form (ICF). An ICF is a
document that requires a participant’s signature upon participating in a
clinical research study. The document gives detailed information about the
study the participant is considering and ensures the health care provider has
given complete information, including the risks and benefits of the study.
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CONTD …
Quality Control (QC) – The internal
Quality Assurance (QA) – operational techniques and activities
Systematic approach to ensure that undertaken within the quality
the data are generated, documented assurance system to verify that the
(recorded), and reported in requirements for quality of trial
compliance with the protocol and related activities have been fulfilled
good clinical practice (GCP) (e.g., data and form checks,
standards. monitoring by study staff, routine
reports, correction actions, etc.).
CONTD …
Source Document – Original documents, data, and records (e.g., hospital records,
clinical and office charts, laboratory notes, memoranda, participant diaries, recorded
data from automated instruments, x-rays, etc.) that are used in a clinical trial.
Recruitment Status
Not yet recruiting: The study has not started recruiting participants.
Recruiting: The study is currently recruiting participants.
Enrolling by invitation: The study is selecting its participants from a population, or group of
people, decided on by the researchers in advance. These studies are not open to everyone who
meets the eligibility criteria but only to people in that population, who are specifically invited to
participate.
Active, not recruiting: The study is ongoing, and participants are receiving an intervention or
being examined, but potential participants are not currently being recruited or enrolled.
Suspended: The study has stopped early but may start again.
Terminated: The study has stopped early and will not start again. Participants are no longer
being examined or treated.
Completed: The study has ended normally, and participants are no longer being examined or
treated (that is, the last participant's last visit has occurred).
Withdrawn: The study stopped early, before enrolling its first participant.
Unknown: A study on ClinicalTrials.gov whose last known status was recruiting; not yet
recruiting; or active, not recruiting but that has passed its completion date, and the status has not
been last verified within the past 2 years.
• DOCUMENTATION - All records (including written documents,
electronic, magnetic or optical records, scans, x-rays etc.) that describe
or record the methods, conduct and results of the study, and the actions
taken. The Documents include Protocol, copies of submissions and
approvals from the office of the Drugs Controller General of India, ethics
committee, investigator(s)’ particulars, consent forms, monitor reports,
audit certificates, relevant letters, reference ranges, raw data, completed
CRFs and the final report.
CONTD … • ESSENTIAL DOCUMENTS - The Documents that permit evaluation of
the conduct of a study and the quality of the data generated.
• VALIDATION - The procedures carried out to ensure and prove that the
data contained in the final report match the original observations. The
procedure is applied to Raw Data, CRFs, computer software, printouts,
statistical analyses and consumption of Study Product / Comparator
Product.
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ALCOA
PRINCIPLES
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Attributable
When documenting data on paper, every written element needs to be traced back to the
authorized individual who is responsible for recording it. This requires a signature or initials, the
date, and an identifier to a subject visit. Similarly, if something needs to be changed on the record,
it needs to be initialed, dated, and should explain the reason for the change.
Audit trails in an electronic system make it very obvious who created a record, when it was
created, who made a change, when the change was made, and the reason a change was made.
A compliant system will automatically track this information and enable electronic signatures.
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• Data should be recorded, signed, and dated at the time of trial conduct,
rather than risk an individual recalling the wrong information from
memory. On paper, data needs to be documented in real-time and
dated with the current date (no predating or postdating).
• Automatic date and time stamps support this every time clinical data is
entered, edited, or modified in an electronic system that has the
appropriate controls in place to fully support compliance with 21 CFR
Part 11.
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• The source is the earliest record – the first place that data is
PRINCIPLES documented. If corrections or revisions need to be made,
changes shouldn’t obscure prior entries. Paper source
documents should be preserved and kept in their original
CONTD … form.
• When the first record is electronic, an audit trail can track any
and all subsequent queries and changes.
ACCURATE - Are all the details, correct?
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STANDARDS
improve the quality and interoperability of medical research and healthcare. CDISC
standards are widely used for study planning and data collection, tabulation,
analysis, and submissions to the US Food and Drug Administration
(FDA), Japanese Pharmaceuticals and Medical Devices Agency (PMDA), and
other regulatory agencies internationally.
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