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      Addressing challenges for clinical research responses to emerging epidemics and pandemics: a scoping review

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          Abstract

          Background

          Major infectious disease outbreaks are a constant threat to human health. Clinical research responses to outbreaks generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses. This scoping review is a systematic appraisal of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges to clinical research responses to emergency epidemics and solutions identified to address these.

          Methods

          A scoping review. We searched six databases (MEDLINE, Embase, Global Health, PsycINFO, Scopus and Epistemonikos) for articles published from 2008 to July 2018. We included publications reporting PEARLES challenges to clinical research responses to emerging epidemics and pandemics and solutions identified to address these. Two reviewers screened articles for inclusion, extracted and analysed the data.

          Results

          Of 2678 articles screened, 76 were included. Most presented data relating to the 2014–2016 Ebola virus outbreak or the H1N1 outbreak in 2009. The articles related to clinical research responses in Africa ( n = 37), Europe ( n = 8), North America ( n = 5), Latin America and the Caribbean ( n = 3) and Asia ( n = 1) and/or globally ( n = 22). A wide range of solutions to PEARLES challenges was presented, including a need to strengthen global collaborations and coordination at all levels and develop pre-approved protocols and equitable frameworks, protocols and standards for emergencies. Clinical trial networks and expedited funding and approvals were some solutions implemented. National ownership and community engagement from the outset were a key enabler for delivery. Despite the wide range of recommended solutions, none had been formally evaluated.

          Conclusions

          To strengthen global preparedness and response to the COVID-19 pandemic and future epidemics, identified solutions for rapid clinical research deployment, delivery, and dissemination must be implemented. Improvements are urgently needed to strengthen collaborations, funding mechanisms, global and national research capacity and capability, targeting regions vulnerable to epidemics and pandemics. Solutions need to be flexible to allow timely adaptations to context, and research led by governments of affected regions. Research communities globally need to evaluate their activities and incorporate lessons learnt to refine and rehearse collaborative outbreak response plans in between epidemics.

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          Most cited references65

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          A systematic approach to searching: an efficient and complete method to develop literature searches

          Creating search strategies for systematic reviews, finding the best balance between sensitivity and specificity, and translating search strategies between databases is challenging. Several methods describe standards for systematic search strategies, but a consistent approach for creating an exhaustive search strategy has not yet been fully described in enough detail to be fully replicable. The authors have established a method that describes step by step the process of developing a systematic search strategy as needed in the systematic review. This method describes how single-line search strategies can be prepared in a text document by typing search syntax (such as field codes, parentheses, and Boolean operators) before copying and pasting search terms (keywords and free-text synonyms) that are found in the thesaurus. To help ensure term completeness, we developed a novel optimization technique that is mainly based on comparing the results retrieved by thesaurus terms with those retrieved by the free-text search words to identify potentially relevant candidate search terms. Macros in Microsoft Word have been developed to convert syntaxes between databases and interfaces almost automatically. This method helps information specialists in developing librarian-mediated searches for systematic reviews as well as medical and health care practitioners who are searching for evidence to answer clinical questions. The described method can be used to create complex and comprehensive search strategies for different databases and interfaces, such as those that are needed when searching for relevant references for systematic reviews, and will assist both information specialists and practitioners when they are searching the biomedical literature.
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            Research as a part of public health emergency response.

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              Full publication of results initially presented in abstracts

              Abstracts of presentations at scientific meetings are usually available only in conference proceedings. If subsequent full publication of results reported in these abstracts is based on the magnitude or direction of the results, publication bias may result. Publication bias creates problems for those conducting systematic reviews or relying on the published literature for evidence about health and social care. To systematically review reports of studies that have examined the proportion of meeting abstracts and other summaries that are subsequently published in full, the time between meeting presentation and full publication, and factors associated with full publication. We searched MEDLINE, Embase, the Cochrane Library, Science Citation Index, reference lists, and author files. The most recent search was done in February 2016 for this substantial update to our earlier Cochrane Methodology Review (published in 2007). We included reports of methodology research that examined the proportion of biomedical results initially presented as abstracts or in summary form that were subsequently published. Searches for full publications had to be at least two years after meeting presentation. Two review authors extracted data and assessed risk of bias. We calculated the proportion of abstracts published in full using a random‐effects model. Dichotomous variables were analyzed using risk ratio (RR), with multivariable models taking into account various characteristics of the reports. We assessed time to publication using Kaplan‐Meier survival analyses. Combining data from 425 reports (307,028 abstracts) resulted in an overall full publication proportion of 37.3% (95% confidence interval (CI), 35.3% to 39.3%) with varying lengths of follow‐up. This is significantly lower than that found in our 2007 review (44.5%. 95% CI, 43.9% to 45.1%). Using a survival analyses to estimate the proportion of abstracts that would be published in full by 10 years produced proportions of 46.4% for all studies; 68.7% for randomized and controlled trials and 44.9% for other studies. Three hundred and fifty‐three reports were at high risk of bias on one or more items, but only 32 reports were considered at high risk of bias overall. Forty‐five reports (15,783 abstracts) with 'positive' results (defined as any 'significant' result) showed an association with full publication (RR = 1.31; 95% CI 1.23 to 1.40), as did 'positive' results defined as a result favoring the experimental treatment (RR =1.17; 95% CI 1.07 to 1.28) in 34 reports (8794 abstracts). Results emanating from randomized or controlled trials showed the same pattern for both definitions (RR = 1.21; 95% CI 1.10 to 1.32 (15 reports and 2616 abstracts) and RR = 1.17; 95% CI, 1.04 to 1.32 (13 reports and 2307 abstracts), respectively. Other factors associated with full publication include oral presentation (RR = 1.46; 95% CI 1.40 to 1.52; studied in 143 reports with 115,910 abstracts); acceptance for meeting presentation (RR = 1.65; 95% CI 1.48 to 1.85; 22 reports with 22,319 abstracts); randomized trial design (RR = 1.51; 95% CI 1.36 to 1.67; 47 reports with 28,928 abstracts); and basic research (RR = 0.78; 95% CI 0.74 to 0.82; 92 reports with 97,372 abstracts). Abstracts originating at an academic setting were associated with full publication (RR = 1.60; 95% CI 1.34 to 1.92; 34 reports with 16,913 abstracts), as were those considered to be of higher quality (RR = 1.46; 95% CI 1.23 to 1.73; 12 reports with 3364 abstracts), or having high impact (RR = 1.60; 95% CI 1.41 to 1.82; 11 reports with 6982 abstracts). Sensitivity analyses excluding reports that were abstracts themselves or classified as having a high risk of bias did not change these findings in any important way. In considering the reports of the methodology research that we included in this review, we found that reports published in English or from a native English‐speaking country found significantly higher proportions of studies published in full, but that there was no association with year of report publication. The findings correspond to a proportion of abstracts published in full of 31.9% for all reports, 40.5% for reports in English, 42.9% for reports from native English‐speaking countries, and 52.2% for both these covariates combined. More than half of results from abstracts, and almost a third of randomized trial results initially presented as abstracts fail to be published in full and this problem does not appear to be decreasing over time. Publication bias is present in that 'positive' results were more frequently published than 'not positive' results. Reports of methodology research written in English showed that a higher proportion of abstracts had been published in full, as did those from native English‐speaking countries, suggesting that studies from non‐native English‐speaking countries may be underrepresented in the scientific literature. After the considerable work involved in adding in the more than 300 additional studies found by the February 2016 searches, we chose not to update the search again because additional searches are unlikely to change these overall conclusions in any important way. Full publication of results initially presented in abstracts Key message Two important factors increase the probability that a study described in an abstract will subsequently be published in full, (1) the presence of 'positive' or statistically significant results in the abstract and (2) whether the team examining subsequent full publication were from an English‐speaking country or wrote their report in English. The consequence is that systematic reviews relying on fully published research may provide inaccurate or biased findings because of an over‐reliance on studies with positive results or from English‐speaking countries. Our question We reviewed the evidence about how often studies submitted as abstracts at a scientific meeting are published in full, usually as a journal article. We found 425 relevant reports, involving 307,028 abstracts. Background Investigators prepare and submit abstracts for presentation at scientific meetings. Abstracts selected for presentation are usually collated as conference proceedings, but these are not easily found. Thus, it is important to know whether the work submitted and presented is later published as a journal article, which can easily be identified and contains more study information than the abstract. It is also important to know if the publication of the study depends on the size or direction of results or other factors. If so, systematic reviews relying on the published literature for evidence about health and social care will have incomplete or unbalanced information, leading to inaccurate or biased estimates of the effects of the interventions studied. Study characteristics We included 425 research reports described in 551 articles, which had studied the subsequent full publication of 307,028 abstracts from a variety of biomedical and social sciences. Fifty‐four reports included data from abstracts describing randomized or controlled trials. Of the 425 reports, 376 were published in English, and 49 in other languages. Key results 1. Less than half of all studies, and about two‐thirds of randomized trials, initially presented as summaries or abstracts at meetings, are published as journal articles in the 10 years after presentation. 2. Studies with positive results are more likely to be published. 3. Studies with larger sample sizes are more likely to be published. 4. Studies with abstracts presented orally are more likely to be published than those presented as posters. 5. Studies accepted for presentation at a meeting are more likely to be published than those not accepted. 6. Studies describing basic science are more likely to be published that those describing clinical research. 7. Studies describing randomized trials are more likely to be published than those describing other types of studies. 8. Studies that took place in multiple centers are more likely to be published than those at a single center. 9. Studies classified as ‘high quality’ are more likely to be published than ‘low quality’ studies. 10. Studies with authors from an academic setting are more likely to be published than those with authors from other settings. 11. Studies considered by the report authors to have a high impact are more likely to be published than other studies. 12. Studies with funding source reported are more likely to be published than those not reporting funding. 13. Studies originating in North America or Europe are more likely to be published than those originating elsewhere. 14. Studies from English‐speaking countries are more likely to be published than studies originating elsewhere. Quality of the evidence We have confidence in our findings. We considered five criteria to constitute a risk of bias in the included reports, including methods to identify and match full publications to abstracts, and methods to determine whether a factor was associated with full publication. Overall, 7.5% (32/425) of the reports were scored as having an overall high risk of bias, 83.1% (353/425) had at least one criterion at high risk of bias, and 6.1% (26/425) had all criteria at low risk of bias. Search Date Our search updated our 2007 review and is current to February 2016. After the considerable work involved in including more than 300 additional studies from the February 2016 searches, we chose not to update the search again because additional searches are unlikely to change our overall conclusions in any important way.
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                Author and article information

                Contributors
                louise.sigfrid@ndm.ox.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                25 June 2020
                25 June 2020
                2020
                : 18
                : 190
                Affiliations
                [1 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, , University of Oxford, ; New Richards Building, Old Road Campus, Oxford, OX3 7LG UK
                [2 ]GRID grid.414601.6, ISNI 0000 0000 8853 076X, Deparment for Primary Care and Public Health, Brighton and Sussex Medical School, ; Brighton, UK
                [3 ]GRID grid.8991.9, ISNI 0000 0004 0425 469X, Department of Global Health and Development, , London School of Hygiene and Tropical Medicine, ; London, UK
                [4 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, School of Population Health and Environmental Sciences, , King’s College London, ; London, UK
                [5 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Primary Care and Public Health, , Imperial College London, ; London, UK
                [6 ]University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
                [7 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Bodleian Health Care Libraries, , University of Oxford, ; Oxford, UK
                [8 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Nuffield Dep of Primary Care Health Sciences, , University of Oxford, ; Oxford, UK
                [9 ]GRID grid.4777.3, ISNI 0000 0004 0374 7521, Evidence Aid, Centre for Public Health, , Queen’s University Belfast, ; Belfast, UK
                Author information
                http://orcid.org/0000-0003-2764-1177
                Article
                1624
                10.1186/s12916-020-01624-8
                7315698
                32586391
                576fb63b-d19d-4c79-9a7c-5355741e67bc
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 December 2019
                : 7 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010661, Horizon 2020 Framework Programme;
                Award ID: 643434
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Medicine
                challenges,barriers,solutions,facilitators,clinical research,emerging infectious diseases,epidemic,pandemic,preparedness

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