Asymptomatic carotid atherosclerosis study: role of the clinical coordinator.

This article introduces the reader to the role of the clinical coordinator in the Asymptomatic Carotid Atherosclerosis Study. The main responsibility lies in recruiting patients into the study and managing their follow-up period very closely for the next three to five years. Each coordinator is vital to its individual center in order to actively participate in this multicenter trial.     

How a clinical coordinator improved emergency care

A clinical ward coordinator role was developed within an emergency admissions ward. The aim was to reduce each patient's length of stay on the admissions ward and the waiting time for a bed in the emergency areas.     

The nurse clinical trial coordinator: benefits and drawbacks of the role

It has become common for nurses to be recruited into and/or seek careers outside of the traditional domain of hospital-based work. This article draws on interview data to consider a position nurses are occupying within biomedicine, that of the nurse clinical trial coordinator. It examines and analyzes the value attributed to such positions by nurse trial coordinators. The analysis reveals that nurses identify three aspects of the position-social relations, the acquisition of skills and knowledge, and work and control-as having both advantages and disadvantages over other work roles within nursing. It concludes with suggestions for further research on the role and involvement of nurses in clinical research.     

Publication of clinical drug trials.

Clinical drug trials are the best means for establishing the efficacy and safety of drug therapy. Peer-reviewed publications are the most efficient and reliable means for wide dissemination of the results. The investigators and industry have an obligation to publish the data obtained from these trials so that patients may receive the most effective treatment in the safest possible way.     

Methods for improving clinical trials.

Over the past decades, the randomized controlled trial has entered an era of continuous improvement and has gradually become accepted as the most effective way of determining the relative efficacy and toxicity of new therapies because it controls for placebo and time effects. However, even sensitive and properly designed and executed trials do not always confirm hypotheses to be tested, and conclusions are not always confirmed by subsequent trials. Although the former may be due to wrong hypotheses, the latter is likely to be due to the presence of certain imperfections within the design and execution of the trial itself. In this opinion paper, while focusing on such imperfections, the author searched for methods for further improvement of controlled trials, particularly clinical trials. The examples used in this paper are obtained from literature search as well as recent studies performed by the Netherlands Working Group on Cardiovascular Research (WCN). Methods for improvement could include: 1. making every effort to avoid asymmetries in the treatment groups; 2. emphasis on statistical power rather than just null-hypothesis testing; 3. adjusting for asymmetries not only of patient characteristics but also of outcome variables; 4. accounting routinely for type III errors; 5. routinely weighing benefits of a new drug against risks.