Definition of Clinical Trials

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Clinical Trials A clinical trial is a prospective biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (vaccines, drugs, treatments, devices, or new ways of using known drugs, treatments, or devices). Clinical trials are used to determine whether new biomedical or behavioral interventions are safe, efficacious, and effective. Clinical trials include behavioral human subjects research involving an intervention to modify behavior (increasing the use of an intervention, willingness to pay for an intervention, etc.) Human subjects research to develop or evaluate clinical laboratory tests (e.g. imaging or molecular diagnostic tests) might be considered to be a clinical trial if the test will be used for medical decision-making for the subject or the test itself imposes more than minimal risk for subjects. Biomedical clinical trials of experimental drug, treatment, device or behavioral intervention may proceed through four phases: Phase I clinical trials test a new biomedical intervention in a small group of people (e.g., 20- 80) for the first time to evaluate safety (e.g., to determine a safe dosage range, and to identify side effects). Phase II clinical trials study the biomedical or behavioral intervention in a larger group of people (several hundred) to determine efficacy and to further evaluate its safety. Phase III studies investigate the efficacy of the biomedical or behavioral intervention in large groups of human subjects (from several hundred to several thousand) by comparing the intervention to other standard or experimental interventions as well as to monitor adverse effects, and to collect information that will allow the intervention to be used safely. Phase IV studies are conducted after the intervention has been marketed. These studies are designed to monitor effectiveness of the approved intervention in the general population and to collect information about any adverse effects associated with widespread use. .

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Observational Clinical Research
E REVIEW ARTICLE Clinical Research Methodology 2: Observational Clinical Research Daniel I. Sessler, MD, and Peter B. Imrey, PhD * † Case-control and cohort studies are invaluable research tools and provide the strongest fea- sible research designs for addressing some questions. Case-control studies usually involve retrospective data collection. Cohort studies can involve retrospective, ambidirectional, or prospective data collection. Observational studies are subject to errors attributable to selec- tion bias, confounding, measurement bias, and reverse causation—in addition to errors of chance. Confounding can be statistically controlled to the extent that potential factors are known and accurately measured, but, in practice, bias and unknown confounders usually remain additional potential sources of error, often of unknown magnitude and clinical impact. Causality—the most clinically useful relation between exposure and outcome—can rarely be defnitively determined from observational studies because intentional, controlled manipu- lations of exposures are not involved. In this article, we review several types of observa- tional clinical research: case series, comparative case-control and cohort studies, and hybrid designs in which case-control analyses are performed on selected members of cohorts. We also discuss the analytic issues that arise when groups to be compared in an observational study, such as patients receiving different therapies, are not comparable in other respects. (Anesth Analg 2015;121:1043–51) bservational clinical studies are attractive because Group, and the American Society of Anesthesiologists they are relatively inexpensive and, perhaps more Anesthesia Quality Institute. importantly, can be performed quickly if the required Recent retrospective perioperative studies include data O 1,2 data are already available.
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