1. Structure and Organization of Research at TJU

2. Stephen Klasko, MD, MBA President and CEO of TJU AND Jefferson Health System
Working toward reunification of TJUH and TJU into a single Academic Medical Center

3. Pillars of the Unified Academic Medical Center
Clinical
Academic
Research
Innovation
Foundation
Goal: Jefferson Health System at the forefront of patient care, basic and clinical research, education and innovation

4. Clinical Research Organizational Chart:
Mark Tykocinski, MD
Provost and EVP, Academic Affairs
Dean, Sidney Kimmel Medical College
Vice Provost for Research
TBD
Brian Squilla, MBA
Chief of Staff
Vice President for Administration
David Whellan, MD, MHS
Associate Provost for
Clinical Research,
Director JCRI
Walter Kraft, MD
Director of
OHR
Tim Schailey, Director of ORA
Sam DiIanni, Director of RACE
ORA -> SPAO (Sponsored Programs Accounting Office)
RACE (Research Administration Center of Excellence) -> Basic science and Federal grants
JCRI Business Operations -> Clinical Research
Laura Vinci, RN, MBA
Senior Director
Clinical Research Operations
JCRI
Kyle Conner, MA, CIP Associate Director, OHR
Ron Polizzi, MBA
Director JCRI
Business Operations
Kathleen O'Malley, RN, CCRP Manager
Education
Training
Paul Park
Manager,
Clinical Research Systems
Suzanne Adams, RN, MPH
Director Clinical Research Operations

5. Reorganizing Clinical Research at Jefferson:
Central Clinical Research Infrastructure for all of research
Regulatory
Operations
Business
Monitoring
Marketing
Training
JeffTrial
JCRI
Processes
SKCC
CTO
SOPs
Planning
Office of Human Research

6. OHR and the offices they work with:
Research Administration & Research Administration Center of Excellence
Environmental Health Services & Institutional Biosafety Committee
Department & Committee Pre-review of IRB Submission
Clinical Trials
Office
Sidney Kimmel Cancer Center
Jefferson Clinical Research Institute
Investigational Drug Service
Office of Radiation Safety
Office of Animal Resources
Office of Research Planning
Office of University Counsel Corp. Compliance & HIPAA
Office of Human Research

7. Who is doing research at Jefferson?
The Sidney Kimmel Medical College of TJU
Jefferson College of Biomedical Sciences
Jefferson College of Health Professions
Jefferson College of Nursing
Jefferson College of Pharmacy
Jefferson College of Population Health
Jefferson Health Systems
TJUH
Jefferson Hospital for Neuroscience
Methodist
Rothman Institute
Abington
Wills Eye Institute
Currently not operating under the Jefferson Federalwide Assurance (FWA)

8. Responsibilities of the Research Team
Sufficient study staff is required in order to perform clinical trials efficiently, effectively and as delineated by the protocol; meeting all appropriate GCP requirements. Need adequate number of personnel. All personnel must be trained appropriately and have the appropriate skill set.

9. Who makes up the research team?
Principal Investigator (PI)
Sub Investigator (Sub I)
Clinical Research Nurse Coordinator (CRNC)
Clinical Research Coordinator (CRC)
Regulatory Coordinator
Key Personnel
Activities and roles may vary depending on the protocol. May need to include other licensed or trained personnel that are involved in study procedures, but play a more peripheral role. They will be on the Delegation of Authority Log. (ex. Investigational Pharmacist)

10. Principal Investigator: An individual who conducts a clinical investigation or, in the event of an investigation conducted by a team of individuals, is the responsible leader of the team.
True leadership lies in guiding others to success. In ensuring that everyone is performing at their best, doing the work they are pledged to do and doing it well. —Bill Owens

11. Principal Investigator Responsibilities
21 CFR : An Investigator is responsible for ensuring that an investigation is conducted according to the signed investigator statement, the investigational plan, and applicable regulations; for protecting the rights, safety and welfare of the subjects under the investigator’s care; and for the control of the drugs under investigation
Protocol compliance
IRB review & approval
Informed consent prior to study procedures
Adverse event reporting
Record keeping and retention
Integrity of data/inspection of records
Control of investigational drug
General responsibilities include, but are not limited to, conducting the study per the protocol, obtaining IRB approval, obtaining informed consent from subjects before initiating any study procedures, reporting adverse events to the sponsor (but also informing the subjects of anything learned during the course of the study that may change the risk of participating), and maintaining accurate study records and test article accountability records.

12. Principal Investigator:
Responsibilities of investigators can be found in the following sections of the regulations: -IND trials: 21 CFR 312 subpart D -IDE trials: 21 CFR 812 subpart E and subpart G -21 CFR 50 (informed consent requirements) -21 CFR 56 (IRB requirements) -ICH E6 Guidelines The investigator must also be aware of any local rules or regulations in addition to those outlined in the CFR.
Definition per the CFR (Code of Federal Regulations). The CFR is law. If found to be non-compliant, it is punishable to the full extent of the law!
ICH: International Conference on Harmonization; A committee of representatives from industry associations and regulatory agencies of Europe, Japan and the US that developed international standards for quality, safety and efficacy in the development of new products.

13. Investigator Statement: Form FDA 1572
A contract between the Sponsor and the investigator in which the investigator agrees to comply with all regulations pertaining to clinical research -Not a regulatory requirement, but used frequently in IND (investigational New Drug) studies -Signed before a clinical trial involving an investigational drug or biologic can begin Investigators participating in IDE (Investigational Device Exemption) studies do not complete a Form FDA 1572, but similar information is collected by the Sponsor -sometimes called an Investigator Agreement
Sponsor: An individual, company, institution, or organization that initiates a clinical investigation; the sponsor must comply with the responsibilities outlined in the regulations.

14. When signing the 1572, the investigator agrees to, among other things:
Personally conduct or supervise the study.
Inform subjects that drugs are investigational and ensure compliance w with requirements for obtaining Informed Consent and IRB approval
Read and understand the information in the IB
Ensure that everyone contributing to the conduct of the study is informed of their obligations in meeting the above commitments (ie. Training!)

15. Principal Investigator Responsibilities
Investigators must understand and adhere to federal regulations…it’s the law!
The regulations are in place to protect the RIGHTS, SAFETY and WELFARE of study subjects.

16. Clinical Research Coordinator: manages and conducts the day-to-day study activities in accordance with the protocol, applicable regulations and GCP requirements.
Vital to the success of a trial
Come from a variety of backgrounds
Regulations require that the PI ensure that all study staff are adequately trained
Going with the football example: The CRC is the Quarterback: On the field, executing the plays.
Brett Favre

17. The responsibilities of the CRC have expanded to beyond the clinical management of subjects to much more sophisticated expertise in compliance, research administration, marketing, fiscal and legal activities
Regulatory submissions and development
Development of data collection tools
Navigating electronic records and electronic data capture
Education and training of site personnel, families and patients
Appropriate billing and payment tracking
Protecting subject and data confidentiality
Adapted from the CTSA Research Coordinator Taskforce
Critical Needs for CRC Training Support and Career Development slides
January 11-12, 2011

18. The skills required to perform essential duties vary widely from one protocol to another. However, should have sufficient knowledge or competency regarding protection of human subjects.
Image courtesy of the Joint Task Force for Clinical Trial Competency (JTFCTC)

19. What makes a successful CRC?
Attention to Detail
Excellent communication skills
Flexibility
Ability to work independently
Organizational skills
Grit / Can-do attitude
Attention to detail: required in all aspects of clinical trial management, but especially when following a clinical protocol
Communication: patient, families, sponsors, monitors, clinical staff (MDs, RNs, lab, techs, schedulers, billing,)…with enthusiasm and confidence!
Flexibility/organization: move from one task to something completely different, need to oversee multiple tasks at one time and prioritize
Persistence: you will hear NO often, people don’t want the additional “burden”. Have to reassure and alleviate from additional responsibilities and work independently in what may be an unfamiliar environment.

20. Additional Research Personnel:
Sub-investigator: A member of the research team designated and supervised by the PI to perform critical study-related procedures and/or to make important study-related decisions
The FDA regards sub-investigators as those individuals authorized to make medical judgments and decisions regarding study subjects
CRNC: Clinical Research Nurse Coordinator
Certain protocol-related activities may require a license or certificate of training (ex. administration of medications or Glasgow Coma Scale)
Certain protocol-related activities may require a license or certificate of training (ex. administration of medication or blood draws)

21. Additional Research Personnel:
Regulatory Coordinator/Specialist:
Prepares and maintains IRB submissions and Regulatory documents
Tracks study progress in Clinical Trial Management systems (Portal and JeffTrial)
Key Personnel:
Personnel considered to be of primary importance to the successful conduct of a research project
Must complete CITI training, COI disclosure, appropriate eMR training
IRB Policy G 601