About the Author
Dr. Baidyanath Mishra completed B.A.M.S as a topper in the university examination from Govt. Ay Medical College & Hospital Balangir Orissa affiliated to Sambalpur University. Later he completed M.D (Ay) from one of the premier institutes of education and research i,e Institute of P.G Ayu Education and Research affiliated to University of Calcutta, and now under West Bengal University of Health Sciences. Presently, he is pursuing his Ph.D (Ay) in the Faculty of Health Sciences at SCSVMB (Kanchi University) at Kanchipuram. Dr. Mishra has contributed more than two decades to teaching and research, including of PG teaching. He successfully guided more than ten students of M.D (Ay) of Sharir Rachana (Anatomy). Presently he is working as Professor & HoD of Sharir Rachana (Anatomy) at Adichunchanagiri Shikshana Trust's'" Sri Kalabyraveswara Swamy Ay Medical College Hospital & Research Centre (SKAMC) Bangalore. Prior to that he was working as Professor in PG Department of Alva's Ayu Medical College Hospital Moodbidri, SJS Ay Medical College Nazarathpettai, Chennai unit of SCSVMB (Kanchi University), and Dhanwanatari Ay Medical College Research centre Siddapura. He has been invited as a resource person for various national & international conferences in India & abroad on key issues on natural products. Apart from hi teaching, he has contributed in research projects associated with other organizations of repute in research & delivery. Presently he is a board member with Bharati Dashan University, Trichy for the M.Sc (Biodiversity) apart from closely associated with various leading organization that includes of recent includes Inno Vision Therapeutics, INC USA, and Inno Vision HealthCare India on various research projects from natural sources delivering patentable deliverable forms.
Foreword
There is no doubt that traditional medicinal system of medicines including Ayurveda, Siddha, and Unani (ASU) plays a crucial in healthcare in India. Even the worldwide interest in the use of natural products and plant-based remedies had led to different situations developing in different countries. In countries with a strong foundation of traditional medicine such as India and China, nationally recognized parallel traditional systems have run for long periods, along with Western medicine with varying degrees of acceptance, integration and assimilation.
That is resulting in developing and manufacturing quality of ASU stands very crucial and is the mantra of the safe and effective therapy. Government of India brings various regulatory guidelines with an aim to provide in the best of the consumers, and continuously advise and train the technical people in working out a vast range of drugs for human & animal use and have evolved in developing the research, documentation and involving sophistication in the production of medicaments.
Accordingly, department of AYUSH has brought forward the detailed guidelines of Good Clinical Practice (GCP), Good Manufacturing Practice (GMP), and regularly amend the related portion of Drugs & Cosmetics Act to create general awareness among the persons who are involved in this professions or who are keen in this profession was long felt.
It is this backdrop that the present book titled 'Comprehensive text book on research methodology with clinical research methods, approaches & techniques' penned by learned Dr. Baidyanath Mishra who is working as professor with a tremendous knowledge on techno- scientific and regulatory inserts of global regulatory on herbals/botanicals, is a desired addition which is by virtue of its meaningful inclusion is bound to go a long way in clearing to the void, which is in operations as of now.
Dr. Mishra along with other supporting authors has diligently and articulately attempted to cover all the aspects of research including special topics on clinical research, domestic regulatory critical points etc in bringing awareness starting from the graduates of Ayurveda.
I am sure that this notable attempt will result in fulfilling the legitimate needs and expectations of the researchers and quality aware-scavy students starting from the study in undergraduate.
I record my gratitude and appreciation to the author for his herculean effort in dispensing a gigantic task.
Preface
Research is a lifelong passion. It is driven by a restless curiosity that is refined by meticulous attention to the minutest details. Research necessitates high self-esteem, advanced skills, robust knowledge and humility. The last quality bespeaks of the fact that science is a collective global enterprise. All this requires years of apprenticeship and training. We are in requirement of more number of people with dual competences in both Ayurveda and basic sciences taking this traditional healthcare facility through scope of research globally. Without such a critical mass, it is unrealistic to expect high quality research.
Ayurveda, the ancient Indian medical wisdom prescribed numerous ways and means to overcome the chronic and incurable diseases and associated medical, psychological and social problems in a holistic way including various metabolic, respiratory, reproductive, digestive, dermatological, musculoskeletal, cardiovascular disorders including cancer.
World Health Organization (WHO) including Government of India along with various key International regulatory organizations enlisted key points in establishing various traditional medicinal systems including of Ayurveda to document the safety, efficacy and purity of the products and practices through the approved research protocols. ASU medicines are governed by rules and regulations prescribed by Drugs & Cosmetic Act] 940 and Rules 1945, whereas herbal nutraceutical products are governed by rules & regulations of Food Safety Standards and Authority of India (FSSAI) Act 2006 and rules 2011. Those design special guidelines which are updated periodically in developing various formulations for India, and these products follow respective guidelines based on the country of export.
The main sources of inspiration to bring out this book have been my continued interaction with students, faculty and practitioners of health sciences including Ayurveda engaged in public health services at various institutions in India and abroad.
This book consists of twenty two chapters and are arranged in descent manner that suits the reading and comprehensive skill of the reader. This book covers variety of topics such as identification and prioritization of research problems that includes bio-ethics, ethical issues in clinical research, product development process, pharmacopoeal standards of ASU ingredients, critical points of good clinical practice, good laboratory and Manufacturing practices including ICH & AYUSH standards, bio-informatics, PKPD, Radiobiology, Pharmacoeconomics etc. which are of time requirement.
Students will find this book is helpful for them with a clear and concise overview of the important topics in which they must become proficient to practice skillfully, ethically and efficiently which are equally cover their recommended study curriculum.
I am thankful with Chaukhamba Orientalia making this mission successful extending my thought process in globalizing Ayurveda through research across all Ayurveda teaching institutes in India and abroad by publishing this book.
I am equally thankful to express my heartfelt appreciation with Mrs. Sujata Mishra-senior faculty in psychology and Mr. Ashok Kumar Satapathy who is a learned faculty in physical sciences contributing their expertise in various related chapters, thus making this book more elaborative.
Hope that it will fulfill the felt needs of not only post-graduate students, but also the young teaching faculty in healthcare profession. However looking forward suggestions from the readers are always welcome so as to enable to incorporate the same in future editions to make this book more reader compatible.
INDEX
S.N.
Chapter Page
Chapter-I
Bioethics-Ethical issues in Biology & Technology
1.0
Introduction
1
1.1
Impact
1.2
Bioethics & Ayurveda
2
1.3
Other ethical committee
3
Chapter-II
Ethical issues in Clinical Research
2.0
4
2.1
Ethical & Safety considerations
2.2
What should be done when an institution does not have IEC
6
2.3
Format for human ethics approval
11
2.4
Is human ethical review committee- Human (HERC) required?
13
Chapter-III
Product Development Process
3.0
15
3.1
Drug, Nutrients and Nutraceuticals with utrigenomics
3.2
Duration for new product development
17
3.3
Monitoring authorities of Drug Development
3.4
Steps involved in new product development process
18
3.5
Ethical issues in product development
19
3.6
Ethical issues in clinical research
20
3.7
Terminologies related to product development
22
3.8
Study of acute, Sub acute and chronic toxicity test
25
Chapter-IV
Research & Pharmaco-poeial standards
4.0
29
4.1
Ayurvedic Pharmacopoea Committee
4.2
Quality control in Ayurvedic drugs-ASU
32
4.3
Important regulatory/legal provisions
33
4.4
Good manufacturing practices (GMP)
34
4.5
Good Agricultural & Collection Practices (GACP)
42
Chapter- V
Good Clinical Practices (GCP)
5.0
43
5.1
Important definitions
5.2
ASU drugs & GCP
50
5.3
Principles of ICH-GCP
5.4
Responsibilities of Institutional Review Board (IRB)/Institutional Ethical Committee (IEC)
51
5.5
Composition & Function of IEC
52
5.6
Principles of GCP-Global Stand
54
Chapter- VI
Essentials & Preparatory before Clinical study
6.0
General information
56
6.1
Aims & Objectives of the study
6.2
Ethical consideration
57
6.3
Study Design
6.4
Inclusion, Exclusion and With drawal of subjects
58
6.5
Assessment of efficacy
6.6
Assessment of safety
6.7
Statistics
6.8
Data Handling and Management
59
6.9
Quality control and Quality assurance
6.10
Finance and Insurance
6.11
Publication Policy
60
6.12
Decision of Ethical Committee
61
Chapter- VII
Informed Consent
7.0
62
7.1
Process
63
7.2
Notes and steps during emergency condition
66
7.3
Compensation of patients/volunteers
7.4
Sample form for the informed consent form
67
Chapter- VIII
Clinical Trial Designs
8.0
77
8.1
Approach to Classify Clinical Studies According to Objective
78
8.2
Importance of clinical trial design
79
8.3
Types of Clinical designs
81
8.4
Common Designs
84
8.5
Special designs for the small scale trials
85
8.6
Advantages Vs Disadvantages of various designs
87
Chapter-IX
Case Record Form (CRF)
9.0
90
9.1
Procedure
91
9.2
Collection of Participant Data
9.3
Data to be collected on CRF
92
9.4
Audit trials
9.5
Check list for handling CRFs
Chapter-X
Randomization and Blinding of Trial
10.0
94
10.1
Need of randomization
10.2
What is meant by randomized clinical trial
10.3
How to randomize
97
10.4
Methods of Randomization
10.5
Problems and Additional Benefits of Randomization
99
10.6
Blinding
100
10.7
Masking & Blinding
103
10.8
Placebo & Blinding
10.9
Does blinding prevent bias
104
10.10
What to look for in descriptions of blinding
Chapter-XI
Phases of Clinical trial
11.0
106
11.1
Discussion & types of clinical trial (Phase-0 to IV)
107
Chapter-XII
Drug sources and method of identification
12.0
111
12.1
Discussion on various types of authentication-Herbal, Mineral & Animal origin ingredients with LCMS, HOLC, HPTLC, TLC, AAS etc
Chapter-XIII
Good Laboratory Practice (GLP)
13.0
127
13.1
Aim of GLP
13.2
Fundamental points of GLP
13.3
OECD-GLP Principles
129
13.4
GLP inspection check list
134
Chapter-XIV
Bio-informatics
14.0
152
14.1
Why Bioinformatics is so important
14.2
Enormity of Genetic Data
14.3
Major Bioinformatics Applications
153
14.4
Aim of informatics
14.5
Bio-informatics and Ayurveda
154
Chapter- XV
Pharmacovigilance
15.0
156
15.1
Why is it import
15.2
Evolution of Pharmacovigilance
157
15.3
Benefits of Pharmacovigilance
15.4
Responsibilities of Pharrnacovigilance
15.5
Process in Pharmacovigilance
15.6
National Pharmacovigilance Programme for ASU drugs
159
Chapter-XVI
Pharmacoeconomics and Pharmacoepidemiology
16.0
166
16.1
Methodological issues in conducting pharmacoeconomics evaluation
16.2
Types of pharmacoeconomic analysis
167
16.3
Need of Pharmacoeconomics
16.4
Pharmacoepidemiology & Ayurvedic Pharmacoepidemiology
Chapter- XVII
Pharmacogenomics
17.0
169
17.1
Pharmacogenomics usefulness
17.2
Pharmacogenomics and Ayurveda
170
Chapter- XVIII
RadioBiology
18.0
172
18.1
Radiation effect of cells
18.2
Process of radiation damage
173
18.3
Direct action of radiation damage
18.4
Indirect action of cell damage
18.5
Fate of irradiated cell
175
18.6
Repair of Radiation Damage
176
18.7
Tissue and Organ Sensitivity to Radiation
18.8
Radiation Effects
18.9
Deterministic Effects
18.10
Thresholds for Deterministic Effects-Health hazard
177
18.11
Stochastic Effects
18.12
High Dose Effects
178
18.13
Late Effects of High Dose Radiation
Chapter-XIX
Various in-vivo (animal) & in-vitro models of bioresearch
19.0
179
19.1
Uses of animal model
19.2
History of use of animals in research
181
19.3
Types of animal model
19.4
In-vitro
182
19.5
Models of in-vitro
Chapter-XX
Phamacokinetics and Pharmacodynamics
20.1
Pharmacokinetics
185
20.2
Pharmacodynamics
186
20.3
Therapeutic drug monitoring
187
20.4
Process of Pharmacokinetics
189
20.5
Models of Pharmacokinetics
191
20.6
Some terminologies
192
20.7
Applications of Pharmacokinetics in Ayurveda
Chapter-XXI
Government organization related to Clinical Research
21.1
Clinical Trial Registry of India (CTRI)
194
21.2
Central Drugs Standard Control Organization (CDSCO)
195
21.3
Central Council Of Research In Ayurvedic Sciences (CCRAS)
196
21.4
Indian Council Of Medical Research (ICMR)
198
Chapter-XXII
Intellectual Property Rights (IPR)
22.0
What is Intellectual Property Rights
200
22.1
Areas of Intellectual Property- Patent, Trade Mark etc
22.2
Types of Intellectual Property- Patent, Trade Mark etc
201
22.3
Ayurveda and Intellectual Properties Rights 203
22.4
Organizations associated with Intellectual Property Rights
203
Chapter-XXIII
Protocols
23.1
Safety & Toxicity profile evaluation of Ayurveda plants and drugs
207
23.2
Rules No. 170, GSR 893 (E), Drugs & Cosmetic Act (4th Amendment) 2008: Guidelines of evaluation of ASU drugs
209
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