Guidelines for Good Pharmacoepidemiology Practices (GPP)
Initially issued: 1996
Revision 1: August 2004
Revision 2: April 2007
Revision 3: June 2015
Pharmacoepidemiologic studies provide valuable information about the health effects of healthcare products. The ISPE Guidelines for Good Pharmacoepidemiology Practice (GPP) are intended to assist investigators with issues pertaining to the planning, conduct, and interpretation of pharmacoepidemiologic research. This paper represents the fourth version and supersedes previous versions. While the overall structure and nature of the GPP has been preserved in the current revision, new sections have been added and the text has been updated to reflect current practice.
Pharmacoepidemiology is being used increasingly to evaluate health care systems, interventions, and health-related behaviors. Pharmacoepidemiology is the scientific backbone of therapeutic risk management—the process of assessing a product's benefits and risks, and developing, implementing, and evaluating strategies to enhance the overall balance of such benefits and risks. Pharmacoepidemiology is also the scientific backbone of comparative effectiveness research (CER). These guidelines are intended to address these activities and other pharmacoepidemiologic studies.
The GPP address the following areas:
The GPP propose essential practices and procedures that should be considered to help ensure the quality and integrity of pharmacoepidemiologic research, and to provide adequate documentation of research methods and results. The GPP do not prescribe specific research methods, nor will adherence to guidelines guarantee valid research.
The GPP have the following specific goals:
- To assist researchers in adhering to good pharmacoepidemiologic research principles, including the use of pharmacoepidemiologic studies for risk management activities and CER.
- To promote sound pharmacoepidemiologic research by encouraging rigorous data collection, analysis, and reporting.
- To provide a framework for conducting and evaluating pharmacoepidemiologic studies.
- To facilitate the appropriate utilization of technical resources by promoting careful study design and planning of study conduct.
- To facilitate transparency and ethical integrity in research conduct
B. Scope and Application
The GPP are intended to apply broadly to all types of pharmacoepidemiologic research, including feasibility assessments, validation studies, descriptive studies, as well as etiologic investigations, and all of their related activities from design through publication.
Therapeutic risk management activities provide a formal framework in which medicine, pharmacoepidemiology and public health are integrated in the development and life-cycle management of healthcare products. Pharmacoepidemiology is the core science of risk assessment and the evaluation of the effectiveness of risk minimization interventions. Therefore, the GPP also support risk management activities.
In a similar fashion, pharmacoepidemiology is the core discipline of comparative effectiveness research (CER). Such activities are based on problems from clinical medicine, by using rigorous methods to compare the outcomes of two or more therapeutic alternatives. Thereby, comparative effectiveness activities are defined by their research questions rather than by their methods.
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II. Protocol Development
Each study should have a written protocol. A protocol should be drafted as one of the first steps in any research project, and the protocol should be amended or updated as needed throughout the course of the study. Some jurisdictions, such as the European Union, through EMA and ENCePP, provide guidance on the content and format of the protocol for post-authorisation safety or effectiveness studies (PASS or PAES). For studies where no such guidance is applicable, the protocol should include the following elements:
- A descriptive title (e.g. indicating study design and population) and version identifier (e.g., date); If applicable, the registration number (clintrials.gov or ENCePP register) should be indicated.
- The names, titles, degrees, addresses, and affiliations of all responsible parties, including the principal investigator, co-investigators, and a list of all collaborating primary institutions and other relevant study sites;
- The name and address of each sponsor;
- A synopsis of the protocol;
- The proposed study tasks, milestones, and timeline;
- A statement of research objectives, specific aims, and rationale;
Research objectives describe the knowledge or information to be gained from the study. Specific aims list key exposures and outcomes of interest, and any hypotheses to be evaluated. The protocol should distinguish between a limited number of a priori research hypotheses and hypotheses that are generated based on knowledge of the source data. The rationale explains how achievement of the specific aims will further the research objectives. The research question may be phrased by using the PICOT template; population, intervention, comparator, outcome and timing.
- A critical review of the literature to evaluate pertinent information and gaps in knowledge;
The literature review should describe specific gaps in knowledge that the study is intended to fill. The literature review might encompass relevant animal and human experiments, clinical studies, vital statistics, and previous epidemiologic studies. The literature review should also cite the findings of similar studies, and the expected contribution of the current study.
- description of the research methods, including:
- The overall research design and reasons for choosing the proposed study design;
Research designs include, for example, case-control, cohort, cross-sectional, nested case-control, self-controlled, randomized trials or hybrid designs. Any feasibility or pilot work that informed the choice of design should be described here.
- The population or sample to be studied;
The population is defined in terms of persons, place, time period, and selection criteria. The rationale for the inclusion and exclusion criteria and their impact on the number of subjects available for analysis should be described, if known. If any sampling from a defined population is undertaken, description of the population and details of sampling methods should be provided.Some justification should be given to support that the necessary study size is actually attainable from the given data source or design. This could be data from informal queries or pilot studies.Considerations of generalizability from the study population to those actually receiving the drug may be voiced here.
- The strategies and data sources for determining exposures, health outcomes, and all other variables relevant to the study objectives, such as potential confounding variables and effect measure modifiers;
Data sources might include, for example, questionnaires, hospital discharge files, abstracts of primary clinical records, clinical databases, electronic medical records, ad hoc data collection, administrative records such as eligibility files, prescription drug files, biological measurements, exposure/work history record reviews, or exposure/disease registries. If the study uses secondary data, the name of the data source should be included (eg, Medicare, CPRD, MarketScan)..Use validated instruments and measures whenever such exist, and describe the validation method and summarize what is known about the completeness and validity of those instruments and measures. If data collection methods or instruments will be tested in a pilot study, plans for the pilot study should be described. Any procedures to be used to validate diagnosis should be described.
- Clear operational definitions of disease state, exposures, health outcomes, and other measured risk factors for outcome;
An operational definition is one that can be implemented independently using the data available in the proposed study. For example "pneumocystis carinii pneumonia, episode" is not an operational definition; a better description would be "hospitalization with a principal discharge diagnosis of ICD-9-CM code 136.3." If complex algorithms are used to establish exposure or health status, they should be described or referenced.
- Projected study size, statistical precision, and the basis for their determination;
Describe the relation between the specific aims of the study and the projected study size in relation to each outcome. In most circumstances it is desirable to express study goals in terms of precision sought for study estimates rather than statistical power. For safety studies, it may be useful to specify the sample size that can minimally detect a pre-specified risk with a pre-specified power, for example, “the study has an 80% power to detect a relative risk of 3 or greater for drug x compared to treatment with other drugs commonly used in this condition.” For descriptive studies, e.g. studies on drug utilization, where the result is a measure of frequency rather than of association, the protocol might specify the expected precision of these frequency estimates, if possible.
- Methods used in assembling the study data;
This should include a description of, or reference to, any pre-testing procedures for research instruments and any manuals and formal training to be provided to interviewers, abstractors, coders, or data entry personnel. This should also include procedures for linkage and data mining of administrative databases. If data are validated, validation methods should mentioned,.e.g. review of ICD codes.
- Procedures for data management;
Describe data management and statistical software programs and hardware to be used in the study. Describe data preparation as well as the methods for data retrieval and collection. Data management also includes methods used to correct inconsistencies or errors, impute values, or modify raw data.
- Methods for data analysis;
Data analysis comprises comparisons and methods for analyzing and presenting results, categorizations, and procedures to control sources of bias and their influence on results, e.g., possible impact of biases due to selection bias, misclassification, confounding, and missing data. For instance, the statistical procedures to be applied to the data to obtain point estimates and confidence intervals of measures of occurrence or association, , should be presented. Any sensitivity analyses should be described.
Details of the statistical analysis may be specified later, but before analysis begins, as part of a protocol amendment to the study protocol, or more typically as a separate document, usually referred to as a Statistical Analysis Plan (SAP). See section IV C.
- A description of quality assurance and quality control procedures for all phases of the study;
Mechanisms to ensure data quality and integrity should be described or referenced if the mechanisms are published elsewhere (e.g., when publications describing procedures for existing data collection systems are published or in the public domain), including, for example, abstraction of original documents, extent of source data verification, validation of endpoints and revision and oversight of programming. As appropriate, include certification and/or qualifications of any supporting laboratory or research groups.
- Limitations or strengths of the study design, data sources, and analytic methods;
At a minimum, issues relating to confounding, misclassification, selection bias, generalizability, and random error should be considered. The likely success of efforts taken to reduce errors should be discussed.
- A description of plans for protecting human subjects;
This section should include information about whether study subjects will be placed at risk as a result of the study, provisions for maintaining confidentiality of information on study subjects, and potential circumstances and safeguards under which identifiable personal information may be provided to entities outside the study. Conditions under which a clinical trial would be terminated for ethical reasons (stopping rules) should be described. Procedures for monitoring results should be described, and the use of a Data Safety Monitoring Board (DSMB) for clinical trials should be considered for this purpose. The need for submitting the protocol to an Institutional Review Board/Independent Ethics Committee (IRB/IEC) and the requirement of informed consent should be considered in accordance with local law. Research using de-identified data from commercially or publically available secondary data sources represents the lowest risk to potential subjects since it involves the collection of anonymous or publically available data. These studies therefore may not require IRB review in all jurisdictions if the study meets other legal and regulatory requirements for the protection of human subjects. If the study is categorized as exempt from IRB review, this should be stated and duly referenced in the protocol. Further, if the investigator’s sponsoring institution (e.g. university) or owner of the data source requires the registration and/or ethical review of all research, including “exempt from human subjects research,” this should also be stated. See Section IV A.
- A description of plans for disseminating and communicating study results, including the presence or absence of any restrictions on the extent and timing of publication;
There is an ethical obligation to disseminate findings of potential scientific or public health importance (e.g., results pertaining to the safety of a marketed medication). Authorship should follow guidelines established by the International Committee of Medical Journal Editors (http://www.icmje.org/). See also, Section V. Communication.
- Bibliographic references;
- Dated amendments to the protocol.
Significant deviations from the protocol, such as any changes in the population or sample that were implemented after the beginning of the study, along with the rationale, should be documented in writing. Any changes made after data analysis has begun should be documented as such and the rationale provided.
- Archiving or registration of protocol;
ISPE endorses the opportunity to register and publicly disclose hypothesis-driven pharmacoepidemiology research protocols in a suitable public site, such as the ENCePP registry (also currently functioning as the EU PAS Register) or ClinicalTrials.gov. If it is chosen, registration and disclosure should be permanent, without the option to retract the protocol. If possible, the researcher may choose to register a protocol with a published timetable for its later disclosure, rather than immediately disclose the protocol at the time of registration. This delay may be scientifically appropriate to avoid the potential for recall or other bias resulting from study participants’ knowledge of the study hypothesis, such as in a case control study collecting data on past exposures. The procedures for protocol registration should also include a mechanism for amendment of previously posted protocols. In the registration statement, the investigators should declare the extent to which they were aware, through advance exploratory analyses, of the likely ultimate findings of the study at the time that the protocol is submitted.
- Exceptions from overall protocol requirement;
Active surveillance of medical products seeks to proactively identify suspected or unanticipated medical product-associated adverse events. The primary goal of active surveillance is to identify potential safety signals quickly. While these active surveillance activities generally employ sound design and analytic approaches, they are often not fully-specified, protocol-driven analyses. As part of surveillance, identified safety alerts undergo further investigations using methods that are tailored to specific product-outcome pairs. If a protocol-driven assessment is deemed necessary to confirm or refute the safety signal, the analysis should follow the GPP to the extent possible.
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III. Responsibilities, Personnel, Facilities, Resource Commitment, and Contractors
The organization(s) and individual(s) conducting and sponsoring the research shall be fully responsible for the research. The relationship, roles, and responsibilities of the organizations and/or individuals conducting and sponsoring the study should be described.
The individuals responsible for pharmacoepidemiologic research, along with the type of expertise and autonomy in conducting the research, should be stated clearly. For projects sponsored by one organization (such as a pharmaceutical company or government agency) but implemented by another (e.g., an academic institution or a contract research organization-CRO), responsibility for scientific integrity is shared by the collaborating institutions (e.g, sponsor, the principal investigator conducting the study, the senior qualified epidemiology staff within the CRO and the organization that employs the principal investigator). In such situations of shared responsibility, contractual arrangements should include a timeline for study completion and potential actions to be taken if the timeline cannot be met. In particular, the contract should delineate the roles and responsibilities to be assumed by the study sponsor and the contractor(s) in communicating various aspects of the study as well as data access, ownership and archiving.
Personnel engaged in epidemiologic research and related activities should have the education, training, or experience necessary to perform the assigned functions competently. The organization should maintain a current summary of training and experience of these personnel. A list of individuals engaged in or supervising activities should be maintained and updated periodically with current job titles.
Adequate physical facilities shall be provided to all those engaged in epidemiologic research and related activities. Suitable storage facilities shall be available to maintain technical records in a secure and confidential environment in compliance with local regulations.
For the purposes of ensuring and documenting the contractor's conformance with the GPP, it is recommended that the study sponsor have the right during the course of the study, and for a reasonable period following completion of the study, to inspect the contractor's facilities, including equipment, technical record, programming, and records relating to the work conducted under the sponsor's contract. The nature of the audit, including procedures that ensure patient confidentiality, should be agreed upon at the outset of any contract.
including equipment, technical record, and records relating to the work conducted under the sponsor's contract. The nature of the audit, including procedures that ensure patient confidentiality, should be agreed upon at the outset of any contract.
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IV. Study Conduct
The principal investigator shall be responsible for the overall content of the research project, including the day-to-day conduct of the study, interpretation of the study data, and preparation and publication of the final report. These responsibilities extend to all aspects of the study, including periodic reporting of study progress as well as quality assurance.
The unusual decision to terminate a study prematurely should be taken with great caution, and should be based on good scientific and ethical reasons and documented in writing. There may be rare instances in which administrative reasons require study termination. Investigators and sponsors should specify and agree in advance about the circumstances under which the study could be terminated early. Included should be a mechanism for resolution of any disagreement.
A. Protection of Human Subjects
Approval by an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or other appropriate body, should be obtained for all research involving human subjects. Studies using commercially or publically available de-identified secondary data sources, or which meet certain other criteria, are not considered research involving human subjects in some countries and may be exempt from IRB review. Informed consent beyond that already obtained for participants in a research database may be needed when the research imposes a risk for patients or data containing personal identifiers is required by the investigator (e.g., medical record). The legal definition of a personal identifier varies across countries; therefore, national and local laws should be consulted when proposing to obtain this type of data.
In some circumstances, and in some countries, disclosure of relevant personal medical information (e.g., medical record) without consent is permissible under public health laws, for example when government organizations conduct infectious disease surveillance or monitoring and reporting adverse drug reactions through secondary data sources (see section II, O on Active Surveillance).
Investigators shall ensure that personal identifiers will be removed from any study files that are accessible to non-study personnel in accordance with applicable laws and regulations. Whenever feasible, study files should be coded and stripped of personal identifiers, and code keys stored separate from study files. All personnel with access to data containing personal identifiers should sign a pledge to maintain the confidentiality of study subjects. For additional information, please consult the ISPE guidelines on Data Privacy, Medical Record Confidentiality, and Research in the Interest of Public Health (http://www.pharmacoepi.org/resources/privacy.cfm). Blood and serum sample collections stored after completion of clinical studies are a valuable resource. However, protecting confidentiality in such data requires special consideration and investigators are encouraged to consult guidelines developed by the NHLBI.2
B. Data Collection, Management, and Verification
All data collected for the study should be recorded accurately, promptly, and legibly. The individual(s) responsible for the integrity of the data, computerized or hard copy, shall be identified, and shall have the education, training, and experience needed to perform the assigned tasks.
All procedures used to obtain, verify and promote the quality and integrity of the data should be recorded in sufficient detail so that others can replicate them. A historical file of these procedures shall be maintained, including all revisions and the dates of such revisions. Any changes in data entries shall be documented. For any endpoint or covariate status ascertainment (in a cohort study or trial) or exposure ascertainment (in a case-control study) that requires adjudication, all measures taken to assure blinding of the adjudicators to the exposure (cohort) or outcome (case-control) status of the subject should be outlined in the protocol. Documentation of these measures needs to be maintained with the data files throughout the course of the study and archiving period.
Security of the data should be maintained at all times. Access should be limited to authorized individuals. Control systems, such as document encryption, should be used to ensure the authenticity, integrity and confidentiality of electronic records when transmitted over open networks (e.g., the internet). Adequate back up of the data should be maintained throughout the course of the study.
- 1. A clearly defined statistical analysis plan, including statistical procedures and shell tables should be documented. The statistical analysis plan should be finalized before the end of data collection
- 2. All data management and statistical analysis programs and packages used in the analyses should be documented and archived. Reasonable effort should be made to document and validate interim steps in the analysis.
- 3. The analysis should be directed toward the unbiased estimation of the epidemiologic parameters of interest (e.g., risk or rate differences, risk or rate ratios). The precision of effect estimates should be quantified using confidence intervals. Comparability of populations for pooled estimates should be assured, and missing of important variables should be addressed.
Interpretation of statistical measures, including confidence intervals, should be tempered with appropriate judgment and acknowledgements of potential sources of error and limitations of the analysis, and should never be taken as the sole or rigid basis for concluding that there is or is not a relation between an exposure and outcome. Sensitivity analyses should be conducted to examine the effect of varying potentially critical assumptions of the analysis.
D. Study Reports
Describe the need and purpose of an interim report or analysis when applicable. If required, the issuance of such reports must be pre-specified in the study protocol.
Completed studies shall be summarized in a final report that accurately presents the study objectives, methods, results, strengths and limitations of the study, and interpretation of the findings.
The final report shall include at minimum:
- A descriptive title;
- An abstract;
- Purpose (objectives) of the research, as stated in the protocol;
- The names, titles, degrees, addresses and affiliations of the principal investigator and all co-investigators;
- Name and address of each sponsor;
- Dates on which the study was initiated and completed;
- Introduction with background, purpose, and specific aims of the study;
- A description of the research methods, including:
- source population and selection of study subjects;
- data collection methods and, if questionnaires or surveys are involved, complete copies (including skip patterns);
- transformations, calculations, or operations on the data;
- statistical methods used in data analyses.
- A description of circumstances that may have affected the quality or integrity of the data; Describe the limitations of study approach and the methods used to address them (e.g., response rates, missing or incomplete data). All sensitivity analyses conducted to assess the impact of critical assumptions should be listed.
- Analysis of the data; Include sufficient tables, graphs, and illustrations to present the pertinent data and to reflect the analyses performed. Epidemiologic parameters (e.g., risks, rates, risk or rate differences, risk or rate ratios) are the most typical epidemiologic measures to report. Both unadjusted and adjusted results should be presented. Effect measures should not be described as “significant” or “not significant.” Precision of estimates should be quantified using confidence intervals. Confidence intervals communicate both the strength of the relationship and the precision of the measure and are therefore more informative than point estimates accompanied by p-values.
- A discussion of strengths, limitations and possible bias of the study, including direction and magnitude of bias, if known.
- A statement of the conclusions drawn from the analyses of the data;
- A discussion of the implication of study results; Cite prior research in support of and in contrast to present findings. Discuss possible biases and limitations in present research. Inferences about causal effects should be based on a variety of factors that should be explored in the discussion section. These factors include strength of relationship, temporal relationship, biological mechanism, plausibility of alternative theories, biases, confounding, precision, and others.
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Each organization and its advisory board, if there is one, shall predetermine procedures under which communications of the intent, conduct, results, and interpretation of an epidemiologic study will occur, including what function individuals associated with the research must fulfill. These individuals should include the principal investigator, study director, and/or the sponsor. This procedure may be documented in the form of a company standard operating procedure, in the study protocol, or through contractual agreement.
ISPE encourages communicating quantitative estimates of epidemiologic measures in the results section, generally by using point estimates and confidence intervals, either directly or graphically. It is useful in reporting results of safety studies to include both the relative and absolute risk estimates. Inferences about causal effects should be based on a variety of factors that should be explored in the discussion section. These factors include strength of relationship, temporal relationship, biological mechanism, plausibility of alternative theories, biases, confounding, precision, and others. Investigators should not make inferences about causation based solely on the outcome of a test of significance (e.g., a p-value or a statement about the confidence interval including or not including the null value).
There is an ethical obligation to disseminate findings of potential scientific or public health importance. For findings which could have a significant impact on public health there may be legal, as well as ethical requirements to report the results immediately to the appropriate regulatory authorities. Scientific peers shall be informed of study results in a timely fashion by publication in the scientific literature and presentations at scientific conferences, workshops, or symposia. Presentations at meetings should not be considered as a substitute for publication in the peer-reviewed literature. Authorship of study manuscripts should follow the guidelines established by the International Committee of Medical Journal Editors (http://www.icmje.org/). All authors should meet the criteria for authorship, and all people who meet the criteria should be authors. Potential conflicts of interest, financial and non-financial, should be disclosed. Agreement to adhere to these guidelines should be described in the protocol.
Finally, research sponsors (government agencies, private sector, etc.) shall be informed of study results in a manner that complies with local regulatory requirements. Sources of research funding, including direct funding and provision of drugs, should always be acknowledged, whether results are presented orally or in writing.
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VI. Reporting of Adverse Drug Events From Pharmacoepidemiology Studies
Pharmacoepidemiologic studies are usually designed to assess the relation between certain exposures and health events based on comparisons of the event frequency in groups with and without the exposure of interest via statistical analyses (i.e., analytic studies). The primary goal of these analytic studies is to determine whether a drug exposure increases the risk of an adverse event or provides protection against it. Therefore, causality assessment and reporting of individual exposed cases offers little, if any, scientific value to this goal.
For primary data collection studies, reporting of adverse events is required by law in most countries. Since information on suspected adverse events may be identified during the course of a study, but not as a formal part of the protocol-defined study objectives, procedures for follow-up and reporting of safety information in the study should be defined by the sponsor and research team at the time of protocol development. For specific requirements, relevant regulatory guidance documents should be consulted (see Table 1). As requirements change repeatedly, the latest versions of regulatory guidances should be consulted prior to study commencement.
Aggregate analysis of electronic healthcare databases may also identify an unexpected increase in risk associated with a particular exposure. Such studies may be reportable as study reports, but do not require reporting of adverse events or adverse reactions. Secondary data source studies that include medical record or narrative text review by a human reviewer, e.g., studies in which endpoint validation is performed using medical record review, are an exception. These studies are generally required to report adverse drug reactions documented in the medical record/narrative text only.
If reporting requirements apply, the protocol should specify what data are being collected and how they will be reported. Regardless of whether individual reporting requirements apply, sponsors should convey findings of their analytic studies in aggregate form as study reports.
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Secure archives must be maintained for the orderly storage and expedient retrieval of all study related material. An index shall be prepared to identify the archived contents, to identify their location, and to identify by name and location any materials that by their general nature are not retained in the study archive. Access to the archives shall be controlled and limited to authorized personnel only. Special procedures may be necessary to ensure that access to confidential information is limited and that the confidentiality of information about study subjects is protected (see, II. Protocol Development, Section I).
Where there are no specified national or regional requirements for retention of study materials, the archive should be maintained for at least five years after final report or first publication of study results, whichever comes later. At minimum, the study archive should contain, or refer to, the following:
- A final report of the study;
- All source data and, where feasible, any biologic specimens. A printed sample of the master computer data file(s), if feasible, with reference to the location of the machine-readable master. All "source data" should comprise the raw data that provided the basis for the final analysis of the study. The archival material should be sufficiently detailed to permit re-editing and re-analysis;
- Documentation adequate to identify and locate all computer programs and statistical procedures used, including version numbers where appropriate (see section IV(C): Study Conduct);
- Copies of electronic versions of analytic data sets and programs, computer printouts, if feasible, including relevant execution code, which form the basis of any tables, graphs, discussions, or interpretations in the final report. Any manually developed calculations shall be documented on a work sheet and similarly retained;
- Correspondence pertaining to the study, standard operating procedures, informed consent releases, copies of all relevant representative material, copies of signed institutional review board and other external reviewer reports, and copies of all quality assurance reports and audits. Communication of study results to the sponsor, regulators, and scientific community should be documented;
Include, for example, questionnaires, name, make and model numbers of relevant measurement instruments, calibration information and procedures.
- Documentation relating to the collection and processing of study data, including laboratory/research notebooks, training and reference documents for abstracts, interviews, and coders.
VIII Other guideline and guidances
Table 1 summarizes other important guidelines for pharmacoepidemiology research. This list is not meant to be exhaustive but provides an overview of important guidelines available at the time of the GPP revision.
- Chemical Manufacturers Association's Epidemiology Task Group. Guidelines for good epidemiology practices for occupational environmental epidemiologic research. JOM 1991; 33:1221-1229.
- Austin MA, Ordovas JM, Eckfeldt JH, Tracy R, Boerwinkle E, Lalouel JM, Printz M. Guidelines of the National Heart, Lung, and Blood Institute Working Group on blood Drawing, Processing, and Storage for Genetic Studies. Am J Epidemiol 1996; 144:437-41.
Elizabeth B. Andrews, MPH, PhD, FISPE
Félix M. Arellano, MD, FISPE
Jerry Avorn, MD, FISPE
Edward A. Bortnichak, MPH, PhD
Robert Chen, MD, MA, FISPE
Wanju S. Dai, MD, DrPH, FISPE
Francisco J. de Abajo, MD, PhD
Gretchen S. Dieck, MPH, PhD
Corinne de Vries MSc PhD
Stanley Edlavitch, PhD, MA
Joel Freiman, MD, MPH
Jesper Hallas, MD, PhD, FISPE
Judith K. Jones, MD, PhD, FISPE
Linda Koo, MD
David W. Kaufman, Sc.D.
Xavier Kurz, MD, MSc, PhD
Stephan Lanes, PhD
Allen A. Mitchell, MD, FISPE
Robert C. Nelson, PhD, FISPE
Ineke Neutel, PhD, FACE, FISPE
Byung-Joo Park, MD PhD, FISPE
Susana Perez-Gutthann, MD, MPH, PhD, FISPE
Robert Reynolds, ScD, FISPE
Susan Sacks, PhD, FISPE
Nancy Santanello, MD, MS, FISPE
Paul Stang, PhD, FISPE
Andrew Stergachis, PhD, FISPE
Brian L. Strom, MD, MPH, FISPE
Til Stürmer, MD, MPH, PhD, FISPE
Darren Toh, ScD
Anne Trontell, MPH, MD
Alexander M. Walker, MD, DrPH, FISPE
Patrick Waller, BMS, MD, MPH, FRCP
Douglas J. Watson, MSPH, PhD, FISPE
Suzanne West, MPH, PhD, FISPE
Karen Wilcock, PhD, MPH
Robert P. Wise, MD, MPH, FISPE
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