a graphical model of a clinical trials gives a broad
view on the organisation and the procedures of a
clinical trial. Besides, clinical trial model may be
suitable to capture trial related rules.
There is no general specification of all
requirements for clinical trial and it complicates
quality control. The model of the clinical trial is not
created during the design of the clinical trial mostly.
As a result of the clinical trial design a clinical trial
protocol is produced. The clinical trial protocol
presents all the information needed for the conduct
of the clinical trial, but the information is
represented in natural language. The use of natural
language for clinical trial description has both
negative and positive aspects:
the positive aspect of the use of natural
language is clarity of the protocol for
everyone interested in the clinical trial. In
other words the protocol is understandable,
easy readable and does not require any special
knowledge;
the negative aspect of the use of natural
language is ambiguity of natural language.
Natural language is informal and can be
interpreted. As clinical trial protocol is the
primary document for the conduct of clinical
trial it is desirable to have unambiguous
specification of all trial procedures.
The use of some formal or semi formal modelling
language for clinical trial modelling may allow
reduce the ambiguity of the protocol. But as there
are special requirements for the clinical trial protocol
and it has to be approved before the start of the trial,
it is impossible to present a model of the trial instead
of clinical trial protocol to the responsible
authorities. Thus a model of a clinical trial cannot
replace protocol. A model of a trial may be prepared
in parallel with the construction of protocol instead
of replacing the clinical trial protocol with the model
of the trial. It would be even better to start the design
of the trial from the model, but it may be impossible,
because the design of the model may prolong the
design of the study. Therefore the trial should be
modelled using any formal or semi formal language
to represent the procedures of the trial in a graphic
way in parallel with the design of the protocol or just
after the clinical trial protocol is created.
There are many modelling languages suitable to
represent different aspects of systems – UML, IDEF,
conceptual graphs, etc (Vasilecas, 2005). As UML
became the most popular modelling language for
any kind of systems in recent years, we analyse the
use UML for clinical trial modelling in this paper.
The Unified Modelling Language is a visual
language for specifying, constructing and
documenting the artefacts of systems. It is a general-
purpose modelling language that can be used with
all major object and component methods, and that
can be applied to all application domains (e.g.,
health, finance, telecom, aerospace) (OMG, 2006).
UML diagrams can be classified into three different
classes (Shen, 2005):
diagrams describing the roles and obligations of
system users generally (Use Case diagrams).
In the clinical trial models these diagrams
should represent the roles and obligations of
the clinical trial team members and
participants. For example, the right to revoke
the patients informed consent or the obligation
of investigator to record medical history in the
Case Report Form can be represented in the
UML Use Case diagrams;
diagrams describing structural system aspects
(class and object diagrams). In the clinical
trial model class diagrams should be used to
represent the organisation of a trial in detail.
For example, each examination, visit,
laboratory assessment, etc., should be
represented as classes with attributes and
operations. Class model may be used to create
the structure of the database for the clinical
trial data;
diagrams describing the internal and external
behaviour of system (state transition diagrams,
sequence and collaboration diagrams). In the
clinical trial models these diagrams should be
used to represent the sequence of actions in
each step of a clinical trial. For example, the
proceeding of screening visit can be described
in sequence or collaboration diagrams and the
states of the patient diary can be represented
in state transition diagrams.
UML models are not fully formal. Some
information represented in UML diagrams can be
interpreted, but generally UML models are suitable
for automation of systems development. We assume
that the use of UML would greatly improve clinical
trial design and data validation processes. We
highlight the following main advantages of UML
usage for clinical trial research:
UML model would give a broad graphical view
on the whole trial. This would improve quality
control and documentation of clinical trial
procedures;
Duties and responsibilities of clinical trail team
members represented in UML Use Case
models would simplify preparation of
operational manuals for investigators and
other team members;
IMPLEMENTATION OF RESTRICTION AND VALIDATION RULES
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