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Muniappan S, Jeyaraman M, Yadav S, Jeyaraman N, Muthu S, Ramasubramanian S, Patro BP. Applications of Blockchain-Based Technology for Healthcare Devices Post-market Surveillance. Cureus 2024; 16:e57881. [PMID: 38725738 PMCID: PMC11079575 DOI: 10.7759/cureus.57881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
The volume of data analysis for medical device post-market surveillance (PMS) has increased dramatically in recent years. It is the more stringent and intricate regulatory criteria of the health authorities that are meant to improve the medical device safety review. As regulators scrutinize device safety more closely, proactive approaches to PMS processes are becoming crucial. To solve some of the issues brought on by this shifting regulatory landscape, new technologies have been investigated. This study envisages the technical features of blockchain technology (BCT) and its role in enhancing the PMS for medical devices. To address the aforementioned challenges, our model involves the establishment of a secure, permissioned blockchain for PMS data management, utilizing a proof-of-authority consensus mechanism. This blockchain framework will exclusively permit a carefully vetted and designated set of participants to validate transactions and record them in the PMS data ledger. The utilization of BCT holds the potential to introduce enhanced efficiency and provide several advantages to the various stakeholders involved in the PMS procedure, including its potential to support emerging regulatory efforts.
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Affiliation(s)
- Swarna Muniappan
- Electronics and Communication Engineering, Dr MGR Educational and Research Institute, Chennai, IND
| | - Madhan Jeyaraman
- Clinical Research, Viriginia Tech India, Dr MGR Educational and Research Institute, Chennai, IND
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Sathish Muthu
- Department of Orthopaedics, Government Karur Medical College, Karur, IND
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, IND
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, IND
| | | | - Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
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Makhene NL, Steyn H, Vorster M, Lubbe MS, Burger JR. Assessment of pharmacovigilance guidelines in the Southern African Development Community: A document review. Pharmacoepidemiol Drug Saf 2024; 33:e5755. [PMID: 38362654 DOI: 10.1002/pds.5755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Lack of harmonization in pharmacovigilance (PV) practice in resource-limited states in Africa has led to differentiation and marginalization, thus creating an environment where weak or absent PV systems may benefit from regional guidelines. PURPOSE To compare the PV guidelines of Southern African Development Community (SADC) member states to international guidelines and identify areas for improvement for aligning PV practice within the SADC region. METHODS We utilized a 73-item checklist to assess the PV guidelines of the SADC member states. Checklist parameters were rated using binary scoring. RESULTS Only seven (Botswana, Mauritius, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe) of the 16 SADC member states had guidelines to assess. Of these, only four had supporting legislation. All seven national medicines regulatory authorities (NMRA)'s guidelines required reporting of local serious adverse drug reactions (ADRs). Four NMRAs implemented device vigilance; none specified submission timelines for ADRs associated with substandard or falsified medicines. Only three NMRAs required electronic transmission of individual case safety reports in the E2B format. Five NMRAs mandated safety monitoring during interventional clinical trials. Five NMRAs required aggregate reporting through periodic safety update reports. Only two NMRAs required submission of the development safety update report. Regarding risk management, four NMRAs required notification of actions taken by foreign NMRAs and four NMRAs expected to review Dear Healthcare Professional Letters before distribution by the marketing authorization holder. CONCLUSIONS Areas for improvement of guidelines to establish common process standards and allow for synchronized submissions of comparable data to SADC NMRAs are provided.
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Affiliation(s)
- Nokuthula L Makhene
- Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Hanlie Steyn
- Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Martine Vorster
- Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Martha S Lubbe
- Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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McDermott O, Kearney B. The value of using real-world evidence as a source of clinical evidence in the European medical device regulations: a mixed methods study. Expert Rev Med Devices 2024; 21:149-163. [PMID: 38041629 DOI: 10.1080/17434440.2023.2291454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES This study investigates the benefits, limitations and awareness of using Real World Evidence and Real World Data for post-market clinical follow-up studies and clinical evaluation reports in the European Medical Device Regulations. METHODOLOGY A mixed methods study was utilized with qualitative interviews and a quantitative survey. RESULTS The findings from the study demonstrate that in the case of the Medical Device Regulations, opportunities exist for manufacturers of legacy devices to conduct Real World Evidence studies to bridge gaps in clinical evidence. The primary value of Real World Evidence lies in its ability to provide an accurate and, therefore, more reliable measure of device safety and performance. As a measure of safety and performance, it supplements clinical evidence generated from pre and post-market clinical investigations, reducing the costs associated with these studies and supporting the manufacturer's benefit: risk conclusion. CONCLUSION This study provides insight into how the medical device industry could utilize Real World Evidence and have an initiative in the EU similar to the FDA-sponsored NESTcc partnership. This would aid medical device manufacturers in transitioning to the MDR clinical evaluation requirements and mitigate the impact on medical device availability in the EU.
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Affiliation(s)
- Olivia McDermott
- College of Science & Engineering, University of Galway, Galway, Ireland
| | - Breda Kearney
- College of Science & Engineering, University of Galway, Galway, Ireland
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Porwal MH, Kumar D, Thalner S, Hedayat HS, Sinson GP. Analysis of reported adverse events of pipeline stents for intracranial aneurysms using the FDA MAUDE database. J Cerebrovasc Endovasc Neurosurg 2023; 25:275-287. [PMID: 36789489 PMCID: PMC10555618 DOI: 10.7461/jcen.2023.e2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Flow diverting stents (FDS) are a validated device in the treatment of intracranial aneurysms, allowing for minimally invasive intervention. However, after its approval for use in the United States in 2011, post-market surveillance of adverse events is limited. This study aims to address this critical knowledge gap by analyzing the FDA Manufacturer and User Facility Device Experience (MAUDE) database for patient and device related (PR and DR) reports of adverse events and malfunctions. METHODS Using post-market surveillance data from the MAUDE database, PR and DR reports from January 2012-December 2021 were extracted, compiled, and analyzed with R-Studio version 2021.09.2. PR and DR reports with insufficient information were excluded. Raw information was organized, and further author generated classifications were created for both PR and DR reports. RESULTS A total of 2203 PR and 4017 DR events were recorded. The most frequently reported PR adverse event categories were cerebrovascular (60%), death (11%), and neurological (8%). The most frequent PR adverse event reports were death (11%), thrombosis/thrombus (9%) cerebral infarction (8%), decreased therapeutic response (7%), stroke/cerebrovascular accident (6%), intracranial hemorrhage (5%), aneurysm (4%), occlusion (4%), headache (4%), neurological deficit/dysfunction (3%). The most frequent DR reports were activation/positioning/separation problems (52%), break (9%), device operates differently than expected (4%), difficult to open or close (4%), material deformation (3%), migration or expulsion of device (3%), detachment of device or device component (2%). CONCLUSIONS Post-market surveillance is important to guide patient counselling and identify adverse events and device problems that were not identified in initial trials. We present frequent reports of several types of cerebrovascular and neurological adverse events as well as the most common device shortcomings that should be explored by manufacturers and future studies. Although inherent limitations to the MAUDE database are present, our results highlight important PR and DR complications that can help optimize patient counseling and device development.
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Affiliation(s)
- Mokshal H. Porwal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Devesh Kumar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sharadhi Thalner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hirad S. Hedayat
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grant P. Sinson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Simunovic A, Kranjcec K, Pekas M, Tomic S. Quality analysis of manufacturer's incident reports regarding medical devices. J Pharm Policy Pract 2023; 16:3. [PMID: 36647170 PMCID: PMC9841638 DOI: 10.1186/s40545-023-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Medical devices provide a great number of medical treatments and have an important role in patients' healthcare; however, there are certain risks, sometimes even serious incidents, associated with their usage. To ensure that benefits of medical device usage always outweigh associated risks, it is necessary to closely monitor known risks post-market and detect new ones as early as possible. Among others, valuable instrument of post-market surveillance is manufacturer incident report. Yet to accomplish its intended use, such report must be sufficiently populated and supplied with correct information. Aim of this paper is to assess the quality of manufacturer's incident reports received in HALMED since 2012 to May 2021. METHODS The study included 578 initial reports and 566 final reports that were scored according to the evaluating system we designed and categorized as Excellent, Good, Medium, Qualified and Unqualified. For each report medical device risk class was also extracted to calculate the frequency of report occurrence per risk class and time that passed between the initial and final report. Difference in quality of the reports between manufacturers based on EU countries and countries outside the EU was determined by Mann Whitney U test. RESULTS Most of initial and final reports fall into two highest quality category level, which means that a sufficient amount of reports are of good/excellent quality and quality of reports prevails. However, the study's results indicate the need for higher scores, especially in critical fields of the form. CONCLUSIONS Data obtained from the manufacturer can be scarce and insufficient, causing negative influence on Competent Authority's investigation procedure. Another issue we recognized is extensive underreporting in Croatia, which can seriously undermine the established system.
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Affiliation(s)
- Antonela Simunovic
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Krunoslav Kranjcec
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Marija Pekas
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Siniša Tomic
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
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Setford S, Liu Z, McColl D, Phillips S, Cameron H, Grady M. Post-Market Surveillance Assessment of the Clinical Accuracy of a Blood Glucose Monitoring System with an Improved Algorithm for Enhanced Product Performance. J Diabetes Sci Technol 2023; 17:133-140. [PMID: 34463143 PMCID: PMC9846413 DOI: 10.1177/19322968211039465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND On-going manufacturer-led post-market surveillance (PMS), assessing the clinical accuracy of blood glucose monitoring (BGM) systems, is critical to substantiate the performance of such products for people with diabetes. MATERIALS AND METHODS Batches of Verio test-strip product were randomly and routinely selected over the period from launch of an improved-algorithm product to reporting date and sent to 3 clinic sites for clinician-led accuracy assessment. Accuracy is reported as per recently adopted FDA guidance for BGM systems, EN ISO 15197:2015 and MARD/MAD (Mean absolute relative difference/Mean absolute difference). RESULTS Thirty-three individual test-strip batches were evaluated corresponding to 506 unique donors. Accuracy performance - FDA: 98.9% of values within ±15% of comparator; ISO: 99.0% within ±15 mg/dL or ±15% at <100 mg/dL (<5.55 mmol/L) or ≥100 mg/dL (≥5.55 mmol/L) glucose, respectively. Overall MARD was 4.19% with a MARD range of 3.54%-5.73% across all test strip batches. CONCLUSIONS This post-market surveillance program demonstrates the new BGM system consistently meets measures of clinical accuracy specified by regulators. This program supports a growing demand by regulators for real-world evidence demonstrating consistent in-market product efficacy as opposed to the current largely passive approach that relies on assessment of reports filed by device users.
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Affiliation(s)
- Steven Setford
- LifeScan Scotland Ltd., Inverness,
UK
- Steven Setford, PhD, LifeScan Scotland Ltd,
Beechwood Park North, Inverness, Highland IV2 3ED, UK.
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7
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Phillips S, Setford S, Grady M, Liu Z, Cameron H. Post-Market Surveillance of a Blood Glucose Test Strip Demonstrates No Evidence of Interference on Clinical Accuracy in a Large Cohort of People with Type 1 or Type 2 Diabetes. J Diabetes Sci Technol 2023; 17:141-151. [PMID: 34486429 PMCID: PMC9846393 DOI: 10.1177/19322968211042352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Regulations and industry guidance relating to testing for interference in blood glucose monitoring (BGM) systems continue to focus on in vitro laboratory bench tests. Post-market surveillance (PMS) in a clinical setting allows for BGM accuracy assessments to evaluate the impact of real-world exposure to polypharmacy in people with diabetes. This study evaluated the OneTouch Select Plus® BGM test-strip accuracy with respect to polypharmacy using a clinical registry dataset. METHODS Medication profiles were analysed for 1023 subjects (425 with type 1 (T1D) and 598 with type 2 diabetes (T2D)) attending 3 UK hospitals. Blood samples were analysed to determine clinical accuracy of the BGM test-strip against a laboratory comparator. RESULTS 538 different medications (48 diabetes and 490 non-diabetes) were recorded across the 1023 subjects. Patients took on average 6.9 (n = 1-36) individual medications and 4.1 (n = 1-13) unique medication classes. Clinical accuracy to EN ISO 15197:2015 criteria were met irrespective of increasing average number of individual medications, categorized from 1-3, 4-6, 7-9, 10-12 and >12 taken per subject (97.7%, 97.7%, 97.8%, 97.8%, and 98.4%, respectively). Clinical accuracy criteria were met across 15 classes of medication using the combined dataset (97.9%; 29784/30433). Surveillance Error Grid (SEG) analysis showed 98.7% (29959/30368) of readings presented no clinical risk. No individual class or combination of medication classes impacted clinical accuracy of the BGM test-strip. CONCLUSIONS Clinical performance for the test strip under assessment demonstrated no evidence of interference from over 500 prescription medications, with clinical accuracy maintained across a range of polypharmacy conditions in people with diabetes.
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Affiliation(s)
- Stuart Phillips
- LifeScan Scotland Ltd, Inverness,
UK
- Stuart Phillips M.Sc., LifeScan Scotland
Ltd, Beechwood Park North, Inverness, IV2 3ED, UK.
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8
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Fiedorova K, Augustynek M, Kubicek J, Kudrna P, Bibbo D. Review of present method of glucose from human blood and body fluids assessment. Biosens Bioelectron 2022; 211:114348. [DOI: 10.1016/j.bios.2022.114348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/15/2022]
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9
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Badnjević A, Pokvić LG, Deumić A, Bećirović LS. Post-market surveillance of medical devices: A review. Technol Health Care 2022; 30:1315-1329. [PMID: 35964220 DOI: 10.3233/thc-220284] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments. OBJECTIVE This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS. METHODS Medline (1980-2021), EBSCO (1991-2021), and PubMed (1980-2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as European Commission, Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices. National and international legislation, standards and guidelines concerning the topic. RESULTS The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world. CONCLUSION Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results.
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Affiliation(s)
- Almir Badnjević
- Faculty of Pharmacy.,Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Lejla Gurbeta Pokvić
- Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,International Federation on Medical and Biological Engineering (IFMBE), Sarajevo, Bosnia and Herzegovina.,European Alliance for Medical and Biological Engineering and Science (EAMBES), Sarajevo, Bosnia and Herzegovina.,, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Amar Deumić
- , Sarajevo, Bosnia and Herzegovina.,Verlab, Medical Device Inspection Laboratory, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
| | - Lemana Spahić Bećirović
- Verlab, Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina.,, Sarajevo, Bosnia and Herzegovina.,Faculty of Pharmacy
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Balancing the customization and standardization: exploration and layout surrounding the regulation of the growing field of 3D-printed medical devices in China. Biodes Manuf 2022; 5:580-606. [PMID: 35194519 PMCID: PMC8853031 DOI: 10.1007/s42242-022-00187-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/17/2022] [Indexed: 12/23/2022]
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Blasimme A, Ferretti A, Vayena E. Digital Contact Tracing Against COVID-19 in Europe: Current Features and Ongoing Developments. Front Digit Health 2021; 3:660823. [PMID: 34713135 PMCID: PMC8521942 DOI: 10.3389/fdgth.2021.660823] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022] Open
Abstract
The SARS-CoV-2 pandemic is a public health challenge of unprecedented scale. In the midst of the first wave of the pandemic, governments worldwide introduced digital contact tracing systems as part of a strategy to contain the spread of the virus. In Europe, after intense discussion about privacy-related risks involving policymakers, technology experts, information technology companies, and—albeit to a limited extent—the public at large, technical protocols were created to support the development of privacy-compatible proximity tracing apps. However, as the second wave of SARS-CoV-2 sweeps the continent, digital contact tracing in Europe is evolving in terms of both technological and governance features. To enable policymakers to harness the full potential of digital health tools against SARS-CoV-2, this paper examines the evolution of digital contact tracing in eight European countries. Our study highlights that while privacy and data protection are at the core of contact tracing apps in Europe, countries differ in their technical protocols, and in their capacity to utilize collected data beyond proximity tracing alone. In particular, the most recently released apps tend to offer users more granular information about risk in specific locations, and to collect data about user whereabouts, in order to enhance retrospective contact tracing capacity. These developments signal a shift from a strict interpretation of data minimization and purpose limitation toward a more expansive approach to digital contact tracing in Europe, calling for careful scrutiny and appropriate oversight.
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Citi V, Neggiani F, Sansò M, Calderone V. Pharmacological evaluation of innovative eye drop formulations containing TS-polysaccaride, hyaluronic acid and glycyrrhizin for irritative ocular diseases using in vitro reconstituted human corneal epithelium model. Toxicol In Vitro 2021; 75:105199. [PMID: 34097953 DOI: 10.1016/j.tiv.2021.105199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
In vitro reconstructed human corneal tissue models are closer to in vivo human corneal tissue in term of morphology, biochemical and physiological properties, and represent a valid alternative to animal use for evaluating the pharmacological effects ophthalmic topically applied medical devices. In this experimental work the in vitro reconstructed human corneal tissues have been used for assessing the potential beneficial effects of an innovative ophthalmic formulation containing hyaluronic acid, glycyrrhizin and TS-polysaccharide for the treatment of symptomatic states on the eye surface including dry eye, itching, foreign body sensation and redness due allergic reaction. Corneal tissues have been treated with benzalkonium chloride for 24 h to induce cell damage and then treated with the tested items for 16 h. After the incubation period, tissue viability, TNF-α, IL-6 and MMP-9 have been assessed. Diclofenac has been used as reference anti-inflammatory drug. The novel formulation protected the tissues against benzalkonium chloride damage, while exerted a mild but not significant reduction of the anti-inflammatory mediator TNF-α.
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Affiliation(s)
- Valentina Citi
- Department of Pharmacy, University of Pisa, via Bonanno 6, 56125 Pisa, Italy.
| | | | - Marco Sansò
- Farmigea S.p.A., via G.B. Oliva 6/8, 56121 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, via Bonanno 6, 56125 Pisa, Italy
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13
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Martelli N, Eskenazy D, Narayanan K, Lafont A, Marijon E. New European Regulation for Medical Devices. Eur Heart J 2021; 42:960-961. [PMID: 33508128 DOI: 10.1093/eurheartj/ehaa924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France.,Université Paris-Saclay GRADES, 92290 Châtenay-Malabry, France
| | | | - Kumar Narayanan
- Cardiology Department, Medicover Hospitals, Hyderabad, India.,Université de Paris, PARCC, INSERM, F-75015 Paris, France
| | - Antoine Lafont
- Université de Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Assistance Publique - Hôpitaux de Paris, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Université de Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Assistance Publique - Hôpitaux de Paris, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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Pane J, Verhamme KMC, Villegas D, Gamez L, Rebollo I, Sturkenboom MCJM. Challenges Associated with the Safety Signal Detection Process for Medical Devices. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:43-57. [PMID: 33658868 PMCID: PMC7917351 DOI: 10.2147/mder.s278868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Previous safety issues involving medical devices have stressed the need for better safety signal detection. Various European Union (EU) national competent authorities have started to focus on strengthening the analysis of vigilance data. Consequently, article 90 of the new EU regulation states that the European Commission shall put in place systems and processes to actively monitor medical device safety signals. Methods A systematic literature review was conducted to synthesize the current state of knowledge and investigate the present tools used for medical device safety signal detection. An electronic literature search was performed in Embase, Medline, Cochrane, Web of science, and Google scholar from inception until January 2017. Articles that included terms related to medical devices and terms associated with safety were selected. A further selection was based on the abstract review. A full review of the remaining articles was conducted to decide on which articles finally to consider relevant for this review. Completeness was assessed based on the content of the articles. Results Our search resulted in a total of 20,819 articles, of which 24 met the inclusion criteria and were subject to data extraction and completeness scoring. A wide range of data sources, especially spontaneous reporting systems and registries, used for the detection and assessment of product problems and patient harms associated with the use of medical devices, were studied. Coding is remarkably heterogeneous, no agreement on the preferred methods for signal detection exists, and no gold standard for signal detection has been established thus far. Conclusion Data source harmonization, the development of gold standard signal detection methodologies and the standardization of coding dictionaries are amongst the recommendations to support the implementation of a new proactive approach to signal detection. The new safety surveillance system will be able to use real-world evidence to support regulatory decision-making across all jurisdictions.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands.,Alcon, Fort Worth, USA
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands
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Giubilato E, Cazzagon V, Amorim MJB, Blosi M, Bouillard J, Bouwmeester H, Costa AL, Fadeel B, Fernandes TF, Fito C, Hauser M, Marcomini A, Nowack B, Pizzol L, Powell L, Prina-Mello A, Sarimveis H, Scott-Fordsmand JJ, Semenzin E, Stahlmecke B, Stone V, Vignes A, Wilkins T, Zabeo A, Tran L, Hristozov D. Risk Management Framework for Nano-Biomaterials Used in Medical Devices and Advanced Therapy Medicinal Products. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E4532. [PMID: 33066064 PMCID: PMC7601697 DOI: 10.3390/ma13204532] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/25/2022]
Abstract
The convergence of nanotechnology and biotechnology has led to substantial advancements in nano-biomaterials (NBMs) used in medical devices (MD) and advanced therapy medicinal products (ATMP). However, there are concerns that applications of NBMs for medical diagnostics, therapeutics and regenerative medicine could also pose health and/or environmental risks since the current understanding of their safety is incomplete. A scientific strategy is therefore needed to assess all risks emerging along the life cycles of these products. To address this need, an overarching risk management framework (RMF) for NBMs used in MD and ATMP is presented in this paper, as a result of a collaborative effort of a team of experts within the EU Project BIORIMA and with relevant inputs from external stakeholders. The framework, in line with current regulatory requirements, is designed according to state-of-the-art approaches to risk assessment and management of both nanomaterials and biomaterials. The collection/generation of data for NBMs safety assessment is based on innovative integrated approaches to testing and assessment (IATA). The framework can support stakeholders (e.g., manufacturers, regulators, consultants) in systematically assessing not only patient safety but also occupational (including healthcare workers) and environmental risks along the life cycle of MD and ATMP. The outputs of the framework enable the user to identify suitable safe(r)-by-design alternatives and/or risk management measures and to compare the risks of NBMs to their (clinical) benefits, based on efficacy, quality and cost criteria, in order to inform robust risk management decision-making.
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Affiliation(s)
- Elisa Giubilato
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Virginia Cazzagon
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Mónica J. B. Amorim
- Department of Biology and CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Magda Blosi
- Institute of Science and Technology for Ceramics, National Research Council of Italy (CNR-ISTEC), Via Granarolo 64, 48018 Faenza, Italy; (M.B.); (A.L.C.)
| | - Jacques Bouillard
- Institut National de l’Environnement industriel et des Risques, Parc Technologique ALATA, 60550 Verneuil-en-Halatte, France; (J.B.); (A.V.)
| | - Hans Bouwmeester
- Division of Toxicology, Wageningen University, 6708 WE Wageningen, The Netherlands;
| | - Anna Luisa Costa
- Institute of Science and Technology for Ceramics, National Research Council of Italy (CNR-ISTEC), Via Granarolo 64, 48018 Faenza, Italy; (M.B.); (A.L.C.)
| | - Bengt Fadeel
- Division of Molecular Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Teresa F. Fernandes
- Institute of Life and Earth Sciences, School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh EH14 4AS, UK;
| | - Carlos Fito
- Instituto Tecnologico del Embalaje, Transporte y Logistica, 46980 Paterna-Valencia, Spain;
| | - Marina Hauser
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (M.H.); (B.N.)
| | - Antonio Marcomini
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | - Bernd Nowack
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland; (M.H.); (B.N.)
| | - Lisa Pizzol
- GreenDecision Srl, Via delle Industrie, 21/8, 30175 Venice, Italy; (L.P.); (A.Z.)
| | - Leagh Powell
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK; (L.P.); (V.S.)
| | - Adriele Prina-Mello
- Trinity Translational Medicine Institute, Trinity College, The University of Dublin, Dublin 8, Ireland;
| | - Haralambos Sarimveis
- School of Chemical Engineering, National Technical University of Athens, 15780 Athens, Greece;
| | | | - Elena Semenzin
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
| | | | - Vicki Stone
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK; (L.P.); (V.S.)
| | - Alexis Vignes
- Institut National de l’Environnement industriel et des Risques, Parc Technologique ALATA, 60550 Verneuil-en-Halatte, France; (J.B.); (A.V.)
| | - Terry Wilkins
- Nanomanufacturing Institute, School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK;
| | - Alex Zabeo
- GreenDecision Srl, Via delle Industrie, 21/8, 30175 Venice, Italy; (L.P.); (A.Z.)
| | - Lang Tran
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK;
| | - Danail Hristozov
- Department of Environmental Sciences, Informatics and Statistics, University Ca’ Foscari of Venice, Via Torino 155, 30172 Venice, Italy; (E.G.); (V.C.); (A.M.); (E.S.)
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Pane J, Verhamme KMC, Shrum L, Rebollo I, Sturkenboom MCJM. Blockchain technology applications to postmarket surveillance of medical devices. Expert Rev Med Devices 2020; 17:1123-1132. [PMID: 32954855 DOI: 10.1080/17434440.2020.1825073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The amount of mandatory data that needs to be analyzed as part of a medical device postmarket surveillance (PMS) system has grown exponentially in recent times. This is a consequence of increasingly demanding and complex regulatory requirements from Health Authorities, aimed at a better understanding of the medical device safety evaluation. Proactive approaches to PMS processes are becoming more necessary as regulators increase the scrutiny of device safety. New technologies have been explored to address some of the challenges associated with this changing regulatory environment. AREAS COVERED This paper focuses on the different technical aspects of blockchain and how this new technology has the potential to support the ongoing efforts to improve the PMS system for medical devices. EXPERT OPINION To address these challenges, we suggest to generate a private PMS data permissioned blockchain with a proof-of-authority consensus mechanism, to which only a restricted number of designated and audited participants have authorization to validate transactions and add them to the PMS data blockchain ledger. Blockchain has the potential to support a more efficient approach, which could offer many advantages to the different stakeholders involved in the PMS process, such as supporting with new regulatory initiatives.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | | | - Irene Rebollo
- Department of CMO & Patient Safety, Novartis , Barcelona, Spain
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do Nascimento JLG, Costa-Felix RPB. Post-market evaluation of medical electrical equipment. RESEARCH ON BIOMEDICAL ENGINEERING 2020. [PMCID: PMC7529352 DOI: 10.1007/s42600-020-00101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose Methods Results Conclusion
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Braillon A, Bewley S. Medical device postmarket clinical follow-up in Europe: Getting priorities right. Pharmacoepidemiol Drug Saf 2019; 29:226-227. [PMID: 31802557 DOI: 10.1002/pds.4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 11/07/2022]
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Pane J, Francisca RDC, Verhamme KMC, Orozco M, Viroux H, Rebollo I, Sturkenboom MCJM. EU postmarket surveillance plans for medical devices. Pharmacoepidemiol Drug Saf 2019; 28:1155-1165. [PMID: 31318470 PMCID: PMC6771951 DOI: 10.1002/pds.4859] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/02/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Abstract
Purpose Recent public health safety issues involving medical devices have led to a growing demand to improve the current passive‐reactive postmarket surveillance (PMS) system. Various European Union (EU) national competent authorities have started to focus on strengthening the postmarket risk evaluation. As a consequence, the new EU medical device regulation was published; it includes the concept of a PMS Plan. Methods This publication reviewed Annex III Technical Documentation on PMS and Annex XIV Part B: Postmarket clinical follow‐up from the new Regulation (EU) 2017/745 of the European Parliament and of the Council on medical devices. Results The results of the PMS activities will be described in the PMS plan and will be used to update other related documents. A modular approach to structure the contents of the PMS plan will help to consistently update other PMS information. It is our suggestion that the PMS plan should consist of a PMS plan Core and a PMS plan Supplement. The PMS plan Core document will describe the PMS system, and the PMS plan Supplement will outline the specific activities performed by the manufacturer for a particular medical device. Conclusions The PMS plan may serve as a thorough tool for the benefit‐risk evaluation of medical devices. If properly developed and implemented, it will function as a key player in the establishment of a new framework for proactive safety evaluation of medical devices.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Patient Safety, Alcon, Fort Worth, Texas.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Reynold D C Francisca
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center - University Medical Center Rotterdam, Rotterdam, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Marcia Orozco
- Department of Patient Safety, Alcon, Fort Worth, Texas
| | - Hilde Viroux
- Department of Regulatory Affairs, HCL Technologies, Frisco, Texas
| | - Irene Rebollo
- Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France.,Department of Patient Safety, Novartis, Barcelona, Spain
| | - Miriam C J M Sturkenboom
- Department of Global Health, University Medical Center Utrecht, Utrecht, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
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