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Mowitz M, Hosseini S, Siemund I, Ulriksdotter J, Svedman C. New device, 'old' allergens. Allergic contact dermatitis caused by the Dexcom G7 glucose sensor. Contact Dermatitis 2024; 90:495-500. [PMID: 38316128 DOI: 10.1111/cod.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) has been reported as an adverse effect from the use of several glucose sensors and insulin pumps from different manufacturers. Isobornyl acrylate (IBOA) has been identified as a major culprit sensitizer, but also other acrylates and (modified) colophonium have been reported as causes of ACD. OBJECTIVES To report the two first cases diagnosed with ACD caused by the Dexcom G7 (DG7) glucose sensor. PATIENTS AND METHODS Two children with suspected ACD from DG7 were patch tested with our medical device series with an addition of selected test preparations including two variants of modified colophonium - methyl hydrogenated rosinate (MHR) and glyceryl hydrogenated rosinate (GHR). Both patients were also tested with acetone extracts made from different parts of the DG7 sensor. The extracts were analysed by gas chromatography-mass spectrometry (GC-MS). RESULTS Both patients tested positive to IBOA, hydroabietyl alcohol and GHR. In addition, patient 1 had a positive reaction to MHR and patient 2 had a positive reaction to colophonium. The GC-MS analyses showed the presence of IBOA and colophonium-related substances in the DG7 extracts. CONCLUSIONS Both patients were diagnosed with contact allergy to well-known medical device-related sensitizers. The presence of IBOA and (modified) colophonium in a newly introduced (on the Swedish market in 2023) glucose sensor is remarkable and indicates an inadequate toxicological assessment of the materials used in the sensor.
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Affiliation(s)
- Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sarah Hosseini
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Dermatology and Venereology, Ryhov County Hospital, Jönköping, Sweden
| | - Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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2
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Pyun AJ, Goodney PP, Eldrup-Jorgensen J, Wadzinski J, Secemsky EA, Cigarroa JE. Device regulation and surveillance in vascular care: Challenges and opportunities. Catheter Cardiovasc Interv 2024. [PMID: 38639136 DOI: 10.1002/ccd.31053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Cardiovascular devices are essential for the treatment of cardiovascular diseases including cerebrovascular, coronary, valvular, congenital, peripheral vascular and arrhythmic diseases. The regulation and surveillance of vascular devices in real-world practice, however, presents challenges during each individual product's life cycle. Four examples illustrate recent challenges and questions regarding safety, appropriate use and efficacy arising from FDA approved devices used in real-world practice. We outline potential pathways wherein providers, regulators and payors could potentially provide high-quality cardiovascular care, identify safety signals, ensure equitable device access, and study potential issues with devices in real-world practice.
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Affiliation(s)
- Alyssa J Pyun
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, California, USA
| | - Philip P Goodney
- Heart and Vascular Center, Dartmouth Health, Lebanon, New Hampshire, USA
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - Jens Eldrup-Jorgensen
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - James Wadzinski
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - Eric A Secemsky
- Division of Vascular Interventions, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joaquin E Cigarroa
- Division of Cardiovascular Medicine, Department of Medicine, Oregon Health Sciences University (OHSU), Portland, Oregon, USA
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3
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Micheels P, Porcello A, Bezzola T, Perrenoud D, Christen MO, Applegate LA, Laurent A. Comprehensive Evaluation of Injectability Attributes in OxiFree™ Dermal Fillers: MaiLi ® Product Variants and Clinical Case Reports. Gels 2024; 10:276. [PMID: 38667695 PMCID: PMC11049332 DOI: 10.3390/gels10040276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Dermal filler injectability is a critical factor for commercial product adoption by medical aesthetic professionals and for successful clinical administration. We have previously reported (in vitro and ex vivo) cross-linked hyaluronic acid (HA)-based dermal filler benchmarking in terms of manual and automated injectability requirements. To further enhance the function-oriented product characterization workflows and the clinical relevance of dermal filler injectability assessments, the aim of this study was to perform in vivo evaluations. Therefore, several variants of the MaiLi® product range (OxiFree™ technology) were characterized in vitro and in vivo in terms of injectability attributes, with a focus on hydrogel system homogeneity and ease of injection. Firstly, standardized in vitro assays were performed in SimSkin® cutaneous equivalents, with variations of the clinical injector, injection site, and injection technique. Then, automated injections in SimSkin® cutaneous equivalents were comparatively performed in a texture analysis setup to obtain fine-granulometry injection force profile results. Finally, five female participants were recruited for the in vivo arm of the study (case reports), with variations of the clinical injector, injection site, and injection technique. Generally, the obtained quantitative force values and injection force profiles were critically appraised from a translational viewpoint, based on discussions around the OxiFree™ manufacturing technology and on in-use specialized clinician feedback. Overall, the present study outlined a notable level of homogeneity across the MaiLi® product range in terms of injectability attributes, as well as consistently high ease of administration by medical aesthetic clinicians.
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Affiliation(s)
| | - Alexandre Porcello
- Development Department, Abcello Sàrl, CH-1432 Belmont-sur-Yverdon, Switzerland;
| | | | | | | | - Lee Ann Applegate
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland;
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Alexis Laurent
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland;
- Manufacturing Department, TEC-PHARMA SA, CH-1038 Bercher, Switzerland
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
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4
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Cao X, Li Q, Li S, Xu X, Wang L, Wang M, Ding B, Bao S, Wang S, Sun B, Cui J, Wang G, Li H, Su Y. Low-Cost Photoelectric Flow Rate Sensors Based on a Flexible Planar Curved Beam Structure for Clinical Treatments. Adv Healthc Mater 2024:e2304573. [PMID: 38558375 DOI: 10.1002/adhm.202304573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/17/2024] [Indexed: 04/04/2024]
Abstract
In clinical treatments, reliable flow rate measurements ensure accurate drug delivery during infusions, precise gas delivery during artificial ventilations, etc., thereby reducing patient morbidity and mortality. However, precise flow rate sensors are costly, so medical devices with limited budgets choose cheaper but unsatisfactory flow rate measurement approaches, leading to increased medical risks. In this paper, we propose a photoelectric flow rate sensor based on a flexible planar curved beam structure (FPCBS). The FPCBS ensures low out-of-plane stiffness of the sensitive sheet and allows large deformation in the elastic range, enabling the flow rate sensor to measure the flow rate with high sensitivity over a wide range. Meanwhile, the flow rate sensor can be mass-produced using mature materials and manufacturing technology at less than $5 each. The flow rate sensors are integrated into a commercial infusion pump to measure drug infusion and a home ventilator to monitor respiration. The results are comparable to those measured by a commercial flow rate sensor, demonstrating the applicability of the sensor. Considering its proven outstanding performance at low cost, the flow rate sensor shows great potential in clinical treatment, medical diagnosis and other medical fields. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xinfang Cao
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Qinlan Li
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Shuang Li
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xinkai Xu
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Liyang Wang
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Mengjie Wang
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Bo Ding
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Shengwen Bao
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Shugang Wang
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Bao Sun
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Jingqiang Cui
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Guosheng Wang
- Henan Key Laboratory of Medical Polymer Materials Technology and Application, Tuoren Medical Device Research & Development Institute Co., Ltd., Tuoren Health Technology Industrial Park, Changyuan County, Henan, 453000, China
| | - Huiling Li
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yewang Su
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
- Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China
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George H, Dendooven E, Aerts O. Old but not forgotten: Vesicular hand dermatitis from a copper-containing intrauterine device. Contact Dermatitis 2024; 90:431-433. [PMID: 38154452 DOI: 10.1111/cod.14496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Hannelore George
- Department of Dermatology, University Hospital Antwerp (UZA), Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - Ella Dendooven
- Department of Dermatology, University Hospital Antwerp (UZA), Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA), Research Group Immunology, University of Antwerp, Antwerp, Belgium
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Xu Y, Cheng M, Zhao P. [Thoughts on the Biological Evaluation of Biodegradable Cardiovascular Implants]. Zhongguo Yi Liao Qi Xie Za Zhi 2024; 48:208-211. [PMID: 38605623 DOI: 10.12455/j.issn.1671-7104.230341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In recent years, new degradable materials have been applied to cardiovascular implants. Cardiovascular implants with different physicochemical properties and degradation properties have special endpoints for their biological evaluation. In this study, the end points of biological evaluation of degradable cardiovascular implants were reviewed by taking vascular stents and occluders as examples.
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Affiliation(s)
- Yun Xu
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | - Maobo Cheng
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | - Peng Zhao
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
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Dincer MM, Yentur S, Colakerol A, Cil G, Yazar RO, Kandirali E, Semercioz A, Muslumanoglu AY, Temiz MZ. Introducing a New Smartphone Applied Semen Analyzer, SpermCell™: A Cross-Sectional Validation Study with a Comparative Analysis and a Mini Patient Questionnaire on a Large Sample Cohort. Diagnostics (Basel) 2024; 14:689. [PMID: 38611602 PMCID: PMC11011288 DOI: 10.3390/diagnostics14070689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Standard semen analysis methods may exhibit variability between observers and/or human error; therefore, additional methods are needed to overcome these handicaps. We aimed to present a new smartphone-applied semen analyzer, Sperm Cell™, investigate its diagnostic efficacy by comparing it with the standard analysis method, and determine its user-friendly nature. (2) Methods: A cross-sectional study was conducted on a large sample cohort, including 102 men. Three semen analyses were performed for each semen sample. The first employed the standard manual method, whereas the others were smartphone-based analyses performed by technicians and patients. We compared major semen parameters between the three semen analyses. The user-friendly nature of the analyzer was also evaluated with a mini-questionnaire completed by the participants. (3) Results: The determined median sperm count, motile sperm count, and percentage of motile sperms, on standard manual semen analysis, were 50.00 × 106/mL (0-160 × 106/mL), 23.94 × 106/mL (0-108 × 106/mL) and 50.00% (0-73.00%), respectively. Median sperm count and motile sperm count were 50.52 × 106/mL (<1-150 × 106/mL) vs. 55.77 × 106/mL (<1-160 × 106/mL) and 23.34 × 106/mL (0-105 × 106/mL) vs. 23.53 × 106/mL (0-104 × 106/mL) for SpermCell™-based semen analysis performed by a technician and patients themselves, respectively. The percentages of motile sperms were 47.40% (0-67.00%) vs. 47.61% (0-80.20%), respectively. All the parameters were statistically similar between the three semen analysis methods (p > 0.05 for each). The SpermCell™ analysis results were correlated with the standard manual method with up to 0.85 correlation coefficients. Moreover, substantial diagnostic accuracy, sensitivity and specificity were obtained in determining the oligospermia and asthenozoospermia via the device-based analyses performed by technician and patients. The mini-questionnaire results revealed that the analyzer is useful. (4) Conclusions: The novel smartphone-applied semen analyzer is a helpful tool with acceptable diagnostic accuracy in determining the major semen parameters. It can be used as an efficient at-home point-of-care testing method in the initial assessment of couples with infertility concerns.
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Affiliation(s)
- Muhammet Murat Dincer
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul 34200, Turkey (A.C.); (R.O.Y.); (A.Y.M.); (M.Z.T.)
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8
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Jenvert RM, Larne O, Johansson A, Berglin M, Pedersen E, Johansson H. Evaluation of the applicability of GARDskin to predict skin sensitizers in extracts from medical device materials. Front Toxicol 2024; 6:1320367. [PMID: 38533186 PMCID: PMC10964320 DOI: 10.3389/ftox.2024.1320367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Biocompatibility testing of medical devices is governed by the ISO 10993 series of standards and includes evaluation of skin sensitization potential of the final product. A majority of all medical devices are tested using in vivo methods, largely due to the lack of in vitro methods validated within the applicability domain of solid materials. The GARDskin method for assessment of chemical skin sensitizers is a validated method included in the OECD Test Guideline 442E, based on evaluation of transcriptional patterns of an endpoint-specific genomic biomarker signature in a dendritic cell-like cell, following test chemical exposure. The current study aimed to evaluate the applicability of GARDskin for the purpose of testing solid materials by incorporation of extraction procedures described in ISO 10993-12:2021, as well as to demonstrate the functionality of the proposed protocols, by testing of custom-made materials spiked with sensitizing agents. It was shown that GARDskin is compatible with both polar and non-polar extraction vehicles frequently used for the purpose of medical device biological testing. Further, exploring three different material types spiked with up to four different sensitizing agents, as well as three unspiked control materials and commercial reference products, it was shown that the method correctly classified all evaluated test materials. Taken together, the data presented suggest that GARDskin may constitute a valid alternative to in vivo experimentation for the purpose of skin sensitization assessment of medical devices.
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Affiliation(s)
| | | | | | | | - Emma Pedersen
- RISE Research Institutes of Sweden AB, Borås, Sweden
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Iliescu DG, Petrita R, Teodorescu C, Olaru RA, Alexa AA, Petre I. Real‑world performance and safety of vaginal ovules in reducing the vaginal symptoms associated with vulvovaginal atrophy and postmenopausal sexual dysfunction. Biomed Rep 2024; 20:35. [PMID: 38312435 PMCID: PMC10831781 DOI: 10.3892/br.2024.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
Decreasing estrogen levels during the postmenopausal period results in tissue atrophy and physiological changes, such as thinning of the vaginal epithelium, prolapse and decreased pelvic floor strength and control. Sexual dysfunction associated with vaginal dryness occurs in postmenopausal patients. The present study (trial no. NCT05654610) was designed as an observational, multicenter, real-world clinical investigation to evaluate the performance and safety of the medical device Halova® ovules in decreasing vaginal symptoms associated with vulvovaginal atrophy and sexual dysfunction. A total of 249 female participants were treated with Halova ovules, both in monotherapy and in combination with vaginal lubricants. The primary objective was to evaluate the tolerability of Halova ovules in the management of symptoms associated with perimenopause or genitourinary syndrome of menopause. The evolution of clinical manifestations such as vaginal dryness, dysuria, dyspareunia and endometrial thickness was defined a secondary objective. Halova ovules were rated with 'excellent' clinical performance by 92.74% of participants as a standalone treatment and 95.71% of the study participants when used in association with vaginal lubricants. Sexual dysfunction-associated parameters, such as vaginal dryness and dyspareunia, were reduced by similar percentages in each arm, 82% (monotherapy) and 80% (polytherapy) for vaginal dryness and 72% in monotherapy vs. 48% polytherapy reducing dyspareunia. No adverse reactions associated with treatment with Halova were reported. The medical device demonstrated anti-atrophic activity in the genitourinary tract, resulting in significantly improved symptoms associated with normal sexual functioning.
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Affiliation(s)
- Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Ramona Petrita
- Biometrics Unit, MDX Research, 300633 Timisoara, Romania
| | - Cristina Teodorescu
- Department of Obstetrics and Gynecology, ‘Nicolae Malaxa’ Clinical Hospital, 022441 Bucharest, Romania
| | - Raluca Alexandra Olaru
- Department of Obstetrics and Gynecology III, National Institute Alessandrescu Rusescu, Clinic of Obstetrics and Gynecology ‘Polizu’, 011061 Bucharest, Romania
| | - Andreea Anda Alexa
- Department of Biochemistry IV, University of Medicine and Pharmacy Victor Babes, 300041 Timisoara, Romania
| | - Izabella Petre
- Department of Obstetrics and Gynecology XII, University of Medicine and Pharmacy Victor Babes, 300041 Timisoara, Romania
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Alhammad A, Yusof MM, Jambari DI. Towards an evaluation framework for medical device-integrated electronic medical record. Expert Rev Med Devices 2024; 21:217-229. [PMID: 38318674 DOI: 10.1080/17434440.2024.2315024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control mechanisms. We reviewed the related literature, including existing EMR and MD risk assessment approaches, to identify MDI-EMR comprehensive evaluation dimensions and measures. AREAS COVERED We searched multiple databases, including PubMed, Web of Knowledge, Scopus, ACM, Embase, IEEE and Ingenta. We explored various evaluation aspects of MD and EMR to gain a better understanding of their complex integration. We reviewed numerous risk management and assessment frameworks related to MD and EMR security aspects and mitigation controls and then identified their common evaluation aspects. Our review indicated that previous evaluation frameworks assessed MD and EMR independently. To address this gap, we proposed an evaluation framework based on the sociotechnical dimensions of health information systems and risk assessment approaches for MDs to evaluate MDI-EMR integratively. EXPERT OPINION The emergence of MDI-EMR cyber threats requires appropriate evaluation tools to ensure the safe development and application of MDI-EMR. Consequently, our proposed framework will continue to evolve through subsequent validations and refinements. This process aims to establish its applicability in informing stakeholders of the safety level and assessing its effectiveness in mitigating risks for future improvements.
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Affiliation(s)
- Aeshah Alhammad
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Maryati Mohd Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Dian Indrayani Jambari
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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11
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Blaszkiewicz M, Tao T, Mensah-Arhin K, Willows JW, Bates R, Huang W, Cao L, Smith RL, Townsend KL. Gene therapy approaches for obesity-induced adipose neuropathy: Device-targeted AAV-mediated neurotrophic factor delivery to adipocytes in subcutaneous adipose. Mol Ther 2024:S1525-0016(24)00104-7. [PMID: 38429927 DOI: 10.1016/j.ymthe.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/15/2023] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
Maintaining functional adipose innervation is critical for metabolic health. We found that subcutaneous white adipose tissue (scWAT) undergoes peripheral neuropathy (PN) with obesity, diabetes, and aging (reduced small-fiber innervation and nerve/synaptic/growth-cone/vesicle markers, altered nerve activity). Unlike with nerve injuries, peripheral nerves do not regenerate with PN, and therefore new therapies are needed for treatment of this condition affecting 20-30 million Americans. Here, we validated a gene therapy approach using an adipocyte-tropic adeno-associated virus (AAV; serotype Rec2) to deliver neurotrophic factors (brain-derived neurotrophic factor [BDNF] and nerve growth factor [NGF]) directly to scWAT to improve tissue-specific PN as a proof-of-concept approach. AAVRec2-BDNF intra-adipose delivery improved tissue innervation in obese/diabetic mice with PN, but after longer periods of dietary obesity there was reduced efficacy, revealing a key time window for therapies. AAVRec2-NGF also increased scWAT innervation in obese mice and was more effective than BDNF, likely because Rec2 targeted adipocytes, the tissue's endogenous NGF source. AAVRec2-NGF also worked well even after 25 weeks of dietary obesity, unlike BDNF, which likely needs a vector that targets its physiological cellular source (stromal vascular fraction cells). Given the differing effects of AAVs carrying NGF versus BDNF, a combined therapy may be ideal for PN.
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Affiliation(s)
| | - Tianyi Tao
- Department of Neurological Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Kofi Mensah-Arhin
- Department of Neurological Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Jake W Willows
- Department of Neurological Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Rhiannon Bates
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Wei Huang
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Lei Cao
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Rosemary L Smith
- College of Engineering, University of Maine, Orono, ME 04469, USA
| | - Kristy L Townsend
- Department of Neurological Surgery, The Ohio State University, Columbus, OH 43210, USA; College of Engineering, University of Maine, Orono, ME 04469, USA.
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12
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Hotton EJ, Bale N, Rose C, White P, Wade J, Mottet N, Loose AJ, Elhodaiby M, Lenguerrand E, Draycott TJ, Crofts JF. The OdonAssist inflatable device for assisted vaginal birth-the ASSIST II study (United Kingdom). Am J Obstet Gynecol 2024; 230:S932-S946.e3. [PMID: 38462264 DOI: 10.1016/j.ajog.2023.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Decreasing rates of assisted vaginal birth have been paralleled with increasing rates of cesarean deliveries over the last 40 years. The OdonAssist is a novel device for assisted vaginal birth. Iterative changes to clinical parameters, device design, and technique have been made to improve device efficacy and usability. OBJECTIVE This study aimed to determine if the feasibility, safety, and efficacy of the OdonAssist device were sufficient to justify conducting a future randomized controlled trial. STUDY DESIGN An open-label nonrandomized study of 104 participants having a clinically indicated assisted vaginal birth using the OdonAssist was undertaken at Southmead Hospital, Bristol, United Kingdom. Data were also collected from participants who consented to participate in the study but for whom trained OdonAssist operators were not available, providing a nested cohort. The primary clinical outcome was the proportion of births successfully expedited with the OdonAssist. Secondary outcomes included clinical, patient-reported, operator-reported, device and health care utilization. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Given that the number of successful OdonAssist births was ≥61 out of 104, the hypothesis of a poor rate of 50% was rejected in favor of a good rate of ≥65%. RESULTS Between August 2019 and June 2021, 941 (64%) of the 1471 approached, eligible participants consented to participate. Of these, 104 received the OdonAssist intervention. Birth was assisted in all cephalic vertex fetal positions, at all stations ≥1 cm below the ischial spines (with or without regional analgesia). The OdonAssist was effective in 69 of the 104 (66%) cases, consistent with the hypothesis of a good efficacy rate. There were no serious device-related maternal or neonatal adverse reactions, and there were no serious adverse device effects. Only 4% of neonatal soft tissue bruising in the successful OdonAssist group was considered device-related, as opposed to 20% and 23% in the unsuccessful OdonAssist group and the nested cohort, respectively. Participants reported high birth perception scores. All practitioners found the device use to be straightforward. CONCLUSION Recruitment to an interventional study of a new device for assisted vaginal birth is feasible; 64% of eligible participants were willing to participate. The success rate of the OdonAssist was comparable to that of the Kiwi OmniCup when introduced in the same unit in 2002, meeting the threshold for a randomized controlled trial to compare the OdonAssist with current standard practice. There were no disadvantages of study participation in terms of maternal and neonatal outcomes. There were potential advantages of using the OdonAssist, particularly reduced neonatal soft tissue injury. The same application technique is used for all fetal positions, with all operators deeming the device straightforward to use. This study provides important data to inform future study design.
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Affiliation(s)
- Emily J Hotton
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, United Kingdom.
| | - Nichola Bale
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Claire Rose
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paul White
- Mathematics and Statistics Research Group, University of the West of England, Bristol, United Kingdom
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Nicolas Mottet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France
| | - Abi J Loose
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mohamed Elhodaiby
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Tim J Draycott
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Joanna F Crofts
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Jensen S, Peverini DR, Amasyali AS, Okhunov Z, Chen R, Hartman JC, Joo EH, Baas C, Ritchie C, Baldwin EA, Farkouh A, Baldwin DD. Not All Flat-Panel C-Arms Are Created Equal: A Comparison of Three Major Manufacturers. J Endourol 2024; 38:228-233. [PMID: 38185836 DOI: 10.1089/end.2023.0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Introduction: Flat-panel detector C-arms (FCs) are reported to reduce radiation exposure and improve image quality compared with conventional image intensifier C-arms (CCs). The purpose of this study was to compare radiation exposure and image quality between three commonly used FCs. Materials and Methods: A cadaver model was placed in the prone position to simulate percutaneous nephrolithotomy. We compared the following three FCs: OEC Elite CFD from GE HealthCare, Zenition 70 from Philips, and Ziehm Vision RFD from Ziehm Imaging. To measure the radiation dose, optically stimulated luminescence dosimeters (OSLDs) were utilized during five 300-second trials, conducted under three settings: automatic exposure control (AEC), AEC with low dose (LD), and LD with the lowest pulse rate (LDLP). Ten blinded urologists evaluated the image quality. Data were statistically analyzed using the analysis of variance (ANOVA) and Tukey's B post hoc tests. Results: In the AEC setting, the Philips C-arm demonstrated lower ventral OSLD exposure (42,446 mrad) compared with both the GE (51,076 mrad) and Ziehm (83,178 mrad; p < 0.001) C-arms. Similarly, in the LD setting, the Philips C-arm resulted in less ventral OSLD exposure (25,926 mrad) than both the Ziehm (30,956 mrad) and GE (38,209 mrad; p < 0.001) C-arms. Meanwhile, in the LDLP setting, the Ziehm C-arm showed less ventral OSLD exposure (4019 mrad) than both the GE (7418 mrad) and Philips (8229 mrad; p < 0.001) C-arms. All three manufacturers received adequate image quality ratings at the AEC and LD settings. However, at LDLP, the Ziehm C-arm received inadequate ratings in 8% of images, whereas both the GE and Philips C-arms received 100% adequate ratings (p = 0.016). Conclusions: Radiation produced by flat-panel C-arms varies dramatically, with the highest exposure (Ziehm) being almost double the lowest (Philips) in AEC. Improved picture quality at the lowest settings may come at the cost of increased radiation dose. Surgeons should carefully select the machine and settings to minimize radiation exposure while still preserving the image quality.
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Affiliation(s)
- Stephanie Jensen
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Daniel R Peverini
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Ricky Chen
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - John C Hartman
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Eun Hye Joo
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Catalina Baas
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Cayde Ritchie
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California, USA
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14
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Mottet N, Hotton E, Eckman-Lacroix A, Bourtembourg A, Metz JP, Cot S, Poitrey E, Delhomme L, Languerrand E, Nallet C, Lallemant M, Draycott T, Riethmuller D. Safety and efficacy of the OdonAssist inflatable device for assisted vaginal birth: the BESANCON ASSIST study. Am J Obstet Gynecol 2024; 230:S947-S958. [PMID: 38462265 DOI: 10.1016/j.ajog.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND The first feasibility study of the OdonAssist inflatable device for use in clinically indicated assisted vaginal birth reported a success rate of 48% with no significant safety concerns. Additional studies exploring the device performance in other clinical settings are warranted before definitive conclusions can be drawn about its safety and efficacy in current practice. OBJECTIVE This study aimed to investigate the safety and efficacy of the OdonAssist before conducting a randomized controlled trial. STUDY DESIGN This was an open-label, nonrandomized study of 104 women with a clinically indicated assisted vaginal birth using the OdonAssist at the Besancon University Hospital, France. Data, including those of a nested cohort group of women who had an assisted vaginal birth using vacuum or spatulas because a trained OdonAssist device operator was not available at the time of delivery, were collected. The primary outcome measure was the proportion of successful assisted vaginal births using the OdonAssist. Neonatal outcome data were reviewed at days 1 and 28, and maternal outcomes were investigated up to day 90. RESULTS Between December 2019 and May 2021, 2191 pregnant women were approached, and 83% (1636/1973) of them consented to participate in the study. Among them, 10.7% (176/1636) required an assisted vaginal birth owing to a vertex presentation at +1 and below. The OdonAssist was used in 59% of births (104/176), and 41.1% (72/176) of the participants were included in the nested cohort group. The rate of successful assisted vaginal births using the OdonAssist was 88.5% (92/104). No emergency cesarean deliveries were performed in the OdonAssist group. There were no serious adverse maternal or neonatal reactions related to the use of the device. The rate of third- and fourth-degree perineal tears with the OdonAssist was 3.8% (4/104). The maternal perception ratings of the birth experience with the OdonAssist (collected on days 1, 7, and 28 using a 15-point scale) were high. In addition, the operators reported a positive perception of the device, with ease of use across the different steps of the procedure. One single technique was used for all vertex fetal head positions. CONCLUSION The OdonAssist is a safe and effective alternative to other current devices for assisted vaginal births. The high acceptance rate (83%) among pregnant women and the high rate of successful assisted vaginal births using the OdonAssist confirm the feasibility of a future randomized controlled trial.
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Affiliation(s)
- Nicolas Mottet
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comte, Besancon, France.
| | - Emily Hotton
- Women and Children's Research Centre, Southmead Hospital, Bristol, United Kingdom; Translational Health Science, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Aude Bourtembourg
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Jean Patrick Metz
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Sophie Cot
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France; Department of Midwifery Science, University of Franche-Comte, Besancon, France
| | - Emilie Poitrey
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France; Department of Midwifery Science, University of Franche-Comte, Besancon, France
| | - Léa Delhomme
- Pediatric Intensive Care, Neonatology and Pediatric Emergencies Departments, CHU Besancon, Besancon, France, Translational Health Science, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Eric Languerrand
- Translational Health Science, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Camille Nallet
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Tim Draycott
- Translational Health Science, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital of Besancon, Grenoble, France
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15
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Ingvar Å, Oloruntoba A, Sashindranath M, Miller R, Soyer HP, Guitera P, Caccetta T, Shumack S, Abbott L, Arnold C, Lawn C, Button-Sloan A, Janda M, Mar V. Minimum labelling requirements for dermatology artificial intelligence-based Software as Medical Device (SaMD): A consensus statement. Australas J Dermatol 2024. [PMID: 38419186 DOI: 10.1111/ajd.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND/OBJECTIVES Artificial intelligence (AI) holds remarkable potential to improve care delivery in dermatology. End users (health professionals and general public) of AI-based Software as Medical Devices (SaMD) require relevant labelling information to ensure that these devices can be used appropriately. Currently, there are no clear minimum labelling requirements for dermatology AI-based SaMDs. METHODS Common labelling recommendations for AI-based SaMD identified in a recent literature review were evaluated by an Australian expert panel in digital health and dermatology via a modified Delphi consensus process. A nine-point Likert scale was used to indicate importance of 10 items, and voting was conducted to determine the specific characteristics to include for some items. Consensus was achieved when more than 75% of the experts agreed that inclusion of information was necessary. RESULTS There was robust consensus supporting inclusion of all proposed items as minimum labelling requirements; indication for use, intended user, training and test data sets, algorithm design, image processing techniques, clinical validation, performance metrics, limitations, updates and adverse events. Nearly all suggested characteristics of the labelling items received endorsement, except for some characteristics related to performance metrics. Moreover, there was consensus that uniform labelling criteria should apply across all AI categories and risk classes set out by the Therapeutic Goods Administration. CONCLUSIONS This study provides critical evidence for setting labelling standards by the Therapeutic Goods Administration to safeguard patients, health professionals, consumers, industry, and regulatory bodies from AI-based dermatology SaMDs that do not currently provide adequate information about how they were developed and tested.
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Affiliation(s)
- Åsa Ingvar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Maithili Sashindranath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Miller
- Australasian College of Dermatologists, Sydney, Australia
| | - H Peter Soyer
- Australasian College of Dermatologists, Sydney, Australia
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Pascale Guitera
- Australasian College of Dermatologists, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Victoria, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Tony Caccetta
- Australasian College of Dermatologists, Sydney, Australia
- Perth Dermatology Clinic, Perth, Western Australia, Australia
| | - Stephen Shumack
- Australasian College of Dermatologists, Sydney, Australia
- Royal North Shore Hospital of Sydney, Sydney, New South Wales, Australia
| | - Lisa Abbott
- Australasian College of Dermatologists, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Skin Hospital, Sydney, New South Wales, Australia
| | - Chris Arnold
- BioGrid Australia Ltd, Melbourne, Australia
- Hodgson Associates, Melbourne, Australia
- Australasian Society of Cosmetic Dermatologists, Melbourne, Australia
| | - Craig Lawn
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence in Melanoma Imaging, Brisbane, Queensland, Australia
| | | | - Monika Janda
- Australasian College of Dermatologists, Sydney, Australia
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australasian College of Dermatologists, Sydney, Australia
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16
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Hill DLG. AI in imaging: the regulatory landscape. Br J Radiol 2024; 97:483-491. [PMID: 38366148 PMCID: PMC11027239 DOI: 10.1093/bjr/tqae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 02/18/2024] Open
Abstract
Artificial intelligence (AI) methods have been applied to medical imaging for several decades, but in the last few years, the number of publications and the number of AI-enabled medical devices coming on the market have significantly increased. While some AI-enabled approaches are proving very valuable, systematic reviews of the AI imaging field identify significant weaknesses in a significant proportion of the literature. Medical device regulators have recently become more proactive in publishing guidance documents and recognizing standards that will require that the development and validation of AI-enabled medical devices need to be more rigorous than required for tradition "rule-based" software. In particular, developers are required to better identify and mitigate risks (such as bias) that arise in AI-enabled devices, and to ensure that the devices are validated in a realistic clinical setting to ensure their output is clinically meaningful. While this evolving regulatory landscape will mean that device developers will take longer to bring novel AI-based medical imaging devices to market, such additional rigour is necessary to address existing weaknesses in the field and ensure that patients and healthcare professionals can trust AI-enabled devices. There would also be benefits in the academic community taking into account this regulatory framework, to improve the quality of the literature and make it easier for academically developed AI tools to make the transition to medical devices that impact healthcare.
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17
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Nguyen QM, Hutchison P, Palombo E, Yu A, Kingshott P. Antibiofilm Activity of Eugenol-Loaded Chitosan Coatings against Common Medical-Device-Contaminating Bacteria. ACS Appl Bio Mater 2024; 7:918-935. [PMID: 38275187 DOI: 10.1021/acsabm.3c00949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The formation of pathogenic biofilms on medical devices is a major public health concern accounting for over 65% of healthcare-associated infections and causing high infection morbidity, mortality, and a great burden to patients and the healthcare system due to its resistance to treatment. In this study, we developed a chitosan-based antimicrobial coating with embedded mesoporous silica nanoparticles (MSNs) to load and deliver eugenol, an essential oil component, to inhibit the biofilm formation of common bacteria in medical-device-related infections. The eugenol-loaded MSNs were dispersed in a chitosan solution, which was then cross-linked with glutaraldehyde and drop-casted to obtain coatings. The MSNs and coatings were characterized by dynamic light scattering, Brunauer-Emmett-Teller analysis, attenuated-total-reflectance Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, 3D optical profilometry, and scanning electron microscopy. The release behavior of eugenol-loaded MSNs and coatings and the antibiofilm and antimicrobial activity of the coatings against adherent Staphylococcus aureus, methicillin-resistant S. aureus, and Pseudomonas aeruginosa were investigated. Eugenol was released from the MSNs and coatings in aqueous conditions in a controlled manner with an initial low release, followed by a peak release, a decrease, and a plateau. While the chitosan coatings alone or with unloaded MSNs demonstrated limited antimicrobial effects and still supported biofilm formation after 24 h, the coating containing eugenol not only reduced biofilm formation but also killed the majority of the attached bacteria. It also showed biocompatibility in indirect contact with NIH/3T3 fibroblasts and a high percentage of live cells in direct contact. However, further investigations into cell proliferation in direct contact are recommended. The findings indicated that the chitosan-based coating with eugenol-loaded MSNs could be developed into an effective strategy to inhibit biofilm formation on medical devices.
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Affiliation(s)
- Quang Minh Nguyen
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Peter Hutchison
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Enzo Palombo
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Aimin Yu
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Peter Kingshott
- Department of Chemistry and Biotechnology, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- ARC Training Centre in Surface Engineering for Advanced Materials, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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18
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Aedla M, Cheng CJ, Zhou AY, Zhang S, Hsu J, Hu K, Qian JC, de Sompel KV, Ho A, Sharma KV, Logsdon EA. Design and Evaluation of a Spoke-Based Double-Lumen Pediatric Gastrostomy Tube. Children (Basel) 2024; 11:263. [PMID: 38397375 PMCID: PMC10888183 DOI: 10.3390/children11020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Gastrostomy tubes (G-tubes) are the gold standard for feeding assistance for children with feeding dysfunction. Current G-tubes pose complications that interrupt the delivery of feed, including tube displacement and difficulty of at-home use. This study details an alternative, spoke-based, double-lumen G-tube design and preliminary validation of its function and usability. Pull force testing was performed on spoke G-tube models across three sizes and two classifications (hard/soft). Preliminary models were evaluated against market standards. Though the pull force of the spoke model was found to be lower than that of both market standards, hard modifications to the spoke model improved retentive force. Ease of use was tested amongst users unfamiliar with G-tube placement. The spoke design required 12.3 ± 4.7 s to deploy, less than half the time required for market standards. However, balloon G-tubes were still perceived to be easiest to use by 70% of participants, with indications that a spoke design may be easier to use if sized similarly to current G-tubes, with auxiliary improvements to factors such as grip. While there is a need for improvements in the material properties and manufacturing of the proposed design, this study provides early validation of the potential to address complications of existing G-tubes.
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Affiliation(s)
- Mihika Aedla
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
- College of Medicine, Ohio State University, Columbus, OH 43210, USA
| | - Charlotte J. Cheng
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Anson Y. Zhou
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Siya Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Jocelyn Hsu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Katherine Hu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Jason C. Qian
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Kevin Van de Sompel
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
| | - Anthony Ho
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
- School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Karun V. Sharma
- Department of Interventional Radiology, Children’s National Hospital, Washington, DC 20010, USA;
| | - Elizabeth A. Logsdon
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA (A.Y.Z.); (K.H.); (K.V.d.S.); (E.A.L.)
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Wu AG, Luch S, Slusher TM, Fischer GA, Lunos SA, Bjorklund AR. The novel LESS (low-cost entrainment syringe system) O 2 blender for use in modified bubble CPAP circuits: a clinical study of safety. Front Pediatr 2024; 12:1313781. [PMID: 38410763 PMCID: PMC10894966 DOI: 10.3389/fped.2024.1313781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Background Bubble continuous positive airway pressure (bCPAP) is used in resource-limited settings for children with respiratory distress. Low-cost modifications of bCPAP use 100% oxygen and may cause morbidity from oxygen toxicity. We sought to test a novel constructible low-cost entrainment syringe system (LESS) oxygen blender with low-cost modified bCPAP in a relevant clinical setting. Methods We conducted a clinical trial evaluating safety of the LESS O2 blender among hospitalized children under five years old in rural Cambodia evaluating the rate of clinical failure within one hour of initiation of the LESS O2 blender and monitoring for any other blender-related complications. Findings Thirty-two patients were included. The primary outcome (clinical failure) occurred in one patient (3.1%, 95% CI = 0.1-16.2%). Clinical failure was defined as intubation, death, transfer to another hospital, or two of the following: oxygen saturation <85% after 30 min of treatment; new signs of respiratory distress; or partial pressure of carbon dioxide ≥60 mmHg and pH <7.2 on a capillary blood gas. Secondary outcomes included average generated FiO2's with blender use, which were 59% and 52% when a 5 mm entrainment was used vs. a 10 mm entrainment port with 5-7 cm H2O of CPAP and 1-7 L/min (LPM) of flow; and adverse events including loss of CPAP bubbling (64% of all adverse events), frequency of repair or adjustment (44%), replacement (25%), and median time of respiratory support (44 h). Interpretation Overall the LESS O2 blender was safe for clinical use. The design could be modified for improved performance including less repair needs and improved nasal interface, which requires modification for the blender to function more consistently.
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Affiliation(s)
- Andrew G Wu
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
| | - Sreyleak Luch
- Department of Pediatrics, Chenla Children's Healthcare, Kratie, Cambodia
| | - Tina M Slusher
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Gwenyth A Fischer
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Scott A Lunos
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, United States
| | - Ashley R Bjorklund
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
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20
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Chapman DP, Wu JY. Concept for intrathecal delivery of brain recording and stimulation device. Front Med Technol 2024; 6:1211585. [PMID: 38390553 PMCID: PMC10883158 DOI: 10.3389/fmedt.2024.1211585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Neurological disorders are common, yet many neurological diseases don't have efficacious treatments. The protected nature of the brain both anatomically and physiologically through the blood brain barrier (BBB) make it exceptionally hard to access. Recent advancements in interventional approaches, like the Stentrode™, have opened the possibility of using the cerebral vasculature as a highway for minimally invasive therapeutic delivery to the brain. Despite the immense success that the Stentrode™ has faced recently, it is limited to major cerebral vasculature and exists outside the BBB, making drug eluting configurations largely ineffective. The present study seeks to identify a separate anatomical pathway for therapeutic delivery to the deep brain using the ventricular system. The intrathecal route, in which drug pumps and spinal cord stimulators are delivered through a lumbar puncture, is a well-established route for delivering therapies to the spinal cord as high as C1. The present study identifies an extension of this anatomical pathway through the foramen of Magendie and into the brains ventricular system. To test this pathway, a narrow self-expanding electrical recording device was manufactured and its potential to navigate the ventricular system was assessed on human anatomical brain samples. While the results of this paper are largely preliminary and a substantial amount of safety and efficacy data is needed, this paper identifies an important anatomical pathway for delivery of therapeutic and diagnostics tools to the brain that is minimally invasive, can access limbic structures, and is within the BBB.
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Affiliation(s)
- Daniel P Chapman
- Department of Neuroscience, Georgetown University, Washington, DC, United States
- Department of Neuroscience, Georgetown University, Washington, DC, United States
| | - Jian-Young Wu
- Department of Neuroscience, Georgetown University, Washington, DC, United States
- Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States
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21
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Tronel A, Silvent AS, Buelow E, Giai J, Leroy C, Proust M, Martin D, Le Gouellec A, Soranzo T, Mathieu N. Pilot Study: Safety and Performance Validation of an Ingestible Medical Device for Collecting Small Intestinal Liquid in Healthy Volunteers. Methods Protoc 2024; 7:15. [PMID: 38392689 PMCID: PMC10892249 DOI: 10.3390/mps7010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
The connection between imbalances in the human gut microbiota, known as dysbiosis, and various diseases has been well established. Current techniques for sampling the small intestine are both invasive for patients and costly for healthcare facilities. Most studies on human gut microbiome are conducted using faecal samples, which do not accurately represent the microbiome in the upper intestinal tract. A pilot clinical investigation, registered as NCT05477069 and sponsored by the Grenoble Alpes University Hospital, is currently underway to evaluate a novel ingestible medical device (MD) designed for collecting small intestinal liquids by Pelican Health. This study is interventional and monocentric, involving 15 healthy volunteers. The primary objective of the study is to establish the safety and the performance of the MD when used on healthy volunteers. Secondary objectives include assessing the device's performance and demonstrating the difference between the retrieved sample from the MD and the corresponding faecal sample. Multi-omics analysis will be performed, including metagenomics, metabolomics, and culturomics. We anticipate that the MD will prove to be safe without any reported adverse effects, and we collected samples suitable for the proposed omics analyses in order to demonstrate the functionality of the MD and the clinical potential of the intestinal content.
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Affiliation(s)
- Alexandre Tronel
- Pelican Health, 107 rue Aristide Briand, 38600 Fontaine, France;
- University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France; (E.B.); (J.G.)
| | - Anne-Sophie Silvent
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, CIC, 38000 Grenoble, France; (A.-S.S.); (C.L.); (M.P.)
| | - Elena Buelow
- University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France; (E.B.); (J.G.)
| | - Joris Giai
- University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France; (E.B.); (J.G.)
| | - Corentin Leroy
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, CIC, 38000 Grenoble, France; (A.-S.S.); (C.L.); (M.P.)
| | - Marion Proust
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, CIC, 38000 Grenoble, France; (A.-S.S.); (C.L.); (M.P.)
| | - Donald Martin
- University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France; (E.B.); (J.G.)
| | - Audrey Le Gouellec
- University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France; (E.B.); (J.G.)
- Service de Biochimie Biologie Moléculaire Toxicologie Environnementale, UM Biochimie des Enzymes et des Protéines, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France
- Plateforme de Métabolomique GEMELI-GExiM, Institut de Biologie et Pathologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Thomas Soranzo
- Pelican Health, 107 rue Aristide Briand, 38600 Fontaine, France;
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, 38000 Grenoble, France
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22
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Hunt R, Scarpace L, Rock J. Integration of Augmented Reality Into Glioma Resection Surgery: A Case Report. Cureus 2024; 16:e53573. [PMID: 38445166 PMCID: PMC10914376 DOI: 10.7759/cureus.53573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Augmented reality (AR) is an exciting technology that has garnered considerable attention in the field of neurosurgery. Despite this, clinical use of this technology is still in its infancy. An area of great potential for this technology is the ability to display 3D anatomy overlaid with the patient to assist with presurgical and intraoperative decision-making. A 39-year-old woman presented with headaches and was experiencing what was described as a whooshing sound. MRI revealed the presence of a large left frontal mass involving the genu of the corpus callosum, with heterogeneous enhancement and central hemorrhagic necrosis, confirmed to be a glioma. She underwent a craniotomy with intraoperative MRI for resection. An augmented reality system was used to superimpose 3D holographic anatomy onto the patient's head for surgical planning. This report highlights a new AR technology and its immediate application to cranial neurosurgery. It is critical to document new uses of this technology as the field continues to integrate AR as well as other next-generation technologies into practice.
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Affiliation(s)
- Rachel Hunt
- Neurosurgery, Henry Ford Health System, Detroit, USA
| | - Lisa Scarpace
- Neurosurgery, Henry Ford Health System, Detroit, USA
| | - Jack Rock
- Neurosurgery, Henry Ford Health System, Detroit, USA
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23
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Ning L, Limpabandhu C, Tse ZTH. Engineering Magnetic Soft and Reconfigurable Robots. Soft Robot 2024; 11:2-20. [PMID: 37527211 DOI: 10.1089/soro.2022.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Magnetic control has gained popularity recently due to its ability to enhance soft robots with reconfigurability and untethered maneuverability, among other capabilities. Several advancements in the fabrication and application of reconfigurable magnetic soft robots have been reported. This review summarizes novel fabrication techniques for designing magnetic soft robots, including chemical and physical methods. Mechanisms of reconfigurability and deformation properties are discussed in detail. The maneuverability of magnetic soft robots is then briefly discussed. Finally, the present challenges and possible future work in designing reconfigurable magnetic soft robots for biomedical applications are identified.
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Affiliation(s)
- Linxiaohai Ning
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Chayabhan Limpabandhu
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Zion Tsz Ho Tse
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
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24
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Okamoto Y, Fukui C, Kobayashi T, Morioka H, Mizumachi H, Inomata Y, Kaneki A, Okada M, Haishima Y, Yamamoto E, Nomura Y. Proof of concept testing of a positive reference material for in vivo and in vitro sensitization testing of medical devices. J Biomed Mater Res B Appl Biomater 2024; 112:e35386. [PMID: 38334720 DOI: 10.1002/jbm.b.35386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/15/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
In vivo skin sensitization tests are required to evaluate the biological safety of medical devices in contact with living organisms to provide safe medical care to patients. Negative and positive reference materials have been developed for biological tests of cytotoxicity, implantation, hemolysis, and in vitro skin irritation. However, skin sensitization tests are lacking. In this study, polyurethane sheets containing 1 wt/wt % 2,4-dinitrochlorobenzene (DNCB-PU) were developed and evaluated as a positive reference material for skin sensitization tests. DNCB-PU sheet extracts prepared with sesame oil elicited positive sensitization responses for in vivo sensitization potential in the guinea pig maximization test and the local lymph node assay. Furthermore, DNCB-PU sheet extracts prepared with water and acetonitrile, 10% fetal bovine serum-containing medium, or sesame oil elicited positive sensitization responses as alternatives to animal testing based on the amino acid derivative reactivity assay, human cell line activation test, and epidermal sensitization assay, respectively. These data suggest that the DNCB-PU sheet is an effective extractable positive reference material for in vivo and in vitro skin sensitization testing in medical devices. The formulation of this reference material will lead to the development of safer medical devices that contribute to patient safety.
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Affiliation(s)
- Yusuke Okamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Chie Fukui
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Toshio Kobayashi
- Chemicals Evaluation and Research Institute, Hita-shi, Oita, Japan
| | - Hisako Morioka
- Chemicals Evaluation and Research Institute, Hita-shi, Oita, Japan
| | | | - Yoriko Inomata
- Evaluation Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Atsushi Kaneki
- Evaluation Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Masayuki Okada
- Evaluation Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Yuji Haishima
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Eiichi Yamamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Yusuke Nomura
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
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25
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Sun L, Wan M, Sun X, Liu J, Gai X, Wang G, Ruan W, Qin Y, Liu C. [Research Status of Nanomaterial Medical Device and Discussion on Biological Evaluation]. Zhongguo Yi Liao Qi Xie Za Zhi 2024; 48:88-93. [PMID: 38384224 DOI: 10.3969/j.issn.1671-7104.230286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
In recent years, China has made great progress in basic nanomedicine, nanotoxicology and nanobiology research. Nanotechnology has been continuously applied in biomaterial and medical device, more and more medical devices applying nanomaterials are developed and manufactured. In order to gain more comprehension and accurate understanding of the research and industrial development in nanobiomaterial medical devices, this study reviewed the common nanomaterial in medical devices and the regulatory situation of nanomaterial medical devices at home and abroad, and discussed the current challenges in biological evaluation of nanomaterial medical devices, with a view to providing ideas for the safety evaluation and research of related products.
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Affiliation(s)
- Lingxiao Sun
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Min Wan
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Xiaoxia Sun
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Jia Liu
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Xiaoxiao Gai
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Guowei Wang
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Wenting Ruan
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Yang Qin
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
| | - Chenghu Liu
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, 250101
- NMPA Key Laboratory for Safety Evaluation of Biomaterials and Medical Devices, Jinan, 250101
- Shandong Key Laboratory of Biological Evaluation for Medical Devices, Jinan, 250101
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26
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Jiang X, Zhou M. [Critical Control Points and Case Studies in the Production of Metal Additive Manufacturing Medical Device]. Zhongguo Yi Liao Qi Xie Za Zhi 2024; 48:94-98. [PMID: 38384225 DOI: 10.3969/j.issn.1671-7104.230217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The critical control points in the production quality management of metal additive manufacturing medical devices, including personnel, hardware, design and development, procurement control, production management and quality control are summarized from the perspective of supervision. The typical cases are analyzed to provide reference for medical device regulatory authorities and enterprises.
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Affiliation(s)
- Xin Jiang
- Shanghai Medical Device and Cosmetics Evaluation and Verification Center, Shanghai, 200020
| | - Minliang Zhou
- Shanghai Medical Device and Cosmetics Evaluation and Verification Center, Shanghai, 200020
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27
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Micheels P, Porcello A, Bezzola T, Perrenoud D, Quinodoz P, Kalia Y, Allémann E, Laurent A, Jordan O. Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments. Gels 2024; 10:101. [PMID: 38391431 PMCID: PMC10888303 DOI: 10.3390/gels10020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM®, Restylane®, BELOTERO®, TEOSYAL RHA®, and STYLAGE® brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin® cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.
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Affiliation(s)
| | - Alexandre Porcello
- School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1211 Geneva, Switzerland
| | | | | | | | - Yogeshvar Kalia
- School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1211 Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1211 Geneva, Switzerland
| | - Alexis Laurent
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1015 Lausanne, Switzerland
- Manufacturing Department, TEC-PHARMA SA, CH-1038 Bercher, Switzerland
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
| | - Olivier Jordan
- School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CH-1211 Geneva, Switzerland
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28
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Lopez-Campos G, Gabarron E, Martin-Sanchez F, Merolli M, Petersen C, Denecke K. Digital Interventions and Their Unexpected Outcomes - Time for Digitalovigilance? Stud Health Technol Inform 2024; 310:479-483. [PMID: 38269849 DOI: 10.3233/shti231011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The application of digital interventions in healthcare beyond research has been translated in the development of software as a medical device. Along with corresponding regulations for medical devices, there is a need for assessing adverse events to conduct post-market surveillance and to appropriately label digital health interventions to ensure proper use and patient safety. To date unexpected consequences of digital health interventions are neglected or ignored, or at least remain undescribed in literature. This paper is intended to raise awareness across the research community about these upcoming challenges. We recommend that - together with developing a new research field of digitalovigilance - a systematic assessment and monitoring of adverse events and unexpected interactions be included in clinical trials, along with the reporting of such events and the conduct of meta-analyses on critical aspects.
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Affiliation(s)
- Guillermo Lopez-Campos
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | | | - Mark Merolli
- Department of Physiotherapy, School of Health Sciences, the University of Melbourne, Melbourne, Australia
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States
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29
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Wang Y, Lyell D, Coiera E, Magrabi F. Automating the Identification of Safety Events Involving Machine Learning-Enabled Medical Devices. Stud Health Technol Inform 2024; 310:604-608. [PMID: 38269880 DOI: 10.3233/shti231036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
With growing use of machine learning (ML)-enabled medical devices by clinicians and consumers safety events involving these systems are emerging. Current analysis of safety events heavily relies on retrospective review by experts, which is time consuming and cost ineffective. This study develops automated text classifiers and evaluates their potential to identify rare ML safety events from the US FDA's MAUDE. Four stratified classifiers were evaluated using a real-world data distribution with different feature sets: report text; text and device brand name; text and generic device type; and all information combined. We found that stratified classifiers using the generic type of devices were the most effective technique when tested on both stratified (F1-score=85%) and external datasets (precision=100%). All true positives on the external dataset were consistently identified by the three stratified classifiers, indicating the ensemble results from them can be used directly to monitor ML events reported to MAUDE.
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Affiliation(s)
- Ying Wang
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - David Lyell
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation, Macquarie University, Australia
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30
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Markerink H, van Geffen GJ, Bruhn J. Topical Anaesthesia Using a Soft Mist Spray Device Allows Comfortable Awake Visualisation of the Airway via Self-Videolaryngoscopy in Volunteers. Medicina (Kaunas) 2024; 60:176. [PMID: 38276056 PMCID: PMC10821280 DOI: 10.3390/medicina60010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Background: During endotracheal intubation, there is a 10% incidence of difficult laryngoscopy, which may result in serious complications. It is important to obtain as much information about the visibility of laryngeal structures before the patient is anaesthetised. Performing awake (video-) laryngoscopy on a patient is uncomfortable and can trigger gagging and coughing reflexes, making visualisation nearly impossible. The objective of this study is to evaluate the effectiveness of a soft mist spray device for airway anaesthesia during awake (video-) laryngoscopy. Methods: Twenty healthy volunteers inhaled through the Trachospray device, which was placed in their mouths. Two 2 mL syringes containing lidocaine at 4% were sprayed into the airway during inspiration. After several minutes, the subjects were asked to perform a videolaryngoscopy on themselves until the glottic structures and the vocal cords were visible. Upon completion of the procedure, all participants were asked to fill out a feedback form. Results: The duration of the videolaryngoscopy to visualisation of the vocal cords averaged 17 ± 13 s. After analysing the data, three distinct groups emerged as follows: Group 1 (70% of participants) showed no response, allowing for easy insertion of the videolaryngoscope. Group 2 (25% of participants) exhibited a light response but still permitted easy insertion and visualisation. One patient demonstrated a clear response with noticeable laryngeal contraction, requiring slightly more effort and discomfort for insertion. In 80% of the participants, the laryngeal structures were visualised according to Cormack-Lehane grade 1. All participants reported a high level of comfort, with an average rating of NRS 8. The anaesthesiologist assessed the level of anaesthesia as good to very good. No adverse events were observed. Conclusions: The Trachospray provided good, reliable, comfortable, and safe topical anaesthesia for awake videolaryngoscopy. This enables a direct visual assessment of the airway and may assist in making decisions regarding airway management for tracheal intubation.
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Affiliation(s)
- Hielke Markerink
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre (RUMC), 6525 GA Nijmegen, The Netherlands
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Kanďárová H, Pôbiš P. The "Big Three" in biocompatibility testing of medical devices: implementation of alternatives to animal experimentation-are we there yet? Front Toxicol 2024; 5:1337468. [PMID: 38259728 PMCID: PMC10800850 DOI: 10.3389/ftox.2023.1337468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Biocompatibility testing ensures the safety of medical devices by assessing their compatibility with biological systems and their potential to cause harm or adverse reactions. Thus, it is a critical part of the overall safety evaluation process for medical devices. Three primary types of biocompatibility tests-cytotoxicity, irritation, and sensitisation assessment-are standard for nearly all medical devices. However, additional biocompatibility tests, such as genotoxicity, systemic toxicity, hemocompatibility, and implantation studies, may also be necessary, depending on the device's nature and intended use. The testing is partly conducted in vitro, but the industry still heavily relies on animal experiments. Compared to other industrial sectors, implementing alternatives in medical device biocompatibility testing has been notably slower. This delay can be attributed to the absence of specific validation processes tailored to medical devices and the resulting hesitation regarding the predictive capacity of these alternative methods despite their successful applications in other domains. This review focuses on the progress and obstacles to implementing new approach methodologies in the areas of cytotoxicity, irritation and sensitisation testing of medical devices. While challenges persist in adopting these innovative methods, the trend towards embracing alternatives remains robust. This trend is driven by technological advancements, ethical considerations, and growing industrial interest and support, all collectively contributing to advancing safer and more effective medical devices.
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Affiliation(s)
- Helena Kanďárová
- Institute of Experimental Pharmacology and Toxicology (IEPT), Centre of Experimental Medicine (CEM), Slovak Academy of Sciences (SAS), Bratislava, Slovakia
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Hsieh HY, Lin CH, Huang R, Lin GC, Lin JY, Aldana C. Challenges for Medical Students in Applying Ethical Principles to Allocate Life-Saving Medical Devices During the COVID-19 Pandemic: Content Analysis. JMIR Med Educ 2024; 10:e52711. [PMID: 38050366 PMCID: PMC10799279 DOI: 10.2196/52711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/18/2023] [Accepted: 12/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process. OBJECTIVE This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. METHODS The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students' ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making. RESULTS We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. CONCLUSIONS This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions.
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Affiliation(s)
- Hsing-Yen Hsieh
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Her Lin
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan
| | - Ruyi Huang
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Holistic Medicine, Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Data Science Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
- Division of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Guan-Chun Lin
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jhen-Yu Lin
- Holistic Medicine, Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Clydie Aldana
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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D'Souza GA, Rinaldi JE, Meki M, Crusan A, Richardson E, Shinnar M, Herbertson LH. Using a Mock Circulatory Loop as a Regulatory Science Tool to Simulate Different Heart Failure Conditions. J Biomech Eng 2024; 146:011004. [PMID: 37831143 DOI: 10.1115/1.4063746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Mechanical circulatory support (MCS) device therapy is one of the primary treatment options for end-stage heart failure (HF), whereby a mechanical pump is integrated with the failing heart to maintain adequate tissue perfusion. The ISO 14708-5:2020 standard prescribes generic guidelines for nonclinical device evaluation and system performance testing of MCS devices using a mock circulatory loop (MCL). However, the utility of MCLs in premarket regulatory submissions of MCS devices is ambiguous, and the specific disease states that the device is intended to treat are not usually simulated. Hence, we aim to outline the potential of MCLs as a valuable regulatory science tool for characterizing MCS device systems by adequately representing target clinical-use HF conditions on the bench. Target pathophysiologic hemodynamics of HF conditions (i.e., cardiogenic shock (CS), left ventricular (LV) hypertrophy secondary to hypertension, and coronary artery disease), along with a healthy adult at rest and a healthy adult during exercise are provided as recommended test conditions. The conditions are characterized based on LV, aorta, and left atrium pressures using recommended cardiac hemodynamic indices such as systolic, diastolic, and mean arterial pressure, mean cardiac output (CO), cardiac cycle time, and systemic vascular resistance. This study is a first step toward standardizing MCLs to generate well-defined target HF conditions used to evaluate MCS devices.
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Affiliation(s)
- Gavin A D'Souza
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Jean E Rinaldi
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Moustafa Meki
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Annabelle Crusan
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Eric Richardson
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Meir Shinnar
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Luke H Herbertson
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
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Garvey M. Medical Device-Associated Healthcare Infections: Sterilization and the Potential of Novel Biological Approaches to Ensure Patient Safety. Int J Mol Sci 2023; 25:201. [PMID: 38203372 PMCID: PMC10778788 DOI: 10.3390/ijms25010201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Healthcare-associated infections caused by multi-drug-resistant pathogens are increasing globally, and current antimicrobial options have limited efficacy against these robust species. The WHO details the critically important bacterial and fungal species that are often associated with medical device HAIs. The effective sterilization of medical devices plays a key role in preventing infectious disease morbidity and mortality. A lack of adherence to protocol and limitations associated with each sterilization modality, however, allows for the incidence of disease. Furthermore, issues relating to carcinogenic emissions from ethylene oxide gas (EtO) have motivated the EPA to propose limiting EtO use or seeking alternative sterilization methods for medical devices. The Food and Drug Administration supports the sterilization of healthcare products using low-temperature VH2O2 as an alternative to EtO. With advances in biomaterial and medical devices and the increasing use of combination products, current sterilization modalities are becoming limited. Novel approaches to disinfection and sterilization of medical devices, biomaterials, and therapeutics are warranted to safeguard public health. Bacteriophages, endolysins, and antimicrobial peptides are considered promising options for the prophylactic and meta-phylactic control of infectious diseases. This timely review discusses the application of these biologics as antimicrobial agents against critically important WHO pathogens, including ESKAPE bacterial species.
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Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland;
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland
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Bieliński J, Jaśkiewicz F, Timler D. Comparing results of three measurement techniques used to determine the size of oropharyngeal airway in adults. Ann Agric Environ Med 2023; 30:715-720. [PMID: 38153076 DOI: 10.26444/aaem/171023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION AND OBJECTIVE The oropharyngeal airway, also known as the Guedel airway, is a crucial medical device used for over a century as a basic way to maintain a patient's airway open and secure. Although it is easy to use, this can be misleading as incorrect sizing can lead to injuries, bleeding, laryngospasm, and potentially fatal complications. This study aims to compare three techniques for selecting the appropriate oropharyngeal airway size using craniofacial anatomical landmarks. MATERIAL AND METHODS Three facial distances were measured, each one according to the techniques described in the scientific sources. For greater reliability of the test, measurements were made sequentially with two different methods. RESULTS The study included over 500 participants. Depending on the measurement technique used, different results of average lengths and thus approximate sizes of oropharyngeal airway were obtained. This indicated that depending on which technique is used for measuring purposes, differences in the size of the oropharyngeal airway can be up to 2-3 cm, with a high degree of statistical significance. CONCLUSIONS Using different craniofacial anatomical landmarks to select the size of the oropharyngeal airway can yield significantly varied results for the same adult patient, thus posing a potentially fatal threat. To ensure effective and safe airway management, proper ventilation and oxygenation, it is recommended to follow the ISA (Initial Size Approximation) approach when choosing the oropharyngeal airway size in medical education, training, and clinical settings. Further research is needed to explore this matter, also in different populations.
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Affiliation(s)
- Jakub Bieliński
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
| | - Filip Jaśkiewicz
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland
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Vizza P, Marotta N, Ammendolia A, Guzzi PH, Veltri P, Tradigo G. REHABS: An Innovative and User-Friendly Device for Rehabilitation. Bioengineering (Basel) 2023; 11:5. [PMID: 38275573 DOI: 10.3390/bioengineering11010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Rehabilitation is a complex set of interventions involving the assessment, management, and treatment of injuries. It aims to support and facilitate an individual's recovery process by restoring a physiological function, e.g., limb movement, compromised by physical impairments, injuries or diseases to a condition as close to normal as possible. Innovative devices and solutions make the rehabilitation process of patients easier during their daily activities. Devices support physicians and physiotherapists in monitoring and measuring patients' physical improvements during rehabilitation. In this context, we report the design and implementation of a low-cost rehabilitation system, which is a programmable device designed to support tele-rehabilitation of the upper limbs. The proposed system includes a mechanism to acquire and analyze data and signals related to rehabilitation processes.
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Affiliation(s)
- Patrizia Vizza
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Pietro Hiram Guzzi
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | | | - Giuseppe Tradigo
- Department of Theoretical and Applied Sciences, University e-Campus, 22060 Novedrate, Italy
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Palenca I, Seguella L, Zilli A, Basili Franzin S, Del Re A, Pepi F, Troiani A, Pesce M, Rurgo S, De Palma FDE, Luglio G, Tropeano FP, Sarnelli G, Esposito G. Intrarectal Administration of Adelmidrol plus Hyaluronic Acid Gel Ameliorates Experimental Colitis in Mice and Inhibits Pro-Inflammatory Response in Ex Vivo Cultured Biopsies Derived from Ulcerative Colitis-Affected Patients. Int J Mol Sci 2023; 25:165. [PMID: 38203336 PMCID: PMC10778920 DOI: 10.3390/ijms25010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Improving clinical outcomes and delaying disease recrudescence in Ulcerative Colitis (UC) patients is crucial for clinicians. In addition to traditional and new pharmacological therapies that utilize biological drugs, the development of medical devices that can ameliorate UC and facilitate the remission phase should not be overlooked. Drug-based therapy requires time to be personalized and to evaluate the benefit/risk ratio. However, the increasing number of diagnosed UC cases worldwide necessitates the exploration of new strategies to enhance clinical outcomes. By incorporating medical devices alongside pharmacological treatments, clinicians can provide additional support to UC patients, potentially improving their condition and slowing down the recurrence of symptoms. Chemically identified as an azelaic acid derivative and palmitoylethanolamide (PEA) analog, adelmidrol is a potent anti-inflammatory and antioxidant compound. In this study, we aimed to evaluate the effect of an intrarectal administration of 2% adelmidrol (Ade) and 0.1% hyaluronic acid (HA) gel formulation in both the acute and resolution phase of a mouse model of colitis induced via DNBS enema. We also investigated its activity in cultured human colon biopsies isolated from UC patients in the remission phase at follow-up when exposed in vitro to a cytomix challenge. Simultaneously, with its capacity to effectively alleviate chronic painful inflammatory cystitis when administered intravesically to urological patients such as Vessilen, the intrarectal administration of Ade/HA gel has shown remarkable potential in improving the course of colitis. This treatment approach has demonstrated a reduction in the histological damage score and an increase in the expression of ZO-1 and occludin tight junctions in both in vivo studies and human specimens. By acting independently on endogenous PEA levels and without any noticeable systemic absorption, the effectiveness of Ade/HA gel is reliant on a local antioxidant mechanism that functions as a "barrier effect" in the inflamed gut. Building on the findings of this preliminary study, we are confident that the Ade/HA gel medical device holds promise as a valuable adjunct in supporting traditional anti-UC therapies.
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Affiliation(s)
- Irene Palenca
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Luisa Seguella
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Aurora Zilli
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Silvia Basili Franzin
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Alessandro Del Re
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Federico Pepi
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (F.P.); (A.T.)
| | - Anna Troiani
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (F.P.); (A.T.)
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Sara Rurgo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Fatima Domenica Elisa De Palma
- Department of Molecular Medicine and Medical Biotechnologies, Centro Ingegneria Genetica-Biotecnologie Avanzate s.c.a rl, 80131 Naples, Italy;
| | - Gaetano Luglio
- Endoscopic Surgery Unit, Department of Medical and Surgical Gastrointestinal Disease, Federico II University of Naples, 80131 Naples, Italy; (G.L.); (F.P.T.)
| | - Francesca Paola Tropeano
- Endoscopic Surgery Unit, Department of Medical and Surgical Gastrointestinal Disease, Federico II University of Naples, 80131 Naples, Italy; (G.L.); (F.P.T.)
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Giuseppe Esposito
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
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Grannell A, Hallson H, Gunlaugsson B, Jonsson H. Exercise therapy as a digital therapeutic for chronic disease management: consideration for clinical product development. Front Digit Health 2023; 5:1250979. [PMID: 38173910 PMCID: PMC10761443 DOI: 10.3389/fdgth.2023.1250979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Digital exercise therapies (DET) have the potential to bridge existing care gaps for people living with chronic conditions. Acting as either a standalone, embedded within multi-modal lifestyle therapy, or adjunct to pharmacotherapy or surgery, evidence-based DETs can favorably impact the health of a rapidly growing population. Given the nascent nature of digital therapeutics, the regulatory landscape has yet to mature. As such, in the absence of clear guidelines clinical digital product developers are responsible for ensuring the DET adheres to fundamental principles such as patient risk management and clinical effectiveness. The purpose of this narrative review paper is to discuss key considerations for clinical digital product developers who are striving to build novel digital therapeutic (DTx) solutions and thus contribute towards standardization of product development. We herein draw upon DET as an example, highlighting the need for adherence to existing clinical guidelines, human-centered design and an intervention approach that leverages the Chronic Care Model. Specific topics and recommendations related to the development of innovative and scalable products are discussed which ultimately allow for differentiation from a basic wellness tool and integration to clinical workflows. By embodying a code of ethics, clinical digital product developers can adequately address patients' needs and optimize their own future digital health technology assessments including appropriate evidence of safety and efficacy.
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Affiliation(s)
- Andrew Grannell
- Sidekick Health, Research & Development Unit, Kópavogur, Iceland
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Au CY, Leow SY, Yi C, Ang D, Yeo JC, Koh MJA, Bhagat AAS. A Sensorised Glove to Detect Scratching for Patients with Atopic Dermatitis. Sensors (Basel) 2023; 23:9782. [PMID: 38139628 PMCID: PMC10748247 DOI: 10.3390/s23249782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
In this work, a lightweight compliant glove that detects scratching using data from microtubular stretchable sensors on each finger and an inertial measurement unit (IMU) on the palm through a machine learning model is presented: the SensorIsed Glove for Monitoring Atopic Dermatitis (SIGMA). SIGMA provides the user and clinicians with a quantifiable way of assaying scratch as a proxy to itch. With the quantitative information detailing scratching frequency and duration, the clinicians would be able to better classify the severity of itch and scratching caused by atopic dermatitis (AD) more objectively to optimise treatment for the patients, as opposed to the current subjective methods of assessments that are currently in use in hospitals and research settings. The validation data demonstrated an accuracy of 83% of the scratch prediction algorithm, while a separate 30 min validation trial had an accuracy of 99% in a controlled environment. In a pilot study with children (n = 6), SIGMA accurately detected 94.4% of scratching when the glove was donned. We believe that this simple device will empower dermatologists to more effectively measure and quantify itching and scratching in AD, and guide personalised treatment decisions.
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Affiliation(s)
- Cheuk-Yan Au
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Syen Yee Leow
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Chunxiao Yi
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Darrion Ang
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Joo Chuan Yeo
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Ali Asgar Saleem Bhagat
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
- Department of Biomedical Engineering, National University of Singapore (NUS), 4 Engineering Drive 3, Singapore 117583, Singapore
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Hamnerius N, Dahlin J, Bruze M, Nilsson K, Sukakul T, Svedman C. Colophonium-related Allergic Contact Dermatitis Caused by Medical Adhesive Tape Used to Prevent Skin Lesions in Soldiers. Acta Derm Venereol 2023; 103:adv18428. [PMID: 38059803 PMCID: PMC10719863 DOI: 10.2340/actadv.v103.18428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
Medical adhesive tapes are commonly recommended for the prevention of friction blisters during hiking and military marches. The aim of this paper is to report on the results of investigations into an outbreak of tape-related foot dermatitis in 26 military conscripts following continuous use of medical adhesive tapes for several days during a field exercise. Patch tests were performed using baseline series and aimed testing was performed with colophonium-related substances and different medical adhesive tapes. Contact allergy to the adhesive tapes used was found in 20 (77%) subjects, and contact allergy to colophonium in 16 (61%). Chemical analysis detected colophonium-related substances in the culprit tapes. Compared with consecutive dermatitis patients investigated at our Department of Occupational and Environmental Dermatology in the previous 10 years, conscripts with colophonium allergy had increased odds ratios for concomitant contact allergy to phenol formaldehyde resins and fragrance substances including hydroperoxides of limonene and linalool. The results show that prolonged use of medical adhesive tapes on intact skin carries a high risk for allergic contact dermatitis. Prior to their introduction on the market, medical devices should be assessed for possible side-effects.
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Affiliation(s)
- Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kristina Nilsson
- Department of Current Operations, Army Command, Swedish Armed Forces, Sweden
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Rockson SG, Skoracki R. Effectiveness of a Nonpneumatic Active Compression Device in Older Adults with Breast Cancer-Related Lymphedema: A Subanalysis of a Randomized Crossover Trial. Lymphat Res Biol 2023; 21:581-584. [PMID: 37729078 PMCID: PMC10753982 DOI: 10.1089/lrb.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background: A recently completed clinical trial compared a novel nonpneumatic compression device (NPCD) with a traditional advanced pneumatic compression device (APCD) for the treatment of breast cancer-related lymphedema (BCRL); the study revealed that the NPCD produced superior clinical and quality-of-life (QOL) outcomes. In this subanalysis, we sought to examine these results within the subset of trial subjects aged ≥65 years. Methods: A randomized crossover head-to-head trial was conducted to compare the NPCD with a commercially available APCD. Patients were randomly assigned to one or the other device for 28 days of use, followed by a 4-week washout period before a comparable 28-day utilization of the alternate device. Limb edema, adherence to daily device use, and QOL measures were collected at day 0 and 28 of each period. Results: A total of 14 subjects were aged ≥65. During NPCD use, subjects experienced a mean decrease in limb edema of 100.3% (p = 0.0082) as well as improvements in mean overall and subscale scores of the Lymphedema Quality of Life Questionnaire (LYMQOL). By comparison, during APCD use limb edema decreased by a mean of 2.9% (p = 0.8899) with no significant changes in any LYMQOL scores. Mean adherence was significantly higher during NPCD use (96.6%) than during APCD use (58.3%, p < 0.0001). Conclusions: The novel NPCD produced superior clinical and QOL outcomes in older subjects with BCRL. ClinicalTrials.gov ID: NCT04908254.
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Affiliation(s)
- Stanley G. Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Roman Skoracki
- Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
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Fang Y, Zhang X, Li Y, Yang H. [Analysis of Factors Affecting Effectiveness of Medical Device Registration Self-inspection from Perspective of Technical Evaluation]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:680-683. [PMID: 38086728 DOI: 10.3969/j.issn.1671-7104.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Type inspection is a necessary precondition of technical evaluation of medical device. The implementation of The Provisions for Administration of Self-Test for Medical Device Registration facilitates the registration pathway for applicants. How to improve the effectiveness of registration self-test has drawn attention from many stakeholders. In this study, we analyzed and discussed the factors affecting the validity of registration self-test from technical evaluation perspective, and proposed suggestions for improvement accordingly. The aim of this article is to boost the reliability and effectiveness of registration self-test and offer a reference for applicants to carry out registration self-test.
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Affiliation(s)
- Yanxue Fang
- Center for Inspection of Gansu Medical Products Administration, Lanzhou, 730070
| | - Xinyan Zhang
- Yangtze River Delta Center for Medical Device Evaluation and Inspection of NMPA, Shanghai, 201210
| | - Yonghong Li
- Center for Inspection of Gansu Medical Products Administration, Lanzhou, 730070
| | - Hua Yang
- Center for Inspection of Gansu Medical Products Administration, Lanzhou, 730070
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43
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Wang X, Geng B, Jiang H. [Reflections on Research and Development Institutions Becoming Medical Device Registrants]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:664-668. [PMID: 38086725 DOI: 10.3969/j.issn.1671-7104.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
As the special subject of the applicant for registration of medical device, the research and development institutions have insufficient conditions and abilities to become medical device registrants, and there are certain difficulties in the actual registration application process, such as not clearing the certification path for the research and development institutions to hold the certificate. In view of the existing problems, by comparing the path of medicine research and development institutions to become medical device registrants and combining with the actual medical device industry to give relevant suggestions, including improving quality management over the whole life cycle of medical devices, quality and safety responsibility ability of research and development institutions, establishing the registration and certification path of research and development institutions, supporting laws and regulations, etc., so as to ensure that the research and development institutions become medical device registrants successfully.
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Affiliation(s)
- Xin Wang
- School of Medical Instruments, Shanghai University of Medicine & Health Sciences, Shanghai, 201318
| | - Boxuan Geng
- School of Law, Capital University of Economics and Business, Beijing, 100070
| | - Haihong Jiang
- School of Medical Instruments, Shanghai University of Medicine & Health Sciences, Shanghai, 201318
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Iorga A, Velezis MJ, Marinac-Dabic D, Lario RF, Huff SM, Gore B, Mermel LA, Bailey LC, Skapik J, Willis D, Lee RE, Hurst FP, Gressler LE, Reed TL, Towbin R, Baskin KM. Venous Access: National Guideline and Registry Development (VANGUARD): Advancing Patient-Centered Venous Access Care Through the Development of a National Coordinated Registry Network. J Med Internet Res 2023; 25:e43658. [PMID: 37999957 PMCID: PMC10709786 DOI: 10.2196/43658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 11/25/2023] Open
Abstract
There are over 8 million central venous access devices inserted each year, many in patients with chronic conditions who rely on central access for life-preserving therapies. Central venous access device-related complications can be life-threatening and add tens of billions of dollars to health care costs, while their incidence is most likely grossly mis- or underreported by medical institutions. In this communication, we review the challenges that impair retention, exchange, and analysis of data necessary for a meaningful understanding of critical events and outcomes in this clinical domain. The difficulty is not only with data extraction and harmonization from electronic health records, national surveillance systems, or other health information repositories where data might be stored. The problem is that reliable and appropriate data are not recorded, or falsely recorded, at least in part because policy, payment, penalties, proprietary concerns, and workflow burdens discourage completeness and accuracy. We provide a roadmap for the development of health care information systems and infrastructure that address these challenges, framed within the context of research studies that build a framework of standardized terminology, decision support, data capture, and information exchange necessary for the task. This roadmap is embedded in a broader Coordinated Registry Network Learning Community, and facilitated by the Medical Device Epidemiology Network, a Public-Private Partnership sponsored by the US Food and Drug Administration, with the scope of advancing methods, national and international infrastructure, and partnerships needed for the evaluation of medical devices throughout their total life cycle.
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Affiliation(s)
- Andrea Iorga
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
- Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Marti J Velezis
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Robert F Lario
- Biomedical Informatics Research, University of Utah, Salt Lake City, UT, United States
| | - Stanley M Huff
- Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Beth Gore
- The Oley Foundation, Albany Medical Center, Delmar, NY, United States
| | - Leonard A Mermel
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - L Charles Bailey
- Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Julia Skapik
- Internal Medicine, Inova Medical Group, Alexandria, VA, United States
- National Association of Community Health Centers, Bethesda, MD, United States
| | - Debi Willis
- PatientLink Enterprises, Oklahoma City, OK, United States
| | - Robert E Lee
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Frank P Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Laura E Gressler
- Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Terrie L Reed
- Symmetric Health Solutions, Pittsburgh, PA, United States
| | - Richard Towbin
- Emeritus, Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States
- VANGUARD Coordinated Registry Network, LLC, Phoenix, AZ, United States
| | - Kevin M Baskin
- VANGUARD Coordinated Registry Network, LLC, Phoenix, AZ, United States
- Division of Interventional Radiology, Department of Radiology, Conemaugh Memorial Medical Center, Johnstown, PA, United States
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Chen L, Yu L, Chen M, Liu Y, Xu H, Wang F, Zhu J, Tian P, Yi K, Zhang Q, Xiao H, Duan Y, Li W, Ma L, Zhou F, Cheng Y, Bai L, Wang F, Xiao X, Zhu Y, Yang Y. A microfluidic hemostatic diagnostics platform: Harnessing coagulation-induced adaptive-bubble behavioral perception. Cell Rep Med 2023; 4:101252. [PMID: 37879336 PMCID: PMC10694630 DOI: 10.1016/j.xcrm.2023.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/10/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Clinical viscoelastic hemostatic assays, which have been used for decades, rely on measuring biomechanical responses to physical stimuli but face challenges related to high device and test cost, limited portability, and limited scalability.. Here, we report a differential pattern using self-induced adaptive-bubble behavioral perception to refresh it. The adaptive behaviors of bubble deformation during coagulation precisely describe the transformation of viscoelastic hemostatic properties, being free of the precise and complex physical devices. And the integrated bubble array chip allows microassays and enables multi-bubble tests with good reproducibility. Recognition of the developed bubble behaviors empowers automated and user-friendly diagnosis. In a prospective clinical study (clinical model development [n = 273]; clinical assay [n = 44]), we show that the diagnostic accuracies were 99.1% for key viscoelastic hemostatic assay indicators (reaction time [R], kinetics time [K], alpha angle [Angle], maximum amplitude [MA], lysis at 30 min [LY30]; n = 220) and 100% (n = 44) for hypercoagulation, healthy, and hypocoagulation diagnoses. This should provide fresh insight into existing paradigms and help more clinical needs.
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Affiliation(s)
- Longfei Chen
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Le Yu
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Ming Chen
- Department of Blood Transfusion, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yantong Liu
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China
| | - Hongshan Xu
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Fang Wang
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Jiaomeng Zhu
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Pengfu Tian
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Kezhen Yi
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Qian Zhang
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Hui Xiao
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yongwei Duan
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Wei Li
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Linlu Ma
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yanxiang Cheng
- School of Medicine, Renmin Hospital, Wuhan University, Wuhan 430060, China
| | - Long Bai
- School of Medicine, Zhejiang University, Zhejiang 310002, China
| | - Fubing Wang
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Xuan Xiao
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China
| | - Yimin Zhu
- School of Medicine, Zhejiang University, Zhejiang 310002, China
| | - Yi Yang
- Department of Clinical Laboratory, Institute of Translational Medicine, Institute of Medicine and Physics, Renmin Hospital of Wuhan University, Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics & Technology, Wuhan University, Wuhan 430072, China; Shenzhen Research Institute, Wuhan University, Shenzhen 518000, China.
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Belgodère L, Emmerich J, Albin N, Bacon T, Daynes P, Vignot S, Vial T, Renaud G, Le Saulnier C, Maillard-Couvreur C, Cachet M, Veyries ML, Youdarene R, Oualikene-Gonin W, Ratignier-Carbonneil C, Maison P. Prevention and management of health products shortages by the French national agency (ANSM), 10 years of experience. Front Public Health 2023; 11:1293110. [PMID: 38045969 PMCID: PMC10690943 DOI: 10.3389/fpubh.2023.1293110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Shortages of drugs and medical devices have tended to increase in France and worldwide, with consequences for patients and healthcare professionals. Preventing shortages of health products has become a priority for regulatory authorities, including the French National Agency for Medicines and Health Products Safety (ANSM). To highlight perspectives for a better prevention, we described and analyzed the management of shortages in the availability of health products in France over the last 10 years. The supply chain was mapped to identify the main causes of shortages and stakeholders involved in managing shortages throughout the supply chain. National and European initiatives and regulatory measures were reviewed. A retrospective nationwide data analysis from the French reporting system of health product shortage reports was conducted over 10 years for drugs (2013-2022) and over an 18-month period for medical devices, from 1st March 2022 to 31st August 2023. An increase in drug shortage reports was observed, rising from 404 in 2013 to 3,761 in 2022 for drugs, with a relatively constant distribution of affected therapeutic classes. In 2022, the main reported causes of drug shortage risk were insufficient production capacity (27.1%), increased sales volume (21.5%), or lack of supply (13.6%). Over half of the reports on medical devices (55.4%) were objectified as indispensable, and their causes were mainly due to a lack of supply (48.2%), discontinuation of marketing (14.9%), increased sales volume (13.2%), and regulatory reasons (9.6%). ANSM and French authorities have engaged a public health policy for prevention and management of health product shortages including financial penalties, minimum safety stocks for Major Therapeutic Interest drugs, and a shortage management plan. Based on 10 years of experience, four priority measures have been identified to anticipate the risk of heath products shortages based: the importance of a national coordination from raw materials to local market, the implementation of new prevention and management actions in the supply chain, strengthening European cooperation and regulation including the establishment of a list of critical drugs, and promoting transparency and information.
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Affiliation(s)
- Laëtitia Belgodère
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Joseph Emmerich
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- Hôpital Saint Joseph Paris (Médecine Vasculaire), INSERM 1153 CRESS, Université de Paris Cité, Paris, France
| | - Nicolas Albin
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- Groupe Hospitalier Mutualiste de Grenoble, Institut Daniel Hollard, Grenoble, France
| | - Trystan Bacon
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- General Practitioner, Montmerle-sur-Saône, France
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de travail "Thérapeutique", Collège de la médecine générale, Paris, France
| | - Pascale Daynes
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- Union Francophone des Patients Partenaires, Faculté de Médecine, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Stéphane Vignot
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- Institut Godinot, Reims, France
| | - Thierry Vial
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- Hospices Civils de Lyon, Lyon, France
| | - Guillaume Renaud
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Carole Le Saulnier
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | | | - Mélanie Cachet
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Marie-Laure Veyries
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Rym Youdarene
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | - Wahiba Oualikene-Gonin
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
| | | | - Patrick Maison
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), Saint Denis, France
- EA 7379, Epiderme, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- CHI Créteil, Créteil, France
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Spadola M, Muhammad N, Ajmera S, Jabarkheel R, Tomlinson S, Miranda SP, Grady MS, Schuster J, Blue R. The Device for Intraventricular Entry guide: a novel solution to a perpetual problem. J Neurosurg 2023:1-6. [PMID: 37976517 DOI: 10.3171/2023.8.jns23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/29/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The authors designed a low-profile device for reliable ventricular access and prospectively studied its safety, efficacy, and accuracy at a large academic center. METHODS A novel device for ventricular entry, the Device for Intraventricular Entry (DIVE) guide, was designed and created by the first and senior authors. Fifty patients undergoing external ventricular drainage (EVD) or shunt placement were prospectively enrolled for DIVE-assisted catheter placement at a single academic center. The primary outcome was the catheter tip location on postprocedural CT. Secondary outcomes included number of catheter passes, clinically significant hemorrhages, and procedure-related infections. RESULTS Fifty patients were enrolled. Indications included subarachnoid hemorrhage, intraventricular hemorrhage, traumatic brain injury, hydrocephalus, pseudotumor, and postsurgical wound drainage. In total, 76% (38/50) of patients underwent right-sided placement and 24% (12/50) underwent left-sided placement. All 100% (50/50) of patients had successful cannulation with an average of 1.06 passes. Postprocedural head CT confirmed ipsilateral frontal horn or third ventricle placement (Kakarla grade 1) in 92% (46/50) of patients and placement in the contralateral lateral ventricle in 8% (4/50) (Kakarla grade 2). There were no clinically significant track hemorrhages or procedural infections. CONCLUSIONS This single-center prospective study investigated the safety and efficacy of DIVE-assisted ventricular access. In total, 100% of procedures had successful ventricular cannulation, with 92% achieving Kakarla grade 1, with an average of 1.06 passes without any clinical complications.
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Kawsar A, Hussain K, Kalsi D, Kemos P, Marsden H, Thomas L. Patient perspectives of artificial intelligence as a medical device in a skin cancer pathway. Front Med (Lausanne) 2023; 10:1259595. [PMID: 38046409 PMCID: PMC10693417 DOI: 10.3389/fmed.2023.1259595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
The use of artificial intelligence as a medical device (AIaMD) in healthcare systems is increasing rapidly. In dermatology, this has been accelerated in response to increasing skin cancer referral rates, workforce shortages and backlog generated by the COVID-19 pandemic. Evidence regarding patient perspectives of AIaMD is currently lacking in the literature. Patient acceptability is fundamental if this novel technology is to be effectively integrated into care pathways and patients must be confident that it is implemented safely, legally, and ethically. A prospective, single-center, single-arm, masked, non-inferiority, adaptive, group sequential design trial, recruited patients referred to a teledermatology cancer pathway. AIaMD assessment of dermoscopic images were compared with clinical or histological diagnosis, to assess performance (NCT04123678). Participants completed an online questionnaire to evaluate their views regarding use of AIaMD in the skin cancer pathway. Two hundred and sixty eight responses were received between February 2020 and August 2021. The majority of respondents were female (57.5%), ranged in age between 18 and 93 years old, Fitzpatrick type I-II skin (81.3%) and all 6 skin types were represented. Overall, there was a positive sentiment regarding potential use of AIaMD in skin cancer pathways. The majority of respondents felt confident in computers being used to help doctors diagnose and formulate management plans (median = 70; interquartile range (IQR) = 50-95) and as a support tool for general practitioners when assessing skin lesions (median = 85; IQR = 65-100). Respondents were comfortable having their photographs taken with a mobile phone device (median = 95; IQR = 70-100), which is similar to other studies assessing patient acceptability of teledermatology services. To the best of our knowledge, this is the first comprehensive study evaluating patient perspectives of AIaMD in skin cancer pathways in the UK. Patient involvement is essential for the development and implementation of new technologies. Continued end-user feedback will allow refinement of services to ensure patient acceptability. This study demonstrates patient acceptability of the use of AIaMD in both primary and secondary care settings.
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Affiliation(s)
- Anusuya Kawsar
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Khawar Hussain
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Polychronis Kemos
- Skin Analytics Ltd., London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | | | - Lucy Thomas
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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Reis ZSN, Pappa GL, Nader PDJH, do Vale MS, Silveira Neves G, Vitral GLN, Mussagy N, Norberto Dias IM, Romanelli RMDC. Respiratory distress syndrome prediction at birth by optical skin maturity assessment and machine learning models for limited-resource settings: a development and validation study. Front Pediatr 2023; 11:1264527. [PMID: 38054190 PMCID: PMC10694507 DOI: 10.3389/fped.2023.1264527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023] Open
Abstract
Background A handheld optical device was developed to evaluate a newborn's skin maturity by assessing the photobiological properties of the tissue and processing it with other variables to predict early neonatal prognosis related to prematurity. This study assessed the device's ability to predict respiratory distress syndrome (RDS). Methods To assess the device's utility we enrolled newborns at childbirth in six urban perinatal centers from two multicenter single-blinded clinical trials. All newborns had inpatient follow-up until 72 h of life. We trained supervised machine learning models with data from 780 newborns in a Brazilian trial and provided external validation with data from 305 low-birth-weight newborns from another trial that assessed Brazilian and Mozambican newborns. The index test measured skin optical reflection with an optical sensor and adjusted acquired values with clinical variables such as birth weight and prenatal corticoid exposition for lung maturity, maternal diabetes, and hypertensive disturbances. The performance of the models was evaluated using intrasample k-parts cross-validation and external validation in an independent sample. Results Models adjusting three predictors (skin reflection, birth weight, and antenatal corticoid exposure) or five predictors had a similar performance, including or not maternal diabetes and hypertensive diseases. The best global accuracy was 89.7 (95% CI: 87.4 to 91.8, with a high sensitivity of 85.6% (80.2 to 90.0) and specificity of 91.3% (95% CI: 88.7 to 93.5). The test correctly discriminated RDS newborns in external validation, with 82.3% (95% CI: 77.5 to 86.4) accuracy. Our findings demonstrate a new way to assess a newborn's lung maturity, providing potential opportunities for earlier and more effective care. Trial registration RBR-3f5bm5 (online access: http://www.ensaiosclinicos.gov.br/rg/RBR-3f5bm5/), and RBR-33mjf (online access: https://ensaiosclinicos.gov.br/rg/RBR-33rnjf/).
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Affiliation(s)
| | - Gisele Lobo Pappa
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Grayek E, Krishnamurti T, Hu L, Babich O, Warren K, Fischhoff B. Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e46237. [PMID: 37966871 PMCID: PMC10687688 DOI: 10.2196/46237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses. OBJECTIVE This systematic review aims to address 2 critical questions regarding clinical trials of software as a medical device (SaMD) apps: How well do researchers report adherence and engagement metrics for studies of effectiveness and efficacy? and What efficacy analyses do researchers use to account for nonadherence and how appropriate are their methods? METHODS We searched the Food and Drug Administration's registration database for registrations of repeated-use, patient-facing SaMD therapeutics. For each such registration, we searched ClinicalTrials.gov, company websites, and MEDLINE for the corresponding clinical trial and study articles through March 2022. Adherence and engagement data were summarized for each of the 24 identified articles, corresponding to 10 SaMD therapeutics. Each article was analyzed with a framework developed using the Cochrane risk-of-bias questions to estimate the potential effects of imperfect adherence on SaMD effectiveness. This review, funded by the Richard King Mellon Foundation, is registered on the Open Science Framework. RESULTS We found that although most articles (23/24, 96%) reported collecting information about SaMD therapeutic engagement, of the 20 articles for apps with prescribed use, only 9 (45%) reported adherence information across all aspects of prescribed use: 15 (75%) reported metrics for the initiation of therapeutic use, 16 (80%) reported metrics reporting adherence between the initiation and discontinuation of the therapeutic (implementation), and 4 (20%) reported the discontinuation of the therapeutic (persistence). The articles varied in the reported metrics. For trials that reported adherence or engagement, there were 4 definitions of initiation, 8 definitions of implementation, and 4 definitions of persistence. All articles studying a therapeutic with a prescribed use reported effectiveness estimates that might have been affected by nonadherence; only a few (2/20, 10%) used methods appropriate to evaluate efficacy. CONCLUSIONS This review identifies 5 areas for improving future SaMD trials and studies: use consistent metrics for reporting adherence, use reliable adherence metrics, preregister analyses for observational studies, use less biased efficacy analysis methods, and fully report statistical methods and assumptions.
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Affiliation(s)
- Emily Grayek
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lydia Hu
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Olivia Babich
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katherine Warren
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, United States
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