1
|
Bowness JS, Liu X, Keane PA. Leading in the development, standardised evaluation, and adoption of artificial intelligence in clinical practice: regional anaesthesia as an example. Br J Anaesth 2024; 132:1016-1021. [PMID: 38302346 DOI: 10.1016/j.bja.2023.12.024] [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: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
A recent study by Suissa and colleagues explored the clinical relevance of a medical image segmentation metric (Dice metric) commonly used in the field of artificial intelligence (AI). They showed that pixel-wise agreement for physician identification of structures on ultrasound images is variable, and a relatively low Dice metric (0.34) correlated to a substantial agreement on subjective clinical assessment. We highlight the need to bring structure and clinical perspective to the evaluation of medical AI, which clinicians are best placed to direct.
Collapse
Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pearse A Keane
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Bowness JS, Metcalfe D, El-Boghdadly K, Thurley N, Morecroft M, Hartley T, Krawczyk J, Noble JA, Higham H. Artificial intelligence for ultrasound scanning in regional anaesthesia: a scoping review of the evidence from multiple disciplines. Br J Anaesth 2024; 132:1049-1062. [PMID: 38448269 DOI: 10.1016/j.bja.2024.01.036] [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: 11/28/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) for ultrasound scanning in regional anaesthesia is a rapidly developing interdisciplinary field. There is a risk that work could be undertaken in parallel by different elements of the community but with a lack of knowledge transfer between disciplines, leading to repetition and diverging methodologies. This scoping review aimed to identify and map the available literature on the accuracy and utility of AI systems for ultrasound scanning in regional anaesthesia. METHODS A literature search was conducted using Medline, Embase, CINAHL, IEEE Xplore, and ACM Digital Library. Clinical trial registries, a registry of doctoral theses, regulatory authority databases, and websites of learned societies in the field were searched. Online commercial sources were also reviewed. RESULTS In total, 13,014 sources were identified; 116 were included for full-text review. A marked change in AI techniques was noted in 2016-17, from which point on the predominant technique used was deep learning. Methods of evaluating accuracy are variable, meaning it is impossible to compare the performance of one model with another. Evaluations of utility are more comparable, but predominantly gained from the simulation setting with limited clinical data on efficacy or safety. Study methodology and reporting lack standardisation. CONCLUSIONS There is a lack of structure to the evaluation of accuracy and utility of AI for ultrasound scanning in regional anaesthesia, which hinders rigorous appraisal and clinical uptake. A framework for consistent evaluation is needed to inform model evaluation, allow comparison between approaches/models, and facilitate appropriate clinical adoption.
Collapse
Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK; Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK. https://twitter.com/@TraumaDataDoc
| | - Kariem El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's & St Thomas's NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK. https://twitter.com/@elboghdadly
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Megan Morecroft
- Faculty of Medicine, Health & Life Sciences, University of Swansea, Swansea, UK
| | - Thomas Hartley
- Intelligent Ultrasound, Cardiff, UK. https://twitter.com/@tomhartley84
| | - Joanna Krawczyk
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK. https://twitter.com/@AlisonNoble_OU
| | - Helen Higham
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. https://twitter.com/@HelenEHigham
| |
Collapse
|
3
|
Glenn B, Tieppo Francio V, Westerhaus BD, Goree J, Strand NH, Sparks D, Petersen E. Accessibility and Ease of Use in Neuromodulation Devices. Neuromodulation 2024; 27:584-588. [PMID: 37045647 DOI: 10.1016/j.neurom.2023.03.003] [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: 12/15/2022] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The utilization of neuromodulation therapy continues to grow as therapeutic indications expand. These conditions often present with comorbid physical, visual, and auditory impairments. Patients with disabilities in these categories may have difficulty operating their devices. Thus, reviewing the accessibility and inclusive design of neuromodulation devices is imperative to ensure equal access for patients of all ability levels. To date, the literature provides little insight into this topic. MATERIALS AND METHODS Manufacturers of Food and Drug Administration-approved neuromodulation devices in the United States completed our electronic survey to assess neuromodulation device features, universal/inclusive design guidelines, and methods used to make the device accessible to patients with disabilities. RESULTS We assessed 11 devices from seven manufacturers. Of those, there were six spinal cord, two peripheral nerve, and three deep brain stimulators. Of all respondents, 91% used universal inclusive design guidelines. Of the studied devices, 91% have an interface that uses visual feedback, and 82% have an interface that uses auditory feedback. All surveyed devices were reported to have an interface that requires physical handling. DISCUSSION Our study found that most devices incorporate auditory signals, buttons with raised indentations, speech commands, or other useful features to assist those with visual disabilities. Visual interfaces may be sufficient for a patient with hearing impairment to use all the surveyed devices. However, dual sensory impairment presents a significant limitation in all devices surveyed. Furthermore, the biggest barrier to using neuromodulation devices was physical impairment because all surveyed devices require physical handling. CONCLUSIONS Manufacturers have awareness of universal inclusive design principles. However, our study was unable to find a device that is accessible to all users regardless of ability. As such, it is critical to involve universal design principles to ensure that inclusive devices are available to improve patient adherence, treatment efficacy, and outcomes.
Collapse
Affiliation(s)
- Brett Glenn
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Vinicius Tieppo Francio
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS, USA; Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Benjamin D Westerhaus
- Cantor Spine Center at The Paley Orthopedics & Spine Institute, West Palm Beach, FL, USA
| | - Johnathan Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
4
|
Naik A, Peterman N, Berke C, Furey CG, DiDomenico J, Abbatematteo J, Detchou D, Catapano JS, Snyder LA, Lawton MT, Stroink A, Arnold PM. Trends in medical device company payments in neurosurgery: a nationwide, multidatabase, geospatial analysis. J Neurosurg 2024; 140:1091-1101. [PMID: 37890179 DOI: 10.3171/2023.8.jns23276] [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: 02/06/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Industry partnerships help advance the field of neurosurgery. Given the nature of the field and its close relationship with innovation, neurosurgeons frequently partner with the medical device industry to advance technology and improve outcomes. However, this can create important ethical concerns for patients. In this paper, the authors sought to comprehensively study how physician payments from medical device companies have changed and what geographic parameters influence the trends observed over the years. METHODS The authors queried and merged several large databases, including Medicare and Medicaid provider usage data and databases from the Open Payments Program, National Plan and Provider Enumeration System, and US Census Bureau. Geospatial analysis was performed using Moran's I and II clustering. Univariate and multivariable analyses were performed using the Mann-Whitney U-test and geospatially weighted multivariable regression for hot spot and cold spot membership. RESULTS Data for 952 counties across the continental United States were analyzed. Ninety-seven counties constituted geographic hot spots. These hot spots were primarily concentrated in Florida, the New York-Pennsylvania region, central Colorado, and southwestern United States. Independent predictors of hot spot membership included greater unemployment rates, the percentage of White patients, the presence of mobile homes, and the percentage of county Hispanic and Black populations. Company-based differences were examined. The vast majority of Medtronic's payments were in the form of royalties and licensing (86.6%). Royalties and licensing accounted for the majority of payments for DePuy (69.4%), Globus Medical (62%), and NuVasive (77.1%). In contrast, other companies, such as Boston Scientific, opted to pay physicians in the form of ownership and investment interests (42.1%). The impact of the COVID-19 pandemic was also assessed. During the onset of the pandemic in 2020, physician payments fell or remained the same across all regions with the exception of the South Atlantic region. However, it was observed that nearly all regions rebounded, with stark elevations in physician payments immediately in 2021. CONCLUSIONS This analysis demonstrates that there are national hot spots and cold spots of physician payments, and offers some social, economic, and company-dependent predictors that may influence the magnitude of payments. Further analysis is needed to better understand this clinical-commercial partnership in healthcare, specifically within neurosurgical practice.
Collapse
Affiliation(s)
- Anant Naik
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Nicholas Peterman
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Chandler Berke
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Charuta G Furey
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Joseph DiDomenico
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Joseph Abbatematteo
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Donald Detchou
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Joshua S Catapano
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Laura A Snyder
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Michael T Lawton
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ann Stroink
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| | - Paul M Arnold
- 1Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois; and
| |
Collapse
|
5
|
Stam R. New developments in cosmetic applications of electromagnetic fields: Client and occupational hazard assessment. Bioelectromagnetics 2024. [PMID: 38533721 DOI: 10.1002/bem.22503] [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: 04/13/2023] [Revised: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Energy-based devices are used to improve features of appearance for aesthetic reasons while avoiding more invasive methods. Examples of treatment targets are the reduction of wrinkles, sagging, unwanted skin lesions, body hair and excess fatty tissue, and the enhancement of muscle tissue. One treatment modality is the use of electromagnetic fields (EMF, 0‒300 GHz). The present work aims to give an up-to-date survey of cosmetic applications of EMF for professional use with an assessment of client and worker exposure and possible adverse effects. A systematic search was conducted for peer-reviewed articles (2007-2022), patents, premarket notifications, manufacturer data, and adverse effects reports. Five categories of cosmetic EMF device with increasing frequency were identified: sinusoid low frequency magnetic fields for lipolysis; pulsed low frequency magnetic fields for skin rejuvenation; pulsed low frequency magnetic fields for muscle building; radiofrequency EMF for lipolysis or skin rejuvenation; microwaves for hair removal or hyperhidrosis. In the vicinity of the last four device categories, there is a potential for exceeding the occupational exposure limits in the European Union EMF Directive, which could lead to nerve or muscle stimulation, burns or overheating. There are also potential hazards for clients or workers wearing active or passive medical devices. The severity of reported adverse effects increases with EMF frequency.
Collapse
Affiliation(s)
- Rianne Stam
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
6
|
Stras A, Grassmann A, Van Campenhout P, Deconinck E, Vanhaecke T, Desmedt B. Analysis of preservatives and fragrances in topical medical devices: The need for more stringent regulation. Contact Dermatitis 2024. [PMID: 38471795 DOI: 10.1111/cod.14533] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/11/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Medical devices (MDs) have a long history of use, and come with regulatory frameworks to ensure user safety. Although topically applied MDs in the form of gels and creams might be used on damaged skin, their composition is often similar to that of cosmetic products applicable to intact skin, especially in terms of preservatives and fragrances. However, unlike cosmetics, these products are not subject to compound-specific restrictions when used in MDs. OBJECTIVE This study aimed to identify and quantify preservatives and fragrances in topically applied MDs and assess their safety towards the Cosmetic Regulation (EC) 1223/2009. METHOD Sixty-nine MDs available on the EU market were subjected to previously validated liquid chromatography tandem mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) methods to identify and quantify occurring preservatives and fragrances. RESULTS Findings revealed that 32% of the examined MDs did not provide comprehensive ingredient lists, leaving users uninformed about potential risks associated with product use. Furthermore, 30% of these MDs would not meet safety standards for cosmetic products and, most significantly, 13% of the analysed samples contained ingredients that are prohibited in leave-on cosmetics. CONCLUSION Results highlight the pressing demand for more stringent requirements regarding the labelling and composition of MDs to enhance patient safety. Improved regulation and transparency can mitigate potential risks associated with the use of topically applied MDs.
Collapse
Affiliation(s)
- Ania Stras
- Medicines and Health Products, Sciensano, Elsene, Belgium
- Department In Vitro Toxicology and Dermato-Cosmetology (IVTD), Vrije Universiteit Brussel, Jette, Belgium
| | | | | | - Eric Deconinck
- Medicines and Health Products, Sciensano, Elsene, Belgium
| | - Tamara Vanhaecke
- Department In Vitro Toxicology and Dermato-Cosmetology (IVTD), Vrije Universiteit Brussel, Jette, Belgium
| | - Bart Desmedt
- Medicines and Health Products, Sciensano, Elsene, Belgium
| |
Collapse
|
7
|
Fernandez LL, Griswold D, Khun I, Rodriguez De Francisco DV. Innovative Solutions for Patients Who Undergo Craniectomy: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e50647. [PMID: 38451601 PMCID: PMC10958337 DOI: 10.2196/50647] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Decompressive craniectomy (DC) is a widely used procedure to alleviate high intracranial pressure. Multidisciplinary teams have designed and implemented external medical prototypes to improve patient life quality and avoid complications following DC in patients awaiting cranioplasty (CP), including 3D printing and plaster prototypes when available. OBJECTIVE This scoping review aims to understand the extent and type of evidence about innovative external prototypes for patients who undergo DC while awaiting CP. METHODS This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. This scoping review will include noninvasive medical devices for adult patients who undergo DC while waiting for CP. The search strategy will be implemented in MEDLINE, Embase, Web of Science, Scielo, Scopus, and the World Health Organization (WHO) Global Health Index Medicus. Patent documents were also allocated in Espacenet, Google Patents, and the World Intellectual Property Organization (WIPO) database. RESULTS This scoping review is not subject to ethical approval as there will be no involvement of patients. The dissemination plan includes publishing the review findings in a peer-reviewed journal and presenting results at conferences that engage the most pertinent stakeholders in innovation and neurosurgery. CONCLUSIONS This scoping review will serve as a baseline to provide evidence for multidisciplinary teams currently designing these noninvasive innovations to reduce the risk of associated complications after DC, hoping that more cost-effective models can be implemented, especially in low- and middle-income countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50647.
Collapse
Affiliation(s)
- Laura L Fernandez
- Clinical & Translational Science Institute and Center for Global Surgery, University of Utah, Salt Lake City, UT, United States
| | - Dylan Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Isla Khun
- University of Cambridge, Cambridge, United Kingdom
| | | |
Collapse
|
8
|
Shah E, Eswaran S, Harer K, Lee A, Nojkov B, Singh P, Chey WD. Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost-benefit and cost-minimization analysis. J Pediatr Gastroenterol Nutr 2024; 78:608-613. [PMID: 38284690 PMCID: PMC10954403 DOI: 10.1002/jpn3.12118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 01/30/2024]
Abstract
Abdominal pain drives significant cost for adolescents with irritable bowel syndrome (IBS). We performed an economic analysis to estimate cost-savings for patients' families and healthcare insurance, and health outcomes, based on abdominal pain improvement with percutaneous electrical nerve field stimulation (PENFS) with IB-Stim® (Neuraxis). We constructed a Markov model with a 1-year time horizon comparing outcomes and costs with PENFS versus usual care without PENFS. Clinical outcomes were derived from a sham-controlled double-blind trial of PENFS for adolescents with IBS. Costs/work-productivity impact for parents were derived from appropriate observational cohorts. PENFS was associated with 18 added healthy days over 1 year of follow-up, increased annual parental wages of $5,802 due to fewer missed work days to care for the child, and $4744 in cost-savings to insurance. Percutaneous electrical field nerve stimulation for adolescents with IBS appears to yield significant cost-savings to patients' families and insurance.
Collapse
Affiliation(s)
- Eric Shah
- Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | - Allen Lee
- Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | | |
Collapse
|
9
|
Duque-Sanchez L, Qu Y, Voelcker NH, Thissen H. Tackling catheter-associated urinary tract infections with next-generation antimicrobial technologies. J Biomed Mater Res A 2024; 112:312-335. [PMID: 37881094 DOI: 10.1002/jbm.a.37630] [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: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.
Collapse
Affiliation(s)
- Lina Duque-Sanchez
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Yue Qu
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nicolas H Voelcker
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Materials Science and Engineering, Monash University, Clayton, Victoria, Australia
| | - Helmut Thissen
- Department of Manufacturing, Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, Australia
| |
Collapse
|
10
|
Sigounas VY. Technologies of care and the engineering imaginary: Two approaches to assistive device design for the Global South. Med Anthropol Q 2024; 38:40-53. [PMID: 37824820 DOI: 10.1111/maq.12818] [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: 12/19/2021] [Accepted: 08/29/2023] [Indexed: 10/14/2023]
Abstract
Assistive devices serve as vectors for the ideals, judgments, and goals that their society of origin has towards people with disabilities. For some Ugandan inventors and prosthetists, familiarity with sociocultural norms and consistent feedback allow them to design prosthetic limbs as technologies of care that specifically meet the needs of Ugandans using these devices. In contrast, many biomedical engineers living in the United States rely on what I call the "engineering imaginary" to produce universalized forms of assistive technology intended for people living in an essentialized Global South. Drawing on research with engineers, prosthetists, and people living with limb loss in Uganda and the United States, I investigate the social and cultural aspects of prosthetic limb design and argue that there is a cross-cultural mismatch about what a prosthetic device does and what kinds of limbs it should fit. This mismatch becomes inscribed in the prosthetic device itself.
Collapse
Affiliation(s)
- Vaia Y Sigounas
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| |
Collapse
|
11
|
Bogdanoski G, Lucas F, Kern W, Czechowska K. Translating the regulatory landscape of medical devices to create fit-for-purpose artificial intelligence (AI) cytometry solutions. Cytometry B Clin Cytom 2024. [PMID: 38396223 DOI: 10.1002/cyto.b.22167] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
The implementation of medical software and artificial intelligence (AI) algorithms into routine clinical cytometry diagnostic practice requires a thorough understanding of regulatory requirements and challenges throughout the cytometry software product lifecycle. To provide cytometry software developers, computational scientists, researchers, industry professionals, and diagnostic physicians/pathologists with an introduction to European Union (EU) and United States (US) regulatory frameworks. Informed by community feedback and needs assessment established during two international cytometry workshops, this article provides an overview of regulatory landscapes as they pertain to the application of AI, AI-enabled medical devices, and Software as a Medical Device in diagnostic flow cytometry. Evolving regulatory frameworks are discussed, and specific examples regarding cytometry instruments, analysis software and clinical flow cytometry in-vitro diagnostic assays are provided. An important consideration for cytometry software development is the modular approach. As such, modules can be segregated and treated as independent components based on the medical purpose and risk and become subjected to a range of context-dependent compliance and regulatory requirements throughout their life cycle. Knowledge of regulatory and compliance requirements enhances the communication and collaboration between developers, researchers, end-users and regulators. This connection is essential to translate scientific innovation into diagnostic practice and to continue to shape the development and revision of new policies, standards, and approaches.
Collapse
Affiliation(s)
- Goce Bogdanoski
- Clinical Development & Operations Quality, R&D Quality, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Fabienne Lucas
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | | | | |
Collapse
|
12
|
González-González MA, Conde SV, Latorre R, Thébault SC, Pratelli M, Spitzer NC, Verkhratsky A, Tremblay MÈ, Akcora CG, Hernández-Reynoso AG, Ecker M, Coates J, Vincent KL, Ma B. Bioelectronic Medicine: a multidisciplinary roadmap from biophysics to precision therapies. Front Integr Neurosci 2024; 18:1321872. [PMID: 38440417 PMCID: PMC10911101 DOI: 10.3389/fnint.2024.1321872] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 03/06/2024] Open
Abstract
Bioelectronic Medicine stands as an emerging field that rapidly evolves and offers distinctive clinical benefits, alongside unique challenges. It consists of the modulation of the nervous system by precise delivery of electrical current for the treatment of clinical conditions, such as post-stroke movement recovery or drug-resistant disorders. The unquestionable clinical impact of Bioelectronic Medicine is underscored by the successful translation to humans in the last decades, and the long list of preclinical studies. Given the emergency of accelerating the progress in new neuromodulation treatments (i.e., drug-resistant hypertension, autoimmune and degenerative diseases), collaboration between multiple fields is imperative. This work intends to foster multidisciplinary work and bring together different fields to provide the fundamental basis underlying Bioelectronic Medicine. In this review we will go from the biophysics of the cell membrane, which we consider the inner core of neuromodulation, to patient care. We will discuss the recently discovered mechanism of neurotransmission switching and how it will impact neuromodulation design, and we will provide an update on neuronal and glial basis in health and disease. The advances in biomedical technology have facilitated the collection of large amounts of data, thereby introducing new challenges in data analysis. We will discuss the current approaches and challenges in high throughput data analysis, encompassing big data, networks, artificial intelligence, and internet of things. Emphasis will be placed on understanding the electrochemical properties of neural interfaces, along with the integration of biocompatible and reliable materials and compliance with biomedical regulations for translational applications. Preclinical validation is foundational to the translational process, and we will discuss the critical aspects of such animal studies. Finally, we will focus on the patient point-of-care and challenges in neuromodulation as the ultimate goal of bioelectronic medicine. This review is a call to scientists from different fields to work together with a common endeavor: accelerate the decoding and modulation of the nervous system in a new era of therapeutic possibilities.
Collapse
Affiliation(s)
- María Alejandra González-González
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, United States
- Department of Pediatric Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Silvia V. Conde
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NOVA University, Lisbon, Portugal
| | - Ramon Latorre
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Stéphanie C. Thébault
- Laboratorio de Investigación Traslacional en salud visual (D-13), Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Querétaro, Mexico
| | - Marta Pratelli
- Neurobiology Department, Kavli Institute for Brain and Mind, UC San Diego, La Jolla, CA, United States
| | - Nicholas C. Spitzer
- Neurobiology Department, Kavli Institute for Brain and Mind, UC San Diego, La Jolla, CA, United States
| | - Alexei Verkhratsky
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Achucarro Centre for Neuroscience, IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- International Collaborative Center on Big Science Plan for Purinergic Signaling, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Stem Cell Biology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Molecular Medicine, Université Laval, Québec City, QC, Canada
- Department of Biochemistry and Molecular Biology, The University of British Columbia, Vancouver, BC, Canada
| | - Cuneyt G. Akcora
- Department of Computer Science, University of Central Florida, Orlando, FL, United States
| | | | - Melanie Ecker
- Department of Biomedical Engineering, University of North Texas, Denton, TX, United States
| | | | - Kathleen L. Vincent
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
| | - Brandy Ma
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States
| |
Collapse
|
13
|
Müller RM, Herziger B, Jeschke S, Neininger MP, Bertsche T, Bertsche A. How Intuitive Is the Administration of Pediatric Emergency Medication Devices for Parents? Objective Observation and Subjective Self-Assessment. Pharmacy (Basel) 2024; 12:36. [PMID: 38392943 PMCID: PMC10893533 DOI: 10.3390/pharmacy12010036] [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: 01/19/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND to assess the intuitiveness of parents' administration of pediatric emergency devices (inhalation, rectal, buccal, nasal, and auto-injector). METHODS We invited parents without prior experience to administer the five devices to dummy dolls. We observed whether the parents chose the correct administration route and subsequently performed the correct administration procedures without clinically relevant errors. We interviewed parents for their self-assessment of their own administration performance and willingness to administer devices in actual emergencies. RESULTS The correct administration route was best for the inhalation device (81/84, 96% of parents) and worst for the intranasal device (25/126, 20%). The correct administration procedures were best for the buccal device (63/98, 64%) and worst for the auto-injector device (0/93, 0%). Their own administration performance was rated to be best by parents for the inhalation device (59/84, 70%) and worst for the auto-injector device (17/93, 18%). The self-assessment of the correct administration overestimated the correct administration procedures for all the devices except the buccal one. Most parents were willing to administer the inhalation device in an emergency (67/94, 79%), while the fewest were willing to administration procedures the auto-injector device (28/93, 30%). CONCLUSIONS Intuitiveness concerning the correct administration route and the subsequent correct administration procedures have to be improved for all the devices examined. The parents mostly overestimated their performance. Willingness to use a device in an actual emergency depended on the device.
Collapse
Affiliation(s)
- Ruth Melinda Müller
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Rostock, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany; (R.M.M.); (B.H.); (S.J.); (A.B.)
- Drug Safety Center, Leipzig University Hospital, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany;
| | - Birthe Herziger
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Rostock, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany; (R.M.M.); (B.H.); (S.J.); (A.B.)
| | - Sarah Jeschke
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Rostock, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany; (R.M.M.); (B.H.); (S.J.); (A.B.)
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse 1, 17475 Greifswald, Germany
| | - Martina Patrizia Neininger
- Drug Safety Center, Leipzig University Hospital, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany;
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center, Leipzig University Hospital, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany;
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Rostock, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany; (R.M.M.); (B.H.); (S.J.); (A.B.)
- Department of Neuropaediatrics, Hospital for Children and Adolescents, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse 1, 17475 Greifswald, Germany
| |
Collapse
|
14
|
Idriss H, Kutová A, Rimpelová S, Elashnikov R, Kolská Z, Lyutakov O, Švorčík V, Slepičková Kasálková N, Slepička P. Polymer-Metal Bilayer with Alkoxy Groups for Antibacterial Improvement. Polymers (Basel) 2024; 16:508. [PMID: 38399886 PMCID: PMC10892951 DOI: 10.3390/polym16040508] [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: 12/26/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Many bio-applicable materials, medical devices, and prosthetics combine both polymer and metal components to benefit from their complementary properties. This goal is normally achieved by their mechanical bonding or casting only. Here, we report an alternative easy method for the chemical grafting of a polymer on the surfaces of a metal or metal alloys using alkoxy amine salt as a coupling agent. The surface morphology of the created composites was studied by various microscopy methods, and their surface area and porosity were determined by adsorption/desorption nitrogen isotherms. The surface chemical composition was also examined by various spectroscopy techniques and electrokinetic analysis. The distribution of elements on the surface was determined, and the successful bonding of the metal/alloys on one side with the polymer on the other by alkoxy amine was confirmed. The composites show significantly increased hydrophilicity, reliable chemical stability of the bonding, even interaction with solvent for thirty cycles, and up to 95% less bacterial adhesion for the modified samples in comparison with pristine samples, i.e., characteristics that are promising for their application in the biomedical field, such as for implants, prosthetics, etc. All this uses universal, two-step procedures with minimal use of energy and the possibility of production on a mass scale.
Collapse
Affiliation(s)
- Hazem Idriss
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Anna Kutová
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Silvie Rimpelová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Roman Elashnikov
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Zdeňka Kolská
- Faculty of Science, J. E. Purkyně University, 400 96 Usti nad Labem, Czech Republic
| | - Oleksiy Lyutakov
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Václav Švorčík
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Nikola Slepičková Kasálková
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| | - Petr Slepička
- Department of Solid-State Engineering, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic
| |
Collapse
|
15
|
Peng JY, Lee SS, Lin CR, Lee H, Chen YC. Examining the Impact of the Current Reimbursement Regulation on Patient Access to Innovative Medical Devices in Taiwan: Insights From 8 Years' Reimbursement Data. Value Health Reg Issues 2024; 42:18-25. [PMID: 38350187 DOI: 10.1016/j.vhri.2023.12.009] [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: 08/09/2023] [Revised: 11/26/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVES This study aimed to assess the impact of the reimbursement regulation of medical devices (Regulation), introduced by the National Health Insurance Administration (NHIA) in 2013, on patients' access to innovative medical devices in Taiwan. METHODS Analysis of the amount of time needed from application for NHIA reimbursement for new medical devices to receiving the decision from NHIA was done using the nonreimbursement product list featured on the NHIA website. Additionally, Welch analysis of variance was used to compare the amount of time it took from application to NHIA with reimbursement decisions made by the NHIA for different nonreimbursement code categories. Further, related Pharmaceutical Benefit Reimbursement Scheme meeting minutes were analyzed to obtain more detailed information concerning medical devices' reimbursement or not. RESULTS From December 2012 to June 2021, the overall reimbursement percentage was 56.7%, and the average amount of time between application and reimbursement was 856.7 ± 474.7 days. The mandatory reimbursement rate was about 45%. NHIA reimbursement decisions as special medical devices also take a longer amount of time, because the applicants need to agree to the decision (P < .05). The NHIA decision-making process for nonreimbursement medical devices requires a significantly longer amount of time than for general materials (eg, suture, etc) decisions. CONCLUSIONS Although the Regulation resolves payment issues, it also increases the amount of time to reach reimbursement decisions, thus hindering patient access to innovative medical devices. The study suggests that the review process needs to be simplified concerning reimbursement notification, using local real-world data to support reimbursement decisions.
Collapse
Affiliation(s)
- Jhao-Yang Peng
- Graduate Institute of Business Administration, Fu-Jen Catholic University, New Taipei City, Taiwan; Associate Manager of Market Access and Public Policy, Roche Diagnostics Ltd., Taipei, Taiwan
| | - Sang-Soo Lee
- Sr. Director of Health Care Economics & Government Affairs, Medtronic North Asia, Korea and Japan; Head of Center of Expertise (COE), Health Care Economics & Government Affairs, Medtronic Asia Pacific; Adjunct Professor, Graduate School for Medical Device Management and Research, SAIHST (Samsung Advanced Institute for Health Science & Technology), Sung Kyun Kwan University, Seoul, South Korea
| | - Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Haine Lee
- College of Pharmacy, Pharmaceutical Medicine & Regulatory Science, Yonsei University, Incheon, Republic of Korea; Data Science Center, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Yong-Chen Chen
- Data Science Center, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan; Master Program of Big Data in Biomedicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
| |
Collapse
|
16
|
Campesi I, Franconi F, Serra PA. The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender. Life (Basel) 2024; 14:234. [PMID: 38398743 PMCID: PMC10890141 DOI: 10.3390/life14020234] [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: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs' complexity is rising, and to ensure their appropriate use they must have a sex-gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.
Collapse
Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Flavia Franconi
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Pier Andrea Serra
- Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, 07100 Sassari, Italy;
| |
Collapse
|
17
|
Wang H, Huddleston S, Yang J, Ameer GA. Enabling Proregenerative Medical Devices via Citrate-Based Biomaterials: Transitioning from Inert to Regenerative Biomaterials. Adv Mater 2024; 36:e2306326. [PMID: 38043945 DOI: 10.1002/adma.202306326] [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: 06/29/2023] [Revised: 10/03/2023] [Indexed: 12/05/2023]
Abstract
Regenerative medicine aims to restore tissue and organ function without the use of prosthetics and permanent implants. However, achieving this goal has been elusive, and the field remains mostly an academic discipline with few products widely used in clinical practice. From a materials science perspective, barriers include the lack of proregenerative biomaterials, a complex regulatory process to demonstrate safety and efficacy, and user adoption challenges. Although biomaterials, particularly biodegradable polymers, can play a major role in regenerative medicine, their suboptimal mechanical and degradation properties often limit their use, and they do not support inherent biological processes that facilitate tissue regeneration. As of 2020, nine synthetic biodegradable polymers used in medical devices are cleared or approved for use in the United States of America. Despite the limitations in the design, production, and marketing of these devices, this small number of biodegradable polymers has dominated the resorbable medical device market for the past 50 years. This perspective will review the history and applications of biodegradable polymers used in medical devices, highlight the need and requirements for regenerative biomaterials, and discuss the path behind the recent successful introduction of citrate-based biomaterials for manufacturing innovative medical products aimed at improving the outcome of musculoskeletal surgeries.
Collapse
Affiliation(s)
- Huifeng Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Samantha Huddleston
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Jian Yang
- Biomedical Engineering Program, School of Engineering, Westlake University, Hangzhou, Zhejiang, 310030, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310030, China
| | - Guillermo A Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL, 60611, USA
- International Institute for Nanotechnology, Northwestern University, Evanston, IL, 60208, USA
| |
Collapse
|
18
|
Ozben T, Fragão-Marques M, Tomasi A. A comprehensive review on PFAS including survey results from the EFLM Member Societies. Clin Chem Lab Med 2024; 0:cclm-2023-1418. [PMID: 38280842 DOI: 10.1515/cclm-2023-1418] [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: 12/09/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Per- and polyfluoroalkyl substances (PFASs) are a large class of synthetic chemicals widely used for their unique properties. Without PFAS, many medical device and in vitro diagnostic technologies would not be able to perform their intended purposes. Potential health risks associated with exposure to PFAS influence their use in IVD applications. This paper aims to assess the current situation concerning PFAS, including regulations and legislations for their use. It is important to know what happens to (PFAS) at the end of their lives in medical laboratories. METHODS A survey was conducted in March 2023 to collect information on the potential emission and end-of-life of PFAS-containing medical technologies in the medical laboratories of the EFLM member societies. A series of questions were presented to the EFLM national societies and the results were documented. RESULTS Eight respondents participated in the survey, representing EFLM member societies in seven different countries including hospital laboratories, university laboratories, and private laboratories. CONCLUSIONS PFAS uses in MD and IVD are influenced by several factors, including evolving regulations, advances in technology, safety and efficacy of these substances. Advancements in analytical techniques may lead to more sensitive and precise methods for detecting and quantifying PFAS in biological samples, which can be essential for IVD applications related to biomarker analysis and disease diagnosis. Collaboration among regulatory agencies, industry, research institutions, hospitals, and laboratories on a global scale can aid in establishing harmonized guidelines and standards for the use of PFAS, ensuring consistency and safety within their applications.
Collapse
Affiliation(s)
- Tomris Ozben
- Department of Medical Biochemistry, Akdeniz University, Medical Faculty, Antalya, Türkiye
- University of Modena and Reggio Emilia, Medical Faculty, Clinical and Experimental Medicine, Ph.D. Program, Modena, Italy
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, S Unic@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Aldo Tomasi
- University of Modena and Reggio Emilia, Medical School, Department of Laboratory Medicine, Toxicology Division, Modena, Italy
| |
Collapse
|
19
|
Cho T, Gowda V, Schulzrinne H, Miller BJ. Integrated Devices: A New Regulatory Pathway to Promote Revolutionary Innovation. Milbank Q 2024. [PMID: 38253988 DOI: 10.1111/1468-0009.12692] [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: 06/20/2023] [Revised: 12/03/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Policy Points Current medical device regulatory frameworks date back half a century and are ill suited for the next generation of medical devices that involve a significant software component. Existing Food and Drug Administration efforts are insufficient because of a lack of statutory authority, whereas international examples offer lessons for improving and harmonizing domestic medical device regulatory policy. A voluntary alternative pathway built upon two-stage review with individual component review followed by holistic review for integrated devices would provide regulators with new tools to address a changing medical device marketplace.
Collapse
Affiliation(s)
- Ted Cho
- University of California, San Francisco, California, USA
| | | | | | - Brian J Miller
- The Johns Hopkins University School of Medicine, Baltimore, USA
- The Johns Hopkins Carey Business School
- American Enterprise Institute
| |
Collapse
|
20
|
Morris G, Goodman S, Sorzabal Bellido I, Milanese C, Girella A, Pallavicini P, Taglietti A, Gaboardi M, Jäckel F, Diaz Fernandez YA, Raval R. Temperature and pH Stimuli-Responsive System Delivers Location-Specific Antimicrobial Activity with Natural Products. ACS Appl Bio Mater 2024; 7:131-143. [PMID: 38079569 DOI: 10.1021/acsabm.3c00588] [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: 01/16/2024]
Abstract
Smart materials with controlled stimuli-responsive functions are at the forefront of technological development. In this work, we present a generic strategy that combines simple components, physicochemical responses, and easy fabrication methods to achieve a dual stimuli-responsive system capable of location-specific antimicrobial cargo delivery. The encapsulated system is fabricated by combining a biocompatible inert polymeric matrix of poly(dimethylsiloxane) (PDMS) and a bioactive cargo of saturated fatty acids. We demonstrate the effectiveness of our approach to deliver antimicrobial activity for the model bacteria Escherichia coli. The system responds to two control variables, temperature and pH, delivering two levels of antimicrobial response under distinct combinations of stimuli: one response toward the planktonic media and another response directly at the surface for sessile bacteria. Spatially resolved Raman spectroscopy alongside thermal and structural material analysis reveals that the system not only exhibits ON/OFF states but can also control relocation and targeting of the active cargo toward either the surface or the liquid media, leading to different ON/OFF states for the planktonic and sessile bacteria. The approach proposed herein is technologically simple and scalable, facing low regulatory barriers within the food and healthcare sectors by using approved components and relying on fundamental chemical processes. Our results also provide a proof-of-concept platform for the design and easy fabrication of delivery systems capable of operating as Boolean logic gates, delivering different responses under different environmental conditions.
Collapse
Affiliation(s)
- Gareth Morris
- Open Innovation Hub for Antimicrobial Surfaces, Surface Science Research Centre, University of Liverpool, Liverpool L69 3BX, U.K
- Department of Physics and Stephenson Institute for Renewable Energy, University of Liverpool, Liverpool L69 7ZE, U.K
| | - Sean Goodman
- Open Innovation Hub for Antimicrobial Surfaces, Surface Science Research Centre, University of Liverpool, Liverpool L69 3BX, U.K
| | - Ioritz Sorzabal Bellido
- Open Innovation Hub for Antimicrobial Surfaces, Surface Science Research Centre, University of Liverpool, Liverpool L69 3BX, U.K
| | - Chiara Milanese
- Department of Chemistry, University of Pavia, Via Taramelli 12, Pavia 27100, Italy
| | - Alessandro Girella
- Department of Chemistry, University of Pavia, Via Taramelli 12, Pavia 27100, Italy
| | | | - Angelo Taglietti
- Department of Chemistry, University of Pavia, Via Taramelli 12, Pavia 27100, Italy
| | - Mattia Gaboardi
- Materials Physics Center, CSIC-UPV/EHU, Donostia - San Sebastian 20018, Spain
| | - Frank Jäckel
- Department of Physics and Stephenson Institute for Renewable Energy, University of Liverpool, Liverpool L69 7ZE, U.K
| | - Yuri A Diaz Fernandez
- Open Innovation Hub for Antimicrobial Surfaces, Surface Science Research Centre, University of Liverpool, Liverpool L69 3BX, U.K
- Department of Chemistry, University of Pavia, Via Taramelli 12, Pavia 27100, Italy
| | - Rasmita Raval
- Open Innovation Hub for Antimicrobial Surfaces, Surface Science Research Centre, University of Liverpool, Liverpool L69 3BX, U.K
| |
Collapse
|
21
|
Meyerholz DK, Burrough ER, Kirchhof N, Anderson DJ, Helke KL. Swine models in translational research and medicine. Vet Pathol 2024:3009858231222235. [PMID: 38197394 DOI: 10.1177/03009858231222235] [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: 01/11/2024]
Abstract
Swine are increasingly studied as animal models of human disease. The anatomy, size, longevity, physiology, immune system, and metabolism of swine are more like humans than traditional rodent models. In addition, the size of swine is preferred for surgical placement and testing of medical devices destined for humans. These features make swine useful for biomedical, pharmacological, and toxicological research. With recent advances in gene-editing technologies, genetic modifications can readily and efficiently be made in swine to study genetic disorders. In addition, gene-edited swine tissues are necessary for studies testing and validating xenotransplantation into humans to meet the critical shortfall of viable organs versus need. Underlying all of these biomedical applications, the knowledge of husbandry, background diseases and lesions, and biosecurity needs are important for productive, efficient, and reproducible research when using swine as a human disease model for basic research, preclinical testing, and translational studies.
Collapse
|
22
|
Harkin KR, Sorensen J, Thomas S. Lifecycle evaluation of medical devices: supporting or jeopardizing patient outcomes? A comparative analysis of evaluation models. Int J Technol Assess Health Care 2024; 40:e2. [PMID: 38179661 PMCID: PMC10859834 DOI: 10.1017/s026646232300274x] [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: 11/28/2022] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Lack of evidence regarding safety and effectiveness at market entry is driving the need to consider adopting a lifecycle approach to evaluating medical devices, but it is unclear what lifecycle evaluation means. This research sought to explore the tacit meanings of "lifecycle" and "lifecycle evaluation" as embodied within evaluation models/frameworks used for medical devices. METHODS Drawing on qualitative evidence synthesis methods and using an inductive approach, novel methods were developed to identify, appraise, analyze, and synthesize lifecycle evaluation models used for medical devices. Data was extracted (including purpose; audience; characterization; outputs; timing; and type of model) from key texts for coding, categorization, and comparison, exploring embodied meaning across four broad perspectives. RESULTS Fifty-two models were included in the synthesis. They demonstrated significant heterogeneity of meaning, form, scope, timing, and purpose. The "lifecycle" may represent a single stage, a series of stages, a cycle of innovation, or a system. "Lifecycle evaluation" focuses on the overarching goal of the stakeholder group, and may use a single or repeated evaluation to inform decision-making regarding the adoption of health technologies (Healthcare), resource allocation (Policymaking), investment in new product development or marketing (Trade and Industry), or market regulation (Regulation). The adoption of a lifecycle approach by regulators has resulted in the deferral of evidence generation to the post-market phase. CONCLUSIONS Using a "lifecycle evaluation" approach to inform reimbursement decision-making must not be allowed to further jeopardize evidence generation and patient safety by accepting inadequate evidence of safety and effectiveness for reimbursement decisions.
Collapse
Affiliation(s)
- Kathleen R. Harkin
- Centre for Health Policy and Management, Trinity College Dublin (TCD), Dublin, Ireland
| | - Jan Sorensen
- RCSI Healthcare Outcomes Research Centre, School of Population Health, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin (TCD), Dublin, Ireland
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Pesset CM, Fonseca COD, Antunes M, Santos ALLD, Teixeira IM, Ferreira EDO, Penna B. Biofilm formation by Staphylococcus pseudintermedius on titanium implants. Biofouling 2024; 40:88-97. [PMID: 38407199 DOI: 10.1080/08927014.2024.2320721] [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: 08/08/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
Osteomyelitis often involves Staphylococcus spp. as the isolated genus in domestic animal cases. Implant-related infections, frequently associated with biofilm-forming microorganisms like staphylococci species, necessitate careful material selection. This study assessed biofilm formation by Staphylococcus pseudintermedius on titanium nuts used in veterinary orthopaedic surgery. Biofilm quantification employed safranin staining and spectrophotometric measurement, while bacterial counts were determined in colony-forming units (CFU). Scanning Electron Microscopy (SEM) evaluated the biofilm morphology on the surface of titanium nuts. All samples had CFU counts. Absorbance values that evidence biofilm formation were observed in seven of the eight samples tested. SEM images revealed robust bacterial colonization, and significant extracellular polymeric substance production, and the negative control displayed surface irregularities on the nut. Whole genome sequencing revealed accessory Gene Regulator (agr) type III in six samples, agr IV and agr II in two each. Genes encoding hlb, luk-S, luk-F, siet, se_int, and the icaADCB operon were identified in all sequenced samples. Other exfoliative toxins were absent. Biofilm formation by S. pseudintermedius was detected in all samples, indicating the susceptibility of orthopaedic titanium alloys to adhesion and biofilm formation by veterinary species. The biofilm formation capacity raises concerns about potential post-surgical complications and associated costs.
Collapse
Affiliation(s)
- Camilla Malcher Pesset
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| | - Carolina O da Fonseca
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| | - Milena Antunes
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| | - Ana Luiza L Dos Santos
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| | - Izabel Melo Teixeira
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| | | | - Bruno Penna
- Laboratory of Gram-Positive Cocci, Biomedical Institute, Federal Fluminense University, Niterói, Brazil
| |
Collapse
|
25
|
Ok J, Park S, Jung YH, Kim TI. Wearable and Implantable Cortisol-Sensing Electronics for Stress Monitoring. Adv Mater 2024; 36:e2211595. [PMID: 36917076 DOI: 10.1002/adma.202211595] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Cortisol is a steroid hormone that is released from the body in response to stress. Although a moderate level of cortisol secretion can help the body maintain homeostasis, excessive secretion can cause various diseases, such as depression and anxiety. Conventional methods for cortisol measurement undergo procedures that limit continuous monitoring, typically collecting samples of bodily fluids, followed by separate analysis in a laboratory setting that takes several hours. Thus, recent studies demonstrate wearable, miniaturized sensors integrated with electronic modules that enable wireless real-time analysis. Here, the primary focus is on wearable and implantable electronic devices that continuously measure cortisol concentration. Diverse types of cortisol-sensing techniques, such as antibody-, DNA-aptamer-, and molecularly imprinted polymer-based sensors, as well as wearable and implantable devices that aim to continuously monitor cortisol in a minimally invasive fashion are discussed. In addition to the cortisol monitors that directly measure stress levels, other schemes that indirectly measure stress, such as electrophysiological signals and sweat are also summarized. Finally, the challenges and future directions in stress monitoring and management electronics are reviewed.
Collapse
Affiliation(s)
- Jehyung Ok
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Sumin Park
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Yei Hwan Jung
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Tae-Il Kim
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| |
Collapse
|
26
|
Luu CH, Nguyen NT, Ta HT. Unravelling Surface Modification Strategies for Preventing Medical Device-Induced Thrombosis. Adv Healthc Mater 2024; 13:e2301039. [PMID: 37725037 DOI: 10.1002/adhm.202301039] [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: 06/14/2023] [Revised: 08/29/2023] [Indexed: 09/21/2023]
Abstract
The use of biomaterials in implanted medical devices remains hampered by platelet adhesion and blood coagulation. Thrombus formation is a prevalent cause of failure of these blood-contacting devices. Although systemic anticoagulant can be used to support materials and devices with poor blood compatibility, its negative effects such as an increased chance of bleeding, make materials with superior hemocompatibility extremely attractive, especially for long-term applications. This review examines blood-surface interactions, the pathogenesis of clotting on blood-contacting medical devices, popular surface modification techniques, mechanisms of action of anticoagulant coatings, and discusses future directions in biomaterial research for preventing thrombosis. In addition, this paper comprehensively reviews several novel methods that either entirely prevent interaction between material surfaces and blood components or regulate the reaction of the coagulation cascade, thrombocytes, and leukocytes.
Collapse
Affiliation(s)
- Cuong Hung Luu
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
| | - Nam-Trung Nguyen
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
| | - Hang Thu Ta
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
| |
Collapse
|
27
|
Pacheco-Barrios K, Gianlorenco AC, Camargo L, Dodurgali MR, Tangjade A, Fregni F. Accelerating the development of noninvasive brain stimulation devices: using design thinking to facilitate its clinical use and acceptance. Expert Rev Neurother 2024; 24:5-9. [PMID: 38149610 PMCID: PMC10983014 DOI: 10.1080/14737175.2023.2292733] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Anna Carolyna Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Lucas Camargo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mustafa Reha Dodurgali
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anamon Tangjade
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Rehabilitation Medicine, Vajira hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
28
|
Li Z, Zhao P, Ling Z, Zheng Y, Qu F, Chang H. An Ultraswelling Microneedle Device for Facile and Efficient Drug Loading and Transdermal Delivery. Adv Healthc Mater 2024; 13:e2302406. [PMID: 37861278 DOI: 10.1002/adhm.202302406] [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: 07/26/2023] [Revised: 09/26/2023] [Indexed: 10/21/2023]
Abstract
The advancement and extensive demand for transdermal therapies can benefit from a safe, and efficient and user-friendly transdermal technology with broad applicability in delivering various hydrophilic drugs. Here the design and proof of concept applications of an ultraswelling microneedle device that enables the facile and efficient loading and transdermal delivery of hydrophilic drugs with different molecular weights is reported. The device consists of a super-hydrophilic hydrogel microneedle array and a resin base substrate. Using a special micromolding technique that involves hydrated crosslinking and cryogenic-demolding, the microneedle part displays a rapid swelling ratio of ≈3800%, enabling the loading of drugs up to 500 kDa in molecular weight. The drug loading process using the device just involves incubating the microneedle part in a drug solution for 1 min, followed by 15 min of drying. The microneedles can easily penetrate the skin under press and detach from the base substrate under shear, thereby releasing the payload. Administration of desired therapeutic agents using the device outperformed conventional administration methods in mitigating psoriasis and eliciting immunity. This biocompatible device, capable of withstanding ethylene oxide sterilization, can enhance the efficacy and accessibility of transdermal therapies in research institutes, hospitals, and even home settings.
Collapse
Affiliation(s)
- Zhiming Li
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
| | - Puxuan Zhao
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
| | - Zhixin Ling
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
| | - Yanting Zheng
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
| | - Fengli Qu
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
| | - Hao Chang
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
| |
Collapse
|
29
|
Başbakkal Z, Yilmaz HB, Gümüş M, Belli M, Erçelik ZE. Medical device-related pressure injuries in paediatric patients: An incidence study in a children's hospital. J Clin Nurs 2023. [PMID: 38131511 DOI: 10.1111/jocn.16973] [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: 07/20/2023] [Revised: 11/05/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
AIM To determine the incidence of pressure injuries from medical devices in children. BACKGROUND Medical devices can cause pressure injuries on skin and soft tissues. DESIGN A prospective, descriptive study adhering to STROBE guidelines. METHODS This study was conducted in the third-level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. RESULTS In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). CONCLUSION The incidence of medical device-related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. RELEVANCE TO CLINICAL PRACTICE The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness-raising and educational activities among health professionals and nurses should be accelerated. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the study.
Collapse
Affiliation(s)
| | | | - Merve Gümüş
- Department of Pediatric Nursing, Ege University, İzmir, Turkey
| | - Mustafa Belli
- Department of Pediatric Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Zübeyde Ezgi Erçelik
- Department of Pediatric Nursing, Bandırma Onyedi Eylül University, Balıkesir/Bandırma, Turkey
| |
Collapse
|
30
|
Somorin YM, O'Connor GM. Assessment of microbial contamination in laser materials processing laboratories used for prototyping of bio medical devices. Access Microbiol 2023; 5:000494.v3. [PMID: 38188238 PMCID: PMC10765054 DOI: 10.1099/acmi.0.000494.v3] [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: 09/13/2022] [Accepted: 11/02/2023] [Indexed: 01/09/2024] Open
Abstract
Microbial contamination of medical devices during pilot production can be a significant barrier as the laboratory environment is a source of contamination. There is limited information on microbial contaminants in laser laboratories and environments involved in the pilot production of medical devices. This study aimed to determine the bioburden and microbial contaminants present in three laser laboratories - an ISO class 7 clean room, a pilot line facility and a standard laser laboratory. Microbiological air sampling was by passive air sampling using settle plates and the identity of isolates was confirmed by DNA sequencing. Particulate matter was analysed using a portable optical particle counter. Twenty bacterial and 16 fungal genera were isolated, with the genera Staphylococcus and Micrococcus being predominant. Most isolates are associated with skin, mouth, or upper respiratory tract. There was no significant correlation between microbial count and PM2.5 concentration in the three laboratories. There were low levels but diverse microbial population in the laser-processing environments. Pathogenic bacteria such as Acinetobacter baumannii and Candida parapsilosis were isolated in those environments. These results provide data that will be useful for developing a contamination control plan for controlling microbial contamination and facilitating advanced manufacturing of laser-based pilot production of medical devices.
Collapse
Affiliation(s)
- Yinka M. Somorin
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
- Irish Photonic Integration Centre (IPIC), Tyndall National Institute, Cork, Ireland
| | - Gerard M. O'Connor
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
| |
Collapse
|
31
|
Gupta P, Rai C, Shahi A, Sharma M, Choudhury R, Kotwal A. A comprehensive roadmap for MedTech innovations uptake into the public healthcare system in India. Front Digit Health 2023; 5:1268010. [PMID: 38107824 PMCID: PMC10722438 DOI: 10.3389/fdgth.2023.1268010] [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: 07/27/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background The burden of communicable, non-communicable diseases and reproductive maternal, newborn, child & adolescent health in India, reflects the necessity to develop tailored solutions. The plethora of MedTech innovations has provided healthcare facilities with more effective, affordable and accessible healthcare for people across the country. However, in spite of the Make-in-India scheme in the country, the indigenously developed healthcare technology is far from making an impact on the healthcare system. Objective To present a roadmap for MedTech innovations for their successful deployment into the public healthcare system. Methodology In addition to the literature review, recommendations were included from several stakeholders such as innovators, manufacturers, policymakers, subject matter experts, funding organizations, State health officials etc. Results and conclusion The journey of healthcare innovation from need identification to ideation, to prototyping and validation has paved the way towards the de novo design that caters to unmet needs. Innovations at the advanced technology readiness level (TRL 7/8 and above) demand a holistic and multidisciplinary approach which includes clinical validation, regulatory approval and Health technology assessment. The deployment of healthcare technology into the public healthcare system must consider resources (e.g., time, staff, budget, investment policies), ethical concerns (privacy, security, regulations, ownership), governance (policy, accountability, responsibility etc.), and Skills (capabilities, culture, etc.). The technologies are considered for field trials before the uptake in the public health system. Technology can be a key tool in achieving Universal Health Coverage but its use has to be strategic, judicious, and cognizant of issues around privacy and patient rights.
Collapse
Affiliation(s)
| | | | | | | | - Ranjan Choudhury
- Healthcare Technology Division, National Health Systems Resource Center (NHSRC), Munirka, India
| | | |
Collapse
|
32
|
Kaufmann NC, Zeka B, Pereira PL. Research in interventional oncology: How sound is the evidence base? J Med Imaging Radiat Oncol 2023; 67:903-914. [PMID: 37170844 DOI: 10.1111/1754-9485.13529] [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: 01/09/2023] [Accepted: 03/26/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Interventional oncology (IO) is an essential component of cancer care, which has gained substantial recognition in recent years. The aim of this review is to evaluate the level of evidence supporting IO and its inclusion in cancer treatment guidelines. METHODS A literature search of the PubMed database was performed to identify publication numbers and types for IO treatments published between 2012 and 2022. Selected cancer treatment guidelines and recommendations were reviewed for their inclusion of IO treatments. RESULTS With 68%, the majority of studies on IO treatments are case reports while randomised controlled trials (RCTs) amount only to 7% of studies. Despite this, IO studies have generated sufficient data to support the inclusion of IO treatments in cancer treatment guidelines and recommendations. This was frequently based on large prospective patient cohorts that corresponded to 24% (20% non-randomised studies and 4% observational studies) of all analysed studies rather than RCTs. CONCLUSION The level of evidence underpinning IO, as well as inclusion of IO in treatment guidelines and recommendations have increased substantially in recent years, indicating the growing importance and acceptance of IO in cancer care. The difficulty in conducting RCTs in IO is mitigated by the observation that they are not necessary to achieve guideline-inclusion. Nevertheless, it is crucial to conduct well-designed research projects to further consolidate the position of IO in the field of oncology. This will ensure that IO continues to evolve and meet the needs of cancer patients worldwide.
Collapse
Affiliation(s)
- Nathalie C Kaufmann
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
- Next Research GmbH, Contract Research Organisation, Vienna, Austria
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
- Next Research GmbH, Contract Research Organisation, Vienna, Austria
| | - Philippe L Pereira
- SLK-Kliniken Heilbronn GmbH, Zentrum für Radiologie, Minimal-Invasive Therapien und Nuklearmedizin, Heilbronn, Germany
- Academic Hospital Karls-Ruprecht University, Heidelberg, Germany
- Eberhard-Karls-University, Tübingen, Germany
- Danube Private University, Krems, Austria
| |
Collapse
|
33
|
Li D, Shi H, Qi Q, Chang B, Jiang Y, Qian K, Guan X, Kang P, Ma N, Zhang Y, Zhang Z, Shi X, Qu C, Wu Y, Chen W, Chen H, Li B, Chen L, Li Z, Ma S, Xu L, Zhang Y, Tian J, Hu Z, Jia W, Cheng Z. Clinically Translatable Solid-State Dye for NIR-II Imaging of Medical Devices. Adv Sci (Weinh) 2023; 10:e2303491. [PMID: 37946702 PMCID: PMC10754084 DOI: 10.1002/advs.202303491] [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] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/04/2023] [Indexed: 11/12/2023]
Abstract
Medical devices are commonly implanted underneath the skin, but how to real-time noninvasively monitor their migration, integrity, and biodegradation in human body is still a formidable challenge. Here, the study demonstrates that benzyl violet 4B (BV-4B), a main component in the FDA-approved surgical suture, is found to produce fluorescence signal in the first near-infrared window (NIR-I, 700-900 nm) in polar solutions, whereas BV-4B self-assembles into highly crystalline aggregates upon a formation of ultrasmall nanodots and can emit strong fluorescence in the second near-infrared window (NIR-II, 1000-1700 nm) with a dramatic bathochromic shift in the absorption spectrum of ≈200 nm. Intriguingly, BV-4B-involved suture knots underneath the skin can be facilely monitored during the whole degradation process in vivo, and the rupture of the customized BV-4B-coated silicone catheter is noninvasively diagnosed by NIR-II imaging. Furthermore, BV-4B suspended in embolization glue achieves hybrid fluorescence-guided surgery (hybrid FGS) for arteriovenous malformation. As a proof-of-concept study, the solid-state BV-4B is successfully used for NIR-II imaging of surgical sutures in operations of patients. Overall, as a clinically translatable solid-state dye, BV-4B can be applied for in vivo monitoring the fate of medical devices by NIR-II imaging.
Collapse
|
34
|
Garot C, Schoffit S, Monfoulet C, Machillot P, Deroy C, Roques S, Vial J, Vollaire J, Renard M, Ghanem H, El-Hafci H, Decambron A, Josserand V, Bordenave L, Bettega G, Durand M, Manassero M, Viateau V, Logeart-Avramoglou D, Picart C. 3D-Printed Osteoinductive Polymeric Scaffolds with Optimized Architecture to Repair a Sheep Metatarsal Critical-Size Bone Defect. Adv Healthc Mater 2023; 12:e2301692. [PMID: 37655491 DOI: 10.1002/adhm.202301692] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/10/2023] [Indexed: 09/02/2023]
Abstract
The reconstruction of critical-size bone defects in long bones remains a challenge for clinicians. A new osteoinductive medical device is developed here for long bone repair by combining a 3D-printed architectured cylindrical scaffold made of clinical-grade polylactic acid (PLA) with a polyelectrolyte film coating delivering the osteogenic bone morphogenetic protein 2 (BMP-2). This film-coated scaffold is used to repair a sheep metatarsal 25-mm long critical-size bone defect. In vitro and in vivo biocompatibility of the film-coated PLA material is proved according to ISO standards. Scaffold geometry is found to influence BMP-2 incorporation. Bone regeneration is followed using X-ray scans, µCT scans, and histology. It is shown that scaffold internal geometry, notably pore shape, influenced bone regeneration, which is homogenous longitudinally. Scaffolds with cubic pores of ≈870 µm and a low BMP-2 dose of ≈120 µg cm-3 induce the best bone regeneration without any adverse effects. The visual score given by clinicians during animal follow-up is found to be an easy way to predict bone regeneration. This work opens perspectives for a clinical application in personalized bone regeneration.
Collapse
Affiliation(s)
- Charlotte Garot
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
| | - Sarah Schoffit
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Cécile Monfoulet
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Paul Machillot
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
| | - Claire Deroy
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Samantha Roques
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Julie Vial
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Julien Vollaire
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Institute of Advanced Biosciences, Université Grenoble Alpes, Grenoble, F-38000, France
| | - Martine Renard
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Hasan Ghanem
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Hanane El-Hafci
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Adeline Decambron
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Véronique Josserand
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Institute of Advanced Biosciences, Université Grenoble Alpes, Grenoble, F-38000, France
| | - Laurence Bordenave
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Georges Bettega
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Annecy Genevois, 1 avenue de l'hôpital, Epagny Metz-Tessy, F-74370, France
| | - Marlène Durand
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Mathieu Manassero
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Véronique Viateau
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | | | - Catherine Picart
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
- Institut Universitaire de France (IUF), 1 rue Descartes, Paris CEDEX 05, 75231, France
| |
Collapse
|
35
|
Gatica-Ortega ME, Rodríguez-Lago L, Beneyto P, Pastor-Nieto MA, Borrego L. Prognosis and sequelae of meth(acrylate) sensitization in beauticians and consumers of manicure materials. Contact Dermatitis 2023; 89:471-479. [PMID: 37667591 DOI: 10.1111/cod.14408] [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: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Allergic contact dermatitis from (meth)acrylic monomers (ACDMA) in manicure products is increasing. OBJECTIVE To evaluate the prognosis, work performance impairment and sequelae of a cohort of beauticians and manicure consumers with ACDMA sensitized from the exposure to manicure products. METHODS We conducted a telephone survey with patients diagnosed with ACDMA. RESULTS One hundred and six patients were evaluated, including 75 (70.8%) beauticians and 31 (29.2%) consumers. All were women with a mean age of 39 (19-62). Thirty-seven of 75 beauticians (49.3%) continued to work. Twenty-seven of 106 (25.5%) patients continued to use manicure products with (meth)acrylates regularly. Seventeen of 51 (33.3%) patients who discontinued the exposure described ongoing nail/periungual changes. Nine of 58 (15.5%) patients who required dental restoration, orthodontic or occlusal splint materials recalled reactions from them; and, 25 of 96 (26%) who used sanitary napkins recalled intolerance to them starting after the diagnosis of ACDMA. Fifteen of 25 (60%) discontinued the use of sanitary napkins. CONCLUSION 49.3% beauticians continued to work; most patients stopped wearing acrylic manicure materials; reactions from dental materials were not uncommon, however, removal of dental materials was never required; and, reactions to sanitary napkins developing after the diagnosis of ACDMA were common most leading to discontinuation of use.
Collapse
Affiliation(s)
- María E Gatica-Ortega
- Dermatology Department, Hospital Universitario de Toledo, Toledo, Spain
- Escuela Internacional de Doctorado, Universidad de Castilla-La-Mancha, Toledo, Spain
| | - Laura Rodríguez-Lago
- Dermatology Department, Hospital Universitario Insular, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Beneyto
- Unidad de Apoyo a la Investigación Department, Hospital Universitario de Toledo, Toledo, Spain
| | - María A Pastor-Nieto
- Escuela Internacional de Doctorado, Universidad de Castilla-La-Mancha, Toledo, Spain
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Dermatology Department, Hospital Universitario de Guadalajara, Madrid, Spain
- Medicine and Medical Specialties Department, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Leopoldo Borrego
- Dermatology Department, Hospital Universitario Insular, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
36
|
Symons J, Rizzi M. Consumers or Patients? Medical Device Recipients under Australian Law Straddle Two Worlds. J Law Med 2023; 30:572-592. [PMID: 38332597] [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: 02/10/2024]
Abstract
This article analyses the status of medical device recipients under Australian law. The 2021 Gill v Ethicon Sàrl litigation in the Federal Court of Australia has brought the issue to the fore. Moving from the Court's findings, the article dissects the specific vulnerability of medical device recipients and explores the under-researched distinction between patients and consumers under Australian law. The analysis spans the regulatory landscape for medical devices prior to marketing approval, the statutory protections and causes of actions available to consumers under the Australian Consumer Law, and the safeguards for patients developed under medical law (particularly medical negligence). In addition to doctrinal clarifications, the article provides a discussion of key policy considerations that frame the various regimes. Patients and consumers share characteristics, but their legal protections differ in terms of focus and objectives. Medical device recipients straddle both worlds, requiring the highest levels of care and disclosure.
Collapse
Affiliation(s)
- Julia Symons
- Adjunct Teaching Fellow, UWA Law School, The University of Western Australia
| | - Marco Rizzi
- Associate Professor and Deputy Head of School (Students), UWA Law School, The University of Western Australia
| |
Collapse
|
37
|
Alzoubi L, Aljabali AAA, Tambuwala MM. Empowering Precision Medicine: The Impact of 3D Printing on Personalized Therapeutic. AAPS PharmSciTech 2023; 24:228. [PMID: 37964180 DOI: 10.1208/s12249-023-02682-w] [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: 08/16/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
This review explores recent advancements and applications of 3D printing in healthcare, with a focus on personalized medicine, tissue engineering, and medical device production. It also assesses economic, environmental, and ethical considerations. In our review of the literature, we employed a comprehensive search strategy, utilizing well-known databases like PubMed and Google Scholar. Our chosen keywords encompassed essential topics, including 3D printing, personalized medicine, nanotechnology, and related areas. We first screened article titles and abstracts and then conducted a detailed examination of selected articles without imposing any date limitations. The articles selected for inclusion, comprising research studies, clinical investigations, and expert opinions, underwent a meticulous quality assessment. This methodology ensured the incorporation of high-quality sources, contributing to a robust exploration of the role of 3D printing in the realm of healthcare. The review highlights 3D printing's potential in healthcare, including customized drug delivery systems, patient-specific implants, prosthetics, and biofabrication of organs. These innovations have significantly improved patient outcomes. Integration of nanotechnology has enhanced drug delivery precision and biocompatibility. 3D printing also demonstrates cost-effectiveness and sustainability through optimized material usage and recycling. The healthcare sector has witnessed remarkable progress through 3D printing, promoting a patient-centric approach. From personalized implants to radiation shielding and drug delivery systems, 3D printing offers tailored solutions. Its transformative applications, coupled with economic viability and sustainability, have the potential to revolutionize healthcare. Addressing material biocompatibility, standardization, and ethical concerns is essential for responsible adoption.
Collapse
Affiliation(s)
- Lorca Alzoubi
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid, 21163, Jordan
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid, 21163, Jordan.
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, LN6 7TS, UK.
| |
Collapse
|
38
|
Gomes M, Teixeira-Santos R, Gomes LC, Sousa-Cardoso F, Carvalho FM, Tomé AR, Soares OSGP, Whitehead KA, Mergulhão FJ. Antibiofilm Effect of Nitric Acid-Functionalized Carbon Nanotube-Based Surfaces against E. coli and S. aureus. Antibiotics (Basel) 2023; 12:1620. [PMID: 37998822 PMCID: PMC10668832 DOI: 10.3390/antibiotics12111620] [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: 10/19/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Chemically modified carbon nanotubes are recognized as effective materials for tackling bacterial infections. In this study, pristine multi-walled carbon nanotubes (p-MWCNTs) were functionalized with nitric acid (f-MWCNTs), followed by thermal treatment at 600 °C, and incorporated into a poly(dimethylsiloxane) (PDMS) matrix. The materials' textural properties were evaluated, and the roughness and morphology of MWCNT/PDMS composites were assessed using optical profilometry and scanning electron microscopy, respectively. The antibiofilm activity of MWCNT/PDMS surfaces was determined by quantifying culturable Escherichia coli and Staphylococcus aureus after 24 h of biofilm formation. Additionally, the antibacterial mechanisms of MWCNT materials were identified by flow cytometry, and the cytotoxicity of MWCNT/PDMS composites was tested against human kidney (HK-2) cells. The results revealed that the antimicrobial activity of MWCNTs incorporated into a PDMS matrix can be efficiently tailored through nitric acid functionalization, and it can be increased by up to 49% in the absence of surface carboxylic groups in f-MWCNT samples heated at 600 °C and the presence of redox activity of carbonyl groups. MWCNT materials changed the membrane permeability of both Gram-negative and Gram-positive bacteria, while they only induced the production of ROS in Gram-positive bacteria. Furthermore, the synthesized composites did not impact HK-2 cell viability, confirming the biocompatibility of MWCNT composites.
Collapse
Affiliation(s)
- Marisa Gomes
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Rita Teixeira-Santos
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Luciana C. Gomes
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Francisca Sousa-Cardoso
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Fábio M. Carvalho
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Andreia R. Tomé
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Olívia S. G. P. Soares
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- LSRE-LCM—Laboratory of Separation and Reaction Engineering, Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Kathryn A. Whitehead
- Microbiology at Interfaces Group, Manchester Metropolitan University, Manchester M1 5GD, UK;
| | - Filipe J. Mergulhão
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.G.); (R.T.-S.); (L.C.G.); (F.S.-C.); (F.M.C.); (A.R.T.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| |
Collapse
|
39
|
Babayan K, Keilty K, Esufali J, Grajales Iii FJ. An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study. JMIR Pediatr Parent 2023; 6:e41393. [PMID: 37938869 PMCID: PMC10666005 DOI: 10.2196/41393] [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: 07/24/2022] [Revised: 01/11/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. OBJECTIVE This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto's Hospital for Sick Children (SickKids). METHODS This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids' electronic medical records (Epic) with a chief complaint of "medical device problems," after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. RESULTS A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to "medical device problems" over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. CONCLUSIONS Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits.
Collapse
Affiliation(s)
- Katherine Babayan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Krista Keilty
- Connected Care Program, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Studies, SickKids Research Institute, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jessica Esufali
- Connected Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Francisco J Grajales Iii
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
40
|
Ormstad SS, Wild C, Erdös J, Moulton K. Mapping horizon scanning systems for medical devices: similarities, differences, and lessons learned. Int J Technol Assess Health Care 2023; 39:e69. [PMID: 37933611 DOI: 10.1017/s0266462323002684] [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: 11/08/2023]
Abstract
OBJECTIVES This article presents the mapping of horizons scanning systems (HSS) for medical devices, conducted by the Medical Devices Working Group of the International Horizon Scanning Initiative (IHSI MDWG). It provides an overview of the identified HSS, highlights similarities and differences between the systems, and lessons learned. METHODS Potentially relevant HSS were identified through literature searches, scan of an overview of EuroScan members, and input from the IHSI MDWG members. Structured information was collected from organizations that confirmed having an HSS for medical devices. RESULTS Sixteen initiatives could be identified, of which 11 are currently ongoing. The purposes of the HSS range from raising awareness of trends and new developments to managing informed decisions on innovative health services in hospitals. The time-horizon is most often 3 years up to a few months before market entry. Three models of identification of new technologies crystallized: a reactive (stakeholders outside HSS inform), a pro-active (actively searching multifold sources), and a hybrid model. Prioritization is often conducted by separate committees via scoring or debate. The outputs focus either on in-depth information of single technologies or on a class of technologies or on technologies in specific disease areas. CONCLUSIONS The identified HSS share the common experience that horizon scanning (HS) for medical devices is a resource-intensive exercise that requires a dedicated and skilled team. Insights into the identified HSS and their experiences will be used in the continued work of the IHSI MDWG on its proposal for an IHSI HSS for medical devices.
Collapse
Affiliation(s)
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment, Wien, Austria
| | - Judit Erdös
- Austrian Institute for Health Technology Assessment, Wien, Austria
| | - Kristen Moulton
- Canadian Agency for Drugs and Technologies in Health is headquartered in Ottawa, Canada
| |
Collapse
|
41
|
Mendhe S, Badge A, Ugemuge S, Chandi D. Impact of Biofilms on Chronic Infections and Medical Challenges. Cureus 2023; 15:e48204. [PMID: 38050493 PMCID: PMC10693677 DOI: 10.7759/cureus.48204] [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: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Biofilms which are intricate colonies of bacteria encapsulated in a self-produced matrix are becoming more widely recognized for their importance in persistent infections. Biofilm-related infections provide distinct diagnostic and therapy issues needing novel approaches. Biofilms are common in clinical settings and contribute to the persistence of diseases related to medical devices, dental health, respiratory disorders, and chronic infection. Overcoming these problems requires a thorough understanding of the elements that influence biofilm development and their complex interactions within the microbial community. Emerging diagnostic techniques and therapy approaches that target biofilm-related disorders at different levels give hope for improved patient outcomes. This review looks at how biofilm formation affects chronic infections in a variety of ways, including increased drug resistance, immune system evasion, and delayed diagnosis.
Collapse
Affiliation(s)
- Sakshi Mendhe
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Sarita Ugemuge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Dhurba Chandi
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, IND
| |
Collapse
|
42
|
Bosch A, Casanova-Batlle E, Constantin I, Rubio C, Ciurana J, Guerra AJ. An Innovative Stereolithography 3D Tubular Method for Ultrathin Polymeric Stent Manufacture: The Effect of Process Parameters. Polymers (Basel) 2023; 15:4298. [PMID: 37959978 PMCID: PMC10650677 DOI: 10.3390/polym15214298] [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: 10/02/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
In the last decades, researchers have been developing bioresorbable stents (BRS) to overcome the long-term complications of drug-eluting stents (DES). However, BRS technology still presents challenging limitations in terms of manufacturing, materials, or mechanical properties. At this juncture, companies have developed ultrathin DES that may further improve the efficacy and safety profile of traditional DES by reducing the risk of target-lesion and target-vessel failures until BRS are developed. Nonetheless, the metallic platform of ultrathin DES still presents problems related to their cellular response. The use of polymers as a permanent platform in DES has not previously been studied due to the limitations of current manufacturing technologies. In this work, an innovative manufacturing method for polymeric stent production using tubular stereolithography (SLA) technology is proposed both for BRS and for ultrathin polymeric DES. The effects of manufacturing process parameters were studied by modelling the outcomes (stent thickness and strut width) with the key manufacturing variables (exposure, resin volume, and number of layers). Two different laser setups were used to compare the results. Microscopy results proved the merit of this novel tubular SLA process, which was able to obtain stents with 70 μm strut width and thickness in barely 4 min using only 0.2 mL of resin. Differential Scanning Calorimetry (DSC) results showed the stability of the manufacturing method. The results obtained with this innovative technology are promising and overcome the limitations of other previously used and available technologies.
Collapse
Affiliation(s)
- Aniol Bosch
- Eurecat, Technology Centre of Catalonia, 08290 Cerdanyola del Vallès, Spain (I.C.); (C.R.)
- Departament of Mechanical Engineering and Industrial Construction, University of Girona, Maria Aurèlia Capmany 61, 17003 Girona, Spain;
| | - Enric Casanova-Batlle
- Departament of Mechanical Engineering and Industrial Construction, University of Girona, Maria Aurèlia Capmany 61, 17003 Girona, Spain;
| | - Iuliana Constantin
- Eurecat, Technology Centre of Catalonia, 08290 Cerdanyola del Vallès, Spain (I.C.); (C.R.)
| | - Carles Rubio
- Eurecat, Technology Centre of Catalonia, 08290 Cerdanyola del Vallès, Spain (I.C.); (C.R.)
| | - Joaquim Ciurana
- Departament of Mechanical Engineering and Industrial Construction, University of Girona, Maria Aurèlia Capmany 61, 17003 Girona, Spain;
| | - Antonio J. Guerra
- Eurecat, Technology Centre of Catalonia, 08290 Cerdanyola del Vallès, Spain (I.C.); (C.R.)
| |
Collapse
|
43
|
Cangelosi M, Chahar A, Eggington S. Evolving Use of Health Technology Assessment in Medical Device Procurement-Global Systematic Review: An ISPOR Special Interest Group Report. Value Health 2023; 26:1581-1589. [PMID: 37353055 DOI: 10.1016/j.jval.2023.06.005] [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: 09/06/2022] [Revised: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES To review the current academic evidence describing how data from health technology assessments (HTAs) informs procurement decisions for medical devices. METHODS A systematic literature review was performed to identify relevant studies and criteria used in medical device purchasing or procurement decisions. Included articles were screened for relevancy and risk of bias. The included studies were summarized qualitatively. RESULTS A total of 292 studies were screened, of which 11 matched the inclusion criteria. Included studies' geographies and HTA maturity varied. Some studies described hospital-level HTA processes, whereas others focused on national-level recommendations. Criteria for procurement decisions included standard HTA factors, such as efficacy, cost, cost-effectiveness, and budget impact; broader issues were also noted, including impact on the organization, ethical aspects, staff workload, and volume. There was little consideration of device-specific characteristics, such as life cycle, learning curve, or incremental technical innovation. Few decisions referred to HTA reports as part of the procurement decision; similarly, few HTA reports included a procurement perspective to help guide the procurement bodies. CONCLUSIONS There is minimal evidence that notes HTA influencing medical device procurement. Procurement bodies and hospitals may not be incentivized to publish their work and transparency could be improved; further research would better describe the link between HTA and procurement. Such research would enable the HTA agencies to meaningfully assess devices to target procurement bodies and allow device sponsors to prioritize evidence. This could limit redundancy, improve evidence, and ultimately promote savings to healthcare systems and expand access.
Collapse
Affiliation(s)
| | | | - Simon Eggington
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
| |
Collapse
|
44
|
Kerr MD, Johnson WT, McBride DA, Chumber AK, Shah NJ. Biodegradable scaffolds for enhancing vaccine delivery. Bioeng Transl Med 2023; 8:e10591. [PMID: 38023723 PMCID: PMC10658593 DOI: 10.1002/btm2.10591] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
Sustained release of vaccine components is a potential method to boost efficacy compared with traditional bolus injection. Here, we show that a biodegradable hyaluronic acid (HA)-scaffold, termed HA cryogel, mediates sustained antigen and adjuvant release in vivo leading to a durable immune response. Delivery from subcutaneously injected HA cryogels was assessed and a formulation which enhanced the immune response while minimizing the inflammation associated with the foreign body response was identified, termed CpG-OVA-HAC2. Dose escalation studies with CpG-OVA-HAC2 demonstrated that both the antibody and T cell responses were dose-dependent and influenced by the competency of neutrophils to perform oxidative burst. In immunodeficient post-hematopoietic stem cell transplanted mice, immunization with CpG-OVA-HAC2 elicited a strong antibody response, three orders of magnitude higher than dose-matched bolus injection. In a melanoma model, CpG-OVA-HAC2 induced dose-responsive prophylactic protection, slowing the tumor growth rate and enhancing overall survival. Upon rechallenge, none of the mice developed new tumors suggesting the development of robust immunological memory and long-lasting protection against repeat infections. CpG-OVA-HAC2 also enhanced survival in mice with established tumors. The results from this work support the potential for CpG-OVA-HAC2 to enhance vaccine delivery.
Collapse
Affiliation(s)
- Matthew D. Kerr
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Wade T. Johnson
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - David A. McBride
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Arun K. Chumber
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Nisarg J. Shah
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| |
Collapse
|
45
|
Gross DC, Scandling BW, Leewood AR, Simonetti OP. Computational modeling of the thermal effects of flow on radio frequency-induced heating of peripheral vascular stents during MRI. Biomed Phys Eng Express 2023; 9:065025. [PMID: 37844574 DOI: 10.1088/2057-1976/ad0398] [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: 06/02/2023] [Accepted: 10/16/2023] [Indexed: 10/18/2023]
Abstract
Purpose. The goal of this study was to develop and validate a computational model that can accurately predict the influence of flow on the temperature rise near a peripheral vascular stent during magnetic resonance imaging (MRI).Methods. Computational modeling and simulation of radio frequency (RF) induced heating of a vascular stent during MRI at 3.0 T was developed and validated with flow phantom experiments. The maximum temperature rise of the stent was measured as a function of physiologically relevant flow rates.Results. A significant difference was not identified between the experiment and simulation (P > 0.05). The temperature rise of the stent during MRI was over 10 °C without flow, and was reduced by 5 °C with a flow rate of only 58 ml min-1, corresponding to a reduction of CEM43from 45 min to less than 1 min.Conclusion. The computer model developed in this study was validated with experimental measurements, and accurately predicted the influence of flow on the RF-induced temperature rise of a vascular stent during MRI. Furthermore, the results of this study demonstrate that relatively low flow rates significantly reduce the temperature rise of a stent and the surrounding medium during RF-induced heating under typical scanning power and physiologically relevant conditions.
Collapse
Affiliation(s)
- David C Gross
- MED Institute Inc., West Lafayette, IN, United States of America
| | | | - Alan R Leewood
- MED Institute Inc., West Lafayette, IN, United States of America
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
- Department of Radiology, The Ohio State University, Columbus, OH, United States of America
| |
Collapse
|
46
|
Giordano N, Rosati S, Macario E, Spaccapietra ML, Balestra G. Design of a Service for the Management of Heart Failure Patients Using Telemedicine. Stud Health Technol Inform 2023; 309:160-164. [PMID: 37869831 DOI: 10.3233/shti230766] [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: 10/24/2023]
Abstract
The tremendous prevalence and mortality of heart failure (HF), along with the social and economic impact of its consequences, make an appropriate disease management utmost important. In this context, telemedicine offers promising possibilities. Current clinical guidelines and technological solutions do not address the problem of monitoring at-risk patients and patients affected by mild HF for prevention purposes. The goal of this work is to design a service based on a telemedicine framework for the management of heart failure patients. The proposed service grounds the monitoring of the patient on a custom multi-sensor array that we designed and developed for the purpose. The description of the processes involved in the service was carried out by means of Process Modelling tools, and in particular through Swim Lane Activity Diagrams. The results look promising for the implementation of the service in a real-life scenario. The main strength of the service resides in a) the use of noninvasive monitoring technologies to include patients with a mild HF or at-risk patients; and b) the integration of hospital and territory services to grant continuity and coherence in the treatment.
Collapse
Affiliation(s)
- Noemi Giordano
- Department of Electronics and Telecommunication, Politecnico di Torino, Italy
| | - Samanta Rosati
- Department of Electronics and Telecommunication, Politecnico di Torino, Italy
| | | | | | - Gabriella Balestra
- Department of Electronics and Telecommunication, Politecnico di Torino, Italy
| |
Collapse
|
47
|
Balzan P, Tattersall C, Palmer R, Murray M. Mapping the development process of transcutaneous neuromuscular electrical stimulation devices for neurorehabilitation, the associated barriers and facilitators, and its applicability to acquired dysarthria: a qualitative study of manufacturers' perspectives. Disabil Rehabil Assist Technol 2023:1-12. [PMID: 37855610 DOI: 10.1080/17483107.2023.2269976] [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: 05/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The fragmented nature of the medical device market limits our understanding of how particular sub-markets navigate the device development process. Despite the widespread use of transcutaneous neuromuscular electrical stimulation (NMES), its use for acquired dysarthria treatment has not been sufficiently explored. This study aims to provide a preliminary understanding of the stages involved in the development of NMES devices designed for neurorehabilitation. It also aims to investigate manufacturers' perceptions concerning factors that facilitate or impede its development and determine its applicability for acquired dysarthria. MATERIALS AND METHODS In-depth semi-structured online interviews were conducted with eight NMES device manufacturers located across Europe, North America and Oceania. The interviews were video-recorded, automatically transcribed, manually reviewed, and analysed using a qualitative content analysis. RESULTS NMES device development for neurorehabilitation involves six complex phases with sequential and overlapping activities. Some emerging concepts were comparable to established medical device models, while others were specific to NMES. Its adaptability to different neurological disorders, the positive academia-industry collaborations, the industry's growth prospects and the promising global efforts for standardised regulations are all key facilitators for its development. However, financial, political, regulatory, and natural constraints emerged as barriers. Indications and challenges for the applicability of NMES for acquired dysarthria treatment were also discussed. CONCLUSION The findings provide a foundation for further investigations on the NMES market sub-sector, particularly in the context of neurorehabilitation. The study also provides insights into the potential adoption of NMES for acquired dysarthria, which can serve as a reference for future research.
Collapse
Affiliation(s)
- Pasquale Balzan
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Catherine Tattersall
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Murray
- Sheffield Healthcare Gateway, University of Sheffield, Sheffield, UK
| |
Collapse
|
48
|
Wynne KJ, Zolotarskaya O, Jarrell R, Wang C, Amin Y, Brunson K. Facile Modification of Medical-Grade Silicone for Antimicrobial Effectiveness and Biocompatibility: A Potential Therapeutic Strategy against Bacterial Biofilms. ACS Appl Mater Interfaces 2023; 15:46626-46638. [PMID: 37782835 DOI: 10.1021/acsami.3c08734] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
A one-step modification of biomedical silicone tubing with N,N-dimethyltetradecylamine, C14, results in a composition designated WinGard-1 (WG-1, 1.1 wt % C14). A surface-active silicon-amine phase (SAP) is proposed to account for increased wettability and increased surface charge. To understand the mechanism of antimicrobial effectiveness, several procedures were employed to detect whether C14 leaching occurred. An immersion-growth (IG) test was developed that required knowing the bacterial Minimum Inhibitory Concentrations (MICs) and Minimum Biocidal Concentrations (MBCs). The C14 MIC and MBC for Gm- uropathogenic E. coli (UPEC), commonly associated with catheter-associated urinary tract infections (CAUTI), were 10 and 20 μg/mL, respectively. After prior immersion of WG-1 silicone segments in a growth medium from 1 to 28 d, the IG test for the medium showed normal growth for UPEC over 24 h, indicating that the concentration of C14 must be less than the MIC, 10 μg/mL. GC-MS and studies of the medium inside and outside a dialysis bag containing WG-1 silicone segments supported de minimis leaching. Consequently, a 5 log UPEC reduction (99.999% kill) in 24 h using the shake flask test (ASTM E2149) cannot be due to leaching and is ascribed to contact kill. Interestingly, although the MBC was greater than 100 μg/mL for Pseudomonas aeruginosa, WG-1 silicone affected an 80% reduction via a 24 h shake flask test. For other bacteria and Candida albicans, greater than 99.9% shake flask kill may be understood by proposing increased wettability and concentration of charge illustrated in the TOC. De minimis leaching places WG-1 silicone at an advantage over conventional anti-infectives that rely on leaching of an antibiotic or heavy metals such as silver. The facile process for preparation of WG-1 silicone combined with biocidal effectiveness comprises progress toward the goals of device designation from the FDA for WG-1 and clearance.
Collapse
Affiliation(s)
- Kenneth J Wynne
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| | - Olga Zolotarskaya
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| | - Rebecca Jarrell
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| | - Chenyu Wang
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| | - Youssef Amin
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| | - Kennard Brunson
- Virginia Bio+Tech Park, WynnVision LLC, Suite 57 800 East Leigh Street Richmond, Virginia 23219-1551, United States
| |
Collapse
|
49
|
Newman G, Leclerc A, Arditi W, Calzuola ST, Feaugas T, Roy E, Perrault CM, Porrini C, Bechelany M. Corrigendum: Challenge of material haemocompatibility for microfluidic blood-contacting applications. Front Bioeng Biotechnol 2023; 11:1297000. [PMID: 37885454 PMCID: PMC10598462 DOI: 10.3389/fbioe.2023.1297000] [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: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fbioe.2023.1249753.].
Collapse
Affiliation(s)
- Gwenyth Newman
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
- Eden Tech, Paris, France
| | - Audrey Leclerc
- Institut Européen des Membranes, IEM, UMR 5635, Univ Montpellier, ENSCM, Centre National de la Recherche Scientifique (CNRS), Place Eugène Bataillon, Montpellier, France
- École Nationale Supérieure des Ingénieurs en Arts Chimiques et Technologiques, Université de Toulouse, Toulouse, France
| | - William Arditi
- Eden Tech, Paris, France
- Centrale Supélec, Gif-sur-Yvette, France
| | - Silvia Tea Calzuola
- Eden Tech, Paris, France
- UMR7648—LadHyx, Ecole Polytechnique, Palaiseau, France
| | - Thomas Feaugas
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
- Eden Tech, Paris, France
| | | | | | | | - Mikhael Bechelany
- Institut Européen des Membranes, IEM, UMR 5635, Univ Montpellier, ENSCM, Centre National de la Recherche Scientifique (CNRS), Place Eugène Bataillon, Montpellier, France
- Gulf University for Science and Technology (GUST), Mubarak Al-Abdullah, Kuwait
| |
Collapse
|
50
|
Yalçin M, Güneş Ü. A point prevalence study of medical device-associated pressure injuries: A cross-sectional study. J Clin Nurs 2023; 32:7618-7625. [PMID: 37726592 DOI: 10.1111/jocn.16831] [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: 12/08/2022] [Revised: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023]
Abstract
AIM AND OBJECTIVE The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey. BACKGROUND MDRPI remain a clinical problem that has garnered the attention of healthcare professionals. DESIGN This study used a cross-sectional design and was conducted over a single day in all intensive care units. METHOD Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration. RESULTS MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9-16 days and 13 times in those who received mechanical ventilator support. CONCLUSION The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was involved in this study.
Collapse
Affiliation(s)
- Melek Yalçin
- Ege University Hospital Chest Clinic, Izmir, Turkey
| | - Ülkü Güneş
- Department of Fundamental of Nursing, Faculty of Nursing, Ege University, Izmir, Turkey
| |
Collapse
|