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Pyun AJ, Goodney PP, Eldrup-Jorgensen J, Wadzinski J, Secemsky EA, Cigarroa JE. Device regulation and surveillance in vascular care: Challenges and opportunities. Catheter Cardiovasc Interv 2024. [PMID: 38639136 DOI: 10.1002/ccd.31053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Cardiovascular devices are essential for the treatment of cardiovascular diseases including cerebrovascular, coronary, valvular, congenital, peripheral vascular and arrhythmic diseases. The regulation and surveillance of vascular devices in real-world practice, however, presents challenges during each individual product's life cycle. Four examples illustrate recent challenges and questions regarding safety, appropriate use and efficacy arising from FDA approved devices used in real-world practice. We outline potential pathways wherein providers, regulators and payors could potentially provide high-quality cardiovascular care, identify safety signals, ensure equitable device access, and study potential issues with devices in real-world practice.
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Affiliation(s)
- Alyssa J Pyun
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, California, USA
| | - Philip P Goodney
- Heart and Vascular Center, Dartmouth Health, Lebanon, New Hampshire, USA
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - Jens Eldrup-Jorgensen
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - James Wadzinski
- The Society for Vascular Surgery's Patient Safety Organization (SVS-PSO) and Vascular Quality Initiative (VQI), Chicago, Illinois, USA
| | - Eric A Secemsky
- Division of Vascular Interventions, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joaquin E Cigarroa
- Division of Cardiovascular Medicine, Department of Medicine, Oregon Health Sciences University (OHSU), Portland, Oregon, USA
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Yoo RM, Viggiano BT, Pundi KN, Fries JA, Zahedivash A, Podchiyska T, Din N, Shah NH. Scalable Approach to Consumer Wearable Postmarket Surveillance: Development and Validation Study. JMIR Med Inform 2024; 12:e51171. [PMID: 38596848 PMCID: PMC11024395 DOI: 10.2196/51171] [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: 07/29/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 04/11/2024] Open
Abstract
Background With the capability to render prediagnoses, consumer wearables have the potential to affect subsequent diagnoses and the level of care in the health care delivery setting. Despite this, postmarket surveillance of consumer wearables has been hindered by the lack of codified terms in electronic health records (EHRs) to capture wearable use. Objective We sought to develop a weak supervision-based approach to demonstrate the feasibility and efficacy of EHR-based postmarket surveillance on consumer wearables that render atrial fibrillation (AF) prediagnoses. Methods We applied data programming, where labeling heuristics are expressed as code-based labeling functions, to detect incidents of AF prediagnoses. A labeler model was then derived from the predictions of the labeling functions using the Snorkel framework. The labeler model was applied to clinical notes to probabilistically label them, and the labeled notes were then used as a training set to fine-tune a classifier called Clinical-Longformer. The resulting classifier identified patients with an AF prediagnosis. A retrospective cohort study was conducted, where the baseline characteristics and subsequent care patterns of patients identified by the classifier were compared against those who did not receive a prediagnosis. Results The labeler model derived from the labeling functions showed high accuracy (0.92; F1-score=0.77) on the training set. The classifier trained on the probabilistically labeled notes accurately identified patients with an AF prediagnosis (0.95; F1-score=0.83). The cohort study conducted using the constructed system carried enough statistical power to verify the key findings of the Apple Heart Study, which enrolled a much larger number of participants, where patients who received a prediagnosis tended to be older, male, and White with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category) scores (P<.001). We also made a novel discovery that patients with a prediagnosis were more likely to use anticoagulants (525/1037, 50.63% vs 5936/16,560, 35.85%) and have an eventual AF diagnosis (305/1037, 29.41% vs 262/16,560, 1.58%). At the index diagnosis, the existence of a prediagnosis did not distinguish patients based on clinical characteristics, but did correlate with anticoagulant prescription (P=.004 for apixaban and P=.01 for rivaroxaban). Conclusions Our work establishes the feasibility and efficacy of an EHR-based surveillance system for consumer wearables that render AF prediagnoses. Further work is necessary to generalize these findings for patient populations at other sites.
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Affiliation(s)
- Richard M Yoo
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Ben T Viggiano
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Krishna N Pundi
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Jason A Fries
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Aydin Zahedivash
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Tanya Podchiyska
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Natasha Din
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Nigam H Shah
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, United States
- Technology and Digital Services, Stanford Health Care, Stanford, CA, United States
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Welzel C, Cotte F, Wekenborg M, Vasey B, McCulloch P, Gilbert S. Holistic Human-Serving Digitization of Health Care Needs Integrated Automated System-Level Assessment Tools. J Med Internet Res 2023; 25:e50158. [PMID: 38117545 PMCID: PMC10765286 DOI: 10.2196/50158] [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: 06/21/2023] [Revised: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
Digital health tools, platforms, and artificial intelligence- or machine learning-based clinical decision support systems are increasingly part of health delivery approaches, with an ever-greater degree of system interaction. Critical to the successful deployment of these tools is their functional integration into existing clinical routines and workflows. This depends on system interoperability and on intuitive and safe user interface design. The importance of minimizing emergent workflow stress through human factors research and purposeful design for integration cannot be overstated. Usability of tools in practice is as important as algorithm quality. Regulatory and health technology assessment frameworks recognize the importance of these factors to a certain extent, but their focus remains mainly on the individual product rather than on emergent system and workflow effects. The measurement of performance and user experience has so far been performed in ad hoc, nonstandardized ways by individual actors using their own evaluation approaches. We propose that a standard framework for system-level and holistic evaluation could be built into interacting digital systems to enable systematic and standardized system-wide, multiproduct, postmarket surveillance and technology assessment. Such a system could be made available to developers through regulatory or assessment bodies as an application programming interface and could be a requirement for digital tool certification, just as interoperability is. This would enable health systems and tool developers to collect system-level data directly from real device use cases, enabling the controlled and safe delivery of systematic quality assessment or improvement studies suitable for the complexity and interconnectedness of clinical workflows using developing digital health technologies.
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Affiliation(s)
- Cindy Welzel
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | | | - Magdalena Wekenborg
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
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Saifuddin PK, Tandon M, Kalaiselvan V, Suroy B, Pattanshetti V, Prakash A, Medhi B. Materiovigilance Programme of India: Current status and way forward. Indian J Pharmacol 2022; 54:221-225. [PMID: 35848694 PMCID: PMC9396683 DOI: 10.4103/ijp.ijp_837_21] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Postmarketing vigilance system for medical devices in India is not as vigorous as of drugs. W Materiovigilance involves post marketing surveillance of adverse events caused by medical devices. As per directive of WHO, many countries including India have established their own post marketing surveillance system. In India it is known as Materiovigilance Programme of India (MvPI). This article reviews the current state of MvPI, compares it with developed countries, identifies gaps, and recommends specific measure to strengthen the existing program.
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Affiliation(s)
- P. K. Saifuddin
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moksh Tandon
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Benjamin Suroy
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidya Pattanshetti
- Department of Pharmacology, Jawaharlal Nehru Medical College, KAHER, Belagavi, Karnataka, India
| | - Ajay Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Prof. Bikash Medhi, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
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Mehta RI, Mehta RI. Hydrophilic Polymer Embolism: Implications for Manufacturing, Regulation, and Postmarket Surveillance of Coated Intravascular Medical Devices. J Patient Saf 2021; 17:e1069-e1079. [PMID: 29557931 PMCID: PMC6146079 DOI: 10.1097/pts.0000000000000473] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Indexed: 01/23/2023]
Abstract
ABSTRACT Hydrophilic polymers are ubiquitously applied as surface coatings on catheters and intravascular medical technologies. Recent clinical literature has heightened awareness on the complication of hydrophilic polymer embolism, the phenomenon wherein polymer coating layers separate from catheter and device surfaces, and may be affiliated with a range of unanticipated adverse reactions. Significant system barriers have limited and delayed reporting on this iatrogenic complication, the full effects of which remain underrecognized by healthcare providers and manufacturers of various branded devices. In 2015, the United States Food and Drug Administration acknowledged rising clinical concerns and stated that the agency would work with stakeholders to further evaluate gaps that exist in current national and international device standards for coated intravascular medical technologies. The present article reviews current knowledge on this complication as well as factors that played a role in delaying detection and dissemination of information and new knowledge once hazards and clinical risks were identified. Furthermore, organ-specific effects and adverse reaction patterns are summarized, along with implications for device manufacturing, safety assurance, and regulation. Qualitative and quantitative particulate testing are needed to optimize coated intravascular device technologies. Moreover, general enhanced processes for medical device surveillance are required for timely adverse event management and to ensure patient safety.
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Affiliation(s)
| | - Rupal I. Mehta
- University of Rochester Department of Pathology and Laboratory Medicine
- Department of Neuroscience
- Center for Neurotherapeutics Discovery (CND)
- Center for Translational Neuromedicine (CTN)
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Krupka DC, Graham J, Wilson NA, Li A, Landman AB, Bhatt DL, Nguyen LL, Reich AJ, Gupta A, Zerhouni YA, Capatch KJ, Concheri KP, Weissman JS. Transmitting Device Identifiers of Implants From the Point of Care to Insurers: A Demonstration Project. J Patient Saf 2021; 17:223-230. [PMID: 33734207 PMCID: PMC7984755 DOI: 10.1097/pts.0000000000000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND For implanted devices, an effective postmarket surveillance system does not exist. For medications, the Food and Drug Administration's Sentinel Initiative plays that role, relying mainly on drug codes in insurance claims. Unique device identifiers (UDIs) could play an analogous role for implants, but there is no mandate for providers to include UDIs in claims or for payers to record them. Objections have been raised to incorporating UDIs into claims based on a potential burden on providers. METHODS To assess this purported barrier, we modified information systems at 2 provider-payer dyads to allow for the transmission of UDI data from provider to payer. In addition, to illustrate the potential benefit of including device data in claims, we used our data to compare rates of 90-day adverse events after implantation using the electronic health record (EHR) alone with the EHR plus claims. RESULTS The software system modifications were modest and performed as designed. Moreover, the level of difficulty of their development and implementation was comparable to that associated with a typical new release of an existing system. In addition, our data demonstrated the ability of claims-based data plus EHR data to reveal a larger percentage of postprocedure adverse events than data from EHRs alone. CONCLUSIONS Modifying information systems to allow for the transmission of UDI data from providers to payers should not impose a substantial burden on either. Implementation of a postmarket surveillance system based on such data in claims will require, however, the development of a system analogous to Sentinel.
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Affiliation(s)
- Dan C. Krupka
- From the Twin Peaks Group, LLC, Lexington, Massachusetts
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger Health, Danville, Pennsylvania
| | - Natalia A. Wilson
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Angela Li
- Blue Cross Blue Shield of Massachusetts
| | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School
| | | | - Amanda J. Reich
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. Chan School of Public Health, Brigham and Women’s Hospital, Mass General Brigham, Boston, Massachusetts
| | - Avni Gupta
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Yasmin A. Zerhouni
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Kevin J. Capatch
- System Support Services, Geisinger Health, Danville, Pennsylvania
| | | | - Joel S. Weissman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. Chan School of Public Health, Brigham and Women’s Hospital, Mass General Brigham, Boston, Massachusetts
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Pane J, Verhamme KMC, Shrum L, Rebollo I, Sturkenboom MCJM. Blockchain technology applications to postmarket surveillance of medical devices. Expert Rev Med Devices 2020; 17:1123-1132. [PMID: 32954855 DOI: 10.1080/17434440.2020.1825073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The amount of mandatory data that needs to be analyzed as part of a medical device postmarket surveillance (PMS) system has grown exponentially in recent times. This is a consequence of increasingly demanding and complex regulatory requirements from Health Authorities, aimed at a better understanding of the medical device safety evaluation. Proactive approaches to PMS processes are becoming more necessary as regulators increase the scrutiny of device safety. New technologies have been explored to address some of the challenges associated with this changing regulatory environment. AREAS COVERED This paper focuses on the different technical aspects of blockchain and how this new technology has the potential to support the ongoing efforts to improve the PMS system for medical devices. EXPERT OPINION To address these challenges, we suggest to generate a private PMS data permissioned blockchain with a proof-of-authority consensus mechanism, to which only a restricted number of designated and audited participants have authorization to validate transactions and add them to the PMS data blockchain ledger. Blockchain has the potential to support a more efficient approach, which could offer many advantages to the different stakeholders involved in the PMS process, such as supporting with new regulatory initiatives.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center University of Rotterdam , Rotterdam, Netherlands
| | | | - Irene Rebollo
- Department of CMO & Patient Safety, Novartis , Barcelona, Spain
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Pane J, Verhamme KMC, Rebollo I, Sturkenboom MCJM. Descriptive analysis of postmarket surveillance data for hip implants. Pharmacoepidemiol Drug Saf 2020; 29:380-387. [PMID: 32128913 PMCID: PMC7216945 DOI: 10.1002/pds.4971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/03/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Purpose Recent safety issues involving medical devices have highlighted the need for better postmarket surveillance (PMS) evaluation. This article aims to describe and to assess the quality of the PMS data for a medical device and, finally, to provide recommendations to improve the data gathering process. Methods A descriptive analysis of medical device reports (MDRs) on the use of MRA, a specific type of hip implant replacement submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience database from 1 January 2008 to 31 December 2017. The number of reports was described as the number of MDRs per unique MDR number and stratified by different variables. The quality was assessed by the level of completeness of the collected PMS data. Results The total number of reports related to MRA was 2377, and the number of MDRs per year ranged between 84 in 2009 and 452 in 2017. Most of the reports were reported by manufacturer Depuy Johnson & Johnson and were reported by a physician. In 44.9% of the reports, the device problem was reported as “Unknown.” When the device problem was known, in the majority of cases, it was related to an implant fracture. The quality of the collected data was assessed as low due to missing information. Conclusion The underlying data should meet high quality standards to generate more evidence and to ensure a timely signal generation. This case study shows that the completeness and quality of the MDRs can be improved. The authors propose the development of tools to ensure a more dynamic complaint data collection to contribute to this enhancement.
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Affiliation(s)
- Josep Pane
- Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irene Rebollo
- Eu2P European Programme in Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux Segalen, Bordeaux, France
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Chung G, Etter K, Yoo A. Medical device active surveillance of spontaneous reports: A literature review of signal detection methods. Pharmacoepidemiol Drug Saf 2020; 29:369-379. [PMID: 32128936 DOI: 10.1002/pds.4980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/26/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE The collection and analysis of real-world data for the active monitoring of medical device performance and safety has become increasingly important. Spontaneous reports, such as those in the Food & Drug Administration's (FDA's) Manufacturer and User Facility Device Experience (MAUDE), provide early warning of potential issues with marketed devices. This review synthesizes the current literature on medical device surveillance signal detection and provides a framework for application of methods to active surveillance of spontaneous reports. METHODS Ovid MEDLINE, Ovid Embase, Scopus, and PubMed databases were systematically searched up to January 2019. Additionally, five methods articles from pharmacovigilance were added that had potential applications to medical devices. RESULTS Among 105 articles included, the most common source of data (84%) was registries; median time between data collection and publication was 8 years. Surgical procedure outcome signal detection articles comprised 83% while 14% were on device outcome signal detection. The most common family of methods cited (70%) was Sequential Probability Ratio. CONCLUSION Application of any signal detection algorithm requires careful consideration of influential factors, data limitations, and algorithmic assumptions. We recommend approaches using disproportionality, statistical process control, and sequential probability tests and provide R packages to further development efforts. The small number of published examples suggest that further development of statistical methods and technological solutions to analyze large amounts of data for device safety and performance is needed. Fundamental differences in products, data infrastructure, and the regulatory landscape suggest that medical device vigilance requires its own body of research distinct from pharmacovigilance.
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Affiliation(s)
- Gary Chung
- Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, New Jersey
| | - Katherine Etter
- Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, New Jersey
| | - Andrew Yoo
- Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, New Jersey
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10
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Abstract
Background Government regulations require postmarket surveillance for cleared/approved medical devices. Trend analysis of newly marketed devices may help to confirm device-related safety or uncover other device or procedure-related problems. Methods Complaints related to the use of 3D-printed triangular titanium implants for sacroiliac joint (SIJ) fusion were compared with those of the prior machined version of the device manufactured with a titanium plasma spray (TPS) coating. Event rates were calculated either by dividing event counts by numbers of surgeries or, for late events, using Kaplan–Meier survival analysis. Results Three types of complaints with nontrial frequencies were identified. Issues in instruments occurred at a low and constant rate (1.3%). Using Kaplan–Meier analysis, pain-related complaints occurred at a low and similar rate in both groups (<0.5%). The 1-year cumulative probability of surgical revision was low in both the 3D and machined versions of the device (1.5% for machined and 1% for 3D printed, P=0.0408 for difference). No implant breakages or migrations were identified in either group, and overall rates were similar to a previously published report. Conclusion The 3D-printed version of triangular titanium implant was associated with complaint and adverse event rates similar to those for the prior machined version of the device.
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Affiliation(s)
- Daniel Cher
- Clinical Affairs, SI-BONE, Inc., Santa Clara, CA, USA,
| | - Kendrick Wroe
- Quality Assurance, SI-BONE, Inc., Santa Clara, CA, USA
| | | | - Scott Yerby
- Research and Development, SI-BONE, Inc., Santa Clara, CA, USA
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Gautron S, Wentzell J, Kanji S, Nguyen T, Kobewka DM, MacDonald E. Characterization of Serious Adverse Drug Reactions in Hospital to Determine Potential Implications of Mandatory Reporting. Can J Hosp Pharm 2018; 71:316-323. [PMID: 30401998 PMCID: PMC6209500] [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] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Protecting Canadians from Unsafe Drugs Act will eventually require institutions to report all serious adverse drug reactions (ADRs), although the proposed regulations do not yet define what will need to be reported and by whom. Knowledge about the occurrence of serious ADRs in the hospital setting is needed to optimize the effectiveness of reporting and to determine the potential implications of mandatory reporting. OBJECTIVES To quantify and characterize suspected serious ADRs in patients admitted to a general medicine service, to assess the likelihood of causality, and to determine inter-rater agreement for identification of ADRs and assessment of their likelihood. METHODS This prospective observational study involved 60 consecutive patients admitted to a general medicine service at a tertiary care teaching centre starting on March 28, 2016. The primary outcome was the number of serious ADRs, defined by Health Canada as ADRs that result in hospital admission, congenital malformation, persistent or significant disability or incapacity, or death; that are life-threatening; or that require significant intervention to prevent one of these outcomes. Medical records were reviewed independently by pairs of pharmacists for serious ADRs, and the likelihood of causality was assessed using the World Health Organization-Uppsala Monitoring Centre system. Inter-rater agreement was calculated using the kappa score, and disagreements were resolved by discussion and consensus. RESULTS Twenty-three serious ADRs occurred in the sample of 60 patients. The proportion of patients experiencing a serious ADR that contributed to the original hospital admission was 19/60 (32%, 95% confidence interval [CI] 20%-43%), and 4 patients (7%, 95% CI 0%-13%) experienced a serious ADR during their hospital stay. Inter-rater agreement for occurrence of serious ADRs was moderate (kappa 0.58, 95% CI 0.35-0.76). CONCLUSION Reportable serious ADRs were common among patients admitted to a general medicine service. Canadian hospitals would face difficulties reporting all serious ADRs because of the frequency of their occurrence and the subjectivity of their identification.
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Affiliation(s)
- Stephanie Gautron
- ,BScPharm, ACPR, was, at the time of this study, a pharmacy resident at The Ottawa Hospital, Ottawa, Ontario. She is now a Pharmacist with the Centre de santé Saint-Boniface, My Health Team, St Boniface/St Vital, Winnipeg, Manitoba
| | - Jason Wentzell
- ,BScPharm, ACPR, BCOP, is a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Salmaan Kanji
- ,BScPharm, ACPR, PharmD, is a Clinical Pharmacy Specialist with The Ottawa Hospital and an Associate Scientist with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Tiffany Nguyen
- ,BScPharm, ACPR, BCOP, is a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Daniel M Kobewka
- ,MD, FRCPC, MSc, is a Staff Physician with the Department of Medicine, The Ottawa Hospital; a Clinician Investigator with The Ottawa Hospital Research Institute; and an Assistant Professor with the University of Ottawa, Ottawa, Ontario
| | - Erika MacDonald
- ,BScPharm, ACPR, MSc, is the Professional Practice Coordinator and a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
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Abstract
Regarding the widespread and ever-increasing applications of biomaterials in different medical fields, their accurate assessment is of great importance. Hence the safety and efficacy of biomaterials is confirmed only through the evaluation process, the way it is done has direct effects on public health. Although every biomaterial undergoes rigorous premarket evaluation, the regulatory agencies receive a considerable number of complications and adverse event reports annually. The main factors that challenge the process of biomaterials evaluation are dissimilar regulations, asynchrony of biomaterials evaluation and biomaterials development, inherent biases of postmarketing data, and cost and timing issues. Several pieces of evidence indicate that current medical device regulations need to be improved so that they can be used more effectively in the evaluation of biomaterials. This article provides suggested conceptual refinements and practical reforms to increase the efficiency and effectiveness of the existing regulations. The main focus of the article is on strategies for evaluating biomaterials in US, and then in EU.
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Affiliation(s)
- Reza Masaeli
- 1 Dental Biomaterials Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavosh Zandsalimi
- 2 Department of Life Sciences Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Lobat Tayebi
- 3 Marquette University, School of Dentistry, Milwaukee, WI, USA.,4 Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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Izem R, Sanchez-Kam M, Ma H, Zink R, Zhao Y. Sources of Safety Data and Statistical Strategies for Design and Analysis: Postmarket Surveillance. Ther Innov Regul Sci 2018; 52:159-169. [PMID: 29714520 DOI: 10.1177/2168479017741112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/16/2022]
Abstract
BACKGROUND Safety data are continuously evaluated throughout the life cycle of a medical product to accurately assess and characterize the risks associated with the product. The knowledge about a medical product's safety profile continually evolves as safety data accumulate. METHODS This paper discusses data sources and analysis considerations for safety signal detection after a medical product is approved for marketing. This manuscript is the second in a series of papers from the American Statistical Association Biopharmaceutical Section Safety Working Group. RESULTS We share our recommendations for the statistical and graphical methodologies necessary to appropriately analyze, report, and interpret safety outcomes, and we discuss the advantages and disadvantages of safety data obtained from passive postmarketing surveillance systems compared to other sources. CONCLUSIONS Signal detection has traditionally relied on spontaneous reporting databases that have been available worldwide for decades. However, current regulatory guidelines and ease of reporting have increased the size of these databases exponentially over the last few years. With such large databases, data-mining tools using disproportionality analysis and helpful graphics are often used to detect potential signals. Although the data sources have many limitations, analyses of these data have been successful at identifying safety signals postmarketing. Experience analyzing these dynamic data is useful in understanding the potential and limitations of analyses with new data sources such as social media, claims, or electronic medical records data.
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Affiliation(s)
- Rima Izem
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, WO Building 21, Silver Spring, MD, 20903, USA.
| | | | | | - Richard Zink
- SAS institute, Inc, JMP Life Sciences, Cary, NC, USA
| | - Yueqin Zhao
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, WO Building 21, Silver Spring, MD, 20903, USA
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Zhu S, Xu X. [United States Medical Device Postmarket Surveillance System Operational Experience and Learning]. Zhongguo Yi Liao Qi Xie Za Zhi 2017; 41:123-126. [PMID: 29862685 DOI: 10.3969/j.issn.1671-7104.2017.02.013] [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: 06/08/2023]
Abstract
To learn the progress, structure and the latest development of medical device postmarket surveillance system in United States, endeavor to get a meaningful approach for Chinese medical device manufacturers. Sort out the recentyear guidance documents issued by US FDA, analyze the current situation after the implementation of postmarket surveillance system (PMS). The all-aspect linkage, multiple data sources and the coordination communication mechanism between various departments implemented by FDA are worthy of learning.
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Affiliation(s)
- Shumin Zhu
- International and Pharmaceutical Business School of China Pharmaceutical University, Nanjing, 211198
| | - Xiaoyuan Xu
- International and Pharmaceutical Business School of China Pharmaceutical University, Nanjing, 211198
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Tabak YP, Johannes RS, Sun X, Crosby CT, Jarvis WR. Innovative Use of Existing Public and Private Data Sources for Postmarketing Surveillance of Central Line-Associated Bloodstream Infections Associated With Intravenous Needleless Connectors. J Infus Nurs 2016; 39:328-35. [PMID: 27598072 PMCID: PMC5014545 DOI: 10.1097/nan.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Centers for Medicare and Medicaid Services (CMS) Hospital Compare central line-associated bloodstream infection (CLABSI) data and private databases containing new-generation intravenous needleless connector (study NC) use at the hospital level were linked. The relative risk (RR) of CLABSI associated with the study NCs was estimated, adjusting for hospital characteristics. Among 3074 eligible hospitals in the 2013 CMS database, 758 (25%) hospitals used the study NCs. The study NC hospitals had a lower unadjusted CLABSI rate (1.03 vs 1.13 CLABSIs per 1000 central line days, P < .0001) compared with comparator hospitals. The adjusted RR for CLABSI was 0.94 (95% confidence interval: 0.86, 1.02; P = .11).
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Affiliation(s)
- Ying P. Tabak
- Clinical Research, CareFusion, San Diego, California (Drs Tabak, Johannes, Sun, and Crosby); Harvard Medical School, Boston, Massachusetts (Dr Johannes); and Jason and Jarvis Associates LLC, Hilton Head Island, South Carolina (Dr Jarvis)
- Ying P. Tabak, PhD, focuses on clinical research at CareFusion in San Diego, California
- Richard S. Johannes, MD, MS, is engaged in clinical research at CareFusion in San Diego, California, and is a member of the faculty at Harvard Medical School in Boston, Massachusetts
- Xiaowu Sun, PhD, is a clinical researcher at CareFusion in San Diego, California
- Cynthia T. Crosby, PhD, works in clinical research at CareFusion in San Diego, California
- William R. Jarvis, MD, has more than 35 years of experience in health care epidomiology and infection control. He held a number of leadership positions at the Centers for Disease Control and Prevention for 23 years, and now is president of Jason and Jarvis Associates, LLC, Hilton Head Island, South Carolina
| | - Richard S. Johannes
- Clinical Research, CareFusion, San Diego, California (Drs Tabak, Johannes, Sun, and Crosby); Harvard Medical School, Boston, Massachusetts (Dr Johannes); and Jason and Jarvis Associates LLC, Hilton Head Island, South Carolina (Dr Jarvis)
- Ying P. Tabak, PhD, focuses on clinical research at CareFusion in San Diego, California
- Richard S. Johannes, MD, MS, is engaged in clinical research at CareFusion in San Diego, California, and is a member of the faculty at Harvard Medical School in Boston, Massachusetts
- Xiaowu Sun, PhD, is a clinical researcher at CareFusion in San Diego, California
- Cynthia T. Crosby, PhD, works in clinical research at CareFusion in San Diego, California
- William R. Jarvis, MD, has more than 35 years of experience in health care epidomiology and infection control. He held a number of leadership positions at the Centers for Disease Control and Prevention for 23 years, and now is president of Jason and Jarvis Associates, LLC, Hilton Head Island, South Carolina
| | - Xiaowu Sun
- Clinical Research, CareFusion, San Diego, California (Drs Tabak, Johannes, Sun, and Crosby); Harvard Medical School, Boston, Massachusetts (Dr Johannes); and Jason and Jarvis Associates LLC, Hilton Head Island, South Carolina (Dr Jarvis)
- Ying P. Tabak, PhD, focuses on clinical research at CareFusion in San Diego, California
- Richard S. Johannes, MD, MS, is engaged in clinical research at CareFusion in San Diego, California, and is a member of the faculty at Harvard Medical School in Boston, Massachusetts
- Xiaowu Sun, PhD, is a clinical researcher at CareFusion in San Diego, California
- Cynthia T. Crosby, PhD, works in clinical research at CareFusion in San Diego, California
- William R. Jarvis, MD, has more than 35 years of experience in health care epidomiology and infection control. He held a number of leadership positions at the Centers for Disease Control and Prevention for 23 years, and now is president of Jason and Jarvis Associates, LLC, Hilton Head Island, South Carolina
| | - Cynthia T. Crosby
- Clinical Research, CareFusion, San Diego, California (Drs Tabak, Johannes, Sun, and Crosby); Harvard Medical School, Boston, Massachusetts (Dr Johannes); and Jason and Jarvis Associates LLC, Hilton Head Island, South Carolina (Dr Jarvis)
- Ying P. Tabak, PhD, focuses on clinical research at CareFusion in San Diego, California
- Richard S. Johannes, MD, MS, is engaged in clinical research at CareFusion in San Diego, California, and is a member of the faculty at Harvard Medical School in Boston, Massachusetts
- Xiaowu Sun, PhD, is a clinical researcher at CareFusion in San Diego, California
- Cynthia T. Crosby, PhD, works in clinical research at CareFusion in San Diego, California
- William R. Jarvis, MD, has more than 35 years of experience in health care epidomiology and infection control. He held a number of leadership positions at the Centers for Disease Control and Prevention for 23 years, and now is president of Jason and Jarvis Associates, LLC, Hilton Head Island, South Carolina
| | - William R. Jarvis
- Corresponding Author: William R. Jarvis, MD, Jason and Jarvis Associates LLC, 135 Dune Lane, Hilton Head Island, SC 29928 ()
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Kramer DB, Hatfield LA, McGriff D, Ellis CR, Gura MT, Samuel M, Retel LK, Hauser RG. Transvenous implantable cardioverter-defibrillator lead reliability: implications for postmarket surveillance. J Am Heart Assoc 2015; 4:e001672. [PMID: 26025935 PMCID: PMC4599526 DOI: 10.1161/jaha.114.001672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background As implantable cardioverter-defibrillator technology evolves, clinicians and patients need reliable performance data on current transvenous implantable cardioverter-defibrillator systems. In addition, real-world reliability data could inform postmarket surveillance strategies directed by regulators and manufacturers. Methods and Results We evaluated Medtronic Sprint Quattro, Boston Scientific Endotak, and St Jude Medical Durata and Riata ST Optim leads implanted by participating center physicians between January 1, 2006 and September 1, 2012. Our analytic sample of 2653 patients (median age 65, male 73%) included 445 St Jude, 1819 Medtronic, and 389 Boston Scientific leads. After a median of 3.2 years, lead failure was 0.28% per year (95% CI, 0.19 to 0.43), with no statistically significant difference among manufacturers. Simulations based on these results suggest that detecting performance differences among generally safe leads would require nearly 10 000 patients or very long follow-up. Conclusions Currently marketed implantable cardioverter-defibrillator leads rarely fail, which may be reassuring to clinicians advising patients about risks and benefits of transvenous implantable cardioverter-defibrillator systems. Regulators should consider the sample size implications when designing comparative effectiveness studies and evaluating new technology for preventing sudden cardiac death.
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Affiliation(s)
- Daniel B Kramer
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.) Hebrew SeniorLife Institute for Aging Research, Boston, MA (D.B.K.) Harvard Medical School, Boston, MA (D.B.K., L.A.H.)
| | | | - Deepa McGriff
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | | | - Melanie T Gura
- Northeast Ohio Cardiovascular Specialists, Akron, OH (M.T.G.)
| | - Michelle Samuel
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.)
| | - Linda Kallinen Retel
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
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18
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Lan CW, Yeh MK, Wu SI, Tu PW. Current development in medical devices postmarket surveillance in Taiwan. J Food Drug Anal 2015; 23:164-5. [PMID: 28911441 DOI: 10.1016/j.jfda.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022] Open
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Abstract
Over the years, drug products, including those indicated for diabetes, have been withdrawn from the marketplace because of quality concerns and/or severe adverse drug reactions. While the drug regulatory process is designed to detect, among other things, adverse drug reactions before a drug receives marketing authorization, for various reasons, premarket detection of all potential adverse reactions associated with a drug may not be possible. As such, regulatory authorities must also react to and manage adverse reactions identified at the postmarket stage. In this article, we provide a general overview of drug regulation in Canada and the United States and consider an example of a drug indicated for the treatment of diabetes and how newly identified potential safety concerns were managed in the postmarket environment.
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Affiliation(s)
- Richard Y Cheung
- Fasken Martineau DuMoulin LLP, 333 Bay St., Suite 2400, Toronto, Ontario, Canada M5H 2T6.
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