Enabling MedTech Translation in Academia: Redefining Value Proposition with Updated Regulations

Exploring Impediments Imposed by the Medical Device Regulation EU 2017/745 on Software as a Medical Device

In light of rapid technological advancements, the health care sector is undergoing significant transformation with the continuous emergence of novel digital solutions. Consequently, regulatory frameworks must continuously adapt to ensure their main goal to protect patients. In 2017, the new Medical Device Regulation (EU) 2017/745 (MDR) came into force, bringing more complex requirements for development, launch, and postmarket surveillance. However, the updated regulation considerably impacts the manufacturers, especially small- and medium-sized enterprises, and consequently, the accessibility of medical devices in the European Union market, as many manufacturers decide to either discontinue their products, postpone the launch of new innovative solutions, or leave the European Union market in favor of other regions such as the United States. This could lead to reduced health care quality and slower industry innovation efforts. Effective policy calibration and collaborative efforts are essential to mitigate these effects and promote ongoing advancements in health care technologies in the European Union market. This paper is a narrative review with the objective of exploring hindering factors to software as a medical device development, launch, and marketing brought by the new regulation. It exclusively focuses on the factors that engender obstacles. Related regulations, directives, and proposals were discussed for comparison and further analysis.

Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review

BACKGROUND

Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments.

OBJECTIVE

This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence.

METHODS

We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases.

RESULTS

From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation.

CONCLUSIONS

ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities.

Preparing healthcare, academic institutions and notified bodies for their involvement in the innovation of medical devices under the new European regulation

INTRODUCTION

Favouring innovation by making timely medical technology available to people and by securing patients' safety is a challenge.

AREAS COVERED

The new European medical device regulation (MDR) will have a central implication in the development of new devices and could affect their innovation and availability, as well as discourage investment in research within Europe.

EXPERT OPINION

Start-ups and small companies might not be able to cope with the increasing complexity and the required changes of perspective. Healthcare institutions are facing an increasing availability of complex technologies, while data on their clinical efficacy and cost-effectiveness are rarely provided.

A partnership/collaboration between healthcare institutions, academia and private industries will enhance their own specific interests with the common goal of improving overall health and quality of life. The complexity of the subject combined with the variety of specialists and stakeholders involved requires the implementation, in hospital centres of clinical excellence, of units dedicated to the whole path of the medical device innovation. Stakeholders should quickly provide adequate measures to facilitate the complex medical device innovation path under the more stringent MDR aimed to increase safety and quality of care.

Translational research in health technologies: A scoping review

Introduction

The current debate on the process of technological innovation points out as a challenge for universities consolidation of competencies that allow the generation and transfer of knowledge to society. The Translational Research (TR) approach has as one of its main objectives the acceleration of the innovation process, based on the transposition from basic science to applied science and innovation, which comprises the different stages of research, development and innovation. The literature points out that the dynamics of translation, which results in new technologies, are complex, transdisciplinary, inter-institutional, systemic, and non-linear. The main objective of this review is to contribute to the adoption of institutional strategies and the formulation of public policies aimed at solving today’s social and economic challenges, ensuring access to technologies and sustainability for the health system. The specific objectives were: (i) to systematize studies that characterized translational research in medical devices; (ii) map the challenges for the implementation of translational health research; (iii) contribute to the design of institutional strategies; and (iv) support the formulation of public policies.

Methods

This study used the scoping review technique, according to PRISMA-ScR and the Joanna Briggs Institute guidelines. Concerning the extraction of relevant articles, the journals indexed in Bireme, Pubmed, Scopus, Web of Science, and Google Scholar were consulted for selecting relevant articles. The search was carried out on November 28, 2021, updated on April 29, 2022, and there were no restrictions as to the year of publication, language or type of analysis. Studies that did not answer the research question were excluded, as they dealt exclusively with the pharmaceutical segment, the translation of knowledge into clinical practice, or addressed the process of translational research applied to specific diseases or technologies.

Results

Thirty-three articles were included indicating that the approach of translation of research is multidisciplinary and transdisciplinary and encompasses knowledge and aspects that go beyond basic and applied research and incorporates final steps concerning regulatory aspects, clinical research, market analysis, technology transfer, production and incorporation of technologies into the health system.

Effect of Mammalian Tissue Source on the Molecular and Macroscopic Characteristics of UV-Cured Type I Collagen Hydrogel Networks

The tissue source of type I collagen is critical to ensure scalability and regulation-friendly clinical translation of new medical device prototypes. However, the selection of a commercial source of collagen that fulfils both aforementioned requirements and is compliant with new manufacturing routes is challenging. This study investigates the effect that type I collagen extracted from three different mammalian tissues has on the molecular and macroscopic characteristics of a new UV-cured collagen hydrogel. Pepsin-solubilised bovine atelocollagen (BA) and pepsin-solubilised porcine atelocollagen (PA) were selected as commercially available raw materials associated with varying safety risks and compared with in-house acid-extracted type I collagen from rat tails (CRT). All raw materials displayed the typical dichroic and electrophoretic characteristics of type I collagen, while significantly decreased lysine content was measured on samples of PA. Following covalent functionalisation with 4-vinylbenzyl chloride (4VBC), BA and CRT products generated comparable UV-cured hydrogels with significantly increased averaged gel content (G ≥ 97 wt.%), while the porcine variants revealed the highest swelling ratio (SR = 2224 ± 242 wt.%) and an order of magnitude reduction in compression modulus (Ec = 6 ± 2 kPa). Collectively, these results support the use of bovine tissues as a chemically viable source of type I collagen for the realisation of UV-cured hydrogels with competitive mechanical properties and covalent network architectures.

Critical Factors and Economic Methods for Regulatory Impact Assessment in the Medical Device Industry

Introduction

Methods

Results

Discussion

Visual outcomes and treatment adherence of patients with macular pathology using a mobile hyperacuity home-monitoring app: a matched-pair analysis

OBJECTIVE

We compared patients with neovascular age-related macular degeneration (nvAMD), diabetic macular oedema (DMO) and other macular pathologies testing their vision with the hyperacuity home-monitoring app Alleye to patients not performing home-monitoring regarding clinical outcomes and clinical management.

DESIGN

Matched-pair analysis.

SETTING

Retina Referral Centre, Switzerland.

PARTICIPANTS

For each eye using Alleye, we matched 2-4 controls not using home-monitoring based on age, gender, number of previous intravitreal injections (IVI), best corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study letters), central macular thickness (CRT) and time point of enrolment, using the Mahalanobis distance matching algorithm. We included 514 eyes (288 patients); 107 eyes with nvAMD using home monitoring and 218 controls not using home monitoring, 25 eyes with DMO (n=52 controls) and 40 eyes with miscellaneous conditions (n=72 controls). 173 eyes (33.7%) received no IVI during follow-up.

MAIN OUTCOME MEASURES

Improvement of ≥5 letters, number of injection visits and treatment retention after correcting for differences in baseline characteristics with multivariate analyses.

RESULTS

The mean follow-up duration was 809 days (range 147-1353) and the mean number of IVI/year among treated eyes was 6.7 (SD 3.1). Mean age at baseline was 70.4 years (SD 10.9), BCVA was 77.6 letters (SD 11.6) and CRT was 263.6 µm (SD 86.7) and was similar between patients using and not using home monitoring. In multivariate analyses, patients using home monitoring had a higher chance to improve visual acuity by ≥5 letters (OR 1.67 (95% CI 1.01 to 2.76; p=0.044)) than controls. Treated eyes using home monitoring had less injection visits/year (-0.99 (95% CI -1.59 to -0.40; p=0.001)) and a longer treatment retention +69.2 days (95% CI 2.4 to 136.0; p=0.042). These effects were similar across retinal pathologies.

CONCLUSIONS

This data suggest that patients capable of performing mobile hyperacuity home monitoring benefit in terms of visual acuity and discontinue treatment less often than patients not using home monitoring.

A roadmap for research in medical physics via academic medical centers: The DIVERT Model

The field of medical physics has struggled with the role of research in recent years, as professional interests have dominated its growth toward clinical service. This article focuses on the subset of medical physics programs within academic medical centers and how a refocused academic mission within these centers should drive and support Discovery and Invention with Ventures and Engineering for Research Translation (DIVERT). A roadmap to a DIVERT-based scholarly research program is discussed here around the core building blocks of: (a) creativity in research and team building, (b) improved quality metrics to assess activity, (c) strategic partnerships and spinoff directions that extend capabilities, and (d) future directions driven by faculty-led initiatives. Within academia, it is the unique discoveries and inventions of faculty that lead to their recognition as scholars, and leads to financial support for their research programs and reconition of their intellectual contributions. Innovation must also be coupled to translation to demonstrate outcome successes. These ingredients are critical for research funding, and the two-decade growth in biomedical engineering research funding is an illustration of this, where technology invention has been the goal. This record can be contrasted with flat funding within radiation oncology and radiology, where a growing fraction of research is more procedure-based. However, some centers are leading the change of the definition of medical physics, by the inclusion or assimilation of researchers in fields such as biomedical engineering, machine learning, or data science, thereby widening the scope for new discoveries and inventions. New approaches to the assessment of research quality can help realize this model, revisiting the measures of success and impact. While research partnerships with large industry are productive, newer efforts that foster enterprise startups are changing how institutions see the benefits of the connection between academic innovation and affiliated startup company formation. This innovation-to-enterprise focus can help to cultivate a broader bandwidth of donor-to-investor networks. There are many predictions on future directions in medical physics, yet the actual inventive and discovery steps come from individual research faculty creativity. All success through a DIVERT model requires that faculty-led initiatives span the gap from invention to translation, with support from institutional leadership at all steps in the process. Institutional investment in faculty through endowments or clinical revenues will likely need to increase in the coming years due to the relative decreasing size of grants. Yet, radiology and radiation oncology are both high-revenue, translational fields, with the capacity to synergistically support clinical and research operations through large infrastructures that are mutually beneficial. These roadmap principles can provide a pathway for committed academic medical physics programs in scholarly leadership that will preserve medical physics as an active part of university academics.