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van Haren JS, Delbressine FLM, Monincx M, Hoveling T, Meijer N, Bangaru C, Sterk J, van der Woude DAA, Oei SG, van der Hout-van der Jagt MB. From intra- to extra-uterine: early phase design of a transfer to extra-uterine life support through medical simulation. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1371447. [PMID: 39229370 PMCID: PMC11368740 DOI: 10.3389/fmedt.2024.1371447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/24/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure. Methods Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians. Results & discussion Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.
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Affiliation(s)
- J. S. van Haren
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, Netherlands
| | - F. L. M. Delbressine
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - M. Monincx
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - T. Hoveling
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - N. Meijer
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, Netherlands
| | - C. Bangaru
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - J. Sterk
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - D. A. A. van der Woude
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, Netherlands
- Department of Obstetrics & Gynecology, Amphia Hospital, Breda, Netherlands
| | - S. G. Oei
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - M. B. van der Hout-van der Jagt
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Douze L, Schiro J, Heyndels L, Pazart L, Pelayo S. Evaluations of medical device usability during clinical investigations: a scoping review of clinical study protocols. Expert Rev Med Devices 2024; 21:781-788. [PMID: 38982753 DOI: 10.1080/17434440.2024.2378093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Combining clinical investigations with usability studies provides valuable information for medical devices evaluation. But both types of study are very different in terms of objectives and methodologies. How are usability studies integrated into clinical investigations in practice? METHODS We searched the ClinicalTrials.gov database for clinical investigation protocols that included usability outcome(s) and analyzed them. RESULTS 77 study protocols were identified for the analysis, including 102 outcomes related to usability in total. The most frequently assessed outcomes were satisfaction (53/102) and ease of use (33/102). The questionnaire was the most frequently planned technique (85/102) followed by interviews (24/102). Other methods were used, such as observation (9/102), mostly when the end users was a healthcare professional, and diary (6/102), mostly with patients. CONCLUSION Our study results showed that the collection of usability data can be included in a clinical investigation, with various levels of investment. Resource-light, rapid integration via a questionnaire will enable the collection of subjective data on the users' perceptions. When more resources are available, observation in accessible environments can be set up (especially during use by healthcare professionals in hospital) or interviews and/or diaries for home-based environments (especially by patients).
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Affiliation(s)
- Laura Douze
- Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, ULR 2694 - METRICS, Lille, France
- Inserm, CIC-IT 1403, Lille, France
| | - Jessica Schiro
- Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, ULR 2694 - METRICS, Lille, France
- Inserm, CIC-IT 1403, Lille, France
| | | | - Lionel Pazart
- INSERM CIC 1431, Centre d'Investigation Clinique, Centre Hospitalier Universitaire de Besançon, Besancon, France
| | - Sylvia Pelayo
- Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, ULR 2694 - METRICS, Lille, France
- Inserm, CIC-IT 1403, Lille, France
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Staats K, Kayani B, Haddad FS. The impact of the European Union's Medical Device Regulation on orthopaedic implants, technology, and future innovation. Bone Joint J 2024; 106-B:303-306. [PMID: 38555944 DOI: 10.1302/0301-620x.106b4.bjj-2023-1228.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Kevin Staats
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
- The NIHR Biomedical Research Centre, UCLH, London, UK
- The Bone & Joint Journal , London, UK
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Wang L, Xiong J, Ruan C. Research on product design of FAHP bone marrow aspiration needle. Heliyon 2024; 10:e27389. [PMID: 38463822 PMCID: PMC10923704 DOI: 10.1016/j.heliyon.2024.e27389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Bone marrow aspiration is a crucial medical procedure to obtain bone marrow samples for diagnosis and treatment. However, traditional bone marrow aspiration needles face several challenges such as operational difficulties, inadequate sample acquisition, and patient discomfort. To address these issues, we aimed to design a bone marrow aspiration needle product by using fuzzy analytic hierarchical process (FAHP). The FAHP method was used to identify key factors in the design of the bone marrow aspiration needle, including technicality, usage, and application characteristics. The importance weights and priorities of each factor were determined through questionnaires and interviews with experts. A new bone marrow aspiration needle product was developed based on the results of the FAHP. The new product design considers the weights and priorities assigned to key factors, resulting in improved convenience during operation and a higher success rate of sample acquisition. This was achieved by optimising the structure and material selection of the needle. This study presents a novel bone marrow puncture needle product that effectively integrates the importance and priority of the key factors. It successfully enhances operational performance and patient experience, thereby offering an innovative solution to improve the success rate and therapeutic effect of bone marrow punctures.
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Affiliation(s)
- Lin Wang
- Department of Product Design, Sanming University, Sanming, Fujian, China
| | - Jianying Xiong
- Department of Stomatology, Sanming Integrated Medicine Hospital, Sanming, Fujian, China
| | - Chenglu Ruan
- Department of Stomatology, Sanming Integrated Medicine Hospital, Sanming, Fujian, China
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Beltzer A, Kölle J, Gil Miró M, Pleus S, Krauss C, Haug C, Safary E, Vetter B, Freckmann G. Benefits of Usability Evaluation in the Development Process of Diabetes Technologies Using the Example of a Continuous Glucose Monitoring System Prototype. J Diabetes Sci Technol 2024:19322968241238146. [PMID: 38477255 DOI: 10.1177/19322968241238146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Usability engineering analyzes the interaction between the intended users and a device. Its implementation is mandatory for manufacturers to obtain regulatory approval for the European market. The aim of this evaluation was assessing the role of usability testing in the development process. For this purpose, a continuous glucose monitoring (CGM) device under development was investigated to determine whether it could be used safely and effectively by the intended users. METHODS Conduct of the usability testing was based on the international standard IEC 62366-1. Medical device use of CGM-experienced and non-experienced users (n = 15 each) was observed without initial training in use scenarios containing 18 tasks. The success rate of task completion was determined and the System Usability Scale (SUS) score was calculated from a questionnaire. A prototype of the FiberSense CGM System (EyeSense GmbH, Großostheim, Germany), comprising of a single-use sensor and a reusable detector, was investigated. RESULTS Most use errors made by both user groups were related to ease of handling of the reusable detectors. The SUS scores achieved in this study were below the pre-defined SUS score acceptance criterion of ≥68. The most frequently mentioned reason for use errors was an incomprehensible and non-chronological instructions for use (IFU). CONCLUSIONS The evaluation provides valuable insights on how to improve usability of the prototype device and demonstrates the value of conducting structured usability testing prior to product finalization. The results reflected areas for improvement of the user interface, mainly by restructuring the IFU, provision of an additional leaflet, and device training prior to use.
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Affiliation(s)
- Anne Beltzer
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Julia Kölle
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Marta Gil Miró
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Collin Krauss
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | | | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Galavi Z, Norouzi S, Khajouei R. Heuristics used for evaluating the usability of mobile health applications: A systematic literature review. Digit Health 2024; 10:20552076241253539. [PMID: 38766365 PMCID: PMC11100408 DOI: 10.1177/20552076241253539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Objective Mobile health applications hold immense potential for enhancing health outcomes. Usability is one of the main factors for the adoption and use of mobile health applications. However, despite the growing importance of mHealth applications, clear standards for their evaluation remain elusive. The present study aimed to determine heuristics for the usability evaluation of health-related applications. Methods We systematically searched multiple databases for relevant papers published between January 2008 and April 2021. Articles were reviewed, and data were extracted and categorized from those meeting inclusion criteria by two authors independently. Heuristics were identified based on statements, words, and concepts expressed in the studies. These heuristics were first mapped to Nielsen's heuristics based on their differences or similarities. The remaining heuristics that were very important for mobile applications were categorized into new heuristics. Results Seventeen studies met the eligibility criteria. Seventy-nine heuristics were extracted from the papers. After combining the items with the same concepts and removing irrelevant items based on the exclusion criteria, 20 heuristics remained. Common heuristics such as "Visibility of system status" and "Flexibility and efficiency of use" were categorized into 10 previously established heuristics and new heuristics like "Navigation" and "User engagement" were recognized as new ones. Conclusions In our study, we have meticulously identified 20 heuristics that hold promise for evaluating and designing mHealth applications. These heuristics can be used by the researchers for the development of robust tools for heuristic evaluation. These tools, when adapted or tailored for health domain applications, have the potential to significantly enhance the quality of mHealth applications. Ultimately, this improvement in quality translates to enhanced patient safety. Protocol Registration (10.17605/OSF.IO/PZJ7H).
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Affiliation(s)
- Zahra Galavi
- Students Research Committee, Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Somaye Norouzi
- Students Research Committee, Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Cocchieri R, van de Wetering B, Baan J, Driessen A, Riezebos R, van Tuijl S, de Mol B. The evolution of technical prerequisites and local boundary conditions for optimization of mitral valve interventions-Emphasis on skills development and institutional risk performance. Front Cardiovasc Med 2023; 10:1101337. [PMID: 37547244 PMCID: PMC10402900 DOI: 10.3389/fcvm.2023.1101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/29/2023] [Indexed: 08/08/2023] Open
Abstract
This viewpoint report describes how the evolution of transcatheter mitral valve intervention (TMVI) is influenced by lessons learned from three evolutionary tracks: (1) the development of treatment from mitral valve surgery (MVS) to transcutaneous procedures; (2) the evolution of biomedical engineering for research and development resulting in predictable and safe clinical use; (3) the adaptation to local conditions, impact of transcatheter aortic valve replacement (TAVR) experience and creation of infrastructure for skills development and risk management. Thanks to developments in computer science and biostatistics, an increasing number of reports regarding clinical safety and effectiveness is generated. A full toolbox of techniques, devices and support technology is now available, especially in surgery. There is no doubt that the injury associated with a minimally invasive access reduces perioperative risks, but it may affect the effectiveness of the treatment due to incomplete correction. Based on literature, solutions and performance standards are formulated with an emphasis in technology and positive outcome. Despite references to Heart Team decision making, boundary conditions such as hospital infrastructure, caseload, skills training and perioperative risk management remain underexposed. The role of Biomedical Engineering is exclusively defined by the Research and Development (R&D) cycle including the impact of human factor engineering (HFE). Feasibility studies generate estimations of strengths and safety limitations. Usability testing reveals user friendliness and safety margins of clinical use. Apart from a certification requirement, this information should have an impact on the definition of necessary skills levels and consequent required training. Physicians Preference Testing (PPT) and use of a biosimulator are recommended. The example of the interaction between two Amsterdam heart centers describes the evolution of a professional ecosystem that can facilitate innovation. Adaptation to local conditions in terms of infrastructure, referrals and reimbursement, appears essential for the evolution of a complete mitral valve disease management program. Efficacy of institutional risk management performance (IRMP) and sufficient team skills should be embedded in an appropriate infrastructure that enables scale and offers complete and safe solutions for mitral valve disease. The longstanding evolution of mitral valve therapies is the result of working devices embedded in an ecosystem focused on developing skills and effective risk management actions.
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Affiliation(s)
| | | | - Jan Baan
- Amsterdam University Center, Technical University Eindhoven, Amsterdam, Netherlands
| | - Antoine Driessen
- Amsterdam University Center, Technical University Eindhoven, Amsterdam, Netherlands
| | | | | | - Bas de Mol
- LifeTec Group BV, Eindhoven, Netherlands
- Amsterdam University Center, Technical University Eindhoven, Amsterdam, Netherlands
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Rêgo ADS, Furtado GE, Bernardes RA, Santos-Costa P, Dias RA, Alves FS, Ainla A, Arruda LM, Moreira IP, Bessa J, Fangueiro R, Gomes F, Henriques M, Sousa-Silva M, Pinto AC, Bouçanova M, Sousa VIF, Tavares CJ, Barboza R, Carvalho M, Filipe L, Sousa LB, Apóstolo JA, Parreira P, Salgueiro-Oliveira A. Development of Smart Clothing to Prevent Pressure Injuries in Bedridden Persons and/or with Severely Impaired Mobility: 4NoPressure Research Protocol. Healthcare (Basel) 2023; 11:1361. [PMID: 37239647 PMCID: PMC10218695 DOI: 10.3390/healthcare11101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Pressure injuries (PIs) are a major public health problem and can be used as quality-of-care indicators. An incipient development in the field of medical devices takes the form of Smart Health Textiles, which can possess innovative properties such as thermoregulation, sensing, and antibacterial control. This protocol aims to describe the process for the development of a new type of smart clothing for individuals with reduced mobility and/or who are bedridden in order to prevent PIs. This paper's main purpose is to present the eight phases of the project, each consisting of tasks in specific phases: (i) product and process requirements and specifications; (ii and iii) study of the fibrous structure technology, textiles, and design; (iv and v) investigation of the sensor technology with respect to pressure, temperature, humidity, and bioactive properties; (vi and vii) production layout and adaptations in the manufacturing process; (viii) clinical trial. This project will introduce a new structural system and design for smart clothing to prevent PIs. New materials and architectures will be studied that provide better pressure relief, thermo-physiological control of the cutaneous microclimate, and personalisation of care.
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Affiliation(s)
- Anderson da Silva Rêgo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Guilherme Eustáquio Furtado
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços–S. Martinho do Bispo, 3045-093 Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Rosana A. Dias
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal; (R.A.D.); (F.S.A.); (A.A.)
| | - Filipe S. Alves
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal; (R.A.D.); (F.S.A.); (A.A.)
| | - Alar Ainla
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal; (R.A.D.); (F.S.A.); (A.A.)
| | - Luisa M. Arruda
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal; (L.M.A.); (I.P.M.); (J.B.); (R.F.)
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - Inês P. Moreira
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal; (L.M.A.); (I.P.M.); (J.B.); (R.F.)
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - João Bessa
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal; (L.M.A.); (I.P.M.); (J.B.); (R.F.)
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - Raul Fangueiro
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal; (L.M.A.); (I.P.M.); (J.B.); (R.F.)
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - Fernanda Gomes
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (F.G.); (M.H.); (M.S.-S.); (A.C.P.)
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
| | - Mariana Henriques
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (F.G.); (M.H.); (M.S.-S.); (A.C.P.)
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
| | - Maria Sousa-Silva
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (F.G.); (M.H.); (M.S.-S.); (A.C.P.)
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
| | - Alexandra C. Pinto
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (F.G.); (M.H.); (M.S.-S.); (A.C.P.)
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
| | - Maria Bouçanova
- Impetus Portugal-Têxteis Sa (IMPETUS), 4740-696 Barcelos, Portugal;
| | - Vânia Isabel Fernande Sousa
- Physics Center of Minho and Porto Universities (CF-UM-PT), Campus of Azurém, University of Minho, 4804-533 Guimarães, Portugal; (V.I.F.S.); (C.J.T.)
| | - Carlos José Tavares
- Physics Center of Minho and Porto Universities (CF-UM-PT), Campus of Azurém, University of Minho, 4804-533 Guimarães, Portugal; (V.I.F.S.); (C.J.T.)
| | - Rochelne Barboza
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - Miguel Carvalho
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (R.B.); (M.C.)
| | - Luísa Filipe
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - João A. Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (G.E.F.); (R.A.B.); (P.S.-C.); (L.F.); (L.B.S.); (J.A.A.); (P.P.); (A.S.-O.)
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9
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Simunovic A, Kranjcec K, Pekas M, Tomic S. Quality analysis of manufacturer's incident reports regarding medical devices. J Pharm Policy Pract 2023; 16:3. [PMID: 36647170 PMCID: PMC9841638 DOI: 10.1186/s40545-023-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Medical devices provide a great number of medical treatments and have an important role in patients' healthcare; however, there are certain risks, sometimes even serious incidents, associated with their usage. To ensure that benefits of medical device usage always outweigh associated risks, it is necessary to closely monitor known risks post-market and detect new ones as early as possible. Among others, valuable instrument of post-market surveillance is manufacturer incident report. Yet to accomplish its intended use, such report must be sufficiently populated and supplied with correct information. Aim of this paper is to assess the quality of manufacturer's incident reports received in HALMED since 2012 to May 2021. METHODS The study included 578 initial reports and 566 final reports that were scored according to the evaluating system we designed and categorized as Excellent, Good, Medium, Qualified and Unqualified. For each report medical device risk class was also extracted to calculate the frequency of report occurrence per risk class and time that passed between the initial and final report. Difference in quality of the reports between manufacturers based on EU countries and countries outside the EU was determined by Mann Whitney U test. RESULTS Most of initial and final reports fall into two highest quality category level, which means that a sufficient amount of reports are of good/excellent quality and quality of reports prevails. However, the study's results indicate the need for higher scores, especially in critical fields of the form. CONCLUSIONS Data obtained from the manufacturer can be scarce and insufficient, causing negative influence on Competent Authority's investigation procedure. Another issue we recognized is extensive underreporting in Croatia, which can seriously undermine the established system.
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Affiliation(s)
- Antonela Simunovic
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Krunoslav Kranjcec
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Marija Pekas
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
| | - Siniša Tomic
- grid.494038.2Croatian Agency for Medicinal Products and Medical Devices, Ksaverska Cesta 4, Zagreb, Croatia
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Jiang T, Kost S, Doshi P, Ho PC, Phillips SD, Mutindi E, Mueller JL, Fitzgerald TN. Crucial Business Model Elements for Medical Device Startup Companies in Emerging Markets. Value Health Reg Issues 2023; 33:83-90. [PMID: 36327768 DOI: 10.1016/j.vhri.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Medical devices that suit the needs and challenges of low- and middle-income countries are desperately needed. To provide sustainable access to such devices, business approaches must be developed to meet the demands of individual economic, healthcare, and innovation ecosystems. Currently, there is a gap in the literature regarding business models for medical devices in low- and middle-income countries. METHODS A multimodal approach using literature review and key informant interviews was performed to determine critical components of business models for medical device organizations operating in LMICs, specifically focusing on models in emerging markets. RESULTS The search resulted in 4,674 articles, of which 31 were determined to be relevant and were reviewed. Additional sources included 1 government website, 5 nongovernmental organization websites, 2 private enterprises, and 6 publicly available, non-peer reviewed websites and 1 video. From these sources, four major criteria were found to be necessary for successful development of medical device business models in emerging markets: value proposition, partnerships, strategic pricing, and funding models. CONCLUSIONS Innovators must custom tailor their business model when implementing these elements to the regulatory, cultural, and economic landscapes of each setting. This will improve access to safer, affordable medical care and successfully bring innovative technologies to emerging markets.
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Affiliation(s)
- Tiffany Jiang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Samantha Kost
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Pratik Doshi
- School of Medicine, Duke University, Durham, NC, USA; Clark School of Engineering, University of Maryland, College Park, MD, USA
| | - Pei Ching Ho
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | | | | | - Jenna L Mueller
- Clark School of Engineering, University of Maryland, College Park, MD, USA
| | - Tamara N Fitzgerald
- School of Medicine, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA.
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11
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Chest Drainage Therapy: What Comes out of Pandora's Box Can Affect Patient Outcomes. J Clin Med 2022; 11:jcm11185311. [PMID: 36142958 PMCID: PMC9500716 DOI: 10.3390/jcm11185311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Over the last 100 years, the original three-bottle chest drainage system has been variously engineered into compact disposables and electronic units. Clinicians are now surrounded by a plethora of different types of systems, but little is known about the way that they work and perform. Thus, we sought to test the performance of the most commonly used chest drainage units under conditions that are relevant to clinical practice. Methods: A pleural space environment simulator was built. Thirty-two units were tested under four clinical scenarios: air leak interpretation during quiet breathing and after obstructed inspiration (−5 to −150 cmH2O), a buildup of negative pressure (−100 cmH2O), a bronchopleural fistula (10 L/min) and the need for effective external suction in the presence of air leakage. Twenty-five units were “traditional” thoracic drainages, five were “digital” low-flow/low-vacuum pumps and two were hybrids (a combination of the two). According to the design of the seal and of the suction control, the units were classified as wet-wet, wet-dry and dry-dry. Results: All wet units showed reverse air flow, with the potential to mimic an air leak when there was none. Ten wet units showed no automatic negative pressure relief features, while five dry-dry did but were slow to react. Ten wet and five dry-dry units showed no capability to handle a 10 L/min leak, as they were restrictive to flow (peak pressure up to 55 cmH2O). Only seven dry-suction units were able to maintain the set suction at high airflow rates (>20 L/min). Conclusions: Different chest drainage unit designs lead to different performances, some of which may negatively impact patient outcomes. This sounds the call to tailor our clinical practice for the individual patient. A paradigm shift to better understand all components of pleural physiology post-surgical intervention on this relatively neglected topic is needed to improve our daily practice.
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Dmytrenko O, Arkhypova M, Starosyla D, Rybalko S, Gevorkyan M, Galkin A. Biological Evaluation of Medical Devices in the Form of Suppositories for Rectal and Vaginal Use. INNOVATIVE BIOSYSTEMS AND BIOENGINEERING 2021. [DOI: 10.20535/ibb.2021.5.4.249082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background. Programs of preclinical safety studies of the health care products depend on the regulatory status of the investigated products. The classification of such products, in particular suppositories for rectal and vaginal use, is a critical step of developing tactics for their biological evaluation. Adaptation of biological evaluation methods for the medical devices based on the combination of biologically active substances, as well as evaluation of the results of such studies is urgent task of biomedicine.
Objective. To substantiate the regulatory status and to carry out a biological evaluation of medical devices in the form of vaginal suppositories based on octenidine dihydrochloride ("Prodexyn") and in the form of rectal suppositories based on Saw palmetto, Levisticum officinale and Calendula officinalis extracts ("Pravenor").
Methods. Biological evaluation was conducted according to the requirements of ISO 10993 standards using in vitro and in vivo biological test systems (cytotoxicity in cell culture and the MTT test, sensitizing and irritating effect in guinea pigs).
Results. The cytotoxicity (СС50) of the medical device "Prodexyn" extract in Vero cell culture was 8.35 μg/ml calculated as octenidine dihydrochloride and 416.65 μg/ml calculated as dexpanthenol. "Pravenor" medical device was found to be non-toxic in Vero cell culture. According to the results of MMT assay CC50 for octenidine dihydrochloride was 1.67 μg/ml, and 83.33 μg/ml – for dexpanthenol. CC50 indicators calculated for the different active ingredients of the medical device "Pravenor" were the following: 50 mg/ml for the dwarf palm berries extract (Saw palmetto), 16.67 mg/ml for the lovage roots extract (Levisticum officinale), and 16.67 mg/ml for the calendula flowers extract (Calendula officinalis). No sensitizing or skin irritating effects were observed in guinea pigs.
Conclusions. Biological evaluation of medical devices in the form of rectal suppositories "Pravenor" and vaginal suppositories "Prodexyn" performed using in vitro and in vivo biological systems. It was demonstrated an acceptable level of safety of the products. The MTT test was 5 times more sensitive than the Vero cell culture method in determination of cytotoxicity.
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13
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Antich-Isern P, Caro-Barri J, Aparicio-Blanco J. The combination of medical devices and medicinal products revisited from the new European legal framework. Int J Pharm 2021; 607:120992. [PMID: 34390808 DOI: 10.1016/j.ijpharm.2021.120992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Medical devices and medicinal products have many similarities in their nature, scope or specific medical purposes, and despite the differences in their principal means of action, they are often used in combination. Indeed, many medicinal products depend on medical devices for their administration, and it is increasingly common for medical devices to contain medicinal substances to support their action. Therefore, the combination of medicinal products and medical devices provides additional benefits for patients. However, their higher technical complexity requires a strengthening of their authorisation and certification requirements. In this regard, more comprehensive requirements and classification rules are introduced by a new European regulation on medical devices that fully applies from May 26th 2021. On account of their therapeutic significance, this review aims at gaining insight into the borderline between medical devices and medicinal products in this new 2021 regulatory framework. For the first time, any item containing a medical device and a medicinal product will have both parts evaluated. Through exemplification of both marketed and investigational devices incorporating medicinal substances and drug-device combinations, the new European requirements and their implications are thoroughly illustrated herein.
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Affiliation(s)
- Pau Antich-Isern
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Julia Caro-Barri
- Notified Body 0318, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Juan Aparicio-Blanco
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain; Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, Spain.
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Alipal J, Lee T, Koshy P, Abdullah H, Idris M. Evolution of anodised titanium for implant applications. Heliyon 2021; 7:e07408. [PMID: 34296002 PMCID: PMC8281482 DOI: 10.1016/j.heliyon.2021.e07408] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/15/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Anodised titanium has a long history as a coating structure for implants due to its bioactive and ossified surface, which promotes rapid bone integration. In response to the growing literature on anodised titanium, this article is the first to revisit the evolution of anodised titanium as an implant coating. The review reports the process and mechanisms for the engineering of distinctive anodised titanium structures, the significant factors influencing the mechanisms of its formation, bioactivity, as well as recent pre- and post-surface treatments proposed to improve the performance of anodised titanium. The review then broadens the discussion to include future functional trends of anodised titanium, ranging from the provision of higher surface energy interactions in the design of biocomposite coatings (template stencil interface for mechanical interlock) to techniques for measuring the bone-to-implant contact (BIC), each with their own challenges. Overall, this paper provides up-to-date information on the impacts of the structure and function of anodised titanium as an implant coating in vitro and in/ex vivo tests, as well as the four key future challenges that are important for its clinical translations, namely (i) techniques to enhance the mechanical stability and (ii) testing techniques to measure the mechanical stability of anodised titanium, (iii) real-time/in-situ detection methods for surface reactions, and (iv) cost-effectiveness for anodised titanium and its safety as a bone implant coating.
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Affiliation(s)
- J. Alipal
- Department of Chemical Engineering Technology, Faculty of Engineering Technology, Universiti Tun Hussein Onn Malaysia (UTHM), Pagoh Higher Education Hub, 84600 Muar, Johor, Malaysia
| | - T.C. Lee
- Department of Production and Operation Management, Faculty of Technology Management and Business, UTHM Parit Raja 86400, Batu Pahat, Johor, Malaysia
| | - P. Koshy
- School of Materials Science and Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - H.Z. Abdullah
- Department of Manufacturing Engineering, Faculty of Mechanical and Manufacturing Engineering, UTHM Parit Raja 86400, Batu Pahat, Johor, Malaysia
| | - M.I. Idris
- Department of Manufacturing Engineering, Faculty of Mechanical and Manufacturing Engineering, UTHM Parit Raja 86400, Batu Pahat, Johor, Malaysia
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