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Neugebauer EAM, Rath A, Antoine SL, Eikermann M, Seidel D, Koenen C, Jacobs E, Pieper D, Laville M, Pitel S, Martinho C, Djurisic S, Demotes-Mainard J, Kubiak C, Bertele V, Jakobsen JC, Garattini S, Gluud C. Specific barriers to the conduct of randomised clinical trials on medical devices. Trials 2017; 18:427. [PMID: 28903769 PMCID: PMC5597993 DOI: 10.1186/s13063-017-2168-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Medical devices play an important role in the diagnosis, prevention, treatment and care of diseases. However, compared to pharmaceuticals, there is no rigorous formal regulation for demonstration of benefits and exclusion of harms to patients. The medical device industry argues that the classical evidence hierarchy cannot be applied for medical devices, as randomised clinical trials are impossible to perform. This article aims to identify the barriers for randomised clinical trials on medical devices. METHODS Systematic literature searches without meta-analysis and internal European Clinical Research Infrastructure Network (ECRIN) communications taking place during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. RESULTS In addition to the barriers that exist for all trials, we identified three major barriers for randomised clinical trials on medical devices, namely: (1) randomisation, including timing of assessment, acceptability, blinding, choice of the comparator group and considerations on the learning curve; (2) difficulties in determining appropriate outcomes; and (3) the lack of scientific advice, regulations and transparency. CONCLUSIONS The present review offers potential solutions to break down the barriers identified, and argues for applying the randomised clinical trial design when assessing the benefits and harms of medical devices.
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Affiliation(s)
- Edmund A M Neugebauer
- Brandenburg Medical School Theodor Fontane & Health Services Research Witten/Herdecke University, Campus Neuruppin, Neuruppin, Germany
| | - Ana Rath
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Doerthe Seidel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Carsten Koenen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Esther Jacobs
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | | | | | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Vittorio Bertele
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Kenngott HG, Wünscher JJ, Wagner M, Preukschas A, Wekerle AL, Neher P, Suwelack S, Speidel S, Nickel F, Oladokun D, Albala L, Maier-Hein L, Dillmann R, Meinzer HP, Müller-Stich BP. OpenHELP (Heidelberg laparoscopy phantom): development of an open-source surgical evaluation and training tool. Surg Endosc 2015; 29:3338-47. [PMID: 25673345 PMCID: PMC4607709 DOI: 10.1007/s00464-015-4094-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023]
Abstract
Background Apart from animal testing and clinical trials, surgical research and laparoscopic training mainly rely on phantoms. The aim of this project was to design a phantom with realistic anatomy and haptic characteristics, modular design and easy reproducibility. The phantom was named open-source Heidelberg laparoscopic phantom (OpenHELP) and serves as an open-source platform.
Methods The phantom was based on an anonymized CT scan of a male patient. The anatomical structures were segmented to obtain digital three-dimensional models of the torso and the organs. The digital models were materialized via rapid prototyping. One flexible, using an elastic abdominal wall, and one rigid method, using a plastic shell, to simulate pneumoperitoneum were developed. Artificial organ production was carried out sequentially starting from raw gypsum models to silicone molds to final silicone casts. The reproduction accuracy was exemplarily evaluated for ten silicone rectum models by comparing the digital 3D surface of the original rectum with CT scan by calculating the root mean square error of surface variations. Haptic realism was also evaluated to find the most realistic silicone compositions on a visual analog scale (VAS, 0–10). Results The rigid and durable plastic torso and soft silicone organs of the abdominal cavity were successfully produced. A simulation of pneumoperitoneum could be created successfully by both methods. The reproduction accuracy of ten silicone rectum models showed an average root mean square error of 2.26 (0–11.48) mm. Haptic realism revealed an average value on a VAS of 7.25 (5.2–9.6) for the most realistic rectum. Conclusion The OpenHELP phantom proved to be feasible and accurate. The phantom was consecutively applied frequently in the field of computer-assisted surgery at our institutions and is accessible as an open-source project at www.open-cas.org for the academic community.
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Affiliation(s)
- H G Kenngott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J J Wünscher
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Wagner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - A Preukschas
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - A L Wekerle
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Neher
- Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Suwelack
- Institute for Anthropomatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - S Speidel
- Institute for Anthropomatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - D Oladokun
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lorenzo Albala
- Ruprecht-Karls-University, Department of General Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - L Maier-Hein
- Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Dillmann
- Institute for Anthropomatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - H P Meinzer
- Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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