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Thinking like a lawyer — human rights and their association with the plastic surgeon of today
(2023)
Plastic surgeons are trained to perform a wide repertoire of surgeries—ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR).
Background
Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) was passed by the European Parliament and the Council of the European Union on 5 April 2017 and came into force on 26 May 2017. A new amending regulation, which introduces a phased implementation of the IVDR with new transitional provisions for certain in vitro diagnostic medical devices (IVDs) and a later date of application of some requirements for in-house devices for healthcare facilities, was adopted on 15 December 2021.
The combined use of CE-certified IVDs (CE-IVDs), in-house IVDs (IH-IVDs), and research use only (RUO) devices are a cornerstone of diagnostics in pathology departments and crucial for optimal patient care. The IVDR not only regulates the manufacture and placement on the market of industrially manufactured IVDs, but also imposes conditions on the manufacture and use of IH-IVDs for internal use by healthcare facilities.
Objectives
Our work provides an overview of the background and structure of the IVDR and identifies core areas that need to be interpreted and fleshed out in the context of the legal framework as well as expert knowledge.
Conclusions
The gaps and ambiguities in the IVDR crucially require the expertise of professional societies, alliances, and individual stakeholders to successfully facilitate the implementation and use of the IVDR in pathology departments and to avoid aberrant developments.
Hintergrund
Die Verordnung (EU) 2017/746 über In-vitro-Diagnostika (IVDR) stellt mehrere Bedingungen an Pathologische Institute, die hausinterne In-vitro-Diagnostika (IH-IVD) entwickeln und anwenden. Diese Bedingungen müssen jedoch nicht alle unmittelbar mit dem Geltungsbeginn der IVDR zum 26.05.2022 umgesetzt worden sein. Auf der Grundlage einer Änderungsverordnung des Europäischen Parlaments und des Rates der Europäischen Union werden die Anforderungen an IH-IVD stufenweise eingeführt. Die Konformität mit den grundlegenden Sicherheits- und Leistungsanforderungen gemäß Anhang I muss seit Mai 2022 gewährleistet sein
Ziel der Arbeit
Mit diesem Artikel möchten wir die praktische Umsetzung der aktuell gültigen Bedingungen für IH-IVD im Pathologischen Institut des Universitätsklinikums Heidelberg vorstellen und damit mögliche Hilfestellung für andere Einrichtungen geben
Schlussfolgerungen
Neben der intensiven Auseinandersetzung mit den Anforderungen an IH-IVD geben mehrere Handreichungen und Hilfestellungen eine Orientierungshilfe zur Umsetzung und Harmonisierung der in Artikel 5 (5) genannten Anforderungen an Gesundheitseinrichtungen. Auch der Austausch in akademischen Netzwerkstrukturen ist für die Interpretation und die praktische Umsetzung der IVDR von großer Bedeutung. Für universitäre und nicht-universitäre Einrichtungen stellt die Sicherstellung der IVDR-Konformität – neben den wesentlichen Aufgaben in der Krankenversorgung, in der Lehre und der Forschung und Weiterentwicklung von Methoden zur optimalen und zielgerichteten Diagnostik sowie der Aufrechterhaltung des sich stetig weiterentwickelnden Qualitätsmanagementsystems – eine weitere personelle und zeitliche Herausforderung dar.
Background
Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) imposes several conditions on pathology departments that develop and use in-house in vitro diagnostic medical devices (IH-IVDs). However, not all of these conditions need to be implemented immediately after the IVDR entered into force on 26 May 2022. Based on an amending regulation of the European Parliament and the Council of the European Union, the requirements for IH-IVDs will be phased in. Conformity with the essential safety and performance requirements of annex I must be ensured from May 2022.
Objectives
With this article, we would like to present the practical implementation of the currently valid conditions for IH-IVDs at the Institute of Pathology at the University Hospital of Heidelberg, in order to provide possible assistance to other institutions.
Conclusions
In addition to the intensive work on the requirements for IH-IVDs, several guidance documents and handouts provide orientation for the implementation and harmonisation of the requirements for healthcare institutions mentioned in Article 5 (5). Exchange in academic network structures is also of great importance for the interpretation and practical implementation of the IVDR. For university and nonuniversity institutions, ensuring conformity with the IVDR represents a further challenge in terms of personnel and time, in addition to the essential tasks of patient care, teaching and research and the further development of methods for optimal and targeted diagnostics, as well as the maintenance of the constantly evolving quality management system.
Three-dimensional medical printing and associated legal issues in plastic surgery: a scoping review
(2023)
Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon’s workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.
