[Regulatory path of the medical device]. / Parcours réglementaire du dispositif médical.

Regulatory path of the medical device. The safety of medical devices (MD) is recognized by the CE marking allowing their free circulation on the European market. The new European regulation will reinforce the application and the survey of MD. For implantable MD, clinical data will be required, and the traceability will be facilitated by the implementation of a unique identifier. The safety of MD is under the European governance responsibility, while the circulation, the reimbursement and the survey of MD is under the responsibility of each country. In France, the evaluation of the clinical benefit and conditions of use of MD reimbursed is under the responsibility of a specific commission of the HAS, while their surveillance is under the responsibility of the ANSM.

"Parcours réglementaire du dispositif médical. Le marquage CE médical garantit la sécurité des dispositifs médicaux et permet sa libre circulation sur le marché européen. Les exigences de ce marquage CE vont se renforcer grâce à la mise en application du nouveau règlement européen tant à l'obtention que dans son suivi. Les investigations cliniques pour les dispositifs médicaux implantables deviennent une règle. La mise en place de l'identifiant unique du dispositif médical va faciliter sa traçabilité. Si la sécurité du dispositif médical relève d'une gouvernance européenne, la prise en charge et la surveillance relève de la compétence de chaque pays. En France l'évaluation du bénéfice clinique et des conditions d'utilisation des dispositifs médicaux relève de la HAS alors que leur surveillance est sous la responsabilité de l'ANSM."

[Connected health objects and medical devices]. / Objets de santé et dispositifs médicaux connectés.

Connected health objects and medical devices.A clear distinction is required between connected devices which change patient's care and those intended to im¬prove his well-being. Connected devices with a medical objective must obtain a CE mark assessing the technical reliability of both the physical piece and the associated software, but also ensuring the control of the hosting of data. Those who demonstrate individual or collective improvement in the diagnosis or treatment of a disease may be financed by the community. This reimbursement is the main tool in France expecting to reduce the digital divide.

Objets de santé et dispositifs médicaux connectés.L'expansion des objets connectés impose de distinguer ceux qui modifient la prise en charge d'un malade, à finalité médicale et ceux destinés à améliorer son bien-être. Les dispositifs connectés ayant une finalité médicale doivent obtenir un marquage CE pour évaluer la fiabilité technique de l'objet physique et du logiciel associé mais aussi pour garantir le contrôle de l'hébergement des données. Ceux qui démontrent une amélioration indivi¬duelle ou collective du diagnostic ou du traitement d'une maladie peuvent être pris en charge par la collectivité. Ce soutien financier représente en France le principal outil pour limiter la fracture numérique.

The Organization of Diagnosis, Care and Funding for Specific Learning and Developmental Disorders (SLDD): A French Regional Experimental Protocol.

Introduction: Access in France to early diagnosis and care for the most severe, but infrequent, Neurodevelopmental Disorders (NDD), autism spectrum disorder and global developmental delay, in children aged 0-7 was improved through measures implemented in 2019. However, there are no such measures for specific learning disorders (SLD), attention, motricity and language disorders (SLDD), despite their annual incidence of between 5 and 8%. Method: We describe the design of a new type of organization and financing of care for SLDD including evaluation procedure, as well as other factors, mainly at the prevention level that will contribute to local and national policy for this frequent health problem. This in response to a national call for projects, commonly called Article 51, targeted innovation in healthcare delivery and funding in the context of medium-term national reform. This provides project stakeholders with the opportunity to set up and implement "bottom-up" projects, mainly using local professionals. A joint initiative by the regional Health Authorities of the Occitanie region, the French Social Security system and a non-profit Association (Occitadys) proposed an experimental new structure of NDD care and funding. Discussion: We here discuss the design of this experiment that aims, over two to three years, to alleviate families' financial burden of care and establish a regional three-tier care system with respect to evaluation, re-education and rehabilitation care. Our approach may benefit SLDD health-care planning, and addresses the questions of prevention, early detection and care-design for families, taking local and socioeconomic disparities into account.

Comparative static curing versus dynamic curing on tablet coating structures.

Curing is generally required to stabilize film coating from aqueous polymer dispersion. This post-coating drying step is traditionally carried out in static conditions, requiring the transfer of solid dosage forms to an oven. But, curing operation performed directly inside the coating equipment stands for an attractive industrial application. Recently, the use of various advanced physico-chemical characterization techniques i.e., X-ray micro-computed tomography, vibrational spectroscopies (near infrared and Raman) and X-ray microdiffraction, allowed new insights into the film-coating structures of dynamically cured tablets. Dynamic curing end-point was efficiently determined after 4h. The aim of the present work was to elucidate the influence of curing conditions on film-coating structures. Results demonstrated that 24h of static curing and 4h of dynamic curing, both performed at 60°C and ambient relative humidity, led to similar coating layers in terms of drug release properties, porosity, water content, structural rearrangement of polymer chains and crystalline distribution. Furthermore, X-ray microdiffraction measurements pointed out different crystalline coating compositions depending on sample storage time. An aging mechanism might have occur during storage, resulting in the crystallization and the upward migration of cetyl alcohol, coupled to the downward migration of crystalline sodium lauryl sulfate within the coating layer. Interestingly, this new study clearly provided further knowledge into film-coating structures after a curing step and confirmed that curing operation could be performed in dynamic conditions.

Comprehensive study of dynamic curing effect on tablet coating structure.

The dissolution method is still widely used to determine curing end-points to ensure long-term stability of film coatings. Nevertheless, the process of curing has not yet been fully investigated. For the first time, joint techniques were used to elucidate the mechanisms of dynamic curing over time from ethylcellulose (Aquacoat)-based coated tablets. X-ray micro-computed tomography (XµCT), Near Infrared (NIR), and Raman spectroscopies as well as X-ray microdiffraction were employed as non-destructive techniques to perform direct measurements on tablets. All techniques indicated that after a dynamic curing period of 4h, reproducible drug release can be achieved and no changes in the microstructure of the coating were any longer detected. XµCT analysis highlighted the reduced internal porosity, while both NIR and Raman measurements showed that spectral information remained unaltered after further curing. X-ray microdiffraction revealed densification of the coating layer with a decrease in the overall coating thickness of about 10 µm as a result of curing. In addition, coating heterogeneity attributed to cetyl alcohol was observed from microscopic images and Raman analysis. This observation was confirmed by X-ray microdiffraction that showed that crystalline cetyl alcohol melted and spread over the coating surface with curing. Prior to curing, X-ray microdiffraction also revealed the existence of two coating zones differing in crystalline cetyl alcohol and sodium lauryl sulfate concentrations which could be explained by migration of these constituents within the coating layer. Therefore, the use of non-destructive techniques allowed new insights into tablet coating structures and provided precise determination of the curing end-point compared to traditional dissolution testing. This thorough study may open up new possibilities for process and formulation control.

Real-time predictions of drug release and end point detection of a coating operation by in-line near infrared measurements.

The aim of this work was to carry out real-time near infrared (NIR) predictions of drug release from sustained release coated tablets and to determine end point of coating operation. In-line measurements were ensured by implementation of a NIR probe inside a pan coater. Tablets were coated using a functional aqueous dispersion of ethylcellulose blended with PVA-PEG graft copolymer to obtain a controlled drug release dosage form over 16h. Samples were collected at regular intervals and subjected to a standardized curing step. Percentages of released drug at 4h, 8h and 12h were selected to describe the controlled drug release of cured tablets. These dissolution criteria were used as reference values to calibrate NIR spectral information and to develop three partial least squares regressions. Low predictive errors of 1.7%, 1.9% and 1.5%, respectively, were obtained. The coating operation was stopped while desired dissolution criteria were achieved, corresponding to a coating level around 10%. The present study demonstrated that real-time NIR measurements could be performed on non-finished drug products to predict dissolution properties of cured coated tablets. This novel and innovative approach fulfils the expectations of ICH Q8 guideline on pharmaceutical development, in terms of process understanding and process analytical technology (PAT) control strategy. This approach should be however adapted to curing operation to allow a real-time release testing.

Development of a Process Analytical Technology (PAT) for in-line monitoring of film thickness and mass of coating materials during a pan coating operation.

The aim of this study was to perform in-line Near Infrared (NIR) measurements inside a pan coater to monitor a coating operation in real-time, by predicting the increases in mass of coating materials and coating thickness. A polymer combination of ethylcellulose/poly(vinyl-alcohol)-poly(ethylene-glycol) graft copolymer was used as functional aqueous coating. Coated tablets were sampled at regular intervals during the coating operation, then subjected to either simple and fast weighing (n=50) or accurate and non-destructive Terahertz Pulsed Imaging (TPI) measurements (n=3). Off-line NIR spectra analysis revealed that the coating operation could efficiently be controlled by focusing on two distinct NIR regions, related to absorption bands of ethylcellulose. Principal component analysis of in-line NIR spectra gave a clear classification of the collected coated tablets. Real-time quantitative monitoring of the coating operation was successfully performed from partial least square calibration models built using either TPI or weighing as reference method. Coating thicknesses as well as mass of coating materials used as primary values provided accurate NIR predictions. A comparison study demonstrated that both reference methods led to reliable and accurate real-time monitoring of the coating operation. This work demonstrated that in-line NIR measurements associated with multivariate analyses can be implemented to monitor in real-time a pan coating operation in order to fulfil the expectations of ICH Q8 guideline on pharmaceutical development, especially in terms of PAT control strategy and reduced end-product testing.