dilluns, 1 d’abril del 2019

S&P boosts Integer Holdings’ outlook

Integer Holdings Integer Holdings (NYSE:ITGR) said it has received a positive outlook and a reaffirmed B+ long-term issuer credit rating from Standard & Poor’s (S&P). The positive outlook, which was revised from stable, is based on Integer’s debt reduction and expected future targeted debt-to-adjusted EBITDA leverage ratio between 2.5X – 3.5X.

S&P also cited Plano, Texas-based Integer’s customer relationships, array of product offerings and competitive advantage as the industry consolidates its supplier base with larger medical device manufacturers. S&P also hinted at an upgrade if Integer demonstrates consistent long-term leverage in the targeted range.

Get the full story on our sister site, Medical Design & Outsourcing.

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Philips wins $450m DoD patient monitor supply contract

Philips

Royal Philips (NYSE:PHG) has won a $450 million contract to supply the U.S. Department of Defense with patient monitoring systems, accessories and training, according to a recently released DoD posting.

The deal comes through a five-year base contract with a single five-year option period. A total of 36 different companies competed for the contract that Amsterdam-based Philips won, according to the DoD release.

Patient monitoring systems, accessories and training will be supplied to the Army, Navy, Air Force, Marine Corps and other federal civilian agencies, with the location of performance noted as Massachusetts. The contract has a performance completion date of March 28, 2024, according to the release.

The contracting was performed through the Defense Logistics Agency Troop Support, the DoD said.

Last week, Philips said that it acquired teleradiology platform developer Direct Radiology for an undisclosed amount.

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Is this the way to improve organ transportation?

Lisa Anderson Headshot

Lisa Anderson, president, co-founder and COO of Paragonix Technologies

Organ transplants are performed annually to remove diseased organs and replace them with healthy ones to extend the lifespan of patients. Potential transplant recipients are placed on a waiting list by a doctor who has determined that a transplant is the best course of action. Once a donor organ is available, the organ transportation system becomes one of the most critical medical devices of the transplantation process, according to Lisa Anderson, president, co-founder and COO of Paragonix Technologies.

Before Anderson helped found Braintree, Mass.–based Paragonix Technologies, she was working in the lab at Harvard Medical School and discovered that two important things were missing in the way organs were being transported:  preservation and respect.

“I was at Harvard Medical School doing research in Type 1 diabetes and one of the aspects of my research was to dissect the human pancreas. This was a revelation to me that when I first saw the human pancreas coming into the lab, I called my colleague and I said, ‘Oh my god, they messed up the packaging here. I can’t believe that organs are transported like that. Is this just for research?’” Anderson told Medical Design & Outsourcing in an interview. “I was really upset about it. I still remember it. We called the lab and the clinical staff and they said, ‘No, this is how organs are transported – even for transplantation.’”

Get the full story on our sister site, Medical Design & Outsourcing.

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MPR: Getting medical device development back on track

In this podcast, experts from MPR discuss what medical device companies can do if things go sideways during the product development process. Drawing from their own experiences, engineers from the firm spoke with MassDevice.com editor Sarah Faulkner about how they tackle device development challenges when they are called into action.

Sarah Faulkner: Hey, everyone. Thanks for downloading this podcast. I’m really excited to bring you this conversation about what to do when things go sideways during the product development process.

Faulkner: I spoke with a group of experts from MPR. They’re a product development firm that specializes in this kind of crisis management technique. They have a history of tackling really hard problems. In fact, their founders, they were at the forefront of the nuclear power movement, helping to guide the successful development and implementation of nuclear power for submarines.

Faulkner: Anyway, I spoke to them about how to navigate some of the challenges that can crop up when you’re designing and developing a product. So without further delay, let’s jump right in.

Faulkner: Let’s start with a story. Based in Harrisburg, Pennsylvania, MacuLogix developed the first and only diagnostic aid that can detect subclinical age-related macular degeneration. Early detection is critical so the doctors can step in and provide treatment early enough to stop blindness from creeping into the patient’s eyes. But the company had a problem. Its devices were experiencing unusual, intermittent instrument failures in the field. The instrument is a complex mix of hardware and software, and the MacuLogix team couldn’t untangle the two to determine a root cause.

Faulkner: After CEO Bill McPhee put a request out to people within his network, he was eventually connected to MPR. And within one day, MPR was in touch with MacuLogix to solve the problem. In a letter to MPR, the company CTO, Greg Jackson, is quoted as saying, “From the outset, MPR treated our problem as if it were their own, as if MPR’s reputation was on the line.” He went on to say, quote, “What was probably most impressive was the speed with which they integrated into our team. Within a day, it’s as though they had worked with us for years. Their extraordinary test facilities and state-of-the-art tools provided us with the level of diagnostic intensity that simply doesn’t exist in-house in most early stage medical device companies.”

Faulkner: Needless to say, MPR got to the root of MacuLogix’s problem, and this is just one example of the countless fire-fighting missions that MPR is hired to tackle. The process that the MPR team follows when they’re called in by a friend to help reroute product development, that process is both methodical and analytical. According to MPR’s Director of Product Testing, Lynessa Erler, the first thing MPR has to do when they’re called in is to identify and wrap their brains around the problem.

Lynessa Erler: Understanding the problem has already been done. Just try to solve it. Try to get all the data. Get the data, not just the opinions as to what conclusions they’ve drawn from the data, but get to the actual data.

Erler: A lot of times, what you find is either they’ve drawn a faulty conclusion on the data, or the data itself was flawed. And that can be very difficult to piece apart if you’re not digging into the details. So that’s where I start, you probably …

Eric Claude: Yeah, no, you’re absolutely right. Here’s the way I think about it, an analogy is, it’s like walking into a crime scene.

Faulkner: That’s Eric Claude, by the way, VP of Product Development at MPR.

Claude: So we start with the forensics. Let’s collect all the data that can be collected, and see if we can find the murder weapon and the fingerprints. And all of the data that surrounds whatever the incident might be, and then start with that.

Erler: But see, with really complicated medical devices, if it’s an intermittent problem, that is half the battle, is finding what conditions lead to the issue, in a repeatable manner. Because that may be your first challenge, is trying to repeat the failure. And until you can do that in a reliable way, you’re just stabbing in the dark. And you’re saying, “Okay, something like that, what might it be?” And then you’re looking around. But until you can recreate it, it’s very difficult.

Faulkner: And it isn’t just the technical challenges that MPR faces when it’s called in to help fix a problem. It also comes down to navigating a company’s culture and working through the tendencies that are brought about by human nature. That’s according to Craig Mauch. He’s MPR’s Director of Product Design.

Craig Mauch: It always goes something like this, is that you’re in a root-cause mode, and invariably, there are people who are engaged in the problem, trying to solve it, sometimes not that happy to see us. Sometimes they’re happy to see us. But there’s usually a lot of preconceived notion of what the problem is, and the notion of doing this root-causes and getting to the bottom of things is to setting up a good framework of, “Let’s identify everything that could cause the problem, and then let’s, in a methodical way, do some kind of test or analysis or thought experiment, or look at the data for each and every one of those conceivable possibilities to prove or disprove whether or not it could contribute.”

Mauch: And sometimes, your hardest problems can be two or three things all at once, massed together, so that’s why a methodical approach is really important. And then because invariably there’s always one person saying, “No, no! It’s this! It’s this, it’s this, it’s this, it’s this! It’s really this!” And there’s usually a more reserved person over in the corner who’s got all the answers but is not necessarily as boisterous.

Erler: I think everybody has hunches, as to … Everybody has their best guess as to what’s wrong when you go in, yes. How strongly they advocate for their theory I think depends on the person. But yes, you get some personalities involved, you get people who feel like you’re blaming them, and it’s really important to come in and make it clear that you really aren’t. The only thing you’re trying to do is solve the problem. You’re not trying to point blame, you’re not trying to get somebody fired, but at the same time, recognize that you’re dealing with human beings and so these anxieties and fears are gonna be there, and you just have to stick to the facts. You just focus on that and try not to bring the emotional component into the root cause.

Claude: To your point about constraints and attitudes, that’s one of the hardest things. It’s human nature to follow your hunches, and it’s often the case in a rescue operation when things go sideways that you have to listen to the customer as they describe, “Well we think it might be this, we think it might be that”, which are largely hunches. But then you have to put all that aside, and you have to say, “Okay, let’s really take an impartial look at what’s happening here, and try to understand what’s going on, and develop facts, the set of facts that either prove something could be the problem, or disprove, and make those fact-based decisions”, which can be hard when the human nature aspect of it is to say, “Well, I have a hunch,” and that can be challenging.

Claude: And as you described with regard to communication, that’s an important aspect of managing those preconceived notions that people often start with on these things.

Claude: We had- so to that point, I’ll share another example of a situation when things go sideways. We had a customer that had launched a new product with a battery-powered surgical tool. And this particular tool had some very strange behavior. After it was used, it would start to heat up unexpectedly. It’s not even being used, it’s starting to heat up. And so the notion there was, “Well clearly there must be a hardware fault happening with this device. It just randomly fails, there must be some electrical component in there that’s causing trouble.” Well it turned out, at the end of the day, the hardware was fine, it was actually a software issue which was the problem, which was completely unexpected. No one expected that to be the challenge. In that case, it was fortunate in a way, because it’s a little bit easier to make a software change and upgrade all the software than to recall a bunch of devices and redo the hardware inside of them.

Claude: So it’s often the case, again, that’s an example of, “It’s easy to have preconceived notions about why we’re having a problem, but often it’s not that. It can be something very unexpected.”

Erler: Or to have preconceived notions as to what’s possible without challenging the why. “Why do you think that this can’t work this way?” And really getting to the bottom of that, because maybe you’re falsely constraining the solutions.

Faulkner: So how can companies avoid these kinds of pitfalls in product development? According to Craig Mauch, it’s all about the basic tenets of engineering.

Mauch: One of the things that’s really big at MPR is about the first principles of engineering, so we like to design the products, and then build the products, and then test the products. And it sounds very rational when you say it that way, but you’d be surprised how many people skip a step or get going too fast and don’t do enough fundamental design work.

Faulkner: Like Mauch said, it sounds obvious: design, build, and then test. But Mauch sees it all the time. People skip steps and they end up paying for it down the line.

Faulkner: I asked Mauch why it is that people are prone to missing these steps that seem like the fundamentals of creating a product.

Mauch: Because they’re not used to development, I think. They come at it from different perspectives. Sometimes they’re researchers, and researchers are never done researching, so the other part of that is you have to tear that away from them and say, “Stop changing it. Stop making it better. You can always make it better, but if you keep changing it, then we’ll never finish.” So that’s on the researcher spectrum on the business perspective, people are excited about what they’re doing and they want to get it to market, and they’re in a great big hurry. And often, it’s either, for the start-ups, it’s they have limited funds and they gotta get to market. With large companies, they’ve got mandates for revenue coming out of new products and so, “I need a new product to make those goals.”

Mauch: And so big and small, you see the same pressures for slightly different reasons. And so well-intended people get themselves in situations that can maybe wanna go forward, sometimes too quickly.

Mauch: The other part of that, too, is design is a really difficult thing. You start, in a lot of cases, with the proverbial clean sheet of paper, and you start putting some building blocks down of things you think are ready to go and some unknowns. And most people can get to what I call the 95% Solution, and they’ve figured 95% of it out, and they keep pushing off that nagging 5% into the corner, and they’re like, “Oh, well, that’ll come together, we’ll figure that out.” And if you’re not careful, that 5% can be your undoing, and be the thing that comes back to bite you in the end. So it really does take a lot of discipline, I think, to have the approach to not just assume that 5% will get better later. And for that reason, I’ve coined a term, which I think I’ve coined, maybe somebody else said it, but the Vertical Slice. I’m a big believer in the Vertical Slice.

Mauch: A lot of people will do A and solve that problem, and then B comes next, and they’ll work on that and solve that. Then there’s a C and a D and an E, and they just magically assume that as they progress, a solution comes and they move on to the next thing and life is great. But life never works out that way. A lot of times, you get to D or E and there’s some great big disconnect that causes you to go back and change the stuff you did before. So what I like to do with the Vertical Slice is think about A, B, C and D all at once, and in a very fast path through there, prototype or work with each one of those elements, so that they all work together and they don’t do everything that you need to do, but you touch on enough of them such that when you need to rely on them, you’ve kicked the tires already, and you know whether it is promising or not. And that helps to avoid big disconnects.

Faulkner: Mauch said that fundamental engineering, it’s just a part of the culture at MPR. And that attitude has its roots in the company’s heritage.

Mauch: We do some pretty fundamental engineering here, and it’s baked into the culture. The founders of MPR designed the first nuclear submarine, the USS Nautilus. So they had to … you can’t really prototype a nuclear submarine so well, you have to really design it right and then build it because it’s a pretty expensive thing to go tinker around with. And so I think that’s baked into our culture. First, we design it, and we know why it’s designed the way it is, and then we build it.

Mauch: And I remember specifically, we were working on an infusion pump project years ago, where we were in our design phase and going through other requirements, and figuring out pumps and tubing and sensors and size of bubbles and all the things that you do for that kind of thing. And we’d been probably on the job for a couple of months, and the client said, “I know you guys are working hard, but I haven’t seen anything go together in the lab yet.” And I’m really nervous because they were used to tinkering and prototyping and iterating, right? And I turned to the client and said, “First, we’re going to design it, and then we’re gonna build it.”

Mauch: And then the first prototype that came together on the bench worked quite well because we had all the fundamentals behind us. “Why are the pumps sized the way they are? Why is the tubing this kind of tubing?” And so on and so forth. And so it goes together better the first time when you do that way, and we used that early prototype to validate those models that we put together in the design phase. So not just cut, try, and repeat kind of thing. Believe it or not, a lot of development goes on that way.

Erler: We don’t just have a book, “Oh let’s open the book and figure out how.” These are all, almost all, first-of-a-kind problems where you really have to pick the problem apart and understand the basics, the first principles of the system that you’re working with, to understand how it could go wrong, and then think, “Okay, if that were going wrong, what would that look like? What would the evidence be?” And then you can see if it fits what’s been seen. So if there’s evidence that matches that, then you know you’ve got a theory.

Faulkner: Despite their analytical methods, Claude and Erler told me that there’s always a bit of nervousness when they first present a solution to a client. Especially when there’s a lot at stake.

Erler: I think you’re always nervous, yeah. You’re always questioning yourself. I think, to some level, it’s the fact that you’re always questioning yourself that leads you to question every piece of data that you come across, that makes it that much more rigorous a process.

Claude: I would say, we’re always a little bit anxious when we get into solving, trying to solve a problem that’s not been solved before, and you don’t know what the answer’s gonna be. But I think a big part of both managing that and ultimately being successful is the team. That you can always go and consult with another expert, subject matter expert, or just talk it out with somebody. You get enough really smart people in the room, combine intelligence and analytical capabilities with creativity, and you’ll always find a way.

Mauch: Yeah, the cool thing about working here is that there’s usually, we’ve been in business for 50 years, and there’s usually somebody down the hall who’s done something similar or has been exposed to something, and it can even be across industries. Whether it’s medical, power, or ships and so on. So the neat thing here, we did a thing for a medical device that was a cell expansion chamber. You seed it with cells, and then you put it an incubator and then you come back and you have many more cells than when you started with. But we had people that normally do fluid dynamics and nuclear power plants helping us design this cell chamber because we were trying to move fluid through there in a very uniform and distributed fashion. And so by us not necessarily doing that every day in medical, we were able to tie into our power business, who we have experts that’s all they do, is thermal hydraulics and fluid design, things like that, so it was really neat to tie the two sides of that expertise together and solve a problem.

Faulkner: The team at MPR is pretty clear. When it comes to rerouting a product development effort that’s gone sideways, it takes more than just following that solid foundation of basic engineering. At the end of the day, it’s really all about the team.

Faulkner: Thanks to the folks at MPR for speaking with me, and thanks to you for listening. For more on this and other newsworthy items in the medical device space, visit massdevice.com. Until next time, I’m Sarah Faulkner.

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Treace Medical touts results of bunion surgery study

Treace Medical’s Lapiplasty bunion procedure is designed to correct foot bone alignment and stabilize the toe. (Image from Treace Medical)

Treace Medical Concepts said a study of its bunion implant surgery showed more rapid healing than traditional osteotomy.

The study of the Ponte Vedra, Fla.-based company’s Lapiplasty 3D bunion correction system showed that most patients were able to stand on their operative foot five days after surgery and had a high rate of healing nine months after the procedure.

The study enrolled 195 patients, including 19.5% who had comorbidities known to compromise bone healing, with a mean follow-up of 9.5 months. Ninety-seven percent of the patients demonstrated a successful bony fusion of the joint and 98.9% maintained a stable joint position over the course of the study, which was published in The Journal of Foot & Ankle Surgery. The implant removal rate was 3.1% compared with conventional plate implants where published removal rates can be greater than of 17% for tarsometatarsal and 20% for big-toe joint fusion procedures.

The Lapiplasty procedure is designed to reproducibly correct all three planes of the bunion deformity and address the root cause of the bunion while allowing patients to get back to their active lives quickly. A bunion, or hallux valgus, is a foot deformity that affects about 60 million Americans and results in approximately 400,000 surgeries in the U.S. annually, according to the company.

“This study demonstrated positive bone healing rates over progressive timepoints when utilizing biplanar plating without a cross-joint compression screw in procedures used to treat bunions or arthritis of the big toe joint,” said lead author Dr. Paul Dayton of the Midwest Bunion Center (Des Moines, Iowa), in a prepared statement. “The bone healing rates were quite encouraging, given this unique fixation approach allowed patients to undergo an accelerated recovery protocol and to initiate weightbearing in a post-operative boot within their first week of surgery.

“Overall, I’m very pleased with these results as they reinforce that I can offer this fixation option to my patients with a high level of confidence that they will experience reliable bone healing under an accelerated weight-bearing protocol.”

“The outcomes of this new study are noteworthy in that they closely mirror those reported in our 13-month multicenter dataset presented at the 2018 American Orthopaedic Foot & Ankle Society’s (AOFAS) annual meeting in Boston,” added Dr. Robert Santrock of West Virginia University and co-author on this new publication. “In the AOFAS dataset, the 61 feet treated with Lapiplasty 3D Bunion Correction showed low 1.6% symptomatic non-union rate and 3% radiographic recurrence rate. Patients in the AOFAS study initiated weightbearing in a post-operative boot at an average of 10.5 days, which is consistent with this new study.”

“The rapid time to weightbearing, high rate of bone healing, and low implant removal rate reported in this study further highlight the patient benefits of biplanar plating — the fixation method used in the Lapiplasty procedure,” said Treace Medical CEO John  Treace. “The study represents the 9th peer review publication supporting the Lapiplasty procedure, another important milestone for our company.”

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Medtronic seeks another bite at the apple in $24m patent loss to spine doc inventor

Medtronic logo updated

Medtronic (NYSE:MDT) asked a federal appeals court for a full-bench review of its nearly $24 million loss in a patent infringement lawsuit brought by a physician inventor.

In February 2014, Dr. Mark Berry alleged that Fridley, Minn.-based Medtronic infringed on three patents covering a “system and method for aligning vertebrae in the amelioration of aberrant spinal column deviation conditions.”

In November 2016, a jury in the U.S. District Court for Eastern Texas sided with Barry, awarding $15.1 million for infringement of one patent, more than $2.6 million for infringement on the second and $2.6 million for overseas infringement. In January 2017 a judge reduced the $20.3 million verdict by $2.6 million, ruling that Barry did not present sufficient evidence on the overseas violation but upholding the U.S. infringement claims. Later that year, the court awarded total damages of nearly $24 million.

In January the U.S. Court of Appeals for the Federal Circuit issued a split 2-1 opinion affirming the lower court’s decision. In a March 27 filing, Medtronic asked the appeals court to seat its full complement of judges for a review of the case, arguing that the dissenting judge’s argument on one of the patents should carry the day.

“In Dr. Barry’s case, all of the foregoing considerations – the lack of records indicating experimentation, the normal fee charged, the control exercised, and the failure to inform customers of experimental purpose – would look the same if the surgeries were for commercial purposes. The only thing that affirmatively suggests these surgeries were experimental is that Dr. Barry said they were – after the fact, during litigation. As a matter of law, that is insufficient to show experimental purpose,” Judge Sharon Prost wrote in the dissent. “The record in this case shows that Dr. Barry waited too long to file for the ‘358 patent and that the on-sale bar applies.”

“Rehearing is warranted to reaffirm that such post hoc testimony, unsupported by contemporaneous objective evidence, cannotsave otherwise-invalid patent claims from operation of the statutory on-sale and public use bars,” Medtronic wrote in its rehearing petition.

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Smith & Nephew to acquire patient monitor dev Leaf Healthcare

Smith & Nephew, Leaf Healthcare

Smith & Nephew (NYSE:SNN) said today that it inked a deal to acquire patient monitoring system developer Leaf Healthcare for an undisclosed amount.

London-based Smith & Nephew said that the acquisition follows a successful two-year partnership deal with Pleasanton, Calif.-based Leaf Healthcare in which Smith & Nephew served as its exclusive distributor and as a strategic investor.

Leaf Healthcare’s flagship product is their Leaf patient monitoring system, which features a wearable wireless sensor designed to track patient movement and notify caregivers to prevent immobility-related health complications, such as pressure ulcers or injuries.

Smith & Nephew said that the Leaf system will join the Allevyn Life, Allevyn Gentle Border and Secura skin care products in its pressure injury prevention portfolio.

“The benefits of patient turning and improved patient mobility are well recognized, including the potential for shorter hospital stays. We are proud of the impact our technology has already made through our existing relationship with Smith & Nephew. We are excited by this new opportunity to deploy our award-winning pressure injury prevention technology through Smith & Nephew’s extensive advanced wound management portfolio,” Leaf Healthcare co-founder & CEO Dr. Barrett Larson said in a prepared statement.

Smith & Nephew said that it expects the acquisition to close during the second quarter of this year, and added that it will finance the purchase from existing cash and debt facilities.

“Consistent with our initial strategic investment, Smith & Nephew is focused on providing not just products to treat conditions, but also supporting clinicians with technologies designed for prevention as well as treatment, and helping healthcare facilities reduce the cost of care. The Leaf patient monitoring system is highly complementary to Smith & Nephew’s existing wound portfolio and we are excited by the opportunities of expanding this product within our global portfolio,” Smith & Nephew advanced wound management prez Simon Fraser said in a press release.

Last week, a group of Osiris Therapeutics (NSDQ:OSIR) shareholders announced they are suing to block its $660 million acquisition by Smith & Nephew because the purchase price is too low.

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