| Preface |
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xv | |
| Acknowledgment |
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xvii | |
| About the Author |
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xix | |
| 1 Introduction to Medical Device Requirements |
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1 | (16) |
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1 | (2) |
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3 | (1) |
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3 | (4) |
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Understanding the Science of Safety |
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7 | (6) |
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Overview of FDA Quality System Regulation |
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7 | (2) |
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Overview of Risk Management Standard ISO 14971 |
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9 | (1) |
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Overview of FDA Device Approval Process |
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10 | (1) |
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Overview of Regulatory Requirements for Clinical Trials |
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11 | (2) |
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13 | (1) |
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14 | (3) |
| 2 Preventing Recalls during Specification Writing |
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17 | (16) |
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17 | (1) |
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Conduct Requirements Analysis to Identify Missing Requirements |
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18 | (4) |
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Specifications for Safety, Durability, and Reliability |
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22 | (4) |
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Specification for User Interface and Usability |
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26 | (1) |
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Specification for Maintainability |
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26 | (2) |
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Specification for Prognostics |
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28 | (1) |
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Specification for Safe Software |
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29 | (1) |
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Negative Requirements Analysis for Worst-Case Scenarios |
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29 | (1) |
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Conducting PHA to Assess Risks |
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30 | (1) |
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Considerations for In Vitro Devices |
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30 | (1) |
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31 | (1) |
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31 | (2) |
| 3 Risk Assessment and Risk Management |
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33 | (10) |
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33 | (1) |
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Developing Risk Acceptance Criteria |
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34 | (1) |
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35 | (2) |
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37 | (1) |
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Mitigating Risks Using World-Class Practices |
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38 | (2) |
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40 | (1) |
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40 | (1) |
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41 | (1) |
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41 | (2) |
| 4 Preventing Recalls during Early Design |
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43 | (10) |
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43 | (1) |
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Functional FMEA on Design Concept to Prevent Failures |
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44 | (1) |
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Conducting a Component-Level FMEA to Identify Parameters Critical to Quality |
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45 | (2) |
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Conduct an FTA to Develop Robust Solutions for Complex Problems |
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47 | (4) |
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Strategy for Developing Solutions |
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51 | (1) |
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52 | (1) |
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52 | (1) |
| 5 Preventing Recalls during the Detail Design Phase |
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53 | (16) |
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53 | (1) |
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54 | (2) |
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Designing for Reliability |
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56 | (2) |
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Designing for Inherent Safety |
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58 | (2) |
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Designing for Inherent Quality |
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60 | (1) |
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Designing to Forgive User Errors |
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60 | (1) |
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Designing for Hazard-Free Maintenance |
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61 | (1) |
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62 | (1) |
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63 | (3) |
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66 | (1) |
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66 | (3) |
| 6 Designing for Prognostics to Protect Patients |
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69 | (8) |
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69 | (1) |
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Preventing False Positives and False Negatives |
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70 | (2) |
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Designing for Alerts When the Device Is Not Performing Accurately |
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72 | (1) |
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Designing to Alert When a Device Is Near the Low End of the Prognostic Distance |
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73 | (1) |
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Shutting Down the Device in a Safe State if the Failure Cannot Be Avoided |
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73 | (1) |
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Progress in Prognostics Health Monitoring |
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74 | (1) |
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75 | (1) |
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76 | (1) |
| 7 Preventing Recalls during Production Validation |
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77 | (12) |
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77 | (1) |
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Understanding Key Design Features That Result in Defect-Free Production |
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78 | (1) |
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Understanding the Theory of Profound Knowledge for Superior Quality |
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79 | (2) |
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Conducting HAZOP Analysis to Identify Latent Hazards in the Manufacturing Process |
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81 | (1) |
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Using ISO 14971 HACCP Analysis to Identify Critical Steps in a Process |
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81 | (1) |
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Assuring Conformance to Key Design Features without 100% Inspection or Testing |
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82 | (1) |
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Auditing to Identify Unacceptable Variation before Defects Are Produced |
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83 | (1) |
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Taking Corrective and Preventive Actions Using the FDA System |
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84 | (2) |
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Training Production Operators to Identify Incidents That May Result in Device Defects |
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86 | (1) |
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Production Validation Testing |
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86 | (2) |
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88 | (1) |
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88 | (1) |
| 8 Preventing Software Design Recalls |
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89 | (14) |
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89 | (1) |
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Software Requirements Analysis |
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90 | (3) |
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93 | (1) |
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Software Interoperability Analysis |
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94 | (1) |
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94 | (2) |
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Selecting Software Structure and Architecture |
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96 | (1) |
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Precautions for Off-the-Shelf Software |
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97 | (2) |
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Designing to Minimize User Interface Risks |
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99 | (1) |
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Common User Interface (UI) Issues |
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100 | (1) |
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Common Reasons for Use Errors |
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100 | (1) |
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100 | (1) |
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101 | (2) |
| 9 Preventing Supply Chain Quality Defects to Avoid Recalls |
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103 | (6) |
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103 | (1) |
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Writing Good Supplier Specifications |
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104 | (1) |
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The Art of Identifying the Features Critical to Quality |
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105 | (1) |
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Assessing Variation in Supplier Quality |
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106 | (1) |
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Supply Chain Control by Suppliers |
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106 | (1) |
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Assuring Reliability in Performance |
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107 | (1) |
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107 | (1) |
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107 | (2) |
| 10 Preventing Recalls Using a Verification Process |
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109 | (8) |
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109 | (1) |
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Independent Verification during Specification Approval |
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110 | (1) |
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Independent Verification during Final Design Approval |
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111 | (1) |
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Independent Verification during Pilot Production Approval |
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112 | (1) |
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Independent Verification of Supplier Quality Assurance |
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113 | (1) |
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Verifying Day-to-Day Control in Production |
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114 | (2) |
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116 | (1) |
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116 | (1) |
| 11 Preventing Recalls Using Design Validation Process |
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117 | (8) |
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117 | (1) |
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Design Validation Testing for Reliability |
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118 | (2) |
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Design Validation Testing for Durability |
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120 | (1) |
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Design Validation for Safety |
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120 | (2) |
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Using Field Validation to Identify New Risks |
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122 | (1) |
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123 | (1) |
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123 | (2) |
| 12 Recall Planning to Maximize Efficiency in the Event of a Recall |
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125 | (10) |
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125 | (1) |
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126 | (1) |
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Immediate Recall Coordination |
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127 | (1) |
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Review of the Discovered Risks |
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128 | (2) |
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Review of Data Management |
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130 | (2) |
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Verification of Activities for Effectiveness |
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132 | (1) |
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132 | (1) |
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133 | (1) |
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134 | (1) |
| 13 Role of Management in Preventing Recalls |
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135 | (12) |
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135 | (1) |
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136 | (1) |
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Management Tasks for Preventing Recalls |
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137 | (2) |
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Product Management Procedures |
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139 | (1) |
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140 | (1) |
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Monitoring Risk Management Processes |
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141 | (2) |
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Using Good Paradigms for Efficiency |
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143 | (2) |
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145 | (1) |
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145 | (2) |
| 14 Innovation Methods Useful in Preventing Recalls |
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147 | (12) |
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147 | (1) |
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Stop Using Outdated Practices |
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148 | (3) |
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151 | (2) |
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Use the Profound Knowledge of the Quality and Safety Gurus |
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153 | (2) |
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Use Classic Innovation Methods |
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155 | (2) |
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157 | (1) |
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157 | (2) |
| 15 Proactive Role of Marketing in Preventing Recalls |
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159 | (8) |
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159 | (1) |
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Don't Repeat Failures of Yesterday in Devices of Tomorrow |
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160 | (1) |
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Gather Intelligence on Customer Safety Needs during Lead Generation |
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161 | (1) |
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Gather Intelligence on Safety and Quality Issues on Device Search Engines |
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161 | (1) |
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Participate in Design Reviews to Be an Advocate for Users |
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162 | (3) |
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Review New Device Specifications with Trusted Customers |
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165 | (1) |
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Provide Intelligence in Risk Assessment to Ensure the Public Health Benefits Outweigh the Risk |
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165 | (1) |
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Market Safety Features to Promote the Device and to Get Feedback from Users |
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166 | (1) |
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166 | (1) |
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166 | (1) |
| Appendix A: Medical Device Safety from the Hospital's Point of View |
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167 | (6) |
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Protecting Patients from Hidden Dangers in Medical Devices |
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167 | (4) |
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168 | (2) |
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How Can Hospitals Protect Patients from These Dangers? |
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170 | (1) |
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Use a Team Approach to Risk Reduction |
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171 | (1) |
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171 | (2) |
| Appendix B: The FDA Quality System Regulation |
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173 | (32) |
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Code of Federal Regulations Title 21 (Food and Drugs), Part 820 |
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173 | (1) |
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Subpart A-General Provisions |
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173 | (6) |
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173 | (3) |
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176 | (3) |
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Sec. 820.5 Quality System |
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179 | (1) |
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Subpart B-Quality System Requirements |
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179 | (3) |
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Sec. 820.20 Management Responsibility |
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179 | (2) |
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Sec. 820.22 Quality Audit. |
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181 | (1) |
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181 | (1) |
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Subpart C-Design Controls |
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182 | (3) |
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Sec. 820.30 Design Controls. |
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182 | (3) |
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Subpart D-Document Controls |
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185 | (1) |
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Sec. 820.40 Document Controls. |
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185 | (1) |
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Subpart E-Purchasing Controls |
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185 | (1) |
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Sec. 820.50 Purchasing Controls |
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185 | (1) |
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Subpart F-Identification and Traceability |
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186 | (1) |
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Sec. 820.60 Identification |
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186 | (1) |
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Sec. 820.65 Traceability. |
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186 | (1) |
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Subpart G-Production and Process Controls |
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187 | (4) |
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Sec. 820.70 Production and Process Controls |
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187 | (2) |
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Sec. 820.72 Inspection, Measuring, and Test Equipment. |
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189 | (1) |
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Sec. 820.75 Process Validation |
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190 | (1) |
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Subpart H-Acceptance Activities |
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191 | (2) |
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Sec. 820.80 Receiving, In-Process, and Finished Device Acceptance. |
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191 | (1) |
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Sec. 820.86 Acceptance Status |
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192 | (1) |
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Subpart I-Nonconforming Product |
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193 | (1) |
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Sec. 820.90 Nonconforming Product |
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193 | (1) |
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Subpart J-Corrective and Preventive Action |
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194 | (1) |
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Sec. 820.100 Corrective and Preventive Action. |
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194 | (1) |
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Subpart K-Labeling and Packaging Control |
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195 | (1) |
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Sec. 820.120 Device Labeling. |
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195 | (1) |
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Sec. 820.130 Device Packaging. |
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195 | (1) |
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Subpart L-Handling, Storage, Distribution, and Installation |
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196 | (1) |
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196 | (1) |
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196 | (1) |
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Sec. 820.160 Distribution. |
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196 | (1) |
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Sec. 820.170 Installation |
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197 | (1) |
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197 | (5) |
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Sec. 820.180 General Requirements. |
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197 | (1) |
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Sec. 820.181 Device Master Record. |
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198 | (1) |
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Sec. 820.184 Device History Record |
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199 | (1) |
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Sec. 820.186 Quality System Record. |
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199 | (1) |
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Sec. 820.198 Complaint Files. |
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200 | (2) |
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202 | (1) |
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202 | (1) |
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Subpart O-Statistical Techniques |
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202 | (3) |
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Sec. 820.250 Statistical Techniques |
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202 | (3) |
| Index |
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205 | |